The recommendation by the National Institute of Clinical Evidence (NICE), that Alzheimer's drugs should be used in a minority of people with the degenerative brain disease, has created both rage and disbelief from charities and drug companies alike.
The cost-effectiveness watchdog's decision is seen by many as a partial climbdown as last year they suggested that anti-cholinesterase drugs were not worth the outlay for any patients.
The new draft guidlines, are subject to further consultation, and say that patients should only be allowed the drugs after the disease had advanced.
According to the Alzheimer’s Society, that is precisly when patients become unable to care for themselves, and have branded the the decision unethical and lacking clinical sense.
Clive Ballard, the director of research for the charity says it puts doctors in an impossible position as patients have to get worse before they can be prescribed drugs designed to stop them getting worse.
The new guidlines appear to be less restrictive than an earlier version that suggested that three drugs, Aricept, Reminyl, and Exelon, should not be prescribed because they were not cost-effective.
NICE received thousands of letters in protest when that guidance was published.
The ruling is likely to become final by July, and means the three drugs will in future be prescribed on the state health service, but only for those with Alzheimer's disease of moderate severity.
This accounts for approximately 40 percent of all patients, and includes people with a mini mental state examination (MMSE) score of between 10 and 20 points.
Newly diagnosed Alzheimer's patients with a mild version of the disease will not be able to access the drugs.