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Streets Of London: Sure To Rise

Streets of London from Malcolm Aitken in London

Sure To Rise, But At What Price?

Viagra is being sold over the Internet in Britain with very few questions asked. The authorities are clearly preparing for a fight. They need to curtail dubious on-line vendors of this much-vaunted mitigator of impotence. Viagra still has question marks over its safety and its long-term effectiveness.

What troubles the Medicines Control Agency (MCA), which attempts to do what its title suggests, is that some on-line vendors are following the letter but not the spirit of the law at best. It’s all so predictable really. The law requires a consultation and prescription, pre-purchase. Potential consumers often partake in on-line ‘consultation and prescription’ that simply involves ticking a series of boxes about existing conditions. There’s no physical examination, not necessarily any follow up and typically the most substantive information you’ll find on these websites selling Viagra, smoking cessation pills, ‘fat-busting’ slimming drugs and similar are very convoluted, cover-all disclaimers. There are reliable websites run by people who insist on prescriptions from a face-to-face consultation, but the charlatans involved in this very lucrative business won’t want to know about it if things go awry for you. The little blue pills are dispensed relatively liberally by GPs, despite furious protests, because Viagra’s not available for anyone who’s impotent- but should surely only be meted out by professionals with patients’ well being as their chief concern, not profits. The MCA needs robust, modern legislation to back it up, fast. Funnily enough the provisions of the 1968 Medicines Act seem somewhat unwieldy in 2002.

The arguments about Viagra’s easy on-line availability feed into a larger debate. Controversy about the costs and benefits of on-line pharmacies has been raging in the Europe and the US for years. Sceptics emphasise the skewed or nearly non-existent information websites give potential customers about the product they’re considering buying. This is an unfair practice, but very common. In reply, professional medical bodies have suggested benchmark accreditation-based schemes. The issues regarding consumer choice are more complex than they may first appear. In the US, for example, advocates of liberalization have pointed out that ‘traditionalist’ medicine suppliers, read big pharmaceutical companies- have a vested interest in face-to-face consultation. Doctors recommend their drugs: what a captive market.

Whatever stance you take on on-line pharmacies, the baby should positively not be thrown out with the bathwater. If they’re well regulated in terms of the information they’re obliged to supply to potential customers and there’s a tighter definition of consultation, they could potentially fill their role as a convenience store well, in countries such as New Zealand where it can be expensive to visit your doctor (it’s free in the UK) or when guidelines mean many people still fall between the cracks. Although more than two million men in the UK are estimated to suffer from impotence, only several hundred thousand prescriptions for Viagra are handed out each year. But, this system only works well if the benefits of an increased libido aren’t offset by a greater risk of a heart attack when customers receive their credit card bill: the price of Viagra, on British websites anyway, is phenomenal. Even if the websites are better run here, the case for at least trying for free NHS drugs will surely remain most compelling.

Viagra’s was at first more difficult to obtain for sufferers of erectile dysfunction. (Viagra is prescribed for diabetes, multiple sclerosis, Parkinson’s Disease and Spinal Chord Injury among other conditions). A successful court challenge backed by doctors a few years ago made it easier for many tens of thousands of British men to regain their sex lives. The Government had intended to be much more restrictive in NHS provision for Viagra but it’s only medium heard to get on the state nowadays: no bad pun intended.

Meanwhile the argument about whether Viagra endangers the heart or decreases the prospects of healthy erections in the longer run continues within the medical establishment. Deaths attributed to Viagra have been remarkably rare and doctors in reputable establishment publications such as the British Medical Journey have even defended the use of Viagra and ‘poppers’ or amyl nitrate together. But others have warned of the deadliness of combining Viagra and nitrates and the German health authorities don’t prescribe it for people with heart problems.

On a less serious note polemicist Germaine Greer has written about the supposed use of Viagra as part of Britain’s gay nightclub scene. In perhaps one of funniest observations of the on-going debate Greer noted in the Guardian in 1999: In hyper-gay circles, it is getting difficult to steer clear of Viagra. Any guy who would prefer to walk and talk, wine and dine, cuddle and kiss his significant other rather than keep him impaled for 48 hours or so is a sissy. When you can have a whole weekend of synthetic priapism [non-stop erection], what red-blooded male would settle for anything less? Viagra weekends could vanquish football as we know it. Even angling might register a serious fall in popularity once the Viagra culture kicks in.

Anyway, Viagra’s one thing: Cialis, which may guarantee ‘rising to the occasion’ for a day after you take the pill, is in the pipeline. Watch this space.

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