Access to Viagra on the NHS should be increased to counter the trade in fake medicines, doctors’ leaders say.

The British Medical Association has urged the Government to review who is eligible for drugs to treat erectile dysfunction. The BMA had “always been against the rather discriminatory way” in which some patients got Viagra and others did not, Hamish Meldrum, the chairman, said. Its view is that doctors should be able to prescribe such drugs to all with a clear clinical need.

The blue pill made by Pfizer has been depicted by some as a “lifestyle medicine”, and there is a booming counterfeit trade founded on the sending of billions of spam e-mails.

In 2003 annual NHS spending on anti-impotence drugs was put at more than £30 million, with costs increasing.

Experts estimate that one in ten of the 2.3 million men in Britain suffering from erectile dysfunction is being treated. Dr Meldrum said that the current compromise was a “rather awful halfway house”. Some men, denied NHS help, had to get the drugs through private healthcare, while others bought pills via the internet that could be fake or harmful. “Many internet sites are offering it [Viagra] at a price lower than at the chemist,” he said. “There are problems with this: you might not be getting Viagra. At best it may be an inert substance, at worst a positively dangerous substance.” Nor were patients who used such sites having a consultation to see if the drug might interfere with their other medication.

The issue was for the Government rather than the National Institute for Health and Clinical Excellence, he said. “Nobody is arguing about the effectiveness of treatments for erectile dysfunction.” The system should be fairer; “I think where they are drawing the line is not a very good place.”

Under the restrictions, set down in 1999, erectile dysfunction drugs can be prescribed on the NHS only to men with certain conditions: diabetes, multiple sclerosis, Parkinson’s disease, polio, prostate cancer, prostatectomy, radical pelvic surgery, kidney failure treated by dialysis or transplant, severe pelvic injury, single gene neurological disease, spinal cord injury and spina bifida. Men in severe distress can be prescribed the drugs by a hospital specialist.

Viagra can be fatal to those with heart conditions and fake versions can contain excessive doses of active ingredients. Dr Meldrum said: “Men are a bit wary of going to their doctor. They may self-diagnose and self-prescribe via the internet. We want patients to be protected and to seek appropriate advice to get proper diagnosis and treatment.”

The Health Department said that a review in 2001 had decided against changing the restrictions. Costs were increasing under the current regime.

— Pomegranate juice may be a natural substitute for Viagra, scientists at the University of California in Los Angeles say. They gave 53 men with mild-to-moderate erectile problems fruit juice each day, the Journal of Impotence Research reported. Nearly half of those who drank pomegranate juice reported improvements, but so did nearly a third of those who drank other juices — possibly because of the placebo effect. Pomegranate juice is thought to be rich in antioxidants that boost blood supply to the male genitals.

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