NICE's consultation on lecanemab and donanemab closes today, giving Britain a procedural clock for a drug class Cochrane says probably produces little or no meaningful benefit while increasing brain swelling and microbleeds. [1][2]

Monday's paper said Day 12 had made Alzheimer's reimbursement a silence story. Tuesday sharpens the contrast. NICE has a consultation close and a June committee meeting. [2] The United States still lacks a visible CMS, FDA, Lilly, or Eisai response artifact.

The Pharmaceutical Journal carried both sides of the dispute: the Cochrane review's skeptical conclusion and the access debate around drugs NICE had previously rejected. [2][3] Alzheimer's Society coverage made the patient stakes plain, because reimbursement decisions become clinic access, not only journal argument. [4]

The divergence is between evidence and payment. Mainstream health coverage litigates whether Cochrane's pooling is fair. Health X asks why public reimbursement proceeds without a public answer. Both questions are legitimate. Only one has a clock.

NICE closing day does not decide the U.S. question. It exposes it. A payer can disagree with Cochrane. It should not pretend Cochrane did not speak.

The American gap is not the absence of opinion. It is the absence of a public decision point families can recognize.

-- KENJI NAKAMURA, Tokyo