Medicine: the pursuit of understanding

Abstract

Covid-19 is neither gone nor is it entirely understood. The lessons of the pandemic are still being learnt, with the most high profile and forensic examination being conducted by the UK’s covid inquiry. Interestingly, there are consistent themes among richer nations, and these include a pre-pandemic erosion of public health and workforce, a failure to protect care homes and staff, and the general unwillingness of politicians to be held accountable.

Pharmaceutical companies that manufactured vaccines were among the winners, although even here the picture was a mixed one. Astra Zeneca’s Oxford vaccine appeared early and was celebrated for doing so, but it became mired in claims about side effects – in particular thromboembolism. The mechanism for this is still being debated, however, a JRSM research paper may shed some light.

Gie Ken-Dror and Pankaj Sharma examine the influence of blood group on development of cerebral venous thrombosis after administration of Astra Zeneca’s Oxford vaccine, and they find that vaccine induced thrombosis is more common in people with blood group O.¹ The proposed mechanism is that vaccination triggers a “negative immunological response” in people with blood group O. Interestingly, evidence also points to the role of blood type in other covid-19 outcomes.

If we are to be truly prepared for the next pandemic then understanding covid-19 remains imperative. A second research paper examines the role of placebo in covid-19 outcomes, and concludes with concerns about placebo’s role in higher all-cause mortality. As fascinating as this finding is, it does require more robust research study designs for it to be substantiated.²

The pursuit of rigorous methods is ancient and international. Magne Nylenna recounts the dawn of controlled trials in Norway³ – incidentally one of the first countries to raise concerns about the safety of Astra Zeneca’s covid-19 vaccine.

The understanding of rigorous methods should be a core medical skill. In a service that faces the “healing challenge” of high staff sickness rates,⁴ and is less than welcoming to international medical graduates,⁵ we might do well to pay heed to Dinesh Bhugra’s new series of letters to a young doctor. Bhugra begins by asking: “What’s medicine for?”⁶

References

Ken-Dror

Sharma

; on behalf of the international Bio-Repository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) collaborators and Cerebral Venous Sinus Thrombosis With Thrombocytopenia Syndrome Study Group. ABO blood group associated with cerebral venous thrombosis after Oxford-AstraZeneca COVID-19 vaccination: a case–control study. J R Soc Med 2024; 117: 69–76. DOI: 10.1177/01410768231214341

Tseng

P-T

Zeng

B-S

Hsu

C-W

Thompson

Stubbs

, et al. The difference in all-cause mortality between COVID-19 patients treated with standard of care plus placebo and those treated with standard of care alone: a network meta-analysis of randomised controlled trials of immunomodulatory kinase inhibitors. J R Soc Med 2024; 117: 57–68. DOI: 10.1177/01410768231202657

Nylenna

Paul Owren, Christopher Bjerkelund and the dawn of controlled trials in Norway. J R Soc Med 2024; 117: 77–84. DOI: 10.1177/01410768231207292

Blaaza

Shemtob

Asanati

Majeed

A healing challenge: examining NHS staff sickness absence rates. J R Soc Med 2024; 117: 55–56. DOI: 10.1177/01410768231223779

Al-Haddad

European international medical graduates (IMGs): are we ignoring their needs and under-representing the scale of IMG issues in the UK?

J R Soc Med 2024; 117: 52–4. DOI: 10.1177/01410768241230804

Bhugra

What’s medicine for?

J R Soc Med 2024; 117: 85–86. DOI: 10.1177/01410768241230769