It is self-evident in a state-funded health system that medical care must be rationed if the costs of such care are not to swamp the entire national exchequer. But the manner and the degree of such rationing require care, expertise and sensitivity if people in need of treatment are not to be left untended and uncared for. The latest issue to give rise to concern in this area was the licensing on Tuesday by the European Commission of the latest and most effective treatment for male impotence, sildenafil citrate, known worldwide under the trade name of Viagra. The decision of the British Secretary of State for Health, Mr Frank Dobson, not to make the treatment available on the National Health Service - at least for the time being - is welcome for the transparency with which it makes the rationing policy evident, even if it is a decision that is wrong and bound to be overturned.
The story of the development and release of Viagra has been an extraordinary spectacle, surrounded in the media by a mixture of hype and schoolboy smut. But beneath the hype and the smut there are serious matters to be addressed. There is, of course, the matter of its cost - although this never seemed to be an issue with earlier, less effective and more expensive treatments for male impotence which are already available within both the British National Health Service and the health services in Ireland. There is the issue of impotence itself which afflicts millions of men worldwide (estimates put its prevalence somewhere between 10 per cent and 35 per cent of all males) to many of whom it is no joke at all, any more than it is a joke to their sexual partners. There are other, more technical, issues such as the safety of the drug itself and its interactivity with other medications, and what controls should be placed over its distribution and use.
To ban its prescription in the National Health Service in Britain means that those seeking its benefits there will have to pay for it and, while it is cheaper than some other impotence treatments, it is not inexpensive at somewhere around £5 to £10 per pill, depending on whether the cost is to the State or to the patient on the retail market. To ban its prescription in the General Medical Services in Ireland could deprive one third or more sufferers from impotence here of its proven benefit. Such bans would effectively say to less affluent people that their sexual dysfunction is not to be taken seriously and that Viagra is (as some Americans have thoughtlessly averred) a recreational drug rather than an appropriate treatment for a condition which can cause a great deal of distress in loving sexual relationships. That is no way to ration health services which already provide many much less significant therapies without charge.
Not only should Viagra be made available on prescription for reasons of non-discrimination, it should be on prescription for reasons of safety and health protection. Not all of its side-effects are yet known and there may well be groups of identifiable individuals who should be advised to avoid it. Only by issuing it on a prescription-only basis can its side-effects be properly monitored, and its risks accurately identified. Its consumers and potential beneficiaries deserve not only to have access to it, but also deserve protection from whatever hazards its use may entail.