Jeremy
Medicine involves difficult judgements. However just because a few
backache patients probably don't have backache we don't deprive all of our
trust or their entitlement to benefit. Sure we get abused sometimes, but
isn't it better to give care to some who need it and a few who don't than
to exclude whole groups of people with legitimate problems?
Loss of arm a disaster and therefore not comparable? I borrowed this
analogy from some debates about infertility. Certainly some women are very
open in their feeling that loss of fertility is loss of something central
to their existence. None of my older male patients has ever really opened
up about how they feel about impotence - not a "male" style perhaps though
they have often described the symptoms of depression. One somewhat younger
patient who has admitted it (post-op Peyronies disease) is clearly quite
troubled. I don't know if he's used the phrase "I'd give my right arm to
be able to have sex again" but that's the kind of feeling one has when he
consults.
>Viagra may not be less important than the lowest priority treatment that
the NHS offers.
>But we have to have sufficient funds available to treat the high priority
issues that I instanced.
>Any surfeit of funds afterwards can be used for lower priority treatments.
We agree and I suspect that these views would be widely accepted.
>I did not say anywhere that Viagra should be lower down than the lowest
priority NHS treatment.
Though the words were never said is this not inevitably the implication of
the "Viagra should not be available on the NHS" stance?
>>cheap arthroplasty to cure pain and Viagra for life? >>
>Poor example
Oops, you're right. Meant to be cheap arthrodesis, though I think the
prinicple rather than exact sums of money involved is the more important
issue.
>It would be interesting to see how a large random sample of patients would
prioritise Viagra,
>if anybody knows of a study, I'd be interested in seeing it.
Agree, but which patients is usually the question. Should we mainly accept
the priority accorded by sufferers or all patients currently needing
treatment for anything or the whole population. In some areas these three
groups may give very disparate answers.
Are these the kinds of questions that PCG boards will have to examine and
decide on? Will doctors / PCG boards have a special empathy with the
monetary committee of the Bank of England? Both groups left to take
professional decisions with enormous political ramifications.
Can modemocracy pull together more wisdom and give us the edge?
(And is 42 really the answer?)
Best wishes,
JB
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