Hair-raising

Science - Ziauddin Sardar on why a miracle cure for baldness will be only patchily available

On the Norwood/Hamilton Vanity Scale, I am somewhere between three and five. That means I am a walking tragedy. If the hair on my head were as abundant as on the rest of my body, I would classify as one. The Kojak style, completely bald on the top and front areas, clocks up seven. I, on the other hand, have been colonised by a neat, round, slowly expanding tonsure, reminiscent of Brother Cadfael.

Needless to say, this gives me many sleepless nights. Not least because science offers little in the way of a viable solution for what is known in the technical jargon as "male pattern hair loss" or, more scientifically, as "androgenetic alopecia", something that effects 50 per cent of men at some point in their follicly challenged lives.

Treatments for receding hairlines are notoriously useless. Even painful procedures such as hair transplantation and hair replacement do little for our egos. The most widely trumpeted drug for hair loss, minoxidil, which goes under the brand name of "Regaine", gives only vague promises of slowing down hair loss and comes with ample warnings of side effects. When I sprayed this concoction on my bald patch, my skin erupted and I was scratching my head for days on end.

But science never admits defeat. Recent research has identified the culprit that is largely responsible for male hair loss: the enzyme type II 5 alpha-reductase. This enzyme is involved in the conversion of the male hormone testosterone to dihydrotesterone (DHT). Men without this enzyme do not suffer hair loss, suggesting that the conversion of testosterone to DHT may be required for hair loss to occur. So, if we can lower DHT levels in men, we can reduce its harmful effects on hair follicles and on subsequent hair loss.

Keith Kaufman of Merck Research Laboratories, Rahway, New Jersey, and Elise Olsen of Duke University, decided to test this thesis. A couple of years ago, in a paper published in the Journal of the American Academy of Dermatology, they reported on an extensive clinical study of men with mild to moderate hair loss. Some guinea pigs from a total sample of 1,553 received 1mg of finasteride, a drug that reduced DHT levels; others were given placebos. The regrowth of hair was measured by hair count and examination of hair density, ratings of photographs by an expert panel, as well as by patient self-assessment. Kaufman et al found that five out of six men treated with finasteride maintained the amount of hair in the vertex area (83 per cent versus 28 per cent placebo); and during the second year of treatment, two out of three men actually regrew hair that visibly increased the coverage of their scalps. Better still: the length and diameter of existing hair also increased significantly.

A small step for science, one may say, but a giant leap for mankind. The good news is that finasteride is now available under the brand name of "Propecia". Marketed by the pharmaceutical giant Merck Sharp & Dohme (MSD), it is taken orally, once a day, and requires six months' supply before counting whether one's hair produces satisfactory results. The bad news is that, like Viagra, it's likely to be available only on prescription. Even worse news: in Propecia, the appliance of science meets the politics of new Labour. So no one is really sure whether Propecia will be available to the receding hairlines of Britain.

Propecia raises a number of interesting issues. Should the NHS pay for a drug to treat a condition that is a source of nightmares for vain individuals such as me, but can hardly be described as an illness? Would socially challenged British men go to their overworked GPs for what is seen as a "lifestyle problem"? Would the GPs, not normally trained in the science of hair loss, refer their patients to hospitals, thus increasing the burden on the NHS? Should a new and innovative medicine be available to all, or limited to those who can afford to pay?

These knotty issues are currently the subject of an intense debate. In the UK, new prescription-only medicines are made available at NHS expense immediately after the licence has been granted. This would mean that, once licensed, Propecia would automatically be available on NHS prescription at NHS expense. But the Department of Health suggests that Britain is too well endowed with bald men and that, at a cost of £275 per patient per year, or a total NHS bill for the next five years of anywhere between £7m and £37m, Propecia is too expensive.

But in the world of new Labour, nothing is that simple. Following the establishment of the Scottish Parliament and the Welsh Assembly, decisions to restrict the availability of prescription-only medicines have been devolved to these national bodies. Thus, three different bodies have to decide whether Propecia should be made available at NHS expense. Moreover, the relevant authority in each area is consulting the opinion of various scientific bodies, as well as the public. Regular readers of this column would by now have gathered that scientific opinion is never unanimous on any issue, and is frequently in conflict with public opinion. So no prizes for guessing that everyone disagrees with everyone else.

We are thus heading for a situation where, theoretically, Propecia could be available on the NHS in Scotland, say, but not in England; and in Wales, a famous bald spot, it may not be available at all.

But this is not the end of the story. If and when Propecia becomes available as a private, prescription-only drug, GPs will not be able to proscribe it automatically. It has to acquire the status of a Schedule 10 drug, a list of drugs that GPs may not prescribe at NHS expense. But if Propecia is granted this special status, GPs will still not be able to charge the patient for writing this prescription. Which raises the question: why should they bother?

MSD has an even bigger challenge. The company has to persuade balding men to actually consult their GPs in the first place. Here, history is not on MSD's side. Unlike women, who freely consult their GPs on cosmetic surgery and breast enhancements, British men prefer to suffer silently rather than see a GP. This has been officially confirmed both by the Department of Health and by the Royal Pharmaceutical Society of Great Britain. At best, MSD's own market research shows, one to two patients per GP per year will consult on hair loss. In the UK, this would amount to fewer than 40,000 men benefiting from Propecia out of an estimated 6.5 million bald men.

Science, it seems, has only one thing to say to the bald men of the world: your days are numbered. Shame about the politicians.

Details of the NHS Executive's policy proposals for Propecia are available from www.doh.gov.uk/propecia

Ziauddin Sardar, writer and broadcaster, describes himself as a ‘critical polymath’. He is the author of over 40 books, including the highly acclaimed ‘Desperately Seeking Paradise’. He is Visiting Professor, School of Arts, the City University, London and editor of ‘Futures’, the monthly journal of planning, policy and futures studies.