Last week, a group of international researchers published a sobering verdict on the new generation of Alzheimer’s drugs. These treatments, the non-profit organisation Cochrane claims, “show no clinically meaningful effect” on memory, daily functioning or the overall course of the disease. The report reviewed 17 trials, each of which lasted more than a year, involving more than 20,000 patients.

This class of drugs, known as anti-amyloids, was rejected last year for routine NHS use by the National Institute for Health and Care Excellence (NICE) in 2025, as the benefits were considered too small to justify the cost. The decision is now under appeal from the manufacturers. Yet, at the same time, these drugs, including Donanemab and Lecanemab, have been hailed in headlines as gamechangers. This has fuelled public demand, with an Ipsos poll last month finding that nearly seven in 10 people want these anti-amyloids made available on the NHS, whatever the price tag.

Policymaking circles are following suit. At the Nuffield Trust’s March summit, a gathering of influential health leaders, crossbench peer Louise Casey made an emotive case for Donanemab and Lecanemab when discussing the review into adult social care that she chairs. “I know the NHS can’t afford every drug,” she said. “But if I was diagnosed with Alzheimer’s disease and a treatment would give me six months to talk to my family and get my affairs in order before the disease took hold, I’m not sure I would call that a small benefit.”

However, these drugs are hardly a miracle fix for Britain’s struggling social-care system. As NICE noted, the treatments aren’t simple to deliver, requiring regular infusion, along with repeated brain scans to watch for adverse side effects such as swelling and bleeding. Then there’s the cost. At an estimated £60,000 to £80,000 per patient each year, there’s no doubt they’re workable at all for a system like the NHS.

Amyloid is a naturally occurring protein, but in Alzheimer’s, it builds up into plaques in the brain. The logic, first shaped by genetic studies over 30 years ago, was that if you could remove the amyloid, you’d protect the brain. And the drugs do remove it: brain scans that have accompanied research make for striking and persuasive images. But as so often in medicine, the picture is more complicated. A single factor rarely drives diseases like Alzheimer’s, and moderating one biomarker doesn’t necessarily change the outcomes that matter most. A result can be statistically significant, yet barely noticeable in everyday life.

Take Lecanemab. Earlier studies focused on a 27% slowing in cognitive decline. But on an 18-point scale measuring memory, reasoning and daily function, patients on a placebo declined by 1.7 points over 18 months, while those on the drug declined by 1.2. That’s a difference, but a small one. Casey and the public might be convinced it’s worth the cost, but is that really enough to meaningfully preserve independence or quality of life, particularly when balanced against the very serious harms?

The question now is whether continuing to pour resources — already running into the tens of billions — into amyloid-targeting drugs will actually pay off. The Cochrane analysis was met with outcry in some quarters, with the Alzheimer’s Society urging caution against dismissing decades of study outright. “Alzheimer’s disease is highly complex and a combination of treatments will likely be needed to target a range of processes involved in its development,” Dr Richard Oakley, the Society’s Associate Director of Research and Innovation, said in a statement. “Anti-amyloid drugs are just one treatment avenue and not a silver bullet.”

Given the enormous cost of developing new drugs, it’s hardly surprising that companies are reluctant to abandon this path. But years of optimistic headlines have sold false hope to patients. Meanwhile, allegations of fraud in amyloid research have only added to concerns. When mainstream medicine falls short, a vacuum appears; this is soon filled by those offering certainty where there is none, often to patients with little else to cling to.

Sure enough, almost as soon as the Cochrane review landed, it was followed by a wave of claims from the “brain health” space touting everything from diet and supplements to sleep, stress and gut health as answers. This reaction says as much about medicine as a whole as it does about Alzheimer’s. After all, we chase what we can measure, mistake statistical gains for real-world impact, and struggle to let go of dominant ideas even when the returns are diminishing. Add in financial incentives, hype and desperate need, and the picture becomes even more blurred.

The danger isn’t just that these drugs disappoint. It’s that the system around them makes it harder to see clearly and to change course when we need to.