Dear Editor,

I read this article with interest today. The author, whom I know and respect, has expertise and interest in the life of Wilfred Owen and Dr. Arthur Brock. While it is the promotion of both their lives that I am sure he wished to achieve in the paper, it is unfortunate that McLennan did not acknowledge that the "innovate" therapy he mentions adn promotes has now evolved into modern day occupational therapy. Such an omission, though I am sure unintentional, has provoked a predictable response both in these pages and on Twitter.

If readers wonder why there has been such a reaction, it is because to suggest ergotherapy is 'innovative' is akin to an exploration of the life of Joseph Lister simultaneously proclaiming that barbers and and butchers could provide innovative solutions to contemporary health outcomes. Things have moved on. Occupational therapy, like modern medicine, has evolved into a patient-centred and evidence-based profession.

The evolution of occupational therapy from the turn of the 20th Century is fascinating in itself. An exploration of the first part of its history can be found here: Paterson, C.F., 2010. Opportunities not prescriptions: The development of occupational therapy in Scotland 1900-1960. Aberdeen History of Medicine Publications.

McLennan notes that the philosophy of Brock could be useful in today's world as we deal with COVID-19 and its sequale. Readers may be interested to learn that modern day occupational therapy is indeed centrally involved in the delivery of long COVID rehabilitation, as our recent national survey found: Duncan E, Cooper K, Cowie J et al. A national survey of community rehabilitation service provision for people with long Covid in Scotland [version 1; peer review: awaiting peer review]. F1000Research 2020, 9:1416 (https://doi.org/10.12688/f1000research.27894.1) https://f1000research.com/articles/9-1416

McLennan has written, presented, and conducted acclaimed tours and events on the lives of Owen and Brock. These contributions are valuable. I am sure that future articles, with larger word counts, and other events will enable the evolution of modern day occupational therapy from these early times to be properly acknowledged.

Dear Editor

Not being a scientist or a professional researcher I found the article more interesting for its lack of relational curiosity! Surely the genetic difference that enables the ability or inability to detect the odor cannot be singularly limited to just asparagus. I am suddenly filled with unanswered questions about the thoroughness of the study!

- Why weren't the research subjects asked to describe the taste of asparagus and whether they did or did not enjoy it? It would be interesting to see how the responses from those with the ability to detect the odor differed from those that could not.

- Why was no attempt made to see if the ability to detect the odor after consumption could be correlated to any differences in taste ability or preference between the two different subjects? Imagine what could be implied if say one group showed a distinct preference for cilantro while the other despised it? People that dislike cilantro often describe it as tasting like soap.

- Why were the subjects not asked if they ever detected a disagreeable odor in their urine after the consumption of other foods? Speaking from personal experience I can state that I usually detect a urine odor after the consumption of most calciferous vegetables. Not as strong as asparagus but still detectable.

- The body produces two primary waste products (urine and feces), both of which are odiferous, so why only question the odor difference of just one of the waste products?

Dear Editor

The valuable research by Dr. Nejstgaard and co-workers found an association between financial conflicts of interest and favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews [1]. This is not surprising considering the great quantity of publications influenced by declared and non-declared conflicts of interest. Certain journals are selecting reliable reports (The BMJ in the first place) but others are publishing biased materials and rejecting criticism. It has become usual practice to disregard published criticism in spite of personal communications and debates at conferences. Some scientists continue their publications ignoring the published comments e.g. [2]. Wrong concepts are persisting, which may result in useless experimentation and application of invasive methods without sufficient indications [3,4]. Some writers tangle their texts, making evaluation increasingly difficult.

In conclusion, the quality of research and hidden conflicts of interest should be taken into account in deciding which studies are to be included into reviews and meta-analyses.

References
1. Nejstgaard CH, Bero L, Hróbjartsson A, Jørgensen AW, Jørgensen KJ, Le M, Lundh A. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review. BMJ. 2020;371:m4234.
2. Jargin SV. Development of antiatherosclerotic drugs on the basis of cell models. Int J Pharmacol Phytochem Ethnomed 2015;1:10-14.
3. Jargin SV. Renal biopsy research in the former Soviet Union: prevention of a negligent custom. ISRN Nephrol. 2012;2013:980859.
4. Jargin SV. Invasive procedures with questionable indications: Prevention of a negligent custom. J Surg Open Access 2017;3(5) https://www.researchgate.net/publication/321245511_Invasive_procedures_w...

Dear Editor,

So many experts now give advice to pharmaceutical companies that it can be very difficult to avoid apparent conflicts of interest, I am not sure that it matters, so long as the experts can divorce themselves from any vested interest, but others will have a different view, not least because confirmation bias is almost inevitable.

It is different, however, when there are apparent conflicts, but these remain secret. Failure to be transparent, in my book, means there is something to hide. Reveal it, and then all can judge fairly.

That said, I have argued almost from the beginning that the SAGE committee has the wrong experts, as implied by Paul Thacker (1). Neither epidemiologists nor public health doctors are the right people to develop the clinical management of a severe disease. In the case of Covid-19 it has become increasingly clear that the serious complications are immunologically related. The specialists with the most experience, and knowledge of such conditions are rheumatologists, and the treatments now being used are familiar to them. It's not too late to include them. However, as my numerous submissions of diagnostic and treatment protocols since the end of April (2) have been studiously ignored I hold out little hope. That my recommendations have become, at least to some extent, mainstream I still wonder how many lives might have been saved had SAGE been more receptive to external input.

Reference:

1. Bamji AN. The Wry Observer's Covid-19 update (25): 18th May 2020. https://bamjiinrye.wordpress.com/2020/05

2. Bamji A N. Rapid Response to "Paying the Ultimate Price". https://doi.org/10.1136/bmj.m1605 (28th April)