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PRESCRIPTION FOR DEBATE
Will Viagra change the way Americans view sexual health? May 15, 1998 |
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Questions asked
in this forum:
What liabilities do doctors face if Viagra causes long-term side effects? Can Viagra help a low libido? How successful would a blue "sugar pill" be? Can Viagra be habit forming? Are insurance companies guilty of a double standard? 
The Online NewsHour asks: Some viewers have suggested that a double standard exists in which drugs and treatments are covered. Is it fair to say that insurance companies have granted more consideration to Viagra than many drugs and treatments related to women’s reproductive health?
Dr. Ira Sharlip responds:
Most insurance companies are restricting payment for Viagra, or are not paying for it at all, just as they do for contraception and for fertility treatment. While I am no fan of the medical insurance industry, I object to speculations that the male-dominated insurance industry has been purposely more sympathetic to the treatment of ED than to women's reproductive issues.
Chip Kahn responds:
Many people may not know that ultimately, it is the purchaser of coverage - typically the employer - that determines the scope of a benefits package (exclusive of any state and federal laws that mandate specific covered benefits). Many people also may not be aware that coverage is readily available for contraceptive devices.
The issue, therefore, is not whether coverage for contraceptive devices is available. Instead, it is whether coverage for contraceptive devices should be mandated. ACOG [American College of Obstetricians and Gynecologists] favors a mandate, and apparently is using interest in Viagra to support its push for a federal mandate for contraceptive services.
HIAA believes that mandates - no matter how well intended - end up hurting consumers because they increase the cost of coverage and price people out of the coverage marketplace. On the other hand, insurers are willing and eager to sell coverage packages that include reimbursement for contraceptive devices if purchasers of coverage want it and are willing to pay for it.
Paul Wolpe responds:
Well, yes and no. On one hand, they have a reasonable argument that they cover pathologies and dysfunctions, and that things like contraception are not for dysfunction (most do cover birth control pills, for example, when used for physiological problems like amennorrhea -- lack of menstruation). On the other hand, there is a reasonable case to be made that prescription contraceptives are an integral part of women's health care. Pregnancy is a potentially life-threatening condition, and for those who do not want to carry a pregnancy to term abortion is a surgical procedures with risks of its own. The problem is that paying for prescription contraception would be extremely expensive for insurance companies, and less easy to set limits on than Viagra (you can't say, "We'll pay for six birth control pills a month").
Most men would like to see prescription contraceptives covered. I do not see this as a gender bias issue, particularly; I doubt the insurance companies would pay for a male oral contraceptive either is one were developed. I do not know of a drug for a pathological problem in female reproductive health that is not covered.
Eileen Palace responds:
I think that the double standard described in the development, availability, and reimbursement of pharmaceutical products for women is a symptom of a much larger issue. An imbalance of scientific knowledge between men and women exists in both medical and clinical research, and findings from male-dominated clinical trials cannot be generalized to women. As a result, the effectiveness of treatments ranging from cold remedies to antihypertensive medications have questionable efficacy, and in some cases, are potentially harmful to women. Further, medical and psychological disorders that affect predominantly women, such as breast and uterine cancer, complaints linked to menopause, orgasm disorders, and reactions to victimization, are understudied. Research on the effects of gender differences such as hormonal fluctuations during the menstrual cycle, patterns of health and disease, an responses to stress on mental and physical health in women are lacking. There is a growing awareness of the absence of medical and clinical research on women, and the statistics on the causes of death in women are revealing a gender-biased knowledge. As evidenced by issues surrounding insurance reimbursement for the birth control pill, once pharmaceutical products become available, an addition reflection of this double standard is lack of the availability for women.
As public awareness increases, national funding opportunities for research on women is increasing and educational institutes, such as the Women's Center of Excellence at Tulane University Medical School, are dedicated to developing new programs for research, education, and treatment for women's health care. As part of this program the Sexual Psychophysiology Laboratory at Tulane's Center for Sexual Health is dedicated to research on the etiology and treatment of sexual dysfunction in women. I am editing a new book with Oxford University Press entitled Women's Health: A Behavioral Medicine Approach to address these issues from a behavioral medicine approach to the prevention and alleviation of psychological and medical disorders for women. United research efforts are needed to instigate programs to facilitate understanding women's sexual health requirements, to pursue new approaches to improve the quality of health care, and ultimately to promote, affordable and accessible mental and physical health for women.
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