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Frankly, I think most doctors aren't qualified to make such a decision by virtue of lacking PhDs: their expertise is in clinical care, not in evaluating research.

Your doctor is a smart person too but they can't simply check every single medication single handily. What even is "your desired standard" here?

Sure, but the doctor doesn't have to do much research in this case. This is front-page news in the NY Times. And about "every single medication": this is the only approved medication to delay clinical decline due to Alzheimer's. And there are only a few medications to treat symptoms.

I know this isn't a perfect world, but it doesn't seem to be asking a lot for a doctor to know this. (Especially for a drug that currently costs $56K/year and presumably will cost more next year.)

You seem to have an incredibly optimistic view of the both the medical profession and human attention span.

Doctors heavily rely on FDA to filter for effective drugs, they're not researchers with the skills to identify whether a drug has efficacy.