Leading Article: The brave new world of the health service

PERHAPS THE 1990s will go down in history as the Happy Decade: this week, the makers of Prozac celebrated the 10th anniversary of the launch of the new, improved anti-depressant. It might also be remembered as the decade in which the rationing of healthcare started in Britain. The Pharmacological Revolution brought us Prozac and the other new wonder- drugs like Viagra - for which Frank Dobson announced the rations this week - and promises chemical treatments for Alzheimer's disease, obesity and ageing in the near future. But it also makes the choices facing the National Health Service starker than ever before. So long as the frontiers of medicine were being pushed forward primarily by surgeons, it was easier to conceal the process of rationing in the system of waiting lists. Economists call it "rationing by queueing": it has the presentational advantage that it does not look like rationing, because everyone in the queue will get their turn if they wait long enough. In that sense, the NHS has rationed healthcare since it was founded in 1948.

But it is only with the advent of the new drugs that rationing becomes explicit. Viagra may be "only" pounds 4 a pill, but the cost of supplying it to everyone who thinks they may need it would bankrupt the NHS within months. And some of the medicines which offer the prospect of relief for common debilitating conditions such as arthritis and Alzheimer's will be considerably more expensive than this.

Who, then, is to decide who gets them and who does not? For the doctors' trade union, the BMA, as selfish and irresponsible a vested interest as the worst of the flying pickets in the 1970s, the answer is simple: doctors. For the BMA, the question of who should pick up the tab is equally simple: their members' employer, the taxpayer.

This cannot be right, and Mr Dobson is to be praised for being the first politician courageous enough to say so. No doctor likes having his or her judgement of a patient's "clinical need" pre-empted by a Secretary of State for Health, but every doctor must realise that there are practical constraints which prevent them doing everything they would ideally do for everyone.

Nor does Mr Dobson pretend that the ordering of priorities in the health service is anything other than a difficult, messy and morally compromised business. But his is the right way to proceed: to lay down guidelines as to who should have Viagra which allow doctors discretion in applying them. For the BMA to instruct its members to defy the Government by prescribing as much Viagra as they think is justified by "clinical need" until the guidelines take effect is the kind of gesture politics which got Arthur Scargill where he is today.

The BMA accuses Mr Dobson of taking advantage of popular prejudice about impotence as some kind of joke to ration Viagra. It would be in a much stronger position if its members did not routinely prescribe unnecessary antibiotics, sundry other placebos and high-cost branded drugs for trivial conditions. But just because impotence can be a serious medical condition does not mean a new treatment must be immediately and fully funded on demand.

Of course, the medical profession has an important argument. It would be quite wrong to lump Prozac, Viagra and anti-obesity pills under the heading "lifestyle drugs", as if these were simply the equivalent of "soma", the happy drug of Brave New World. Depression can be a real, disabling condition with physical causes; likewise impotence and obesity.

But the BMA would do us all a service if it engaged in serious and persuasive argument, either that NHS spending as a whole is too low, or that spending in some areas of the NHS was less important to the health of the nation than spending on Viagra.

Healthcare is already being rationed: let the doctors join a grown-up process of managing the compromises and trade-offs required, instead of engaging in acts of petty defiance of guidelines with which they do not agree.

Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
Arts and Entertainment
Israeli-born actress Gal Gadot has been cast to play Wonder Woman
film
News
Top Gear presenter James May appears to be struggling with his new-found free time
people
Arts and Entertainment
Kendrick Lamar at the Made in America Festival in Los Angeles last summer
music
Arts and Entertainment
'Marley & Me' with Jennifer Aniston and Owen Wilson
film
Arts and Entertainment
Jon Hamm (right) and John Slattery in the final series of Mad Men
tv
Arts and Entertainment
theatre
Arts and Entertainment
Place Blanche, Paris, 1961, shot by Christer Strömholm
photographyHow the famous camera transformed photography for ever
Arts and Entertainment
The ‘Westmacott Athlete’
art
Arts and Entertainment
‘The Royals’ – a ‘twisted, soapy take on England’s first family’
tv Some of the characters appear to have clear real-life counterparts
News
Brooks is among a dozen show-business professionals ever to have achieved Egot status
people
Arts and Entertainment
A cut above: Sean Penn is outclassed by Mark Rylance in The Gunman
film review
Arts and Entertainment
arts + ents
Arts and Entertainment
James Franco and Zachary Quinto in I Am Michael

Film review Michael Glatze biopic isn't about a self-hating gay man gone straight

Arts and Entertainment
A scene from the movie 'Get Hard'
tvWill Ferrell’s new film Get Hard receives its first reviews
Arts and Entertainment
Left to right: David Cameron (Mark Dexter), Nick Clegg (Bertie Carvel) and Gordon Brown (Ian Grieve)
tvReview: Ian Grieve gets another chance to play Gordon Brown... this is the kinder version
Arts and Entertainment
Benedict Cumberbatch and Martin Freeman in the first look picture from next year's Sherlock special

TV
Arts and Entertainment
Because it wouldn’t be Glastonbury without people kicking off about the headline acts, a petition has already been launched to stop Kanye West performing on the Saturday night

music
Arts and Entertainment
Molly Risker, Helen Monks, Caden-Ellis Wall, Rebekah Staton, Erin Freeman, Philip Jackson and Alexa Davies in ‘Raised by Wolves’

TV review
Arts and Entertainment

TV
Arts and Entertainment
James May, Jeremy Clarkson and Richard Hammond in the Top Gear Patagonia Special

TV
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    No postcode? No vote

    Floating voters

    How living on a houseboat meant I didn't officially 'exist'
    Louis Theroux's affable Englishman routine begins to wear thin

    By Reason of Insanity

    Louis Theroux's affable Englishman routine begins to wear thin
    Power dressing is back – but no shoulderpads!

    Power dressing is back

    But banish all thoughts of Eighties shoulderpads
    Spanish stone-age cave paintings 'under threat' after being re-opened to the public

    Spanish stone-age cave paintings in Altamira 'under threat'

    Caves were re-opened to the public
    'I was the bookies’ favourite to be first to leave the Cabinet'

    Vince Cable interview

    'I was the bookies’ favourite to be first to leave the Cabinet'
    Election 2015: How many of the Government's coalition agreement promises have been kept?

    Promises, promises

    But how many coalition agreement pledges have been kept?
    The Gaza fisherman who built his own reef - and was shot dead there by an Israeli gunboat

    The death of a Gaza fisherman

    He built his own reef, and was fatally shot there by an Israeli gunboat
    Saudi Arabia's airstrikes in Yemen are fuelling the Gulf's fire

    Saudi airstrikes are fuelling the Gulf's fire

    Arab intervention in Yemen risks entrenching Sunni-Shia divide and handing a victory to Isis, says Patrick Cockburn
    Zayn Malik's departure from One Direction shows the perils of fame in the age of social media

    The only direction Zayn could go

    We wince at the anguish of One Direction's fans, but Malik's departure shows the perils of fame in the age of social media
    Young Magician of the Year 2015: Meet the schoolgirl from Newcastle who has her heart set on being the competition's first female winner

    Spells like teen spirit

    A 16-year-old from Newcastle has set her heart on being the first female to win Young Magician of the Year. Jonathan Owen meets her
    Jonathan Anderson: If fashion is a cycle, this young man knows just how to ride it

    If fashion is a cycle, this young man knows just how to ride it

    British designer Jonathan Anderson is putting his stamp on venerable house Loewe
    Number plates scheme could provide a licence to offend in the land of the free

    Licence to offend in the land of the free

    Cash-strapped states have hit on a way of making money out of drivers that may be in collision with the First Amendment, says Rupert Cornwell
    From farm to fork: Meet the Cornish fishermen, vegetable-growers and butchers causing a stir in London's top restaurants

    From farm to fork in Cornwall

    One man is bringing together Cornwall's most accomplished growers, fishermen and butchers with London's best chefs to put the finest, freshest produce on the plates of some of the country’s best restaurants
    Robert Parker interview: The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes

    Robert Parker interview

    The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes
    Don't believe the stereotype - or should you?

    Don't believe the stereotype - or should you?

    We exaggerate regional traits and turn them into jokes - and those on the receiving end are in on it too, says DJ Taylor