This is a bittersweet moment for people living with Alzheimer’s disease and their families.
Hopes had been high that for the first time they would have access to a treatment that could slow the decline in memory and thinking.
When a pivotal clinical trial was released last year doctors hailed lecanemab as a game-changer, one that could delay the need for care and give families more time together.
But while the medicine’s regulator has agreed that the drug can be prescribed, the NHS spending watchdog has ruled in draft guidance that it is too expensive to justify the benefits.
Unusually that isn’t just because of the cost of the drug.
It’s also the resource implications for the NHS of organising fortnightly infusions for so many people. And then there is the careful diagnosis and intensive monitoring that is needed to keep patients safe.
Lecanemab is a potent drug. It clears the clumps of abnormal protein called amyloid that build up in the brains of people with Alzheimer’s.
But in doing so it can sometimes cause dangerous swelling and bleeding in the brain.
So doctors need to be sure patients really have Alzheimer’s before they start treatment.
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That can only be done at the moment with expensive PET brain scans or samples of spinal fluid – and the NHS doesn’t have enough of the right machines or staff.
And patients also need regular checks with an MRI scanner to check there are no side effects in the brain.
All in all, the National Institute for Health and Care Excellence (NICE) said it wasn’t worth all the resources just to delay the slide from mild to moderate disease by about four to six months.
The decision applies to England – Wales and Northern Ireland often follow that lead. Scotland’s spending watchdog has yet to make a decision.
So where does this leave patients?
Those who have the funds will be able to pay for private care. In the US that’s upwards of £20,000 a year. It will feel unfair to many that availability is only there for the privileged.
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But some doctors argue that although the drug was a milestone – the first to have an effect – the effect was relatively modest.
A healthy lifestyle can also slow the progress of the disease – a good diet, lots of exercise, not smoking and maintaining social connections are really important.
Decades of research are beginning to pay dividends. Lecanemab is the first of many drugs coming down the tracks. Each will have to be judged on its merits.
But sometime soon it will be possible to give people the hope of treatment.
The UK is on a “slippery slope towards death on demand”, according to the justice secretary ahead of a historic Commons vote on assisted dying.
In a letter to her constituents, Shabana Mahmood said she was “profoundly concerned” about the legislation.
“Sadly, recent scandals – such as Hillsborough, infected blood and the Post Office Horizon – have reminded us that the state and those acting on its behalf are not always benign,” she wrote.
“I have always held the view that, for this reason, the state should serve a clear role. It should protect and preserve life, not take it away.
“The state should never offer death as a service.”
On 29 November, MPs will be asked to consider whether to legalise assisted dying, through Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill.
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14:46
Minister ‘leans’ to assisted dying bill
Details of the legislation were published last week, including confirmation the medicine that will end a patient’s life will need to be self-administered and people must be terminally ill and expected to die within six months.
Ms Mahmood, however, said “predictions about life expectancy are often inaccurate”.
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“Doctors can only predict a date of death, with any real certainty, in the final days of life,” she said. “The judgment as to who can and cannot be considered for assisted suicide will therefore be subjective and imprecise.”
Under the Labour MP’s proposals, two independent doctors must confirm a patient is eligible for assisted dying and a High Court judge must give their approval.
The bill will also include punishments of up to 14 years in prison for those who break the law, including coercing someone into ending their own life.
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However, Ms Mahmood said she was concerned the legislation could “pressure” some into ending their lives.
“It cannot be overstated what a profound shift in our culture assisted suicide will herald,” she wrote.
“In my view, the greatest risk of all is the pressure the elderly, vulnerable, sick or disabled may place upon themselves.”
Labour MP Kim Leadbeater, who put forward the bill, said some of the points Ms Mahmood raised have been answered “in the the thorough drafting and presentation of the bill”.
“The strict eligibility criteria make it very clear that we are only talking about people who are already dying,” she said.
“That is why the bill is called the ‘Terminally Ill Adults (End of Life) Bill’; its scope cannot be changed and clearly does not include any other group of people.
“The bill would give dying people the autonomy, dignity and choice to shorten their death if they wish.”
In response to concerns Ms Mahmood raised about patients being coerced into choosing assisted death, Ms Leadbeater said she has consulted widely with doctors and judges.
“Those I have spoken to tell me that they are well equipped to ask the right questions to detect coercion and to ascertain a person’s genuine wishes. It is an integral part of their work,” she said.
In an increasingly fractious debate around the topic, multiple Labour MPs have voiced their concerns.
In a letter to ministers on 3 October, the Cabinet Secretary Simon Case confirmed “the Prime Minister has decided to set aside collective responsibility on the merits of this bill” and that the government would “therefore remain neutral on the passage of the Bill and on the matter of assisted dying”.
“Immediate action” is being taken after blueprints of jail layouts were shared online.
The maps detailing the layouts of prisons in England and Wales were leaked on the dark web over the past fortnight, according to The Times.
The detailed information is said to include the locations of cameras and sensors, prompting fears they could be used to smuggle drugs or weapons into prisons or help inmates plan escapes.
Security officials are now working to identify the source of the leak and who might benefit from the details.
The Ministry of Justice did not disclose which prisons were involved in the breach.
A government spokesperson said in a statement: “We are not going to comment on the specific detail of security matters of this kind, but we are aware of a breach of data to the prison estate and, like with all potential breaches, have taken immediate action to ensure prisons remain secure.”
The leak comes amid a chronic prison overcrowding crisis, which has led to early release schemes and the re-categorising of the security risks of some offenders to ease capacity pressures.
The UK will “set out a path” to lift defence spending to 2.5% of national income in the spring, the prime minister has said, finally offering a timeframe for an announcement on the long-awaited hike after mounting criticism.
Sir Keir Starmer gave the date during a phone call with Mark Rutte, the secretary general of NATO, in the wake of threats by Moscow to target UK and US military facilities following a decision by London and Washington to let Ukraine fire their missiles inside Russia.
There was no clarity though on when the 2.5% level will be achieved. The UK says it currently spends around 2.3% of GDP on defence.
A spokeswoman for Downing Street said that the two men “began by discussing the situation in Ukraine and reiterated the importance of putting the country in the strongest possible position going into the winter”.
They also talked about the deployment of thousands of North Korean soldiers to fight alongside Russia.
“The prime minister underscored the need for all NATO countries to step up in support of our collective defence and updated on the government’s progress on the strategic defence review,” the spokeswoman said.
“His government would set out the path to 2.5% in the spring.”
The defence review will also be published in the spring.
While a date for an announcement on 2.5% will be welcomed by the Ministry of Defence, analysts have long warned that such an increase is still well below the amount that is needed to rebuild the armed forces after decades of decline to meet growing global threats from Russia, an increasingly assertive China, North Korea and Iran.
They say the UK needs to be aiming to hit at least 3% – probably higher.
With Donald Trump returning to the White House, there will be significantly more pressure on the UK and other European NATO allies to accelerate increases in defence spending.