Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect.

As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen.

Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment.

John tells us about the Danmask study - what question it was actually trying to answer.

We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb.


Reading list:
A living WHO guideline on drugs for covid-19
https://www.bmj.com/content/370/bmj.m3379

Covid-19’s known unknowns
https://www.bmj.com/content/371/bmj.m3979

Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers
https://www.acpjournals.org/doi/10.7326/M20-6817

Talk evidence covid-19 update - uncertainty in treatment, uncertainty in prevention

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Hilary Cass, the former president of the Royal College of Paediatrics, has spent the last 3 years collating the evidence for treatment of gender questioning young people; engaging with those young people, their families and their clinicians - all with the aim of improving NHS treatment of this complex and vulnerable group.
In this interview, Kamran Abbasi, editor in chief of The BMJ, speaks in depth to Cass about her review - about evidence base for transitioning, but also about the way in which the siloing of care for young trans people has failed them. 
They discuss the need to support young people in their journey - Cass is clear that the NHS should allow young people to explore their gender, but that ultimately, that may not mean medical intervention at all. 
 
Reading list
The Cass Review - final report
The systematic review and meta-analyses published in Archives of Disease in Childhood
BMJ Opinion: Gender medicine for children and young people is built on shaky foundations

Improving NHS gender identity services - Hilary Cass

Derogation, the way in which striking doctors can be recalled to the ward to protect patient safety, was agreed by NHS England and the BMA. Now, new data The BMJ has uncovered shows that the mechanism was rarely used - and when it was tried, was often rejected. Gareth Iacobucci explains what that means about relations between the government, the NHS, and doctors.
Felice Jacka, director of the Food & Mood Centre at Deakin University, is one of the authors of our recent ultra-processed foods umbrella review - and joins the podcast to talk about the link between diet and health; and why goverments need to pay more attention to the food system.
Finally, John Appleby, senior associate at the Nuffield Trust, and Gillian Leng, dean and president elect of the Royal Society of medicine, have been thinking about healthcare funding, and how more stability is essential in securing the service's future.
 
Reading list
Hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show
Ultra-processed food exposure and adverse health outcomes
NHS funding for a secure future
 
Chapters
00:31 Derogation and doctor strikes
06:59 Ultra processed food producers and health
13:59 Rethinking NHS funding

Derogation, an ultra processed food system, and catch up pay for the NHS

In this week's podcast:
 

How AI will affect the clinician-patient relationship? Our annual Nuffield Summit roundtable asks how the promise of tech tools stacks up against reality, and how the future of the therapeutic relationship can be protected (participants below).
 

Your code is as important as your methods, which is why The BMJ now requires you to share it - Ben Goldacre and Nick De Vito, from the Bennett Institute for Applied Data Science at the University of Oxford, explain why it's so important, and how The BMJ's new data and code sharing policy could change research transparency.
 
Nye Bevin set up the NHS when the UK was in the economic doldrums, and the public's need for care was becoming an emergency - BMJ columnist Matt Morgan has helped turn that story into a play, currently showing at the National Theatre; and reflects on the parallels between now and then.
 
1:58 Nuffield Summit roundtable
17:32 New BMJ rules on data and code sharing
29:03 Aneurin "Nye" Bevan play
 
Taking part in our roundtable were:


Rebecca Rosen, Senior Fellow at the Nuffield Trust and GP


Juliet Bouverie, CEO of The Stroke Association


Daniel Elkeles, CEO of London Ambulance Service

Neil Sebire, Professor and Chief Research Information Officer at Great Ormond Street Hospital


Reading list:
How is technology changing clinician-patient relationships?
Mandatory data and code sharing for research published by The BMJ
Scalpels and spotlights: bringing theatre to the theatre

The future of the clinical relationship, code sharing, and a Nye-t at the theatre

The U.S. Supreme Court is hearing a case on the approval of mifepristone for medical abortion - a case which could change the availability of the drug in the US, and which hinges on papers linking abortion to mental distress. However, those papers are contested (including a paper published by BMJ), and some have been retracted already - Julia Littell and Antonia Biggs tell us how that science is being used in court, and why retraction is essential.
Awakening from anaesthetic is difficult enough, but imagine you're three and only communicate through sign language - which no one can understand. We hear from Kirsten, a mother who thinks everyone should learn at least a few key sign language phrases.
Finally, the London Medical Orchestra is turning 70 - having had their start in The BMJ's letters pages. Stuart Delve and Peter Gough help explain the orchestra's longevity.
 
01:00 The Supreme Court Case on Medical Abortion
10:27 The Role of Journal Editors in Scientific Integrity
19:54 The Impact of Deafness on Patient Experience
30:57 The Joy of Music in a Medical Career: London Medical Orchestra
 
References
Analysis: Correcting the scientific record on abortion and mental health outcomes
WYPIT: The importance of British Sign Language
Asha's instagram for BSL tips
London Medical Orchestra's 70th anniversary concert - 6:30pm, Sun, 10 Mar 2024

Retracting abortion papers, deafness in the clinic, and 70 years of a medical orchestra

Social media, and the rate at which the online world is changing, is worrying - especially the speed at which health disinformation can speed around the globe. We look to tech companies for a solution to the problems of their own making - but Heidi Larson, director of the Vaccine Confidence Project, and professor of anthropology, risk and decision science at LSHTM, joins us to explain why we should be cautious about focussing our attention there.
Next on the podcast, research just published in The BMJ looks at the efficacy of exercise at controlling depressive symptoms - but helps finally answer the key question - which exercise works best. Lead author, Michael Noetel, senior lecturer in psychology at the University of Queensland, joins us to explain the research, and how well exercise stacks up against pharmacological treatments.
Finally, while it’s tempting to try and put the pandemic behind us, its effects linger - and many healthcare staff are still dealing with their experience of that time. Rachel Clarke, a palliative care doctor in the UK, joins us to explain why she has felt the need to document the pandemic, first in a book and now in a new TV drama set to air in the UK next week. 
 
06:15  Heidi Larson on vaccine confidence and social media
15:31 Exploring the effectiveness of exercise for depression
26:56 Rachel Clark on seeing her experiences reflected on screen
 
Reading list
BMJ Collection: How are social media influencing vaccination
Feature: Medical misinformation on social media—are the platforms equipped to be the judge?
Research: Effect of exercise for depression

Talk evidence covid-19 update - uncertainty in treatment, uncertainty in prevention

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