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To: BigKNY3 who wrote (6777)	1/22/1999 7:42:00 AM
From: BigKNY3	Respond to of 9523

Dobson bows to reality of rationing: Friction between Government and GPs over prescription of anti-impotence drug forces centralised policy, reports Sarah Boseley SARAH BOSELEY 01/22/99 The Guardian FRANK Dobson, the Health Secretary, has adamantly refused to accept that there is rationing in the NHS. He may not like the word, but yesterday it was in heavy use to describe his decision on Viagra . In his anxiety not to be labelled a rationer, Mr Dobson has dragged his feet over the decision he promised to make on the impotence pill to the point where, in the end, it appeared to be forced out of him by the threats of the British Medical Association to tell GPs to prescribe it regardless. The guidance to doctors that the Department of Health finally published yesterday was promised in September, when Mr Dobson asked GPs not to prescribe Viagra for the time being.His decision had been expected within six weeks. The advice from the Standing Medical Advisory Committee (SMAC) that Mr Dobson said he was waiting for arrived on November 9. As the weeks passed by, doctors grew more impatient. Just before Christmas the BMA began to say that doctors risked breaching their terms of service if they did not give patients the treatment on the NHS. Then it delivered its ultimatum. If the guidance was not forthcoming by January 21, it would advise GPs to prescribe the tablets on the NHS. Yesterday, the letter duly arrived. Last September it looked as though Mr Dobson was willing to confront the difficult issues around rationing - or as he prefers it, prioritising. Rationing in some shape or form has always been with us. Without a bottomless pool of cash, the NHS cannot afford to give everybody every treatment. Government and opposition both acknowledge this. Ann Widdecombe, shadow health secretary, claims to have offered Mr Dobson a truce on this issue. Her solution proposes a big shift towards the private sector for those who can afford it. The previous government avoided the issue altogether, shuffling off awkward decisions on expensive new drugs to the hapless health authorities. Prescribing by postcode began and is now well established - the more expensive treatments, like beta-interferon for multiple sclerosis, are only available in some areas. The issue got a lot of publicity with the case of Jaymee Bowen, originally known as Child B. She had leukaemia. Cambridgeshire health authority drew a line on its balance sheet. It was not prepared to pay pounds 75,000 for what emerged later to be a highly experimental bone marrow transplant for her. She had it privately and gained a year of life at the cost of some suffering. Mr Dobson has won praise for not doing what his predecessors did. He said that the decision on Viagra would be taken centrally, by the Government. In the end, it was, and the NHS Confederation, representing the health authorities, was delighted. 'These are landmark proposals from government,' said its chief executive, Stephen Thornton. 'Representing the first time that it has set clear eligibility criteria for a new drug on a national basis . . . Setting limits to health care is never easy, but we believe these proposals are fair. 'This will ensure we have a uniform approach around the country, avoiding the danger of 'postcode prescribing'. We would support similar action from the Government in respect of new drugs in the future, as resources must be managed in the NHS so as to protect other, more pressing priorities.' The King's Fund welcomed the Government's six weeks consultation period on the proposals, hoping it would get the big issue out into the open. 'This is the first time a government of any party has involved the public in a rationing debate,' said Angela Coulter, director of policy and development at the health think tank. But even if the Government is prepared to look rationing squarely in the face, the uproar its decision attracted from doctors yesterday shows it is not in for an easy ride.

To: BigKNY3 who wrote (6777)	1/22/1999 7:44:00 AM
From: BigKNY3	Respond to of 9523

China testing Viagra , Health Ministry cautious on introduction 01/22/99 BBC Worldwide Monitoring Source: Xinhua news agency, Beijing, in English 0149 gmt 22 Jan 9 Excerpt from report by Xinhua news agency Beijing, 22nd January: China has been cautious up to now to the introduction into the country of Viagra , a sex-enhancing drug for men popular in foreign countries since last year. The new drug has been found, however, in the medical markets of Beijing, Guangzhou, and Zhengzhou, and in all cases it has been dealt with as fake medicine by local public health departments. In a telephone interview with Xinhua, an official with the Ministry of Health, who refused to give his name, disclosed that the ministry "is rather cautious on the import of this medicine". Sources with the State Drug Administration explained that according to laws and regulations relating to medicine, China will monitor the efficiency of any imported drug by conducting clinical test before allowing it into the market... A professor at the urology department of the No.1 Hospital Attached to the Beijing Medical Sciences University, Xue Zhaoying, who is responsible for the test of Viagra in China, noted that they have chosen seven hospitals in Beijing, Shanghai, and Wuhan, including his hospital and the Peking Union Medical College Hospital, to test 300 patients. They have also tested another 300 men in two hospitals in Shanghai and one in central China's Hubei province. All the patients are volunteers and the hospitals will keep their records secret. Topics related to sex have long been rather private ones or even taboos in China, so no one knows for sure how many people with sexual disabilities there are in the country. The hospitals have made abundant preparations to guard against any possible emergency situations that may arise from these test, and sources said they have been going smoothly so far. The tests in Beijing are expected to be completed in April or May, and the State Drug Administration will decide whether to introduce Viagra into China based on the conclusions in the clinical reports furnished by the seven hospitals. Officials with the administration made it clear that they will set certain limits on Viagra 's sales and applications, even if they do allow the drug to enter China.

To: BigKNY3 who wrote (6777)	1/22/1999 7:47:00 AM
From: BigKNY3	Read Replies (1) \| Respond to of 9523

GPs fear Viagra guidelines divide impotent men into the 'worthy or not': Libby Brooks on problems for doctors LIBBY BROOKS 01/22/99 The Guardian 'INTELLECTUALLY bankrupt, with no scientific basis,' was Laurence Buchman's diagnosis of yesterday's guidelines on the prescription of Viagra . 'I much prefer the Government to do the rationing, but it has to be done logically,' said the north London GP. He argued that most men who came to him for impotence treatment displayed no obvious physical reason for their condition - meaning they were outside the guideline groupings. Similarly, Jonathan Reggler, whose practice is in Marlow, Buckinghamshire, believed there was an identifiable medical reason for impotence in only 25-30 per cent of cases. 'These proposals basically divide impotence sufferers into the worthy and the unworthy,' he said. 'If 75 per cent fall outside the specified categories of illness, next the GP must decide how distressed they are. Dobson says this only happens in exceptional circumstances, but all the men who come to see me are distressed about impotence.' In this final category, the guidelines require a specialist assessment, but this will only put further pressure on an already over-burdened system, argued Dr Reggler. 'Should I refer them to a urologist, to confirm my diagnosis of impotence, or to a psychiatrist, when as their family GP I probably know them better? Does a GP ration by not referring, or refer them pointlessly and overload the system? It's farcical.' The Government was assuming a profound lack of judgment among GPs which simply did not exist, said George Ray, who practices in Whitley Bay, Tyne and Wear. 'The Government has reacted like this primarily because of cost concerns, prompted by the initial rush for prescriptions. But GPs are intelligent people. We are aware we are working with finite resources and infinite demands, and could have found a balance.' Dr Reggler added: 'Every now and again a drug comes along that is extremely effective, has few side effects and really changes patients' lives. 'I'm delighted to prescribe Viagra .'