Nobody needs an erection at public expense

EDITOR—I am a BMA member, but Drs John Chisholm and Ian Bogle do not speak for me on sildenafil (Viagra). 1 2 I understood that we had been asking successive governments for years to accept the need for explicit rationing decisions. As soon as this government makes one—a sensible one that the general public accepts—we kick it in the teeth.

The grounds for differentiating between different causes of erectile dysfunction outlined by the health secretary, Frank Dobson, were imperfect but not unreasonable3; for the first time there was an overt admission that totally comprehensive demand-led care had to be limited. This was not the time to pick a fight. The media comment suggests that the public accepts that when resources are limited conditions such as cataract and stroke should be given higher priorities than erectile dysfunction.

I have been telling my patients who request sildenafil that the NHS cannot afford it. I still take that view, but the BMA's reported comments will make my position harder to sustain. Sildenafil should be available at cost without prescription; it will cost about as much as an acceptable bottle of table wine.

True debate is needed

EDITOR—The proposals for rationing of sildenafil (Viagra) put forward by the secretary of state are unethical,1 and the General Practitioners Committee is correct to advise general practitioners to prescribe the drug on prescription to all patients who require it.2

Many doctors would welcome a mature debate regarding rationing in the NHS, recognising that in an underfunded service where rationing has always existed such a discussion should be held openly and honestly. Few, however, can have expected that the first politically …