A Viagra elite


WASHINGTON -- Bob and Elizabeth Dole may have told us more than we wanted to know about their sex lives. But I'm glad they did.

The 74-year-old former Republican presidential candidate revealed last week on CNN's "Larry King Live" that he was in a group that tested the new anti-impotency drug Viagra. As casually and candidly as he might sound if recommending a golf club for a chip shot, he pronounced it to be "a great drug."

His 61-year-old wife, president of the American Red Cross, agreed with a smile in New York City on Sunday, "It's a great drug, OK?"

Good for the Doles. Some of my friends think Bob and Liddy should turn in their conservative credentials, as if conservatives aren't supposed to enjoy having sex, especially in their golden years.

I thought it was great. For years Bob Dole, who says he owes his life to early detection and treatment of prostate cancer, has been urging the rest of us guys who have passed 40 -- and especially those who have passed 50 -- to get annual prostate exams.

Just as it is important for women to examine themselves monthly for lumps in their breasts, it is important for men to get examined annually for irregularities in their prostates.

Deadly disease

Prostate cancer is a killer, especially in African-American men and Asian-American men who, for reasons that are not clear to researchers, have higher prostate cancer rates in America than do our male cousins in Africa or Asia, according to my prostate specialist.

Women are much more up-front. They talk much more openly and seriously about their most urgent gender-related danger, breast cancer. They examine themselves regularly. They lobby for their cause and advertise it vigorously.

Unfortunately, us aging guys have a big enemy working against us: our own macho pride.

"Saturday Night Live," in an occasional bursts of genuine wit, recently lampooned it by asking men on the street what they thought of Viagra and hearing responses like, "I don't need it." "What do you mean? I don't need it." "No, not me. I don't need it." "No, what are you talking about? I don't need it." "No." "Go to hell!" "Yeah, go to hell!"

We're the same way with prostate tests. A lot of us don't want to go because, on some level, we don't want to admit we're getting older and we're afraid to hear the results.

Yes, I said the "A" word, "afraid." In men, fear of impotence ranks right up their with fear of death. In some men, it probably ranks higher. As a result, the fear of impotence is a major deterrent to men who should be getting themselves examined.

Inasmuch as Viagra boosts the message that, yes, there is life after prostate cancer, it may reduce male fear and anxiety about aging and impotence and reduce the reluctance many men feel bTC toward getting their annual prostate exams.

So that's why I am delighted the Doles have come out, in their own way, as a happy Viagra couple. With their help, Viagra has potential not only as a life-enhancing drug, but also a life-saving influence.

Which raises my concern about a potential new class in American society: the Viagra elite. They are the folks who can afford to buy Viagra or have it provided for them by their health plans.

The rest fall into a Viagraless underclass. If you are poor your ability to buy Viagra under Medicaid depends upon the policies of your state, since federal officials have left Medicaid drug coverage up to the individual states.

A survey by the Washington-based Urban Institute found at least 11 states and the District of Columbia have approved the drug for Medicaid recipients and 12 have rejected coverage. A state-by-state survey by Steve Zuckerman, an Urban Institute researcher, raises more intriguing public policy questions.

Why, for example, does Utah allow payment for up to a generous 10 tablets a month, at $10 a pop, while Alabama and Florida only fork over enough for a measly four a month? By contrast, the big Medicaid states like California, New York and Illinois look like tightwads -- so far, they're not paying for Viagra.

Gender bias

In the private sector, by contrast, the American College of Obstetricians and Gynecologists charged Tuesday that health insurers who cover Viagra but don't pay for female contraception are guilty of "gender bias."

Well, maybe not quite. The functions are different. Viagra boosts sexual potency while contraceptives suppress fertility.

And the public is no less divided than the insurers. When a recent Gallup Poll asked whether private health plans should cover Viagra, 50 percent of respondents said "no."

Viagra may be a great drug, as the Doles call it, but it doesn't come free. With us baby boomers aging in great numbers, I expect the debate over who shall be in the Viagra elite and who's going to pay for it will be a potent one for years to come.

Clarence Page is a syndicated columnist.

Pub Date: 5/15/98

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