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But while the medicine’s regulator has agreed that the drug can be prescribed, the NHS spending watchdog has ruled in draft guidance that it is too expensive to justify the benefits.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.
Image: Lecanemab is a potent drug that can cause dangerous brain swelling
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.
Advertisement
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.
Follow Sky News on WhatsApp
Keep up with all the latest news from the UK and around the world by following Sky News
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.
Donald Trump may be denied the honour of addressing parliament on his state visit to the UK later this year, with no formal request yet submitted for him to be given that privilege.
Sky News has been told the Speaker of the House of Commons, Sir Lindsay Hoyle, hasn’t so far received a request to invite the US president to speak in parliament when he is expected to visit in September.
It was confirmed to MPs who have raised concerns about the US president being allowed to address both houses.
Kate Osborne, Labour MP for Jarrow and Gateshead East, wrote to the speaker in April asking him to stop Mr Trump from addressing parliament, and tabled an early-day motion outlining her concerns.
“I was happy to see Macron here but feel very differently about Trump,” she said.
“Trump has made some very uncomfortable and worrying comments around the UK government, democracy, the Middle East, particularly around equalities and, of course, Ukraine.
“So, I think there are many reasons why, when we’re looking at a state visit, we should be looking at why they’re being afforded that privilege. Because, of course, it is a privilege for somebody to come and address both of the houses.”
But the timing of the visit may mean that any diplomatic sensitivities, or perceptions of a snub, could be avoided.
Image: France’s President Emmanuel Macron addressed parliament during his state visit this month
Lord Ricketts, a former UK ambassador to France, pointed out that parliament isn’t sitting for much of September, and that could help resolve the issue.
In 2017, he wrote a public letter questioning the decision to give Donald Trump his first state visit, saying it put Queen Elizabeth II in a “very difficult position”.
Parliament rises from 16 September until 13 October due to party conferences.
The dates for the state visit haven’t yet been confirmed by Buckingham Palace or the government.
However, they have not denied that it will take place in September, after Mr Trump appeared to confirm they were planning to hold the state visit that month. The palace confirmed this week that the formal planning for his arrival had begun.
Image: Mr Trump has said he believes the trip to the UK will take place in September. Pic: Reuters
When asked about parliamentary recess potentially solving the issue, Ms Osborne said: “It may be a way of dealing with it in a very diplomatic way… I don’t know how much control we have over Trump’s diary.
“But if we can manoeuvre it in a way that means that the House isn’t sitting, then that seems like a good solution, maybe not perfect, because I’d actually like him to know that he’s not welcome.”
A message from the speaker’s office, seen by Sky News, says: “Formal addresses to both Houses of Parliament are not automatically included in the itinerary of such a state visit.
“Whether a foreign head of state addresses parliament, during a state visit or otherwise, is part of the planning decisions.”
Image: Mr Trump made his first state visit to the UK in June 2019 during his first presidency. File pic: Reuters
It’s understood that if the government agrees to a joint address to parliament, the Lord Chamberlain’s office writes to the two speakers, on behalf of the King, to ask them to host this.
It will be Mr Trump’s second state visit.
During his first, in 2019, he didn’t address parliament, despite the fact that his predecessor, Barack Obama, was asked to do so.
It was unclear if this was due to the fact John Bercow, the speaker at the time, made it clear he wasn’t welcome to do so.
However, it didn’t appear to dampen Mr Trump’s excitement about his time with the Royal Family.
Speaking earlier this year, he described his state visit as “a fest” adding “it’s an honour… I’m a friend of Charles, I have great respect for King Charles and the family, William; we have really just a great respect for the family. And I think they’re setting a date for September.”
It is expected that, like Mr Macron, the pageantry for his trip this time will revolve around Windsor, with refurbishment taking place at Buckingham Palace.
Fuel to the engines of the Air India plane that crashed last month appears to have cut off shortly after take-off, a preliminary report has found.
According to the report switches in the cockpit that controlled fuel moved to a “CUTOFF” position.
It said: “Engine 1 and Engine 2 fuel cutoff switches transitioned from RUN to CUTOFF position one after another with a time gap of one second.
“The Engine N1 and N2 began to decrease from their take-off values as the fuel supply to the engines was cut off.”
Image: The crash site. Pic: AAIB
There was then confusion in the cockpit. In the voice recording, one of the pilots is heard asking the other why he “cut off”. The other pilot responds that he did not do so.
There were no conclusions as to how the switches were moved.
One of the engines was able to be restarted, but could not reverse the plane’s deceleration, the report found.
“At this stage of investigation, there are no recommended actions to Boeing 787-8 and/or GE GEnx-1B engine operators and manufacturers,” India’s Aircraft Accident Investigation Bureau (AAIB) said in the report.
Image: A diagram in the report shows how the plane crashed into a building. Pic: AAIB
No significant bird activity was observed in the vicinity of the plane’s flight path, the report said. The aircraft started to lose altitude before crossing the airport perimeter wall, it added.
The plane plummeted into a busy area, killing 241 passengers and 19 others on the ground while incinerating everything around it.
The AAIB’s report is based on the initial findings of the probe, marking 30 days since the crash.
Follow The World
Listen to The World with Richard Engel and Yalda Hakim every Wednesday
Liverpool have retired the number 20 shirt in honour of Diogo Jota – the first time it has made such a gesture.
The club said it was a “unique tribute to a uniquely wonderful person” and the decision was made in consultation with his wife and family.
The number 20 will be retired at all levels, including the men’s and women’s first teams and academy squads.
A statement said: “It was the number he wore with pride and distinction, leading us to countless victories in the process – and Diogo Jota will forever be Liverpool Football Club’s number 20.”
The club called it a “recognition of not only the immeasurable contribution our lad from Portugal made to the Reds’ on-pitch successes over the last five years, but also the profound personal impact he had on his teammates, colleagues and supporters and the everlasting connections he built with them”.
Image: Jota’s wife joined Liverpool players to view tributes at Anfield on Friday. Pic: Liverpool FC
Image: Pic: Liverpool FC
Newly-married Jota died alongside his brother when his Lamborghini crashed in northern Spain on 3 July.