Press: Viagra, rationed
Authors: K. Abbasi
Journal: BMJ (1999)

On 21 January, the health secretary Frank Dobson’s announcement on prescribing Viagra (see p 273 and p 279) was denounced by the BMA as “cruel and unethical.” But doctors found few allies in the press. As Jennifer Trueland wrote in the Scotsman (22 January), the Viagra debate “shows that the NHS has finite resources and that it cannot meet every demand.” The Evening Standard, however, was first into the fray (21 January): “Doctors do not run the National Health Service: taxpayers do. But try telling that to the British Medical Association. It was in the interests of the taxpayers, and of common sense, that the Health Secretary, Frank Dobson, announced his new, binding guidelines.... The BMA needs to be slapped down hard on this.”


The Independent (23 January) argued that “rationing by queueing” was as old as the NHS, and that, while the 1990s was “the Happy Decade” (thank you Prozac and Viagra), it would “also be remembered as the decade in which the rationing of healthcare started in Britain.” The BMA, it claimed, was more concerned about doctors’ priorities than those of the NHS—“as selfish and irresponsible a vested interest as the worst of the flying pickets in the 1970s.” Doctors had become rebels, and their leaders rabble rousing trade unionists: “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.” 




“Dobson’s choice,” as the media dubbed it, centred around the health minister’s belief that impotence isn’t life threatening and doesn’t cause physical pain. “We have to find a sensible balance between treating men with a distressing condition and protecting the resources of the NHS to deal with other conditions, for example,” chose Mr Dobson, “cancer, heart disease, and mental health problems.” Apparently not the mental anguish of impotent men, though.

General practitioner David Devlin told the Daily Telegraph (22 January): “I think this is quite unfair. I have more than 100 patients on Viagra and all are suffering from impotence caused by psychological or physical disorders. A lot of people consider Viagra users to be promiscuous men. This is not true.”

Andrew Marr of the Observer offered an explanation (24 January): “We had reason to think that his [Dobson’s] contribution to the drugs debate would be to manufacture the filthiest Viagra joke on the planet. Instead he has changed the National Health Service forever. This is about values: and unlike his jokes, Dobson’s are decent to the core. A nation which spends taxpayers’ money on better erections, while leaving old ladies to soil themselves and starve in under-staffed wards, is sick indeed.” Marr is convinced that Dobson’s choice is the “clearest act of national drugs rationing yet.” Who could disagree?

Mr Dobson was firm, doctors were defiant, and Pfizer—manufacturer of Viagra—was furious but exploring “all its options.” For three days the controversy raged: “Impotence is not a joke, say doctors” (Independent 22 January), while “Impotence is not really such a serious problem, claims Dobson” (Express 22 January). The Express applauded as “Dobson strikes right balance on Viagra” (22 January), but added a new twist: “And today The Express reveals that because the drug is registered in Britain, this country’s exchequer makes money from every pill sold across the world—in theory, more than enough to offset the costs of prescribing Viagra.”

Confused? The Sun seemed to be as well. The “Sun Man’s Sex File” confessed: “Dear Mr Dobson, I am a Sun journalist and I am on Viagra—when I can afford it” (22 January). Page 3 not doing the trick then? “How dare you suddenly change the rules of the NHS now, after I have spent the better part of my working life paying into it? Viagra has been a Godsend.” Another Sun journalist, Richard Littlejohn, was unhappy that the NHS should “legalise and supply a proven killer like Viagra.” Instead, he offered his own rationing test: “If you’re strong enough to get the cap off the bottle, you can buy it yourself.”

Inevitably, the prime minister made one of his regular forays into the tabloid press. “We have to be hard on Viagra,” he exclusively told the Mirror on 23 January. “I personally believe that the public understands very well that there are certain severe medical conditions in relation to impotence that should be treated on the NHS.” Do they? “You have got to make a choice as to priorities.”

Rationing is the word the government dare not mention—prioritisation is more acceptable in “Third Way” terminology—but everyone else is dispensing it freely. The first rationing skirmishes have been won in the press by the government, with doctors portrayed as power crazed idealists rather than patients’ advocates. Rationing is now clearly with us, though the method of making it work remains elusive. Where will the National Institute of Clinical Excellence fit in? How might doctors’ and patients’ views be better considered?

Viagra has crystallised the rationing debate as only a matter of male sexual prowess could. Where now Viagra? Where now rationing? The future is foggy, not least for impotent men.