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Welcome to Tuesday’s Early Edition from i.

It’s been hailed as a wonder drug, a long-awaited revolution in the treatment of obesity. After decades of tried, and failed, weight loss drugs, the success of semaglutide – the appetite suppressant sold as Wegovy and Ozempic – has gone global. Figures such as Elon Musk and Jeremy Clarkson have spoken about losing weight on them, helping to fuel their popularity. But there’s a problem. The huge drive for the injectable medicines has led to shortages, and on top of that, the constant hype on social media has also encouraged those who want to take it to lose weight but don’t meet the NHS prescribing guidelines to find a way to obtain it. Ozempic, for example, is only approved for the management of diabetes but can be prescribed off-label to aid weight loss. It’s not just weight loss, either, with fresh research suggesting the suppressant may hold even more benefits. Now experts fear that will create yet more potential demand – and dangers. We’ll look at what they are, after the headlines.

Today’s news, and why it matters

Another serial killer like Lucy Letby could hide in plain sight within the NHS unless whistleblowers are listened to and their concerns acted on, the head of Doctors’ Association UK has said. Dr Matt Kneale, co-chair of the group, called for urgent reform of a system that he said continues to ignore, or blame as the problem, anyone who raises concerns about colleagues.

The Bank of England is under pressure to stop raising interest rates even as economists forecast they will be increased again next month and may soon be nudging 6 per cent. A panel of experts has called for the Bank’s main interest rate to go up to 5.5 per cent or even 5.75 per cent, from its current level of 5.25 per cent, when the monetary policy committee meets in a few weeks’ time.

Recent high levels of persistent absence from school are likely to have led to poorer performance in this year’s GCSEs, an assessment expert has warned. Meanwhile Ofqual, the exams regulator, has acknowledged that the disruption caused to education during the pandemic could also have meant a “weaker” showing in the exams hall by students this year. But the problems are to be masked by the watchdog’s decision to bring grading back to “normal” 2019 levels.

The England women’s football team is in line for gongs in the New Year Honours list after falling just short of winning the World Cup. The Lionesses are also set to be invited to 10 Downing Street for a reception with Rishi Sunak to celebrate their success in reaching the final of the tournament in Australia, a year after they became European champions.

A pair of rare hybrid dolphins have been spotted off the coast of Falmouth in Cornwall in what is thought to be a UK first. Tourists and crew on a wildlife watching boat spotted the mammals, said to be a cross between a common dolphin and a striped dolphin.

Four questions on semaglutide injections:

What is it? Semaglutide is an appetite-suppressant drug manufactured by Danish firm Novo Nordisk. Patients inject themselves weekly with the drug, which mimics the hormone glucagon-like peptide-1 (GLP-1), the same hormone released after eating. This makes people feel full, meaning they eat less and lose weight. One study found that people who are given the drug saw their weight drop by 12 per cent on average after 68 weeks. Ozempic is currently licensed in the UK for people with diabetes, but can be prescribed “off-label” for weight loss. Wegovy, meanwhile will only be offered on the NHS to adults with at least one weight-related condition and a body mass index (BMI) score of at least 35. However its rollout has been delayed due to major shortages. Read the full explainer on the drugs here.

Why are there shortages? Increased media attention, celebrity endorsements and the possibility of other health benefits have all helped fuel the popularity of semaglutides, and another similar drug, Saxenda. There are now global supply shortages as Novo Nordisk struggles to keep up with the demand for its products. That’s led the NHS to delay its planned rollout of Wegovy. Meanwhile, many people in the UK have sought off-label prescriptions privately, making it more difficult for NHS patients to access the medication. Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies told i recently: “Front line pharmacists are having to run from pillar to post to try and chase prescriptions – we are having real difficulties obtaining supplies for our diabetic patients, it’s crazy. And they are also informing stressed diabetic patients that this product cannot be obtained and we don’t know when it’s going to be available and it’s likely that there’s going to be months and months of delay.” Read that story here. However other products on the horizon may help alleviate this. As i‘s Stuart Ritchie explains: Semaglutide is likely to be eclipsed by newer, even better drugs. Not only is there tirzepatide (marketed as Mounjaro), which produces closer to 17 per cent losses in body weight and has been shown to be more cost-effective than semaglutide for weight loss in diabetics, but there’s the newest drug, retatrutide, which works by affecting the same hormonal mechanism as semaglutide. Read the full piece here.

How have shortages created an opportunity for scammers? Dr Leyla Hannbeck said, some prices of Ozempic have shot up from around £70 a month to around £250 or £300. “We know that some clinics are charging £400 a month for the drug for weight loss,” she said. But even more worryingly, she revealed: “We are aware that some people are doing home manufacturing of the drug, which is very alarming, dangerous and illegal.” Earlier this year, doctors warned people against the “illegal and dangerous” practice of buying prescription weight loss injections on the black market via Facebook. Today, social media firms have been criticised for failing to crack down on the promotion and sale of fake semaglutide injections, amid fears patients’ lives could be at risk. i analysis of posts across the social media platforms found Ozempic and Wegovy being advertised for sale from non-pharmaceutical sources, with other posts claiming to be selling the active ingredient semaglutide in its “raw” form. Novo Nordisk, the Danish manufacturer of the drug, told i that it is aware of “an increase in illicit sales of counterfeit products online, including semaglutide”. Read the full story here.

What other warnings are there? Just like any other ‘wonder drug’, the latest generation of weight loss drugs are not without some disclaimers. First, there’s the side effects. Some patients report diarrhoea and constipation as well as vomiting. Katie Crawcombe, a semaglutide user, was prescribed the drug by the NHS to manage her weight loss after being diagnosed with type 2 diabetes. She told i: “I also have terrible cramps. When I first started I needed to go to the toilet a lot.”She added: “I’m not sure why celebrities would want to put themselves through the nausea and shits for the sake of a few pounds.” Other experts have warned against the “quick fix” nature of the drug. Dr Stephen Lawrence, associate clinical professor at the University of Warwick, warned the medication is “not a replacement for following a healthy lifestyle, which includes regular physical activity and healthy eating”. There are also concerns about the drugs’ attraction to people with eating disorders. Tom Quinn, Beat’s director of external affairs, previously said: “Weight-loss medications like semaglutide can be extremely attractive to people with eating disorders as they appear to provide quick results. However, these medications can be very dangerous as they can worsen harmful thoughts and behaviours for those unwell, or contribute to an eating disorder developing for someone who is already vulnerable.”

Novo Nordisk’s semaglutide, seen here marketed as Wegovy, has already begun to change the world (Photo: Jim Vondruska/Reuters)

 Around the world

Donald Trump has said he will surrender himself to authorities in Atlanta on Thursday in connection with the charges of conspiracy and racketeering that he faces in Georgia. The former US president, who also faces a $200,000 bond and orders not to send threatening social media messages, had until this Friday at noon to surrender. “Can you believe it? I’ll be going to Atlanta, Georgia, on Thursday to be ARRESTED,” Trump said on his Truth Social platform.

An Ironman swim event in which two competitors died was not sanctioned by Triathlon Ireland, the head of the organisation has said. There has been shock after it emerged that Ivan Chittenden, in his 60s and from Toronto in Canada, and Brendan Wall, who was in his 40s and living in the UK but originally from Co Meath, died competing in an Ironman Cork event on Sunday.

The editor-in-chief of Russia Today was narrowly missed by a drone in the latest attack on Moscow on Monday morning, with some of the capital’s most exclusive suburbs increasingly coming under fire. “The drone that was shot down in the Istra district fell on the street next to us,” said Margarita Simonyan, one of the highest-profile Russian media personalities and a staunch supporter of the invasion of Ukraine.

India’s space agency has released incredible new images of the far side of the Moon, as its spacecraft prepares for an attempted historic landing on the lunar south pole. India is aiming to become the first country to land on the Moon’s unexplored south pole, after the failure of a mission by Russia, whose lunar craft crashed on Sunday in a humiliating setback for the country.

Rising temperatures above Italy’s Alps amid a heatwave dubbed Nero has stoked fears over the future of the country’s glaciers. A weather balloon registered the “zero-degree line” — the altitude at which the temperature falls to zero — at 5,298m, beating a previous record of 5,184m set last year. Experts predict that most of the Italian glaciers will be gone by 2050.

 Watch out for…

 the Lionesses, who touched down in England this morning and are expecting to be greeted with a big welcome. 

 Thoughts for the day

Why murderers like Lucy Letby cannot be forced to appear in court, regardless of political posturing. The Government’s plan is likely to encourage the hideous spectacle of a bloodied and bruised prisoner shouting foul abuse at the victims’ families, says the Secret Barrister.

Angela Rayner’s raves and love of vaping are just the tonic for a public sick of polish. I’m starting to think she might be the right person for the top job, reveals Rebecca Reid.

The sadness of seeing my nan with dementia makes me determined to hold onto joy. You can’t pick how it starts or how it ends, but you should grab hold of the middle and do what you can to make that joyful, writes Greg James.

Culture Break

We’ve all got police drama fatigue – the cure is bringing back The Bill. The long-running show came to an end in 2010 after 27 years, but it’s never really gone away, writes Michael Hogan.

Eric Richard as Sgt Bob Cryer, Trudie Goodwin as Sgt June Ackland and Tony O’Callaghan as Sgt Matthew Boyden in hit ITV show The Bill (Photo: UKTV/ Fremantle)

The Big Read

Why scientists are happy for Japan to pump radiation into the Pacific Ocean. Engineers are planning to dispose of radioactive water from the Fukushima nuclear plant, but scientists say the danger levels are even less than for normally operating power plants in Europe.

The Tsurishihama fishing port in Shinchimachi, Fukushima Prefecture, some 60km north of the crippled Fukushima Daiichi nuclear plant (Photo: Philip Fong/AFP via Getty)

 Sport

Arsenal’s ‘shock-yellow’ away kit – divisive, inspired by Islington and a future classic? Adidas’s Inigo Turner explains to Michael Hincks how the Gunners’ bold new jersey came to life as it makes its debut under the Selhurst Park floodlights.

Bukayo Saka and Declan Rice will be wearing Arsenal’s new kit on Monday night (Photo: Adidas/Arsenal)

 Something to brighten your day

How I made new friends in 30 days, as a 41-year-old parent who hates social situations. Meeting anyone new beyond the school gates felt inconceivable to Jennifer Barton, until a month-long activity spree helped her forge new connections.

Jennifer Barton, right, had great fun at the book club set up by Taragh Godfrey, left (Photo: Supplied)

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