Woman's Hour - Review of the Nursing and Midwifery Council, Black market weight loss drugs, Composer Undine Smith Moore

Episode Date: July 9, 2024

Former Chief Prosecutor Nazir Afzal speaks to Nuala McGovern about his independent culture review of the Nursing and Midwifery Council, which is the independent regulator for nurses and midwifes in the UK. The report is highly critical, finding that a "dysfunctional culture" at the council has "threatened public safety and puts nurses at risk." Sir David Warren, Chair of the Council also joins them to respond to the findings of the report.Women are turning to increasingly risky ways to get weight loss drugs, like Ozempic and Wegovy, as online prescribers become more stringent about who they will give them to. Two young women tell Woman’s Hour’s Melanie Abbott about using drugs they buy on the black market, despite the potential dangers. Plus Professor Kamila Hawthorne from the Royal College of GPs explains the dangers of taking unregulated drugs.A new Radio 3 documentary looks at the life and work of 20th Century American composer Undine Smith Moore. Presenter Dr Samantha Ege tells Nuala about the woman affectionally called “The Dean of Black Women Composers”. She explains how Moore’s radical, experimental composition ‘Soweto’ helped her find her anger and heal after trauma.Presenter: Nuala McGovern Producer: Olivia Skinner

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, this is Nuala McGovern and you're listening to the Woman's Hour podcast. Hello and welcome to Woman's Hour. Bullying, racism, incompetence, they are just some of the charges levelled at the organisation which oversees and regulates hundreds of thousands of nurses and midwives. We're going to hear the details of the review of the Nursing and Midwifery Council, including a response from the chair of the NMC, Sir David Warren. Also later this hour, you'll hear some startling stories on women who are determined to buy

weight loss medications on the black market. We'll bring you our report. And today we will also hear about the woman who was called the Dean of Black Women Composers. That's Udine Smith-Moore. I'm looking forward to talking about her. Plus, it is the first day of the new parliament. MPs will start being sworn in from this afternoon. Here are some of the stats.

334 rookie MPs and the new parliament has a record number of women, 264. Some of those rookie, some of them long established. But we have heard that the House of Commons has a first day at school feeling. And I wondered if you have a story to share about your first day or week at a new job. What did you do to try and make a good first impression?

And I'm particularly interested if there was a hiccup or even a disaster. One of my Woman's Hour colleagues was just telling me that she slept through her alarm on her very first day and was two hours late. Can you beat that? You can text the programme. The number is 84844.

On social media, we're at BBC Woman's Hour or you can email us through our website. For a WhatsApp message or a voice note, that number is 03700 100 444. Again, to text 84844. But let us begin. The former chief prosecutor, Nazir Afzal, publishes his independent review today

of the Nursing and Midwifery Council. The report is highly critical, finding that a dysfunctional culture at the council has threatened public safety and puts nurses at risk. The NMC is the independent regulator for nurses and midwives in the UK. It's responsible for their professional standards, also their education,

and it maintains the register of professionals that are eligible to practice. Now, this review was commissioned after disclosures from a whistleblower, and it found that an urgent turnaround is needed after finding bullying, racism and burnout, which was not only causing distress among staff, but also impacting on safeguarding decisions.

The report also found that six nurses have taken their lives in the past year while under investigation by the NMC. This is the first of several independent reviews that are due to be published investigating the culture of the NMC and the way it handles cases against nurses and midwives, which we know are roles that are held mainly by women. Sir David Warren, Chair of the Council, is here with me in the studio. Good morning. Good morning, Nuala.

And we also have Nazir Afzal, who wrote the report and also led the culture review into the London Fire Brigade that you might remember previously. Let me start with you, Nazeer. You talk about a dysfunctional culture. What did you discover about the working environment for staff at the Nursing and Midwifery Council? Good morning to you, Nuala. And good morning, David. Firstly, can I thank David for the fact that he actually invited me in to carry out this review. As you'd appreciate, a lot of organizations are in denial about this.

And it takes great courage to invite independent people to come in and talk to their staff as we've done. We found a workforce that's really struggling, an environment where poor judgment, as you said, toxic behaviors and a paralysis that was affecting decision making. You've mentioned the bullying. We also encountered people who were suffering racism. We also encountered people that were struggling with mental health, significantly traumatised by their experiences. We found people were leaving because they couldn't cope. We found others that felt that there was nothing they could do.

They didn't feel very safe in being able to speak up. And what the review was an opportunity for them to be able to speak in confidence to me and my team to enable us to analyse what they've said and to follow the evidence and to report as we've just said a moment ago. What struck me was the good nurses were finding themselves being investigated for years over minor issues, and in some cases, no issues at all. And bad nurses were escaping sanction because of a system that wasn't functioning as well as it should. Staff were really frustrated that it was taking so long in so many cases. We're talking years and years and years. As you know, I was chief prosecutor. And if any case lasted a year or more, I'd be very, very, very upset about how that was taking place,

because of the impact it has on witnesses, it has on the people who were accused. But routinely, we were finding cases that were lasting several years. And ultimately, by the time a sanction was pursued, if there was a sanction, it meant that it was almost irrelevant because all the damage had already been done. We were also aware, as you said a moment ago, about the fact that six nurses had taken their lives during the last year. We can't prove a correlation. That's for the coroners to do in due course. But the fact that cases were taking so long clearly must have had some impact. And again, I refer to my old role. I oversaw the prosecution of about a million cases during my career, and I can only recall one person

taking their life when they were accused of it. And so that will suggest one in a million compared to six in 6,000. That in itself is an issue of real serious concern. We were concerned also that some cases just weren't taken very seriously. So we became aware from staff of a nurse that was in possession of Category A child indecent images of children, which, as you will appreciate, is the worst form of indecent images of children, which, as you will appreciate, is the worst form of indecent images of children. And the decision was taken, according to staff, not to pursue that allegation because that allegation took place in their private lives. And additionally, there was an individual that was accused of rape back in 2017. It took seven years until this year before that individual was struck off. So, you know, the reality is that, again, the decision was taken on the basis,

or the decision not to pursue it was taken on the basis that it took place in their private lives. But you and I know that people don't stop being predators at the door of their workplace. And so we've got to understand why these things happen. Good news, there is good news, and the report outlines the good news. A lot has changed over the last few months. So they've brought in a new policy which will take account of people's private activities quote unquote uh we've they've brought in a new hr directors who are making significant changes to the way people are being treated in the organization and ultimately beyond but what i think was missing

a lot a lot was missing what was missing mainly i think was a. What was missing mainly, I think, was a lack of humanity, that people were so legalistic and so process driven, and driven by the fact that we just do it this way, that they'd forgotten that there were human beings involved. So let me get into a couple of the issues which our listeners may have as well. Sir David Warren,

how many people are on the council? Twelve. Twelve, and representing hundreds of thousands of nurses and midwives. To be strictly accurate, Nuala, we're not representative. No, I suppose regulating. We are the regulator. As you said at the start, we set the standards. We set the educational standards.

We maintain the code and code of practice for nurses, midwives across the four nations. And in England, nursing associates. And we govern the regulation of this register, which is an enormous register, but we're not a representative body. We want to support our professionals because the nurses and midwives across the United Kingdom are working under phenomenal pressure at the moment, as we all know. So our work as a core regulator is designed to help and support them but the members of council six of whom are registrants these are nurses and midwives six are lay like me who come from other backgrounds we are not the representatives of the nursing and

midwifery but you actually answer my other question i was wondering how much direct experience some of them have but you mentioned that 50 do what about some of the findings that Nazir has just outlined? Some people may find them jaw-dropping. Can I start by thanking Nazir for the report that he and his team have produced? We're really grateful for this. It holds up a mirror to us. It's very uncomfortable. It's deeply disturbing. But it's important that we know this. I have to say that not all of it is a complete surprise to but it's important that we know this. I have to say

that not all of it is a complete surprise to us, but we needed to know this in the experiential detail that the report gives. What was surprising to you? The depth of feeling around the toxic behaviour that is described in the report, racism, sexism, bullying and harassment. And I'd like to start, if I may, by saying sorry. I want to say sorry to our staff, because nobody should be working in those conditions, in that environment, and we must eradicate it. I want to say sorry also to the registrants who are caught up in fitness-to-practice processes

which are far too protracted, or many of which are far too protracted or many of which are far too protracted. That also is something which we must work and are working to correct and these actions are necessary if we are to continue to maintain public trust in what we do and that is at the heart of our mission as a regulator. What were you already aware of? Well, we were aware of, as Nazir indicates, concern about the length of time that it was taking to take our fitness to practice processes through to effective closure. We've had a caseload of between 5,000 and 6,000 for most of the time that I've been the chair of the council, which is the last three years. We put a lot of our fitness to practice processes on pause, effectively during the pandemic.

But we've not made the progress that we would like to have made after the end of the pandemic. And the number of what we call referrals, these are expressions of concern about individual registrants, has risen over the last year. So we were beginning to reduce the numbers last year, but I'm afraid they've crept up again to around 6,000. And we know that that is a major issue for us, which is why we've put a lot of resources into resolving it. Do you feel you have enough resources to tackle that backlog that you describe? I do. Our resources come from our registrants. We are an independent regulator. We are not in receipt of public money from the government.

Our registrants pay a yearly fee. And that is the money which we must apportion in order to ensure that we have the people and the technology that enables us to get through the caseload more expeditiously. What I was struck with what Nazir was saying there that seemed to be at the heart of some of these issues is dangerous groupthink. What are you doing to dismantle that? Well, dangerous group think is always a risk in all organisations. And the basic way of tackling this has to be through the most effective management of performance across the organisation. Nazir paid tribute, and I'm glad that he did, to our people directors who've been with us for nearly two years

now, who have professionalised the way in which the NMC manages all of these areas of performance management, how you appraise people, how you help people grow in their jobs so they can be promoted and progress, particularly those members of our staff who are black and minority ethnic who are suffering in the evidence which has been given to Nazir's inquiry and we aim to ensure that this process is managed as effectively and as as efficiently as possible so that it reaches fair and kind and correct outcomes. But what is that? I'm just trying to think of like the very concrete steps. You know, people, as we've heard, feel that they can't speak out. This review happened because of a whistleblower who decided to take that step. But as we've heard, there is that culture of silence

about what's actually happening. I mean, that sounds to me like it needs root and branch, that it needs a complete radical reform of how things have been done. Well, it certainly needs attacking the structures which inhibit people from speaking out. Because you're right, Nazir is right, people should be able to speak out if they have concerns. And we've appointed a freedom to speak up guardian who will oversee that work.

In the area specifically of racism, we will be appointing an equality, diversity and inclusion advisor to the executive board. The executive board is not as diverse as it should be, and we will be working to correct that as well with new appointments. So there are various ways in which we can tackle both the issue of diversity in the broadest sense and also the issue of ensuring that people feel comfortable speaking up because that has to be at the heart of what we do. Because the other line that struck me with Nazir was the lack of humanity. How can you bring humanity to the council? I want to actually particularly underline just also for some

that that might just be joining us as we were hearing from Nazir that six nurses took their own lives in the past year while under investigation by the NMC. Now, we do not know what was going through those people's heads at that time. There is not correlation, but it is a shocking figure. It is a shocking figure. It's a harrowing testimony that we've received in Nazir's report. And I want to say how sorry I am to the families of those registrants

who died by suicide, either while they were undergoing fitness to practice procedures or after the procedure had concluded. We will, in due course, in most of these cases, I think there will be a coroner's inquest and we will want to act on whatever recommendations the coroners may make that relate to us and other organisations may also be involved, of course. But I want to repeat how sorry I am that these tragic, avoidable suicides should have happened. And our commitment as a council to understanding what the impact of our fitness to practice processes are on the people who are going through them. And also, I should add, as Nazir has made this point in his report, on the staff who are administering the fitness to practice processes

too. You talk, if I may say, Nuala, about humanity. This is essentially about the values of the organisation. We do have values which are important to us, which include fairness and kindness, as well as a desire to collaborate and to set ourselves ambitious targets. These values have to be lived by everybody in the organisation. But they're not being at the moment. And I think that is what the report is telling us. And that means that we have to have more active and energetic leadership. And it has to start from the council, which I chair, which is a non-executive board of governors, if you like.

It has to start from the council to ensure that these values actually inform our work. You know, Nazir, there's so many people that you spoke to. I believe 85% of NMC staff and there were surveys, there was hundreds of hours of interviews, multiple focus groups. I'd like to hear your response first to what Sir David has mentioned, and also perhaps give us some real life examples of what people are going through. Yeah, absolutely. Again, compliments to David and the current board. We wouldn't be here doing this. There are lots of organisations, Nuala, that are turning a blind eye to their own internal cultures, and the NMC is not one of them. So that's very positive.

People need to be invested in. People were highly stressed. People told us that they were in some cases suicidal. And this is staff I'm talking about. People told us that their hair was falling out, they couldn't sleep. And the massive delays in the system. The reality is that some cases were taking several years, I mean, years and years and years,

which will have an impact on the people who are being investigated, for want of a better term, and those who are carrying out the investigation. That, I think, was a significant issue for us. It was too legalistic. The organization, I mean, as a lawyer, I'll tell you this, an organization can be too legalistic. It would seem to have lost the confidence of people and also remembering that people are people. And they can't be held waiting for years and years on end to find a

resolution. And it does strike me that people entered a system and stayed in that system for maybe up to 10 years. Up to 10 years. Absolutely, yeah, which is unacceptable in any environment. And that's the legalistic nature of an organization, which undoubtedly will be addressed. The positives are the NMC have now allocated £30 million to investment in its people to ensure that it does speed up these cases. One of the recommendations we make is that basically the screening process, which is the initial decision to what to do with the case, will be done in two months rather than the current 18 months, which will undoubtedly speed things up and enable people to be able to move on with their lives in ways that are currently not able to do so. The black minority ethnic staff will feel, and those who are engaged with, will feel that it's much more an organization they can trust and one that works in their interest and in the wider public interest too. Safeguarding will be at the center of everything that they do and that's not just safeguarding of

the patient and people within the organization but also the wider public. So there's so much we've recommended we've made 36 recommendations, Nuala, which people can have a look at online if they wish. And it's really about ensuring that people are at the centre of all of this rather than it being a process driven organisation with groupthink. So they may be nurses, they may be midwives listening, that feel affected by this issue. There may also be people who have been patients because Sir David Warren, would there not be, or has there not been, knock-on effects for the public with this lack of process, this slow procedures that were not coming to any resolution?

There must be knock-on effects for the public, of course, and this is all about safety of the public. I would, if I may, just like to offer one kind of, not corrective, but a sort of sense of the size of the problem. It's very big from our perspective of bringing down the caseload, but the caseload, which is at the moment around 6,000, is a tiny proportion of the total number of nurses and midwives and associates who are working in health and care services across the four countries. It's upwards of 820,000 nurses and midwives who are on the register, and the vast majority we know are providing fantastic care, kind and effective care to patients day in, day out. But we have to tackle the problem, which has been identified,

of a caseload which is some cases in which are taking far too long to resolve. Not all. We get through cases in many instances more expeditiously, but it is not acceptable that there should be as many cases as staff have identified to Nazir and as I'm apologising for today that take too long to resolve. But you know Nazir has done this review very thorough as we're hearing but it's not the first report on the council. There have been several over the past 15 years and I think it's half a dozen and looking back how come they didn't make a difference? Why are you still in the same position? Well, I think there has been some difference in the last few years.

You're saying under your chairmanship? Well, I don't take responsibility for that. I'm just the chair. The chief executive and her team can take a lot of pride. I believe the Chief Executive, who's now sadly had to stand down because of ill health, should take a lot of pride in the management of this activity

during the pandemic. And the beginning, and I accept Nazir's criticism, this has come too late, but the beginning of tackling some of the outstanding issues in terms of our people management and in terms of attacking

the problem of fitness to practice caseload not being brought down effectively. And also there are other details relating to how we highlight safeguarding as an important area of risk. Again, we've come to this too late, but we are now tackling it with determination. The person you mentioned is Andrea Sutcliffe. She said she received the draft of the report three weeks after her decision to step down due to ill health that you mentioned, but that she was devastated that it happened on her watch. She apologised

to everyone affected, saying her colleagues, professionals on the register and also the public. Nazir, has the case of Lucy Letby, which of course was so in the news, a former nurse, last week she was given a 15th whole life sentence on the murder of another baby. Did that feature in the investigation? No, because as you know, Lucy Letby will have its own inquiry starting

in September. And we didn't look at that. It wasn't appropriate for us to do so. There is a public inquiry taking place in relation to that. That said, undoubtedly there's learning from the Letby case that will impact on the NMC's future role. I'm satisfied, let me say this, that David and the NMC leadership will rebuild confidence. They will protect the public. They will ensure that all nurses and midwives are treated fairly. What they have done, which is a real positive, is accept everything that I've said in my report, and have also accepted every single one of our recommendations. I'm hopeful, despite the fact that there's been 16 years of reports, that this one will make a difference, because it's got the leadership totally behind it, and as importantly, the funding totally behind it and as importantly the funding

totally behind it. My big concern however is that it's only because the NMC looked at themselves. What about all the other organisations? You know we've had a scandal after scandal whether it's Blood, whether it's Grenfell, whatever it is. These other organisations need to look at how they approach the cultures of their organisation. Yes, and today, of course, we are talking about the NMC. Thank you so much for coming in, Sir David Warren, and also to Nazir Afzal,

who has carried out that review. A lot of reaction. I just want to read some of the comments that have been coming in. I also want to read a statement from the Department of Health. Here's one. I'm a nurse who began as a mature person

with years of work experience. This segment gives a sense of the reasons why most nurses live in fear of making a mistake and being referred to the NMC. It's unsafe is what's said about the short-staffed environments. But the subtext is, I'm terrified I'll be blamed for the breaking system

and spend years in fitness to practice process, just as was outlined by Nazir. Another anonymous message, listening to the report on the NMC to protect my interests. I've always found it to be ineffective. It needs to be reinvented and funded by the government. I and many of my colleagues have no faith in the NMC. And I just want to turn to as well the Department of Health statement, which has just come into us.

This is from the Department of Health and Social Care. A spokesperson says, bullying and racism are unacceptable. It is vital that whistleblowers are free to speak up, knowing that they will be supported and their concerns will be listened and acted upon. This review makes clear recommendations for the NMC. We expect its council to respond with swift and robust action. And as you know, as you were hearing perhaps at the beginning, the Nursing and Midwifery Council is independent of the government. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who's faking pregnancies. I started like warning

everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now. I want to turn to something else. We've spoken about this actually a number of times

on Women's Hour, it's about new weight loss drugs, Zempic, Wegovi, you might be familiar with those brands but we want to talk about again some of the issues that they throw up we know that some women are turning to increasingly risky ways to procure those drugs

it's happening as online prescribers become more stringent about who they give drugs to. The Royal College of GPs is warning about the dangers of buying from unrecognised sources. Young women have been telling us it's easy to get them if you know where to go. And our reporter, Melanie Abbott, has been investigating for us. And she's with me in the studio.

Welcome, Mel. What have you been finding out? Well, you'll probably remember, Nuala, that we had the Pharmacists Defence Association, which represents the pharmacists, on this programme last month, talking about the ease of getting these drugs online and asking for tougher rules to govern that. And now since then, Boots, for instance, has changed its policy. It changed it after a Times reporter who wasn't overweight was given the drug Wigovi with only a few checks. The online pharmacy now asks for extra photos of the person applying,

wearing fitted clothing so they can try and see what kind of size they are. Of course, there are ways around this, but some of the women I've been talking to say that instead of this effort, if you like, of subterfuge or lying, they found other ways of getting hold of these drugs. Worryingly, these women that I've met do admit to having disordered eating in the past, if not now, none would be considered obese. Harriet, that's not her real name, started taking Ozempic after buying it from an online pharmacy, but then finding other ways of sourcing it.

She's now taking Wigovi, that's a very similar drug. She told me how she started off taking weight loss drugs. In the beginning, you just fill out a form and tick the boxes to say that you're in the obese category and then they would send it to you. And then it ramped up to they would need a photo of you. And then it would be a photo with you and then it would be a photo with you holding your ID and then a photo of you holding a picture of today's date on. They also wanted to have video calls but I found it was easier to find new sources. And were you actually getting turned down for it when you were trying to get it online? Yes I made one photo of myself I think I

was a size 14-16 but then I edited it to what I thought was. I think I was a size 14, 16. But then I edited it to what I thought was to look like I was 17 stone. They rejected it because I hadn't edited it to look big enough. They said that there's no way you're 17 stone. And then they also wanted a phone conversation with me. And it just felt a lot more deceptive talking to them on the phone. Lying to this person who you also know they could get in trouble if they were to prescribe you this. I um yeah found different ways how are you getting it now I just got a number off a friend I don't text him um and he does rounds a bit like a milkman like he comes around on a Wednesday

and uh he just drops it off you have to meet him at a certain spot and he'll he has a little fridge in his car and you just get his car how does it feel getting it that way it feels naughty it's also like I don't know anything about this man it could be anything he's giving to me I do believe because of the fact my friends have been taking it before me and then the fact it looks so legitimate and he doesn't come across like your usual dealer who doesn't sell other things what did he say when he first met you when he was bringing you your first dose when I got in his car he sort of said oh is this is this for you? Because obviously I was like a size maybe eight because I'd already been on it for a while.

And he said, oh, you don't look like my usual clients. He went, you shouldn't be on this. But then I told him, the reason I look like this is because I'm on this. Yeah, and then since I've recommended a few friends to him and he says he's seeing that more people like me are coming to him. Do you have any idea what his source

is, where he gets it? I haven't asked him I don't want to pry he just sort of I don't know he just says he gets it and then we sort of leave it there we don't we don't ask each other questions. And how much does it cost you? £295 for 2.4 mil you have like eight or nine weeks from that so then it works out at about £150 of the month or something but does it cross your mind that really he could be putting anything in this wagovi looking box yeah obviously there's you can think that but there's there's a certain type of pen the pen that it comes in it's fully sealed it's exact same box as i used to get from the legitimate pharmacies

were you overweight seriously when you started taking it? Yes my biggest was 14 stone maybe size 14 16. I want to and I feel happier at size 8 and I'm sort of maintaining that there's no way I'm wanting to go lower there was a time when I was doing 2.4 mil that I think maybe you could go lower if you really concentrated on it, but I don't want to. I feel a lot, like, comfortable now. It is a real pressure that if you are thinner, people give you more leeway at work, people are nicer to you, people... Do you really think that?

I think definitely. I think it's even your family and your parents. Like, my dad is a lot prouder of me when I'm thinner. Really? Yeah, definitely. He would, like, tell me to come and my really yeah definitely he would like tell he would like tell me to come and like meet his friends but I've never seen my daughter and you don't think he does that so much if you're a size 16 no definitely not I feel a pressure but there can

be serious side effects it can affect your pancreas can affect your kidneys I sort of weighed it up with you've got to weigh up the risks because I find something else that haven't as then because stopped me doing is sort of broken this food addiction. You used to have this addiction to processed food. Like you're never satiating, you're always eating more and more of it. That's been shown to be incredibly damaging to your health. Have you had disordered eating in the past? Since I was probably like 15 or something,'ve always had bulimia and then I

went to university I severely abuse laxatives and then since being on a Zempic I haven't had any of those wants or needs. And have you thought about how long you will take it for? Now I'm sort of at the weight I want to be and I'm reducing it down I've gone from 2.4 to now I'm on 1.2. And then I'm going to try and wean myself down. A lot of my friends have gone down to 0.25. But I'm doing it slowly because I once stopped it abruptly and then I put on half a stone within like two weeks. Mel, it's so interesting to hear Harriet there and her story, but it does sound so risky.

I know, I know. And of course, it is illegal to sell this drug without a prescription. Buying it isn't illegal, but the person selling it to them is certainly breaking the law. And recently, the World Health Organization issued a global alert over Fakazempic, which is on the market. It's out there. Last year, the BBC reported on someone who took a substance claimed to be semaglutide, that's the active ingredient in a Zempic and Wegovy, and then ended up vomiting blood in A&E. And I've also got figures from Toxbase. Toxbase is a national database that records overdoses for all drugs. But for semaglutide, there were 23 inquiries last

year. Now, as a caveat, they don't record if these were all different incidents. In the wrong hands, there's no doubt it can be dangerous. And even if you get the right stuff, there's a long list of possible side effects. It can interact with other medication. But perhaps even more worrying, one woman I met, she's taken the risk of buying the powder and then mixing it up for herself, buying the semaglutide and mixing it and self-injecting. We'll call her Emily. Her words have been voiced by an actor. She says that buying Wegovy, the real stuff, online was too expensive. I thought this isn't really a good idea for me to be spending this much money when it's only like a little bit of weight that I want to lose.

I thought somebody must be doing it cheaper. And then I saw these websites and they say it's for research purposes, but they essentially sell you a kit. You get your alcohol wipes, needles, the solution to mix it up, and then they give you instructions as well. Why do you think they say research? They say it to sort of cover their backs if anybody was to investigate them. And how easy was it? I think the first time you're a bit nervous because you don't actually know what you're essentially injecting. I started off with like maybe half of what was recommended

to see if I had any weird reaction. I didn't have any nausea. I didn't have any stomach cramps, constipation, diarrhea, nothing. I've been on it now for seven or eight months and I've lost four kilos. So it's not like extreme rapid weight loss. It's probably even actually slower than like most safe diets, like two pounds a week. How much did you weigh when you started? Like 59 kilos. That's not exactly heavy. It's not heavy. I never said I was heavy. In fact, like before I even started this, a lot of people would say how slim I was. It was just, I hated the little bit that I could grab on my stomach. And now I'm actually really happy with my body, which I've never been able to say in my life.

It is really, really risky, though, what you're doing. I mean, the next batch you get could be the wrong batch, could be anything. It could, and you're completely right. And I think that is, I guess, just one of the risks that I'm willing to take. I think as well, you know, that there's a lot of bad stuff that people put in their bodies anyway, that's not regulated, not tested. I've looked into the health problems that can be associated with it, which is like inflammation of the pancreas, thyroid issues. I think if I can get my doctor to keep on top of that I can just sort of say can we get this checked out I'm having some symptoms even if

I maybe wasn't just to get it checked because I don't know how comfortable I would feel explaining that I'm actually on this sort of homemade medicine you wouldn't want your GP to know what you're doing absolutely not no oh yeah I Oh, yeah, I know. You probably think I'm crazy. Why not? Because I know what they'll say. They'll just say, you know, it's very dangerous. It's the same reason why, to be honest, I haven't told my friends and family because of the judgment.

And, you know, are you crazy? And probably I am, in all honesty. But, you know, I just thought, well, if that's the compound and that's in this, then hopefully it'll make me lose the weight that I want. And so far it has. Is the risk really worth it, though, just to get the perfect body when, as you say, people told you you were slim before? Yeah, but, you know, I was never actually happy with myself before. Whereas now I can actually say that I am happy with myself. What do you think your family would say if they knew what you were doing?

They would probably be not very happy about it. Probably be quite worried about me, I would imagine. Because if you think about somebody who didn't need to lose any weight, that they're taking like this dangerous and regulated peptide, probably not going to be very happy about it, are they? How long do you think you'll keep taking it for? So this is the thing. You know, as soon as you stop taking it, all your cravings come back.

And then I would essentially just go back to where I began. I'd probably say that I would need to stay on it to be able to maintain my results, which again costs money, again, could be unsafe. So I do understand what I'm doing. You know, it might not be the best thing for my health, but it's my decision. You could imagine taking it for the rest of your life. Yeah, I could. You know, other people are on medication for the rest of their lives. But that's normally for a health condition, not because they want to be slimmer. Yeah, but also a lot of those medications

can have really bad side effects, negative impact on them long term. But if you have to take it for a health condition, it is quite different from what you're doing. Yeah, yeah, I agree. It's different. That was a woman we are calling Emily, not her real name,

and her words were voiced by an actor. I want to thank our reporter, Melanie Abbott. If you have been affected by anything you've been hearing this morning and you've got concerns about disordered eating, you can find help and support on the Woman's Hour website. I want to continue speaking about this because listening to those voices was Professor Camilla Hawthorne. She's chair of the Royal College of GPs.

Welcome to Woman's Hour. I'm just curious, first, your reaction to what you've heard. Good morning, Leela. I think my first reaction was, oh, dear. It really is. Because I feel so sad that people are doing this, especially if their weight is within the normal range. You know, so they're not really taking it for health reasons at all. They're taking it without clinical supervision and in an unlicensed way. And that does carry inherent dangers, even though the two cases we've just

heard are asserting very loudly that they're fine. But no, it comes with side effects. Yes, well, Melanie Abbott, as we heard, our reporter, did outline the risks. But you can hear from those two women that it doesn't make a difference. And I'm wondering, I mean, what would you say to them if you could speak to them directly? I think I'd say you really need to be extremely careful, especially the one who's injecting herself with, you know, sort of ready made ingredients that she puts together and injects. I think the risks of developing abscesses for a start are really quite high. Leave aside the side effects of whatever it is she's injecting into herself. I think that we certainly one of them did sound as if she had an eating disorder. And, you know, you can see how that fuels the sort of drive to buy this stuff and give it to

yourself. And I feel very sad that that's the case that we live in a society where, as the former Duchess of Windsor used to say, you can never be too rich or too thin. And that's just so very sad that that permeates through our culture and women are constantly looking at their bodies and constantly criticising themselves, where actually a lot of men don't see them that way at all. And I don't have the figures on men or women that are using a Zenik in this way.

But I was also struck by our guest who said there was no way she could tell her GP about what she's taking. So I've definitely had patients come to tell me about things that they have bought and are taking. But usually it's when they have side effects that they can't explain. And did they buy them online? The person I'm thinking of actually bought it at his local leisure centre and was taking a hormonal drug to prevent baldness and presented with breast enlargement. And it is a side effect of what he was taking. So, you know, that's how it tends to present to us in general practice.

And so what do you do with that? Because some listeners might be judging or feeling intolerant perhaps of certain people's decision-making processes. But, and obviously that woman is concerned that her GP is going to judge her that's why she's not saying I would imagine. I don't think any GP would condone what those two ladies were doing really because you know we are trained to give prescription medicines for health-related problems

and what they're doing is they're taking prescription medicines, but they're taking it without a prescription in an unlicensed way. That is a kind of Wild West, really, out there. And although they're all right, I don't know how many others will not be all right if they take it. We are hearing actually very, very early report just recently been published of a higher risk of eye conditions with semaglutide. Eye? Yes, eye. And this is just a very new, it's only just been reported. It's preliminary, a lot more research is needed. But you just have to bear in mind that these are relatively new drugs, and we don't still know how it's all going to pan out particularly if you end

up needing to take it for most of your life because you're afraid that you'll then gain weight when you stop taking it and there's good evidence that when you stop taking it the weight comes back on again well as we heard i think um one of our guests said she will take it for the rest of her life may May I ask just very briefly what the symptoms are with the eye condition that you mentioned? I think it can result in blindness but this as I say this is a very early early report. I understand I just I just wanted to to know that but coming back to that point about not telling your GP and I know you reiterate that you feel they are

it's basically the Wild West that they're operating in at the moment but how do GPs I suppose open that conversation or being able to project that their surgery is a place for people to come that are thinking about this because I think they

felt from what I heard that they weren't going to walk through the GP's door and say look I have an issue with the way my body is even if I'm not obese I really want this drug if you're not going to prescribe it for me I'm going to get it whatever way that I want to I think that's the reality of what you're dealing with now. Yes. Now, you know, weight is a real problem. Not just in the UK, but right across Europe, although I think UK is worse than the rest of the Western European countries. One in six of us are classed as obese. And the UK, as I say, is the worst. So a lot of my conversations are with people who are very overweight or obese, to try to persuade them to lose weight for health reasons. And yes,

of course, we also have the opposite, talking to people who think that they need to lose weight, when in fact, they are completely normal from a health point of view, obviously not in their own minds. But those conversations are fewer, I quite agree. I think, you know, as your family doctor, probably your GP is the one person that you can confide in. Everything you say is confidential, unless it's illegal or criminal. But otherwise, everything is confidential. And if you feel anxious about your body shape or size, please come and talk to us. I think we are trying to be approachable. Clearly, we've got a problem at the moment in general practice in terms of access. And that's because there aren't enough of us. But we're being promised by the new Labour government that they will remedy that. Probably will take a little bit of time. But we're being promised by the new Labour government that they will remedy that.

Probably will take a little bit of time. But essentially, we need more GPs on the ground so that we can offer continuity of care. And so if you're going back to a health professional that you've met before, known for a while, you're much more likely to confide in them. And really, it's that relationship of trust that's needed. Before I let you go, well, a couple of things, really. I don't have a response, obviously, from any of the weight loss drug companies about the eyesight effects that you were mentioning. But it has been reported that some pharmaceutical companies

are working on developing more generic forms of these drugs, which would make them much cheaper. I'm wondering, that throws up a whole load of other issues. Would you welcome that? So we've got a real problem at the moment with this class of drugs

in that because there's such demand for them, they're not really available for the people who need them. Use them for type 2 diabetes, of which we have a real preponderance in this country. And also under the name Wigovi, so Zempic is for diabetes,

Wigovi is for weight loss but it is both of them are semaglutide which is the generic name for them and at the moment we have weight loss clinics nhs weight loss clinics that are closing their waiting lists because they can't get hold of wigovi um and we as gps are being asked not to prescribe it because that's enough for the people who really need it. So I think it's, you know, shortages of drugs are really serious. And the European Medical Agency is really worried and is calling this a major public health concern that's unlikely to be resolved in 2024. So it's going to take some months before these companies actually start producing enough

of it so that the patients who need it can have it. So interesting. I don't think it's the last time we're going to talk about it. Professor Camilla Hawthorne, Chair of the Royal College of GPs. Thank you so much for joining us on Women's Hour. Right. At the beginning, I was asking you about first day impressions. You know, it's the first day of Parliament, MPs getting sworn in. First, what do they call them? Kind of first day of school vibes. That's what one MP called it. And I wanted to know how you made an impression, any of the hiccups that you might have had on your first day. Here's

a couple. Uncanny timing on Woman's Hour. Today my son slept through his alarm on his second day of work experience. Oh, poor thing. I was supposed to drive him there. Despite setting the alarm on the clock, I didn't activate it so I also overslept. I am mortified.

I'm trying to be positive. Work experience is a better time for him to learn this important lesson than the real thing. Correct. It's a lesson. It's a lesson that has been learned. Joe says many years ago I was appointed to the position of PA to the deputy group managing director. OK, fancy job. I was told I needed to dial nine for an outside line. On the first day, I tried to make an outside line call

and thinking I hadn't pressed the button properly, I pressed it two additional times. Then I was asked which emergency service I required. They kept asking if I was sure I didn't need them, all within earshot and sight of my new boss. Oh, thank you for sharing, Joe. 84844 if you'd like to get in touch. Okay, I want to talk next

about a new Radio 3 documentary. It explores the life and work of the 20th century American composer Houdin Smith Moore. Now, she was affectionately nicknamed the Dean of Black Women Composers.

Her powerful or experimental work remains much less well-known still than male composers of that time. Only 26 out of the 100 works were published in her lifetime. The pianist and musicologist Dr. Samantha Egge presents the documentary,

which can be found right now on BBC Sounds. It's a great listen. She has her own connection to Undine Smith-Moore, which we will hear more about. But first, let me play a little of Moore Smith herself speaking in the documentary about how supportive her family were of her musical ambitions. When my father heard that I had been awarded this first Juilliard scholarship at Fisk, he went immediately from his job as a brakesman to the elegant Steinway house in Richmond.

Still in his work clothes, he walked up to Mr. Handel and said, if money is no object, what is the best piano? The result was that when I returned home from school, I found a brand new Steinway grand piano in the living room. It stands in my living room now after all these years. Well, listening to that in studio with me is Dr. Samantha Agay, who joins me. You're very welcome to Women's Hour. Thank you for having me. So tell me a little bit more about this remarkable woman. Undine Smith-Moore was born in Virginia at the turn of the century and born in the deep,

deep south. So Jim Crow segregation was her life experience and she was the descendant of enslaved people. She had a real passion though for music that really shone through early on in life. And as you heard in that audio clip, her parents did not get in the way of that. They got her a Steinway piano and they completely enabled her to flourish. And the fact that she was known as the Dean of Black Women Composers really conveys just how well she was respected amongst her community. She was beloved from listening to your documentary. But why do you think her compositions still aren't as well known as some of her male peers? Well, she was in many regards a sort of lone woman in a sea of particularly black male composers. And then on top of that, she was teaching at a historically black college.

And so her work circulated amongst her community. And it has been wonderful that the music has traveled, but she was essentially creating music for audiences that would receive it. And in the segregated South, that largely comprised a black audience. And she's so interesting at her time as well. Her impact in the late 1960s as well, really early 60s, I suppose, right through the 60s and that time of such turbulence, particularly for black Americans in the United States.

Absolutely. She was so politically attuned and she allowed her music to speak to that, which I think is quite distinct from earlier generations of black composers in the United States who are very much politically attuned, but their music is more conservative in its style. So we hear a lot more experimentation from Undine Smith-Moore. In 2022, you're a fellow at Oxford University and you got an opportunity to perform on stage and you decided you wanted to perform one of her works. But you had to find it, it is this twist in the tale. Tell me a little bit about that time. Yes, so I was collaborating with a Boston-based group called Castle of Our

Skins and they had been programming the work of a contemporary South African composer called Bongani Dodana Breen. And so to complement this program, I thought it would be wonderful if we could play Undine Smith Moore's Soweto, which I had never heard before, but I knew that it existed. So you just had the faith. I did. And this is very thematic throughout my career in that I simply will hope that a piece of music is good because I'm very attached to the idea of playing it. And so I knew that there were two movements to this Soweto piece because I'd seen this in catalogues of repertoire by black women composers. But then when I requested the music, which is held at the archives at Emory University in Atlanta, they sent over about 300 pages of handwritten manuscript, because as you said, a lot of this music wasn't actually published. And so as I'm going through

these 300 sheets, I realised that there's a third movement to the composition, which was never performed in Moore's lifetime. She called it an unused movement. And so that's what made this a world premiere recording because the two movements had been performed in Moore's lifetime, but now we were adding this third movement, which brought a completely different dimension to the performance. You performed it on the 10th anniversary of a traumatic event in your life. Your ex-partner committed an act of femicide when you tried to leave him,

which led to one of the women who came to help you being murdered. Can you tell me a little bit more about playing that piece with that as the backdrop? You've said you have to slap and hit the piano. Yes, it's a very physical piece. And I would definitely say that my career as a pianist is certainly influenced by what happened. But this was the first time that I had let anger into my creative repertoire. And that was because of Undine Smith-Moore. And I remember practicing this piece at Lincoln College in Oxford and feeling almost an electric energy. Energy, that's the real word, isn't it? Yes, definitely.

And it was incredibly cathartic to be able to release that. And is it though, what I was thinking when I was listening to it, is it cathartic every time or do you get angry every time? Or is it both? I think it's more cathartic every time or do you get angry every time or is it both? I think it's more cathartic every time because I think what's really important is that even in Undine Smith Moore's practice, anger was never the final destination. It was a journey to action. Anger is the energy that will lead to and power and fuel something else. And so it's more of a process, more of a journey than a destination

and that's what I feel and that catharsis remains each time. I have to let people know again that they can find it on BBC Sounds, that it's there right now and Dr Samantha Agay has just done

this beautiful really look into the life and legacy of Undine Smith-Moore. Thank you so much for coming into us on the Woman's Hour Studio. Thank you. It's been a real pleasure. That's it for this morning. Tomorrow, Hannah Mills, the most successful female sailor in Olympic history, should be joining me to talk about the International Sailing Competition Sail GP.

And also, I'll be speaking to Nazareth Metab at one time the most senior Asian woman in the Metropolitan Police. She has a new book that actually shines a light on her 30-year career in the Met. One more. On my first day in my new job, I was so nervous that I forgot my glasses

and had to go home again to collect them. It wasn't a good start. I will see you right here tomorrow on Woman's Hour. That's all for today's Woman's Hour. Join us again next time. How would a world heavyweight boxing champion cope if they were left alone on a desert island? When you're preparing for a fight,

a big part of it is isolation, this preparation to get ready for battle and to be victorious. Hello, I'm Lauren Laverne, presenter of Desert Island Discs from BBC Radio 4 and I'm here to tell you about a very special castaway, the world heavyweight boxing champion, Anthony Joshua. When you look at a lion and they're showing affection, you think, oh, they're so amazing, I'd love to give one of those a cuddle. Then you put a gazelle in front of a lion

and you see his pupils widen. I feel we all have that nature, right? When it's time to eat, I love to hunt. That's just in my nature. Anthony Joshua on Desert Island Discs. Listen on BBC Sounds. I'm Sarah Treleaven and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies.

I started like warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby.

It's a long story, settle in. Available now.