We’re never going to be satisfied with the search of direct randomised evidence in paediatrics - unless we’re working in the hallowed hills of 'paed oncology' of course - so how should we think about the weight of evidence to change things?

There’s a classic lack of direct, trial data when it comes to considering when to give vaccines after TNF-alfa treatments in pregnancy [https://adc.bmj.com/content/107/1/93.1] but what is out there can be digested and considered and given as a pithy conclusion … as can the consideration of radiotherapy for a non-malignant condition … (something we’ve tended to shy away from after treating - effectively - ringworm with scalp focussed zapping and accidentally creating meningiomas where there was only an annoying fungal infection before) … should you block or blast in Grave’s disease? [https://adc.bmj.com/content/107/1/97]