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Wednesday, March 24, 1999 Published at 12:22 GMT


Pressure mounts for Viagra U-turn

Only men with impotence from certain conditions can have Viagra

Doctors have formally condemned the restrictions placed on NHS prescriptions of Viagra.

The British Medical Association's GP Committee said Health Secretary Frank Dobson's interim guidance as to who should get the anti-impotence treatment paid no heed to clinical evidence.

The eligible categories of patients have been selected without regard to evidence of cost effectiveness, equity, or social values, it adds.

And the King's Fund says the issue illustrates that rationing of treatments is inevitable and the government should be more open about it.

Period of concern

On 21 January, Mr Dobson issued interim guidelines on the prescription of Viagra.

Under the guidance, Viagra is available on the NHS to to men with conditions such as multiple sclerosis, diabetes and spinal injury.


[ image: Frank Dobson imposed the restrictions]
Frank Dobson imposed the restrictions
However, he denied the treatment to men whose impotence was caused by psychological factors.

He then said there should be a consultation period and invited comments from all interested parties on how Viagra. That period ends on Thursday.

Viagra has caused particular interest because it is the first time a Health Secretary has intervened to ration NHS treatment.

But while doctors have welcomed the acknowledgement that some treatments must be rationed, they are unhappy with the way Mr Dobson set the criteria for Viagra.

Letter to Mr Dobson

Dr John Chisholm, chairman of the GPC, has written to the Health Secretary.

He said: "Our main concern is that, for possibly the first time within the NHS, national policy will determine that patients with equal clinical need are to be treated differently."


[ image: Dr John Chisholm protested at how the criteria were set]
Dr John Chisholm protested at how the criteria were set
He said that in future rationing decisions would have to be made more carefully.

"We would urge that any decision over the availability of Viagra and other impotence treatments must be based on a careful consideration of patient need, the available evidence of clinical effectiveness and cost effectiveness, ensuring equity between patients and taking account of public opinion.

"Your current proposals for limiting treatment of impotence under the NHS do not, in our view, deal with all these considerations satisfactorily."

'Rationing should be fairer'

John Appleby is health systems manager of the King's Fund, an independent health care watchdog.

He said the government's restrictions may not be fair.

"There is no reason why men with conditions like multiple sclerosis, diabetes and spinal injuries are any more 'deserving' of the drug than those who suffer from impotence for other reasons," he said.

He added that the government should aim to make rationing fairer and more transparent.

The National Institute of Clinical Excellence, which comes into being on 1 April, could be responsible for developing a rationing framework, he said.

The fund welcomed the recognition that some treatments should be the subject of a national debate, but was concerned the government might dump difficult decisions on NICE.

Political decisions

Steve Dewar, King's Fund fellow in effective practice, said: "It is the job of a political leader, not a civil servant, a committee or a doctor, to make tough choices about the allocation of public money for public good.

"Politicians have for some time dodged the rationing issue by using labels like 'priority-setting' or by leaving tough choices to doctors and health authorities.

"The Government should not leave NICE to advise the NHS on the cost effectiveness of new drugs without public involvement or political debate."

The Department of Health will make a statement on Thursday, a spokeswoman said.

It will outline how much evidence has been presented to the government on the issue.

The government will then consider the submissions.



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