In a message dated 04/08/98 13:01:05 GMT, Julian wrote:
<<
Surgery I did not long before starting a holiday included 2 patients with
specific requests.
Pt. 1:-
Female, 40s, I'm going on holiday and my periods due. Can I have some
norethisterone? Given without hesitation, deviation, or repetition in
"just a minute".
Pt. 2:-
Male, 60's, diabetic. Tried Caverject but couldn't tolerate the needle.
Enquired re. Viagra .....
Which is social and which medical?
Why can patients receive treatment costing thousands of pounds for
non-dominant (and not life threatening) arm
injuries, yet we flinch at prescribing treatment for others with a
disabling but not life threatening problem?
Human function surely includes human sexuality. What is the ethical or
medical basis for those, like Jeremy Sager who wrote to Pulse, who claim
that Viagra should not be available on the NHS to those with a medical
need? Jeremy, function of any part of our bodies is a privilege more than
a right, but how do you justify the implication that one part of a person's
body is worth more than another?
If the consensus really is in the direction that prescribing Viagra on the
NHS is wrong should we all stop funding surgery with purely functional
benefit, prescribing contraception (non-medical and allows recreational
sex), HRT unless clear medical indications, drugs to delay periods etc?
Whatever the consensus we should be consistent and who could live with this
scenario?
JB
Lurker
>>
There are so many points to cover here but ...............
Both the examples you quote are social prescriptions.
As far as the norethisterone goes, we're talking about a cheap drug given for
2 weeks only. Viagra will be a lifetime's prescription. And when you
prescribe, how many tablets will you give? One a day? two a day? more? To be
crude, how many erections would be reasonable under the NHS?
Then there is the medical need thing. Are you suggesting that Viagra should
only be available on the NHS to those with a recognised medical condition
causing erectile dysfunction like DM or CRF? Because if you are, what about
all the people who are not impotent as a result of a definable medical
problem? Is their "need" for treatment any the less justified? In any case,
our knowledge of the causes of erectile dysfunction is advancing all the time
and many previous psychological cases can now be reclassified as having a
medical basis. Soon everyone will have a "medical need." And how do you prove
a patient's erectile dysfunction? What will stop people who want to use Viagra
in a recreational fashion to enhance potency getting treatment. You see
Julian, what a can of worms you can open.
Taking the point you make about arm injury, thousands of pounds may be spent
justifiably in cases like these which affect people's livelihoods and ability
to support their families. How does Viagra do that?
In my neck of the woods, to quote but one example, the wait for joint
replacement surgery is long and painful. Despite Mr Dobson's cash injection I
do not forsee any improvement in the short or medium term future. I have had
patients in tears in the surgery, telling me that their restricted and painful
lives are not worth living. Can you imagine their responses if I had to tell
them that the waiting list was to rise still further because funds were to be
diverted to erectile dysfunction?
Oh, and with respect to your point about one part of the body being of more
value than another; if I was suffering from triple vessel IHD and impotence, I
know what I would want to be treated for first. You don't die of impotence ;-)
As I said in Pulse, if we had unlimited money with which to treat patients,
I'd support NHS prescribing of Viagra.Until then, we have to ration NHS
precribing and Viagra comes very low down on a list of priorities, way down
past cancer services, joint replacement surgery and cardiovascular surgery.
Cheers
Jeremy Sager
GP
Leeds
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