Discovering the positives in healthcare

There are nonetheless grounds for some optimism that advances are being made, not least in the progress made by research funders in cracking down on unpublished clinical trials (doi:10.1136/bmj.p840).7 Two new research papers also carry some good news. Denosumab use for osteoporosis in adults may simultaneously reduce the risk of type 2 diabetes (doi:10.1136/bmj-2022-073435).8 And discussion with patients, using a prognostic algorithm, and providing information could help GPs identify patients with respiratory tract infections who are at lower risk and do not need immediate antibiotic treatment (doi:10.1136/bmj-2022-072488).9 Finally, Helen Salisbury writes about not just good news but "something so positive, so joyful and life affirming”—an initiative in which medical students mentor asylum seekers and support them through the healthcare system (doi:10.1136/bmj.p919).10 A junior doctor who helped coordinate the work spoke of finding focus and purpose and "falling in love with medicine again.” BMJ 2023;381: e073435. 10.1136/bmj-2022-073435 37072150 9 Blair PS Young G Clement C. Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial.

The inconvenient truths of health and climate crises that can’t just be ignored

Current workforce gaps are equivalent to 110 000 full staff in NHS trusts in England and 100 000 in adult social care (doi:10.1136/bmj.o1726).1 More than half of advertised consultant physician posts in England and Wales went unfilled last year (doi:10.1136/bmj.o1782).6 The campaign group EveryDoctor has called for urgent talks with medical unions and the General Medical Council to tackle “unacceptable” working conditions (doi:10.1136/bmj.o1773).7 As the NHS struggles with workforce pressures and the need to tackle elective care waiting lists, hospital admissions caused by covid are once again rising and disrupting services. [...]the Independent Scientific and Advisory Group for Emergencies has outlined a seven point plan for how the UK can suppress SARS-CoV-2 infections and reduce disruption (doi:10.1136/bmj.o1803).9 David Oliver also calls for honest recognition of the pandemic’s impact on the NHS, writing movingly about how covid has affected him (doi:10.1136/bmj.o1761).10 Yet more honesty is needed about the consequences for public health of the climate emergency. Despite rising global temperatures, and repeated warnings about health risks, many countries did not act to tackle the health risks of extreme heat until high temperatures led to sudden and alarming deaths (doi:10.1136/bmj.o1741).4 England’s heat plan was drawn up only after a heatwave in 2003 that led to thousands of excess deaths (doi:10.1136/bmj.o1772).5 Knowledge about heat stress and the risks of extreme heat is still not yet being shared adequately worldwide. The UK’s Met Office estimates that the extreme heat experienced in the past week was made 10 times more likely by climate change.

Covid-19: Two hundred thank yous

The Cardiff artist Nathan Wyburn created this collage during the covid-19 lockdown from hundreds of images sent to him by health workers. Wyburn put out a request on social media for NHS workers to send him pictures of themselves and was taken aback by the …

Following the evidence, from coronavirus to terrorism response

The emergence of a novel coronavirus has led China to impose travel restrictions around Wuhan and other cities (doi:10.1136/bmj.m349). Yet, as G James Rubin and Simon Wessely point out (doi:10.1136/bmj.m313), we don’t not know whether the potential benefits of mandatory mass quarantine outweigh the psychological costs of such an intervention to the people affected. Elisabeth Mahase summarises what we know so far about the virus and its effects (doi:10.1136/bmj.m308);clearly there is much we …