The arrival this week of the latest wonder drugs--the anti-impotence pill Viagra and a new anti-obesity tablet called Xenical--has Britons questioning just how much health and happiness taxpayers should subsidize.
Fearing a huge and costly demand, Britain's National Health Service has banned its doctors from prescribing Viagra until the department can come up with a way to ensure that only "deserving" patients get the drug for a reduced fee.
"I don't really think the NHS should be financing people waving their potency at a disco," said Health Secretary Frank Dobson, who oversees the system that offers free health care to Britons.
Yet no restrictions have been placed on NHS prescriptions for Xenical, a "fat-blocker" that some people are calling the next Viagra for its potential sales to dieters.
Viagra was approved for sale throughout the European Union last week and is available in Britain privately for about $10 to $25 a pill. This has led to charges that the government is allowing "prescription by postcode," making sex an income and class issue.
"When we are old and poor, sex is about the only free pleasure left," an irate Sutton resident wrote to the Guardian newspaper. "Frank Dobson is denying the comfort of sex to older people and sufferers from diabetes and prostate cancer purely on cost grounds, although the government can find billions for Trident [missiles]."
Dobson says the issue is one of national priorities, not age and income. It is estimated that Viagra could cost the NHS between $85 million and $255 million a year.
"That money isn't there, so therefore we have to take the money away from maternity services for women having babies or people who are being treated for cancer or people who are being treated for heart disease," Dobson told BBC radio.
The Royal Pharmaceutical Society, meanwhile, called for an "open and rational debate" on what medicines and treatments society is prepared to underwrite.
Italy, Austria, Belgium and Greece plan to offer Viagra through their national health services on a selective basis, although Germany does not. Spain is still debating the issue, and France plans to make patients pay a lower price.
Britain's NHS also eventually plans to make the pill available to what Dobson called the "deserving," by which he means those who are impotent and not those trying to heighten pleasure or improve their sexual performance.
The NHS will offer the pill for the manufacturer's basic price of about $8.25 a pill, having tried unsuccessfully to get Pfizer Inc. to reduce the cost. Now the NHS is under pressure to come up with its criteria for distributing the pill through its service among the estimated 10% of the adult male population that is impotent.
Meanwhile, private doctors are prescribing Viagra, and pharmacies and clinics are selling it for as much as a 50% profit. It is also available on the Internet and the black market for up to $42 a pill, which is taken before sex.
Xenical, which is meant only for truly obese people and not for average dieters who want to lose 10 pounds, was launched in Britain on Monday. The drug, which prevents the body from absorbing about 30% of fat intake, is to be used in conjunction with a reduced-fat diet and exercise.
But some health officials fear that this too could become a drain on the public health system in a country where about 13% of men and 16% of women are classified as obese. Xenical must be taken three times a day at a price of about $73 for a month's supply, leading to media reports that the cost to the NHS could quickly surpass $1 billion--a figure that the Swiss manufacturer Roche Holding said was inflated.
Roche representatives said the pill will save the NHS money by reducing obesity and weight-related illnesses, such as diabetes and heart problems.