Why Dobson must stand firm on Viagra

So the BMA really does have balls. Instead of bowing down to the argument that resources are limited and that medical services need to be prioritised, it has struck its flag on the principle of patient need.

The opportunity came when Frank Dobson finally decided what to do about Viagra, drawing the limit to its prescription on the NHS to men with major illnesses, or those rendered impotent by medical and surgical treatments. This allowed the BMA to restate its role as advocate of the patient, calling for wider availability of the new drug and denouncing Dobson’s categorisation of patients into the deserving, and by implication the undeserving, impotent.

This is nonsense, and the government is right. Many services are rationed, and many under-resourced. To argue that all of them need extra funding, alongside Viagra and any other designer drug that comes along to enhance the quality of our lives, is naïve. In the time it would take to reduce the hip replacement waiting list by recruiting more nurses (in a staffing crisis, please note), opening more wards, running more operating lists and training more surgeons the whole budget for this initiative could have been used up in a surge of demand-led prescribing for impotence, baldness, attention deficit, fatness or any other source of distress.

To raise money to replace this expenditure and get the hip replacement programme back on stream would mean making the decision to increase taxation, actually collecting the money and then beating off all other demands for it from other sectors — benefits, social care, transport, education — and from other parts of the NHS. In the time that this would take a new drug that eliminates snoring would be marketed, ratcheting the whole process up a few notches. To believe that the NHS can solve every problem for every person who suffers it is to live in a fantasy land. Rationing and prioritisation are here to stay.

The BMA knows that well, and has never been averse to rationing when it suited its members. Long waiting lists promote private practice, which has no shortage of advocates in the medical profession, and waiting lists are tolerated, up to a point. Viagra is already available privately, but the BMA is not content with that. It wants a fight with the government over expenditure on the NHS.

The last time that happened, in the late eighties, the government responded to the crisis by launching the review of NHS funding that ushered in the internal market and introduced privatisation mechanisms to the clinical heart of the public sector. This has always been the long-term aim of the political Right, and the BMA colludes with its agenda. If the NHS cannot afford Viagra and more hip replacements, nor any other expensive innovations alongside its existing portfolio of services, its financial basis must change. Goodbye meagre taxation funding, hello generous insurance systems!

But the Secretary of State is sufficiently Old Labour to see this, and rightly advocates restricted access to the new drug, promoting a long overdue public debate on priorities for the NHS in doing so. Ironically, Viagra could put some zing back into the life of the flagging public health service, even before it does so for a single NHS patient.