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4 VIEWS &: REVIEWS The ins and outs of sildenafil The European Commission approved the marketing of Pfizer's sildenafil ['Viagra'] on September 15 of this year, just 1 day after the UK Department of Health advised that until definitive guidelines have been drawn up 'doctors should not prescribe sildenafil' , and that for the time being the drug will not be funded by the National Health Service (NHS), reports the Lancet. I Government impotent? Richard Smith, Editor of the BMJ, ascribes this proscription to the 'inability of Britain s government to come to terms with rationing', despite the fact 'that patients are denied the treatment they need every day of the week' . 2 Instead, Mr Smith says, the UK government attempts to maintain a fiction that the NHS 'can provide a comprehensive, high quality service that is free at the point of delivery and covers everybody'. In addition, Mr Smith chides Frank Dobson, UK secretary of state for health, for attempting to shift the blame to the media for creating what Mr Dobson calls expectations about sildenafil that could prove a serious drain on NHS funds. Mr Smith adds that given that the NHS cannot meet its 4 founding principles, many people may in fact agree with sacrificing the notion of comprehensive- ness, but he emphasizes that if rationing decisions are required, they should be the subject of a 'comprehens- ive, transparent, continuing debate' , rather than being a matter for experts to determine 'behind closed doors, according to unknown criteria' . Costly pleasures Alex Brooks, also writing in the BMJ, notes that the UK government has agreed to Pfizer's suggested price of £4.84 per 50mg sildenafil tablet, and adds that the British Medical Association has estimated the potential annual cost of providing sildenafil to all who might benefit as > £1 billion annually.3 However, Mr Brooks points out that each 5J.1.g injection of alprostadil ['Caverject'] costs £6.74, and that the government already spends about £12 million annually on impotence treatments. He adds that a non-lifesaving drug like sildenafil is 'an easy target for rationing'. Bestseller Dr Alain Gregoire from Old Manor Hospital, Salisbury, UK, says that for men with erectile dysfunction, an oral treatment like sildenafil 'must have seemed too good to be true'. because of the 'unacceptability, poor effectiveness, or unavail- ability' of other treatments. 4 He notes that since its launch in the US, sildenafil has become 'the fastest selling drug ever' . With respect to safety and efficacy, Dr Gregoire points to pooled data from 18 studies involving > 3700 men that 'showed no evidence of serious adverse effects attributable to sildenafil' . 1. Bradbury J. VIagI"ll approved in Europe, but UK government tells doctors not to prescribe. Lancet 352: 963, 19 Sep 1998 2. Smith R. viagra and rationing. Inpharma- 26 Sep 1II1II No. 11 se British Medical JoumaJ 317: 760-761, 19 Sep 1998 3. Brooks A. VlagI"llis licensed in Europe but rationed in Britain. British Medical Journal 317: 765, 19 Sep 19984. Gregoire A. VIa8flI' on release. British Medical JoumaJ 317: 759-760, 19 Sep 1998 100632299 1173-832419811156-OOO41$01.or:f' Ad'- International Limited 1II1II. All rlgla ..-weI

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Page 1: The ins and outs of sildenafil

4 VIEWS &: REVIEWS

The ins and outs of sildenafil The European Commission approved the marketing

of Pfizer's sildenafil ['Viagra'] on September 15 of this year, just 1 day after the UK Department of Health advised that until definitive guidelines have been drawn up 'doctors should not prescribe sildenafil' , and that for the time being the drug will not be funded by the National Health Service (NHS), reports the Lancet. I

Government impotent? Richard Smith, Editor of the BMJ, ascribes this

proscription to the 'inability of Britain s government to come to terms with rationing', despite the fact 'that patients are denied the treatment they need every day of the week' .2 Instead, Mr Smith says, the UK government attempts to maintain a fiction that the NHS 'can provide a comprehensive, high quality service that is free at the point of delivery and covers everybody'.

In addition, Mr Smith chides Frank Dobson, UK secretary of state for health, for attempting to shift the blame to the media for creating what Mr Dobson calls expectations about sildenafil that could prove a serious drain on NHS funds.

Mr Smith adds that given that the NHS cannot meet its 4 founding principles, many people may in fact agree with sacrificing the notion of comprehensive­ness, but he emphasizes that if rationing decisions are required, they should be the subject of a 'comprehens­ive, transparent, continuing debate' , rather than being a matter for experts to determine 'behind closed doors, according to unknown criteria' .

Costly pleasures Alex Brooks, also writing in the BMJ, notes that

the UK government has agreed to Pfizer's suggested price of £4.84 per 50mg sildenafil tablet, and adds that the British Medical Association has estimated the potential annual cost of providing sildenafil to all who might benefit as > £1 billion annually.3

However, Mr Brooks points out that each 5J.1.g injection of alprostadil ['Caverject'] costs £6.74, and that the government already spends about £12 million annually on impotence treatments. He adds that a non-lifesaving drug like sildenafil is 'an easy target for rationing'.

Bestseller Dr Alain Gregoire from Old Manor Hospital,

Salisbury, UK, says that for men with erectile dysfunction, an oral treatment like sildenafil 'must have seemed too good to be true'. because of the 'unacceptability, poor effectiveness, or unavail­ability' of other treatments.4 He notes that since its launch in the US, sildenafil has become 'the fastest selling drug ever' .

With respect to safety and efficacy, Dr Gregoire points to pooled data from 18 studies involving > 3700 men that 'showed no evidence of serious adverse effects attributable to sildenafil' .

1. Bradbury J. VIagI"ll approved in Europe, but UK government tells doctors

not to prescribe. Lancet 352: 963, 19 Sep 1998 2. Smith R. viagra and rationing.

Inpharma- 26 Sep 1II1II No. 11 se

British Medical JoumaJ 317: 760-761, 19 Sep 1998 3. Brooks A. VlagI"llis licensed in Europe but rationed in Britain. British Medical Journal 317: 765,

19 Sep 19984. Gregoire A. VIa8flI' on release. British Medical JoumaJ 317: 759-760, 19 Sep 1998 100632299

1173-832419811156-OOO41$01.or:f' Ad'- International Limited 1II1II. All rlgla ..-weI