HEALTH Secretary Frank Dobson seems to have passed the buck somewhat over the prescribing of the anti-impotence drug Viagra that might help as many as two million men with problems, but which, at £6 a tablet, would cost the hard-pressed NHS a fortune.

He proposes that it should be available on the NHS at the rate of just one tablet a week to men with serious disabilities or suffering from "severe distress." Otherwise, they must pay for the pill themselves.

But this raises all sorts of concerns. Mr Dobson is rationing health care and interfering with doctors' clinical judgment.

His reasons may be valid - the NHS does not have infinite resources and must, therefore, give priority to treatments for people with actual illnesses rather than unfortunate conditions which, after all, is what impotence is. It is hard to argue against people with cancer, heart disease or mental problems being put before those seeking sexual pleasure.

But in intruding into the doctors' domain by determining what treatment they may give to patients by way of limiting it, he has understandably run into a row. For while the raising of the touchy medical profession's hackles may in some part be due to its doctor-knows-best wisdom being questioned, Mr Dobson has nonetheless left it with a real problem because of the blur in his proposed restrictions.

For, as one East Lancashire specialist asks today, how do doctors define "severe distress"? One upshot is that they will differ and that the prescribing of Viagra will be subject to arbitrary reasoning - hardly fair on the patients who happen on a doctor who interprets this more strictly than others.

Or, more likely, the majority of doctors will decide "severe distress" occurs in practically every case and prescribe the pill to virtually all - so ruining the necessary aim of protecting the NHS's resources for those who need them most.

If only Mr Dobson had been more brave and less afraid of upsetting anyone and refused to make Viagra available at public expense on the grounds that it is a lifestyle drug, rather than a therapeutic one - as most countries in Europe have done.

Then, the doctors' judgment would not be questioned; they would not have had this dilemma passed to them; they would be free to privately prescribe as much or as little as they thought fit; there would be no cost to the NHS and, surely, most patients would accept the logic and principle of this.

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