Health: Viagra's fall-out

Health Check

WHEN FRANK Dobson announced his decision on Viagra last week, it set me thinking about my feet. This is not some tale of sexual perversion but an observation on a historic decision for the NHS.

As a student I had athlete's foot, and I amassed a cupboard-full of over-the-counter creams and lotions to treat it. Nothing worked. I then developed a fungal infection of my toenails which left them thickened and discoloured. About a decade ago, I learnt there was a new oral treatment for thickened toenails called Lamisil, so I asked my GP if he would prescribe it. He agreed, I took the pills for about nine months, and now my toenails, bar one, look much the same as anybody else's.

The only drawback to Lamisil is its cost. I calculated at the time that the NHS had paid a couple of hundred pounds for my treatment. And what did it achieve? Thickened toenails are not life-threatening (unlike impotence, but we will come to that later).

Now consider Viagra. This is the first drug in NHS history to be explicitly rationed at national level. In practice many drugs and treatments are rationed on the NHS - think of IVF for infertility, or beta-interferon for multiple sclerosis, or Taxol for ovarian cancer - but in each case the decision about who is to be treated has been left to individual health authorities.

In the case of Viagra, the Government has spelt out who will qualify for NHS treatment. The list of conditions covers only 17 per cent of impotent men, according to the Impotence Association.

There are two remarkable features to this decision. It is the first acknowledgement by any government that the NHS can no longer honour its founding principle of providing comprehensive care to all, free at the point of use. More astonishing than this is that the decision to breach this founding principle apparently has the public's support. Mr Dobson reported that of the 861 responses received by the health department to its proposal to limit the NHS availability of Viagra, three quarters agreed to rationing, including 60 per cent of GPs.

There are two (at least) ways to interpret this. Either one can say it shows there is still widespread ignorance of the suffering impotence can cause. Depression, marriage breakdown and suicide are known sequels of the condition.

Or one can say that it indicates a new public recognition that limits must be set to the NHS - and a readiness to set them. If Viagra is to be rationed to one in six impotent men where does that leave the pill? Or HRT? Or Prozac? Or IVF?

I foresee hard choices ahead. As for Lamisil, I'd say it was dead in the water already.