Jacqui Wise

A next generation weight loss drug, retatrutide, could cut the weight of people living with obesity and type 2 diabetes by up to a quarter, new trial results suggest.1 Retatrutide, which has not yet been approved by any regulatory agency, also improved glycaemic control, the phase 3 double blind, randomised controlled trial found. The drug is a triple hormone receptor agonist. It targets glucagon-like peptide-1 (GLP-1) and glucose dependent insulinotropic polypeptide (GIP) receptors, as well as glucagon. By contrast, semaglutide (Wegovy or Ozempic) targets only GLP-1 receptors and tirzepatide (Mounjaro) targets GLP-1 and GIP. The results come amid increasing concern that patients are securing and taking supplies of substances claiming to be retatrutide from online sellers.2 This summer the Medicines and Healthcare Products Regulatory Agency (MHRA) warned people “not to be tempted by the online hype around retatrutide.”3 The agency said it is not authorised …

NICE’s change in decision to recommend the breast cancer drug has prompted questions over which other treatments could be next, and the potential impact on the NHS. Jacqui Wise reports The National Institute for Health and Care Excellence’s decision to recommend the life extending breast cancer drug trastuzumab deruxtecan (Enhertu) on the NHS comes after successful negotiations over its cost. In 2024 NICE ruled that it was not cost effective for use on the NHS.1 But NICE said that recent changes to its cost effectiveness thresholds for assessing new drugs and new methods for assessing quality of life meant that it was now recommending the treatment. In April 2026, NICE increased the upper threshold range it uses when evaluating new medicines from £20 000-£30 000 per quality adjusted life year (QALY) to £25 000-£35 000.2 This change was made because of a trade deal with the US, whereby the UK agreed to spend 25% more on “innovative” new medicines. Charities and patient groups also lobbied hard for Enhertu to be made available on the NHS in England.3 Before the threshold change, NICE said that it approved 91% of the medicines it evaluated. It estimated that increasing the standard threshold to £25 000-30 000 would lead to it recommending “an additional 3-5 new medicines or indications per year.”4 This week, the government’s science minister Chris McDonald told a fringe event at the Labour Party conference that the NHS’s success in driving down the cost of drugs in the past had come at the expense of more medicines being available for patients.5 In …

A botched execution attempt of a woman on death row in Tennessee has reignited the debate over use of the lethal drug phenobarbital. Christa Pike, 50, was taken to hospital after two syringes of pentobarbital were administered at a prison in Nashville. According to her legal team, these failed to stop her heartbeat and she could be heard snoring. Pike’s lawyers filed an emergency motion seeking to immediately halt the execution, saying she was in unnecessary agony and it was violating her right to be executed free of cruel and unusual punishment. Pentobarbital is a short acting barbiturate that slows down the central nervous system. In the UK it is used almost exclusively for veterinary euthanasia (box). David Nicholl, a UK doctor who submitted a petition to the Florida Supreme Court to stop an execution using pentobarbital in 2011, said the Pike case highlighted why it should not be used in lethal injections. “The whole thing is surrounded in secrecy, and I suspect that the staff doing the procedure weren’t particularly experienced,” he told The BMJ . “Drugs like this should not be used outside of a critical care setting.” In 2011, Nicholl argued to the court that pentobarbital had never been clinically tested or approved for use in …

A laboratory worker at an anti-plague research institute near Irkutsk, in the Siberian region of Russia, has reportedly died after being diagnosed with a pneumonia of “unknown” origin. She was admitted to hospital on 29 September and placed on a ventilator but died two days later. Rospotrebnadzor, the Russian agency that handles infectious disease, said that authorities had imposed “anti-epidemic measures” in response, according to media reports.12 The facility at the hospital where the 28 year old female lab worker was treated has been put into quarantine. According to the independent regional news outlet Liudi Baikala, nearly 200 people are under observation. Maxim Modin, the mayor of the Shelekhovsky district where the lab is situated, reported that there had been no cases of infectious disease reported among the institute staff over the past 10 days and that all the employees’ recent contacts were being tested. Russian officials initially avoided publicly referring to plague. But Alexei Tsydenov, head of the neighbouring republic of Buryatia, said that the woman had died from an unspecified form of plague. Plague is a disease caused by infection with the bacterium Yersinia pestis usually found in small mammals and their fleas. It is no longer found in the UK but occurs in several countries in Africa, Asia, and the Americas, according to the UK Health and Security Agency (UKHSA). 3 There are three main forms of plague depending on the …

No, these really are edible. Researchers have made a battery using a substance resembling edible rice paper that could power swallowable electronic medical devices. Well, the tiny devices have been tested only in pigs so far and not in humans. However, the hope is that one day an edible battery could provide electricity …

The risk of a plague epidemic is low after the death of a laboratory technician who worked at a plague research institute in Russia, the World Health Organization (WHO) has said. However, the United Nations body said that it was closely monitoring the situation and urged Russian authorities to be “transparent” about the death. Darya Shipilova, 28, worked at the Irkutsk Antiplague Research Institute in the Siberia region of Russia. She died on 2 October, two days after being admitted to hospital and placed on a ventilator.1 Russian authorities have downplayed the incident and said that Shipilova died of “pneumonia of an unknown aetiology.” However, media reports suggested that she died of pneumonic plague and that she may have become infected after an …

The government is likely to “fall a long way short” of reaching its headline target on elective care waiting times, mainly because of a rise in GP referrals, an analysis by a health think tank has suggested.1 In 2024 the then prime minister, Keir Starmer, said the top priority for the NHS was for 92% of patients to be treated within 18 weeks by the end of the parliament. But the Health Foundation noted that, while there has been some progress in bringing down waiting times, a rise in referrals—largely by GPs—is making the pledge increasingly hard to deliver. Based on current activity, the think tank estimates that by July 2029 (the latest date a general election can be called) it is likely that 92% of waits will be within 34.9 weeks, rather than 18 weeks. “While there is time for new …

Children and adolescents aged 10 or over can be considered for weight loss jabs and other similar drugs to help combat childhood obesity, the World Health Organization (WHO) says. However, WHO ruled out the prescription of any weight loss drugs to children under 10’, in its first ever guidelines relating to the sharp rise in obesity among children and adolescents.1 In 2024, 70 million children aged 5 to 9 and 100 million adolescents aged 10 to 19 had obesity worldwide. Obesity prevalence in this age group has quadrupled since 1990, rising from 2% to 8%. For children and adolescents, WHO strongly recommends structured dietary, physical activity based, and behaviour changing interventions delivered individually or as part of a combined programme. For adolescents …

The BMA has rejected draft national clinical protocols that it claims would effectively allow physician assistants (PAs) to see patients who have not yet been seen by a doctor. The union intervention followed a consultation process—commissioned by the Department of Health and Social Care—seeking to clarify how PAs work, which patients they can see, and how they are supervised. This draft document, which has not been made public but has been seen by The BMJ , sets out to define what an undifferentiated patient is and a national clinical protocol in which PAs may see them. The BMA has set out its objections in a letter to Gillian Leng, who carried out last year’s review into the safety and …

Ten NHS staff have been suspended from duty after accessing the medical records of 3 year old Noah Woods who went missing and was later found dead. This latest unauthorised access of patient data came to light just a day after NHS England warned that there would be a “zero tolerance crackdown on snooping staff.”1 Jim Mackey, NHS England chief executive, wrote to every NHS trust saying that staff suspected of accessing patient records without proper justification would be suspended pending investigation and have their access to NHS systems paused. The Information Commissioner’s Office (ICO) said that the latest breach and other recent high profile incidents was “painting an extremely worrying picture” that pointed to a “systemic cultural issue requiring urgent action.” Noah went missing on 15 September …