Friday, February 16, 2007


The news today is full of a story concerning an off licence use of Viagra (sildenafil) to further the recovery of a premie baby.

This use is not really news. I'm sure you all know what Viagra is used for now, but it was intended as a drug to lower blood pressure. And it has found use in treating pulmonary hypertension in newborns before.

This provoked much controversy.

I must confess to being unaware of this potential use for Viagra before today, but received the news with great joy. Not just because a baby is alive who might otherwise be dead. But also because it does a little to restore my faith in medicine. There is a grand tradition of using unorthodox treatment in medicine. I remember my first boss reacting angrily when told by a drug rep that he couldn't use a particular medication in the way he did, because it was off licence. He was quite confident in his medical knowledge, backed by many years of experience. He reminded me that Registered medical practitioners are entitled to prescribe as they see fit. I suspect the local formulary has more to say about it these days...

In the 'good old days', I'm sure many unorthodox / experimental treatment was carried out without full consent. While I don't condone this, I can't help bu feel that the pendulum has swung too far the other way. In the modern age of Evidence Based Medicine and protocol driven care, delivered by practitioners with limited knowledge base and experience , there seems to be little room for the use of a medication or treatment for any purpose than the manufacturers intend.

I'm not proposing that patients should be peppered with untested drugs, or at random. But I think we are loosing the part of medicine that was, and is, it's art. The science is stronger than ever, but there should be more to it than that.

Sometimes you have to think laterally.

A Professor of Surgery, under whom I worked when I was an Anatomy Demonstrator wrote this:

And how many of us, having carried out some new and untried treatment, have had this experience of being unable to sleep and of creeping to the ward before anyone else is around, with pulse racing, to see whether the treatment has been a brilliant success or a disastrous failure!*

That was published in 1996. I suspect the answer is 'none of us', now.

So give thanks today, not only for a life saved, but for a flicker of life in the Art of Medicine.
Operations that Made History, Ellis H CBE; Greenwich Medical Media 1996


Shinga said...

I was a little irritated by that story - it wouldn't have had nearly as much press had it been about some of the NO effects of the drug rather than Viagra which is associated with 'naughtiness'.

I haven't seen it, but BBC4 is showing a well-received series, Medical Mavericks which highlights people who have researched upon themselves.

Patient Anonymous said...

I just wanted to say that I agree with your comments about the "art" of delivery of care and EBM. I agree with your philosophy about needing to strive for whatever needs to solve the problem without adhering to stifling "practices" of medicine.

That being said, it doesn't mean you go on a irresponsible prescription/procedural spree, either. You do need to have some balance and wits about you.