(Viagra: a botched test case for rationing. If it leads to a proper debate over rationing the decision on sildenafil will not be all bad)

The secretary of state's proposals for the introduction of sildenafil (Viagra) may be rationing but they are not rational, says Dr John Chisholm in an editorial in this week's BMJ. In dressing up a rationing decision as a clinical one, the secretary of state has ended up with the worst of all possible worlds: a decision that makes no sense on clinical, equity or cost-effectiveness grounds. After months of uncertainty over how sildenafil would be made available on the NHS, Dr Chisholm suggests that these proposals may lead to a long-awaited public debate about NHS rationing.

The secretary of state has effectively admitted that the government can no longer fund an NHS according to its founding principles of comprehensiveness, universality and access based on need, but has made a decision that will at least ensure consistent access across the UK. Although the BMA has campaigned vigorously for increased NHS funding, it has also stated that if the government and taxpayers do not provide these financial resources, the government should explicitly state what the NHS can and cannot provide, rather than "leaving such decisions to individual doctors or to the accident of where patients live".

Contact:

Dr John Chisholm, Chairman General Practitioners Committee, via the BMA Press Office pressoffice@bma.org.uk

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Contact: Jill Shepherd
jshepherd@bma.org.uk
44-171-383-6529
BMJ-British Medical Journal
29-Jan-1999