Friday, December 11, 1998 Published at 16:17 GMT
Viagra: a great British invention
This week I have been talking to Mr Alvan Pope M.D. FRCS, a leading London urologist, on the subject of Viagra:
Mr Pope was quick to point out that treatment of impotence or erectile dysfunction (ED) is not new and there are many existing successful treatments.
However, Viagra is the first clinically tested and licensed drug to treat ED taken by mouth...and just like the hovercraft it was a British invention, hurrah!.
Viagra works by affecting an enzyme which is only found in the penis, allowing the substance that causes erections, cyclic GMP, to hang around longer.
Viagra works for men with both physical and psychological problems, particularly for those who are not completely impotent but have difficulty maintaining an erection.
Psychological factors are only the primary cause in about 14% of men with ED, but more commonly these psychological fears and worries combine with the effects of pre-existing medical conditions to make erectile dysfunction worse.
The Department of Health has issued a temporary block on the prescription of Viagra on the NHS, saying it should only be prescribed in exceptional circumstances.
It is working on specific guidelines on who should get the drug and these are expected to be published before the end of the year.
Mr Pope told me that he has not prescribed Viagra on the NHS, but has used it for a handful of private patients with about a two-thirds success rate.
The point is that Viagra is the cheapest available treatment compared to existing ones, but because of its ease of administration by mouth, there will be an increase in demand, and therefore the overall cost to the NHS could be huge.
It is important that those taking Viagra are under medical care as there are potential side effects and dangers if the person is taking other drugs containing nitrates.
Experience in the US of 69 deaths in 3.5 million Viagra prescriptions is not unexpected in the particular age group and the US Food and Drug Administration has not changed its view on the drug's safety.
Incidentally, those buying Viagra illegally for kicks are wasting their money as it has no effect on normal erections and could indeed be dangerous.
At present the Department of Health has sat on the fence over Viagra, but the government needs to decide whether the treatment of impotence is in or out of the NHS.
It is not a practical option to have rationing of care because there is no medical test for impotence and therefore it would be almost impossible to apply fair and consistent criteria for treatment across the board.
Mr Pope's personal view, and that of many of his colleagues, is that Viagra should be freely available to appropriate patients on the NHS.
It would be best prescribed by GPs in the first instance and, if patients do not respond, that is the appropriate time to refer to a specialist for further investigation and treatment.
In the future more Viagra-type drugs will be on the way. On the cards is a wafer popped under your tongue for the desired effect without the nuisance of finding a glass of water...
So be careful when asking for a wafer with your ice cream from now on!