>On Sun, 12 Jul 1998 09:02:03 +0100, Katie Law wrote:
>>I'd like some thoughts on Viagra, and *if* I were to agree to prescribe
>>it, what criteria I could apply to maintain objectivity in deciding who
>>gets it?
Risk riposted
>If you were to allow 2 bonks a week on the Nash, the cost would be at
>least 6 million pounds a week.
There are some assumptions in this - for instance, with careful timing
and enthusiasm one tablet could provide more than one bonk, could it
not.
The leaflet one's practice nurse hands out with the prescription should
make this clear.
Seriously,
When we work out Indicative prescribing amounts, we should do three
things
- specify that these only apply to existing treatments, or perhaps
treatments for already treatable conditions/modalities. You know what
I mean, not including new inventions.
- recalculate the IPA if a new advance becomes available, based on a
professionally informed but centrally, financially, made and
accountable estimate of cost and provision
- and/or look at the statistics and accounts for the last few years,
and work out how much or what proportion of the drug budget aimed at
IPA items should be held as a reserve against the next major
introduction, whether it be Interferon, a new antiviral, or bonkomatic
tablets.
Meanwhile, remember Imigran? Pateints very soon found that breaking a
tablet and using half each time eked out their ration. That could get
it up to 4 per week per tablet.
It wold be terribly disappointing to think that the reliable first
reaction to a new scientific advance would be for my colleagues to
express their heartfelt enthusiasm for any excuse to avoid treating
that, hitherto poorly treatable, condition, and if this revolves around
the possibility of acquiring a proportion of the underspend on drugs,
this represents an institutionalised corruption which it is a pity the
profession were not proof against during the Thatcher years. At least
let us try to work around the temptations by engineering a system which
tends not to corrupt us, and yet lets our patients bonk.
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