After a long period of consultation and deliberation, the UK health secretary Frank Dobson announced last week the government’s restrictions on prescribing the anti-impotence drug sildenafil citrate (Viagra). Mr Dobson bowed to public pressure with a small increase in the range of conditions for which general practitioners will be allowed to prescribe the drug under the NHS. But men who come into these categories will still make up only about 20%of the total who are impotent.
Mr Dobson originally proposed in draft guidelines issued in January that GPs would be allowed to prescribe the drug only for men who were impotent because of having undergone a prostatectomy or radical pelvic surgery, or who had a spinal cord injury, diabetes, multiple sclerosis, or single gene neurological disease (30 January, p 279). Under the new proposals, six further conditions will qualify for Viagra to be prescribed on the NHS: kidney failure, spina bifida, polio, Parkinson’s disease, severe pelvic injury, and treatment for prostate cancer—not just removal of the prostate. These men will be entitled to a prescription for one pill a week.
For other men who are caused “severe distress” by impotence, it is proposed that treatment should be available in exceptional circumstances, but only after a specialist assessment. GPs will be allowed to issue private prescriptions for the drug to their own patients (the pills cost about £6 each) but will be banned from charging for the consultation. They will also be able to prescribe impotence treatments to men not in the approved categories but who were receiving drug treatment for impotence on or before 14 September 1998.
The changes will come into effect from 1 July 1999. Mr Dobson’s is a landmark decision, because it is the closest the government has yet come to admitting that certain NHS treatments will have to be rationed.