Health Check: Who will foot the bill for the wonder drugs?

IT HAS been a good week for women - and I am not just thinking of Viagra (a hard man is good to find, as Mae West unsentimentally observed).

It began with the launch of the remarkable new drug, raloxifene, which may turn out to be even better at protecting the breast than it has already been proved to be at protecting the bones in older women. There was news of improved survival in breast cancer for women who add chemotherapy to their other treatments.

And yesterday saw the launch of the first anti-fat pill, orlistat, which, while not directed specifically at women, will be of keen interest to anyone who has ever been on a diet.

A week is a long time in medicine. The pace of advance leaves one breathless - and wondering who will foot the bills, for there are some bank-breakers coming in.

Take raloxifene, whose trade name is Evista and is made by Eli Lilley. At first glance it appears to be just another new drug licensed, in this case, as a preventive against osteoporosis in post-menopausal women.

But when you hear what some of the country's leading specialists have to say about it, it is clear this is no ordinary drug. In early trials it has been shown to cut cases of newly diagnosed breast cancer by 52 per cent.

At its launch last week, Trevor Powles, director of the breast unit at the Royal Marsden hospital, in London, said: "Its potential is immense."

I am not a betting man but when the head of the breast unit in Britain's premier cancer hospital says the potential of a new drug is immense I rather wish I had a stockbroker.

Consider the attention that Viagra has attracted - and the pleasing response of its manufacturer, Pfizer's, share price - all for a drug that treats a condition suffered by one in ten men of whom at most 30 per cent are expected to come forward to get it.

Now consider the potential market for raloxifene (Evista) which may, if its early promise is fulfilled, offer women protection against three of the major diseases associated with ageing - breast cancer osteoporosis and heart disease - in a single pill.

Specialists including Ignac Fogelman, professor of nuclear medicine at Guy's hospital, London, say it could become standard treatment for all post-menopausal women after HRT has got them through the immediate symptoms of the menopause. "We are all playing down how excited we feel," said Professor Fogelman.

There are about eight million women over 55 in this country compared with an estimated 2.5 million impotent men. Many of the men who could be potential candidates for Viagra are older, not interested in sex or too embarrassed to seek help but all women are interested in protecting themselves against cancer, heart disease and crumbling bones. Raloxifene costs pounds 20 a month. You can see why it is not only the specialists who are excited.

Meanwhile the purseholders of the NHS are alarmed. Urgent negotiations are underway between ministers and the drug companies over the Pharmaceutical Price Regulation Scheme - a voluntary five year arrangement due for renewal in October which is intended to cap the companies' profits while allowing them to earn a reasonable return (currently 15 to 20 per cent) to fund the high costs of drug research.

The negotiations are reportedly getting tetchy. It is not difficult to see why.