Medicine and Science from The BMJ

The evidence geekery continues, and this week Helen Macdonald and Duncan Jarvies are joined again by Joe Ross, The BMJ's US research editor, and professor of medicine and public health at Yale. This week we update you on treatment - the WHO's guidelines for covid and ivermectin, and why they're not ready to recommend it's use in treatment, and prophylactic anticoagulation treatment. We hear about two papers from the UK and Switzerland which look at children and covid, and we pick up on varients of concern and long covid. Reading list. Association between living with children and outcomes from covid-19: OpenSAFELY cohort study of 12 million adults in England https://www.bmj.com/content/372/bmj.n628 Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools https://www.bmj.com/content/372/bmj.n616 Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study https://www.bmj.com/content/372/bmj.n579 Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study https://www.bmj.com/content/372/bmj.n311 Editorial - Prophylactic anticoagulation for patients in hospital with covid-19 https://www.bmj.com/content/372/bmj.n487 Living with Covid19 – Second review - Informative and accessible health and care research https://evidence.nihr.ac.uk/themedreview/living-with-covid19-second-review/

In the UK, phase 2 of our coronavirus vaccination strategy may be delayed by supply problems, at the same time many GPs, who carried out the majority of the first vaccination phases, are declining to take on the addition burden and are trying to return to normal clinical work. In this podcast, Duncan Jarvies, multimedia editor for The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton.

In this Wellbeing podcast, sponsored by medical protection, Abi Rimmer and Cat Chatfield talk to Susanna Petche and Reina Popat, GPs and members of First You - an organisation of healthcare workers, promoting wellbeing in the NHS. They discuss why it is that clinicians learn to subjugate their own wellbeing to their patients', and the ways in which working in the healthcare system perpetuate that. They discuss how systemic change can come through individual action, and how peers can band together to support each other.

This round table, recorded at the nuffield summit 2021, asks what does following the science actually mean - do ministers understand the nuance of the science in the pandemic, and how does uncertainty get interpreted through the lens of ideology and the power of compelling stories. Taking part are: Kamran Abassi, executive editor of The BMJ Partha Kar, consultant in diabetes and endocrinology Deborah Cohen, health correspondent for BBC Newsnight Tom Sasse, associate director at the Institute for Government Christina Pagel, professor of Operational Research at University College London Matt Morgan, intensive care consultant Andy McKeon, chair of the Nuffield Trust Isobel Hardman, assistant editor of The Spectator Mary Dixon-Woods, director of This Institute Ben Page, chief executive of Ipsos MORI Alexandra Freeman, executive director of the Winton Centre for Risk & Evidence Communication Will Moy, chief executive of Full Fact Nigel Edwards, chief executive of the Nuffield Trust

In a slightly different talk evidence, Helen Macdonald and Duncan Jarvies are bringing you a couple, of in depth interviews, Firstly, Anthony Harnden, GP, academic and member of the UK's Joint Committee on Vaccination and Immunisation takes us inside their decision making, and explains what evidence they look at, how they assess it, and what the next year of vaccination may look like. Also in this episode, Gordon Guyatt, one of the founders of EBM, joins us to talk about Grade - the framework in which evidence for guidelines can be assessed - and explains why the most important thing is not the RCTs, but being very clear about what the guideline is supposed to achieve. https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation https://www.gradeworkinggroup.org/

Never has the spotlight been as strong on a clinical trial as that on the Pfizer BioNTech vaccine, the first approved for covid-19. In this interview, Joanne Silberner spoke to its lead principal investigator, Stephen Thomas chief of infectious diseases at SUNY Upstate Medical University, New York, became the lead principal investigator for one of the most closely watched clinical trials in history. They discuss the moment the positive results came through, what will happen to the people who are still enrolled in the trial, but got a placebo dose, and why the trial was designed in the way it was. www.bmj.com/coronavirus

Many surgeries have been cancelled during the pandemic, with good reason, as early data showed the increase in mortality associated with a coronavirus infection, but now waiting lists grow, and there are questions about how the NHS will pick up the slack. In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to the full panel; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Matt Morgan, a consultant in a intensive care medicine in Cardiff, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. They are joined by Mary Venn, research fellow, and honorary surgical registrar in London, who's been looking into the pandemic's effect on surgery. For more on that research: http://nihrglobalsurgery.org/surgeryduringcovid To register for our covid known unknowns webinar - https://www.bmj.com/covid-19-webinars

Ashling Lillis is a now consultant in acute medicine at Whittington Health NHS Trust, but she was almost a consultant in intensive care medicine - but a mental health crisis just 6 months before she qualified made her reassess her career, and choose a different path. In this podcast, Ash talks to Abi and Cat about the difficulty many doctors have when discussing their mental health - and how speaking out about her own experiences, has encouraged others to talk to her privately - and opened her eyes to the extent of the problem in the NHS. www.bmj.com/wellbeing

Jeremy Farrar, is director of the Wellcome Trust, as well as advisor to the government on SAGE. Trained as a medic and with a PhD in neuro-immunology, he was a professor of Tropical Medicine and Global health at the University of Oxford. In this podcast, he tells us why he thinks that vaccine nationalism is a very short-termist response the pandemic, and why he's bullish about new variants of the SARS-CoV-2 virus. www.bmj.com/coronavirus

In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to; Partha Kar, consultant in diabetes and endocrinology in Portsmouth, Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, public health consultant in Southampton. This week our special guest is Rachel Clarke, author and palliative care specialist. The panel discuss how end of life care has changed in the pandemic, and how clinicians have become targets of abuse on social media, for speaking out about things like masks and hospital capacity.