You say this as if it is established fact, but there has been no RCT convincingly showing the effect you are describing - typically called "source control" - can be achieved from the use of a respirator to interdict individual transmission. In fact, no RCT powered for such a finding has even been attempted to my knowledge (though I haven't combed through the research in the past couple months or so - link me if I'm out of date!).
It has also not been demonstrated that source control can be used to reduce community transmission (though I realize that your point is not about community transmission).
The reasons for not funding / performing such a RCT continue to astound - the demagoguery of comparing masks to parachutes notwithstanding.
RCT is unlikely to be a good tool to determine the effectiveness of masks, if for no other reason, compliance is marginal at best (how do you recognize &record every instance when someone pulls it down for a short time exposing their nose or both airways?).
Perhaps the best evidence that even badly used masks are effective is that measures such a using masks for a year killed every instance of a strain of flu - deas, gone, extinct.
Just by reducing the R0 value to the point where there were no survivors. (but not enough that more virulent COVID-19 strains couldn't survive).
Masks, particularly N95-level, work. Period. Not perfectly, nothing does. But they work. Regardless of any FUD you may want to spread.
>> RCT is unlikely to be a good tool to determine the effectiveness of masks, if for no other reason, compliance is marginal at best (how do you recognize &record every instance when someone pulls it down for a short time exposing their nose or both airways?).
But this is exactly the point, surely? If people won't comply in an RCT, they won't comply in real life either and so mask wearing will have no benefit.
It just tells us that people probably need to comply more, not that we shouldn't bother with certain interventions. Suggesting we shouldn't try mask mandates because not everyone complies is like suggesting you shouldn't have laws about piling bags of trash on your lawn because some people still pile trash on their lawn. The real problem is the people who feel that "take your trash to the dump" is an imposition and resent having to do something to help the community around them.
Yes, perhaps someone could develop a new kind of glue that will enable them to be stuck to children's faces so they can't be removed.
I don't think that getting the levels of compliance required is possible, absent civil liberty abuses which are worse than the disease we are trying to cure.
Yes, it should be strongly encouraged in crowded places, not discouraged.
As to "You First", I still do avoid random crowds and I wear an N95 when I do go out in random crowds, including the last time I went to the grocery store. I'm not the only one I see doing that ('tho it is far less common than a year ago).
But sure, you do you, because evidently your approach to life prioritizes your immediate gratification, and doing nothing that might help the general welfare, or help everyone (even you) in the longer term.
I am disgusted by the totalitarian urge which has been normalized by the pandemic. Your trauma is not my problem, and I will not permanently alter my behavior to satisfy your ever-escalating urge to dominate me.
You think that having no public health measures is data driven? Go read some data. Seriously. Or, just go to pre-1950s graveyards and gather data on how many dead children there were before public health measures. Or look at the data on how the public health measures ran extinct a strain of flu so it is no longer being included in the vaccine formula.
I don't see anybody advocating for no public health measures - perhaps you might consider that the views of others are as nuanced as yours.
> Or, just go to pre-1950s graveyards and gather data on how many dead children there were before public health measures.
Indeed! But this doesn't mean that every measure undertaken was reasonable or evidence-based. Germane to the thread at hand: at the height of the polio epidemic, some states sprayed DDT in a bizarre and mistaken belief that it was likely to reduce transmission of the virus. As with lockdowns and masks and surface 'disinfectants' and other unproven measures today, this happened over the objection of a chorus of experts who had already begun to unearth the fecal-oral route of transmission of polio.
Yes, in retrospect, this seems silly and trivial. But at the time, it must have been very frustrating to spend your life (or even your hobby time, as I do) studying public health only to have a hairbrained idea with no empirical basis become the framework on which policy was decided.
> Or look at the data on how the public health measures ran extinct a strain of flu so it is no longer being included in the vaccine formula.
I... presume you are talking about the B/Yamagata lineage of Influenza B?
Nobody knows why this lineage disappeared, and anybody who claims to is trying to sell you something or influence you.
One exciting prospect is that it is the result of viral interference, a phenomenon frequently observed but not yet understood, and potentially the basis of future immune therapy.
In any case, the disappearance of a particular lineage of Influenza B or of H3N2 (which of course is the current endemic influenza, but began as an epidemic subtype in the 1960s) is not an overall public health win or loss; it just means that other lineages (in this case, B/Victoria) will present the endemic strains in future years unless B/Yamagata re-emerges.
EXACTLY, the Flu strain had a lower R value than COVID-19. So, the experiment has been done, proving that masks work as expected, even badly implemented.
Two different airborne diseases, F and C, with R0 values under unprotected conditions of something like F=3 and C=9, and masking very badly implemented [0,1,2,3,4]. The results are that disease F went completely extinct, but disease C was slowed in areas with better compliance, but still persevered, and mutated in favor of better-spreading strains such that the unprotected R0 of current strains is ~15.
This unequivocally shows that there is a real public health benefit to simple measures of using N95 masks, and strongly suggests that better implementation (e.g., full supply and broader use) would improve containment, reducing cases, and reducing the rate of cases, allowing for better treatment.
There is no requirement that the measures be perfect, indeed it is a multi-layered approach that works for public health, due to the dynamics of disease.
>>Again, listen to me. I'm not telling you merely that I disagree with you. I'm telling you that you have no power over me, and you never will.
Yes, that was evident from the beginning, and you've confirmed it.
Your attitude has nothing to do with actual science, and everything to do with serious ignorance about how public health works, a hard unwillingness to help your fellow citizens, hostility to anyone who might slightly inconvenience you, and a misguided idea of "muh fredumbs' mixed with entitlement.
The fact is no one GAF about controlling you; you are just not that important to anyone but you (I'm not either, and contrary to your assertion, IDGAF abt "controlling" you either).
Wearing N95s is no different a safety measure than hard hats or steel-toed shoes on a worksite, or seat belts in a car or airplane. If you think that is somehow an affront to your manhood or whatever, shows you have real issues. Seriously. Perhaps you will learn to join society as a contributing member and stop acting like a spoiled petulant child. We can all hope so.
[0] WHO and CDC failed to emphasize the importance of N95-quality masks, likely in an effort to preserve limited stocks for the healthcare workers (they knew N95s work)
[1] the supply of N95-level masks was constrained so many people used only makeshift or lower-quality masks.
[2] many people were very lax about using masks, consistently failing to cover their nose, or just wearing them as a 'chin-diaper' to comply but not really.
[3] a significant part of the population turned it into a misguided political event, adamantly refusing to wear masks and belligerently intimidation others and businesses to not wear them and not require them.
[4] inconsistent measures implemented in different countries, some much stronger and some much weaker.
Yikes, Pandemic public health measures are NOT totalitarian in any way, shape or form.
Totalitarian measures are "TOTAL"; i.e., they encompass all aspects of govt and society.
Public health measures are LIMITED to the scope of the public health threat.
Being unwilling to take even small measures that not only help you but also help your fellow citizens does not make you some kind of 'free-thinking libertarian'.
It simply shows you like to behave like a sociopath, and your statement that a policy idea is a result of "trauma" is an uncalled-for insult, as you intended it (which again shows your drive to prioritize feelings over facts). Seriously, no one is trying to "dominate" you. As if you were that important. Sheesh.
It's not totalitarian. How do you feel about having a sewer hookup or a septic system in your house? Because those things were largely mandated and not by grassroots. With that kind of attitude we'd all be crapping in outhouses and standing in our own poop within a decade.
I agree with reasonable limits to public power, but I think data driven public health approaches are an area where the public should have a lot of power. We've eradicated things like hookworm in part because we have asked people to put shoes on their children and stop pooping in holes in the ground.
In an unlikely turn of events, you appear to be an actual human and not a bot (from a cursory look at your comment history). So I say, gently:
> because evidently your approach to life prioritizes your immediate gratification
Do you genuinely believe that this is a fair characterization of the sentiment of the person (or position) to which you are responding, giving the benefit of the doubt?
> Yes, it should be strongly encouraged in crowded places, not discouraged.
It boils down to this: encouraging an intervention in public places needs to be based on unambiguous evidence, supported by genuine, authentic science and presented in a way that is convincing to a scientifically-literate society such as ours.
Consider, for example, the evidence in favor of the use of seatbelts, condoms, traffic-calming infrastructure, or hard hats (the latter of which I acknowledge don't require RCTs to be validated).
These products have produced a reliable, measurable, significant change in outcomes to the extent that no reasonable person questions their efficacy impact (though even with these, there is some reasonable dispute regarding trade-offs in each case).
The intervention in question has fallen way, way short of this standard - so much so that it's difficult to make a viable comparison. Despite mandates across a literal majority of geographic landmass of the country, there is still no evidence of any benefit with regard to community transmission rates. And on the research side, only nine RCTs - and none at all regarding source control - have been conducted.
We've watched as a huge chorus of the world's experts have called for RCTs, and have been told by charlatan bureaucrats and profiteers that such a venture is comparable to a parachute RCT. Do you think that's likely to be convincing?
Meanwhile, the (typical, expected, obvious) extrapolation in the Cochrane review has been singled-out, and the waters muddied, for pointing out in sober terms what the RCTs actually said.
It has been reduced to "well, absence of evidence isn't evidence of absence", creating an obvious catch-22 as the same data is puzzlingly used as an excuse not to perform further science on the matter.
Believe me when I say: we care about you. I wish you good health and am happy to take evidence-based steps to ensuring that the world is a healthy, vibrant place for you and people like you. But you go too far when you ask that others to ignore their own good-faith assessment of the facts at hand. And the facts are unambiguous: respiratory pathogens emerge every so often and infect nearly all members of many animal species. There does not appear to be a viable intervention to stop this, and it's not even obvious is stopping it is desirable, as these pathogens confer immunity to those infected. It's an equilibrium and part of a broader ecology in which we live.
You are loved, even by this stranger. Please don't see commitment to data-driven approaches to public health interventions as a hunger for immediate gratification; this is nearly the opposite of the reality of the situation.
What data do you have that say that my comment is likely to be a bot? (genuinely curious)
As I first mentioned, Random Controlled Trials are unlikely to be the best measure for this.
>>encouraging an intervention in public places needs to be based on unambiguous evidence, supported by genuine, authentic science and presented in a way that is convincing to a scientifically-literate society such as ours.
>>These products have produced a reliable, measurable, significant change in outcomes
Yes, true for those products and also for the intervention of wearing N95 masks (I fully agree that other masks are basically placebos).
Again, the most convincing evidence of the effectiveness of mask intervention is that despite crazy levels of anti- and poor-compliance, and limited availability of N95 masks, we drove extinct an entire lineage of another airborne disease, simply by taking small measures that reduce R0 of airborne pathogens. It was not even the target, just collateral damage.
>>to the extent that no reasonable person questions their efficacy impact
This is a nice to have but definitely not necessary qualifying criteria. And, with every one of the measures you mentioned, there were and still are people who claim to be unconvinced. It is kind of what leadership is about - moving the comfort zone to a better place.
>>hunger for immediate gratification
Watching the anti-mask / anti-vax attitudes, especially when they are expressed as some kind of fear of state power over the individual, I'm sorry to say that the most fundamental basis I've seen for that is freeloading and entitled hostility to inconvenience or needing to care about others in society.
They refuse to undertake a minor inconvenience to what will help them and everyone else in society, and in doing so, freeload on the herd immunity or reduction in R0 maintained by their smarter peers. Valuing your own convenience over everyone else's health maybe isn't best called "instant gratification", but it isn't far off. If you have a better suggestion, let me know.
Thx for the love; same to you. I'm all for data-driven approaches to public health interventions; sadly many of those who oppose them are not data driven, but have other motivations, and disguising those as "data driven" does not make it so.
...this link is not a new RCT. It is an article about the Cochrane review which we all read a long time ago.
And, despite the (somewhat reasonable) chagrin expressed by the authors, the Cochrane review did indeed show that masks are largely ineffective (and cloth masks, completely so) at stopping viral transmission - the link is right there in the article to which you've linked.
What we need are sober, old-school RCTs powered to assess both filtration and source control across individuals (and sure, some for community transmission as well). And then we need them replicated. And then we can finally stop this ridiculous 'debate'. Today's humans are the most scientifically literate society in history; there's no reason we need to make important social and political decisions with such shitty data.
First, as the sibling comment pointed out, the Cochrane review article didn't show that masks were ineffective. "Relatively low numbers of people followed the guidance about wearing masks or about hand hygiene, which may have affected the results of the studies" [1]. Their results were inconclusive since the people the asks to wear masks, didn't.
But there's still evidence that masks are effective. The question of whether N95 filter media can block virus-carrying droplets is a _physics_ question-- which has been replicated in experiment after experiment since the 90s ([2] is a recent study).
I've done a lot of looking, but I've yet to find any explanation as to why if someone is wearing a (properly fitted) N95, so their air goes through a filter media, which has been repeatedly shown to block droplets, they could still inhale disease-carrying droplets.
> I've yet to find any explanation as to why if someone is wearing a (properly fitted) N95, so their air goes through a filter media, which has been repeatedly shown to block droplets, they could still inhale disease-carrying droplets.
It's worth keeping in mind that even if someone wearing an N95 mask does manage to inhale some percentage of the airborne disease-carrying droplets around them, viral load matters a lot. A tiny amount of virus could be fought off by the immune system before it has a chance to take hold in the body, and even if that fails and the virus does infect the body, larger exposures tend to result in worse outcomes. Even an imperfect protection can have a beneficial effect.
It's the same for people spreading the virus. Even if a mask isn't perfect, that doesn't make it useless. Putting just about anything in front of someone's virus spewing face holes is going to reduce the amount of virus that gets into the air and limit how far it spreads. This is why we teach small children to "vampire cough". Not because the inside of our elbows provide N95 levels of protection, but because doing so still helps to prevent the spread of disease.
>>Their results were inconclusive since the people the asks to wear masks, didn't.
Their review was at the macro, population level. If people aren't wearing masks properly through carelessness or ignorance, this proves their point.
Shooting a virus at a masked mannequin in a lab might show some prevention, but in the real world people forget and scratch their nose, rub their eyes, get sneezed on by a stranger etc.
I agree that the Cochrane review is better evidence of "if you don't wear/use a mask properly, it won't work," rather than "masks don't work." (This is one of the reasons I'm against mask mandates, btw.)
I'm invested in this only because, due to my health condition, I don't want to get covid. As far as I'm aware, the evidence says that so long as I properly wear an N95 (so I'm not taking my mask off to scratch my nose, have passed a fit test, etc.), I will significantly reduce my risk of getting covid.
But rather than "if you don't wear/use a mask properly, it won't work", I'd more restate it as "for a given population size, enough people would mess up that making everyone wear one would not slow the spread of the disease".
I also think that if you, as an individual, are especially diligent it may well lower your personal chances of catching COVID. And given your health conditions, I really hope that is the case for you.
> I'd more restate it as "for a given population size, enough people would mess up that making everyone wear one would not slow the spread of the disease".
...but this is even less conservative than the review summary, which was inexplicably panned.
The clause "enough people would mess up that making everyone wear one would not slow the spread of the disease" is part of the consideration that goes into "community transmission" (or the phrase "in the community", which is sometimes used in formal publications as an abstraction for real-world compliance levels) and is distinct from "individual transmission".
The sentence in question is:
"Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants;" [0]
...it's hard to imagine how this extremely sober (and factually proper) extrapolation of the data has caused such a kerfuffle.
Is it any wonder that the people who have been studying this topic since before it was cool are puzzled?
edit: my apologies - I just read that you addressed this elsewhere in the thread. It seems that we are in agreement (and I just don't think there is a reasonable alternative assessment for any numerate / literate reading of the data.)
Your point is even stronger than you make it sound.
Nobody shot a virus at anything. They shot beads of polystyrene latex.
If you woke up from a dream where such a study occurred, you'd laugh/sigh at your own outlandish imagination.
I admit - I actually took this seriously for a brief while and believed that masks were a plausible intervention. But how people can still hold that assessment years on is baffling. I have to believe it's mostly just bots at this point; no humans in my actual life have had their mind unchanged by the intervening data.
> the Cochrane review did indeed show that masks are largely ineffective (and cloth masks, completely so) at stopping viral transmission - the link is right there in the article to which you've linked.
Many commentators have claimed that a recently updated Cochrane review shows that ‘masks don’t work,’ which is an inaccurate and misleading interpretation,” Karla Soares-Weiser, the editor in chief of the Cochrane Library, said in a statement.
“The review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses,” Soares-Weiser said, adding, “Given the limitations in the primary evidence, the review is not able to address the question of whether mask wearing itself reduces people’s risk of contracting or spreading respiratory viruses.”
She said that “this wording was open to misinterpretation, for which we apologize,” and that Cochrane would revise the summary.
Soares-Weiser also said, though, that one of the lead authors of the review even more seriously misinterpreted its finding on masks by saying in an interview that it proved “there is just no evidence that they make any difference.” In fact, Soares-Weiser said, “that statement is not an accurate representation of what the review found.”
You are guilty of pushing the very misinformation that you claim to be against.
The review itself said:
‘Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness / Covid‐19-like illness compared with not wearing masks… Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza / SARS‐CoV‐2 compared with not wearing masks.’
The fact that the editor-in-chief of Cochrane embarrassed herself due to the pressure of an opinion-piece by a non-expert in the NYT is irrelevant.
If you think that Cochrane revises their reviews based on "pressure of an opinion-piece by a non-expert in the NYT" I doubt any amount of research will change your mind from what you've decided to believe. I think it's clear that Tom Jefferson was embarrassed at being called out for misinterpreting the evidence, but he's plainly wrong that she never provided a reason. She was clear that it was due to the "limitations in the primary evidence", something many others pointed out as well.
Cochrane didn't revise their review, neither did the author so I'm not sure where you imagined that. What happened was the the managing editor issued a statement in response to an NYT op-ed that criticised the review.
And there was no misinterpreting the evidence. He said that there is no evidence that masks work. You can't then say "yeah but there's only no evidence because all the evidence is low quality" because then you are effectively agreeing that there is no evidence.
If people are so confident masks work, do an RCT. That is how science is supposed to work, right? Not guessing something might work and doing it anyway.
> Cochrane didn't revise their review, neither did the author so I'm not sure where you imagined that.
That would have been the part where the editor in chief of the Cochrane Library said that they would, and then did. To quote (again):
She said that “this wording was open to misinterpretation, for which we apologize,” and that Cochrane would revise the summary.
> If people are so confident masks work, do an RCT. That is how science is supposed to work, right?
No it isn't. There are zero RCTs done for all kinds of things that we're confident work. There are many reason RTCs aren't always done. Reasons like "well understood physics" and "ethics" and "unfavorable signal to noise ratios" that would make doing them pointless at best, and harmful in the worst cases. RCTs are only a tool, and like all tools, they aren't appropriate or necessary in all circumstances.
Please, I beg for your sensibility and brief attention here. This issue continues to tear fissures in what seem like otherwise reasonable and literate communities.
The sentence in question is:
"Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants;"
This is very typical wording, and a very typical application of limited data, for a Cochrane review. There's nothing here that jumps out, on first read or after ingestion of all of the primaries, which I'm guessing we've all done multiple times.
I think we all agree with you (and thus, with Soares-Weiser) about the frustration (heck, downright confounding) resulting from the lack of evidence. Top experts from every one of the big 5 have repeatedly called for and proposed RCTs to solve this problem.
...but there is absolutely nothing wrong with looking at these data and concluding that, in each statistically-significant case, masking "probably makes little or no difference to the outcome of" ILI.
Is it possible that a larger, properly-powered RCT will find that some form of N95 application will have some effect on community transmission? Sure. We'd all love to know about that.
It it possible that a larger, properly-powered RCT will find a similar outcome from cloth masks? No. Not unless all of the current data on the matter is completely flawed.
Is it possible that even a small, properly-powered RCT will find statistically significant reductions in individual transmission from source control measures? Yes! That's possible! And that's the topic of this entire thread - we're talking about an individual patient largely confined to an iron lung.
Has that RCT been performed? No.
Can we all agree on at least these limited, well-defined assessments of the available data?
Of course. And John Ioannidis. And Jay Bhattacharya. And Martin Kulldorf. And Stefan Baral. And Sunetra Gupta. And Vinay Prasad. And dozens of other acclaimed researchers who represent the core of the incredible, laudable, essential, dear sciences of epidemiology and evidence-based medicine.
An entire generation of the top experts in these fields were sidelined, and the spotlight suddenly shifted to nervous second-stringers in order to present the appearance of a vibrant debate in front of profiteering media, piped into television screens in the waiting rooms of daycare centers where under-privileged two-year-olds were forced to put cloth across their face for no reason.
It's obvious to everyone, and yet the apperance of debate is still kept up through not only through dishonest pundits, but botnets on reddit and, I fear, even here on HN.
It's wild.
But we'll overcome it. Don't let it get you down. The scientific method endures and it will eventually win out. People are getting more and more literate and younger ages. The facade is nearly finished.
> The sentence in question is:
"Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants;"
In a statement about the review, Lisa Bero (the Cochrane Public Health and Health Systems Senior Editor) says explicitly:
“The results of this review should be interpreted cautiously, and the uncertain findings should not be taken as evidence that these measures are not effective."
> I think we all agree with you (and thus, with Soares-Weiser) about the frustration (heck, downright confounding) resulting from the lack of evidence.
There is not lack of evidence on the effectiveness of masks to prevent/spread illness. There is a lack of evidence on the effectiveness of policy. This is not evidence that those polices are themselves ineffective. Quoting again:
"An updated review of physical interventions by Jefferson and colleagues assesses three commonly recommended interventions: masks, hand hygiene, and physical distancing.[2] They found evidence that masks had limited or no benefit in terms of preventing influenza‐like illnesses or laboratory‐confirmed influenza. However, except for a handful of studies, most of the evidence is from studies examining effects in wearers. An important effect may still lie in how masks reduce transmission of virus to others, which is more difficult to ascertain.[3] Resulting uncertainty in the evidence for public health measures has fed controversies regarding the legitimacy of public health policies involving these measures, with face masks being a special target for criticism.[4, 5]"
"For each measure, though, lack of evidence of effectiveness is not evidence that the interventions are ineffective. Rather, the details of these reviews show why there may never be strong evidence regarding the effectiveness of individual behavioural measures when deployed, often in combination, in a general population living in the complex, diverse circumstances of individuals' everyday lives. Waiting for strong evidence is a recipe for paralysis." (source: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED...)
> Is it possible that a larger, properly-powered RCT will find that some form of N95 application will have some effect on community transmission?
Anything is possible, but it appears that any attempt at such a study would likely result in a failure to uncover actionable data. Reasons for that are explicitly listed in the source above which goes on to state the following: "However, while there is reason to believe in the combined effects of multiple behavioural measures, there is not, and may never be, high‐quality evidence from randomized trials on those effects."
RCTs are a very useful tool, but they aren't the right tool for every circumstance. This appears to be one of those cases. It's fortunate then that we don't need to depend on them in every circumstance. We can have an extensive pool of other types of high quality evidence to draw conclusions from. We have lab tests where we have no issues testing the physics involved in different kind of masks blocking virus-sized particles on simulated inhales and exhales. There have been RCTs involving health care personnel which show that worn correctly and consistently masks work. The effectiveness of masks to help keep people from getting and spreading disease is not really in question. The questions we do have, aren't ones RCTs are likely to help us answer.
If someone comes up with some way to perfectly control, and fully and accurately observe and record the behavior of large populations 100% of the time for the entire duration of the trial, and can do all of that ethically, then you might get the perfect research you'd love to see. Until then, we should focus on what we do know with confidence and what we've learned through other forms of high quality research.
I think any reasonable observer can conclude that we have reached a point in the discussion in which it is evident that you are not participating in good faith.
> That sentence is not in question. It doesn't exist anywhere in the review. Please read the review yourself.
Please don't implicitly accuse me of not having read the material. I read it the day it was published, with the counsel of friends who are experts in the field, who, along with most of their colleagues, have objected to this entire charade all along.
It's hard to imagine that you actually believe that this sentence is not the controversial one; it has been the topic of discussion in circles of epidemiology and evidence-based medicine around the world and is the focus of the clarification you've linked. A simple web search will confirm this.
Moreover - and I presume this was a mistake on your part - the PDF you've linked actually still contains the sentence in question (I assume you meant to sneakily link the revised summary and pasted the wrong URL). I hope this reveals the tactics at work here to any discerning reader. (As I write this, the PDF linked in your comment is: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...)
> RCTs are a very useful tool, but they aren't the right tool for every circumstance. This appears to be one of those cases.
Yes of course those cases exist, and no this isn't one of them. And essentially all of the world's top researchers in evidence-based medicine agree on this point (despite having a wide array of opinions on the underlying question).
We're talking about asking one group of people to put something on their face for a while, and another not to, in a variety of circumstances. Nearly all of the world's top experts have asked for this (including the authors of the review and primaries in question, which together represent tenure at all five of the world's top institutions of medicine) and been silenced, while a group of second-stringers willing to toe the line have been propped up to create the appearance of significant debate. I have no doubt based on your knowledge and articulation that you are well aware of this, and I hope that now anyone reading this far is as well.
Given the decreasing apparent veracity of your statements, I'm choosing as my last message in this thread.
I don't want to be adversarial, but it feels impossible and invalidating to engage in discussion when we can't agree that the sky is blue.
All I can ask is that you contemplate whether what you are doing is in the best interests of science.
If anyone in interested in reading further rebuttal, I suggest this piece by Tom Jefferson (author of the review in question) joined by Carl Heneghan (whom you probably already know, but if not, was the editor-in-chief of the BMJ of evidence-based medicine at the time of the publication in question). [0]
edit: I had originally written a response that dissected the dishonest characterization of the text of the review, but replaced it with the Jefferson / Heneghan piece, which goes directly into the substance, which seems more appropriate.
> Please don't implicitly accuse me of not having read the material.
I didn't intend for my invitation to be an accusation. I'm sorry that I wasn't clearer. I'd publish my own revision if I could. I just wanted to give you the opportunity to see for yourself that the text isn't there. I'd hoped to even make it easy for you, but also for anyone else reading who might be working from outdated information on this topic.
> It's hard to imagine that you actually believe that this sentence is not the controversial one; i
It was a controversial sentence, but mostly because it was poorly/incorrectly worded which is what necessitated it being removed from the text and replaced with something more appropriate. It was exactly because it was misleading so many people that Cochrane has worked so hard to clarify the situation. From revisions, to statements made to the press, to editorials published on their own site, I think they've done everything they reasonably could do to let the public know that the review does not support what was initially said as it was initially phrased. It'd be hard to get more explicit than they have been. "the uncertain findings should not be taken as evidence that these measures are not effective." I don't know what more people want from them. It must be maddening for them to know that for all their efforts what was initially published is still giving people the wrong idea.
> Moreover - and I presume this was a mistake on your part - the PDF you've linked actually still contains the sentence in question (I assume you meant to sneakily link the revised summary and pasted the wrong URL).
Yes, I did link to an outdated version in error. I apologize for that too. I had (and have) enough tabs and browser windows open that it was all too easy to just grab the wrong one by mistake (it's a wonder firefox hasn't crashed on me yet). I corrected it as soon as I noticed but you were too quick for me. This wasn't "sneaky" or some trick. My intent was very much to post the most current and corrected version. What good is it to argue over something that was later corrected? The most recent version is always best to work from, and that's especially true in cases where you know revisions had to be made and the problems with older versions are leading to misunderstandings and confusion.
> Yes of course those cases exist, and no this isn't one of them.
Many people, including experts, disagree with you. Experts can disagree, but if someone thinks they can design a RCT that doesn't suffer from the kinds of problems that others see as being highly likely then they are free to design one, make their case for funding, and run it. Evidence is king. We know this review was deeply flawed because of the lack of high quality evidence. If finding that high quality evidence is possible, then let someone do it already and prove everyone else wrong. That's how science works.
> All I can ask is that you contemplate whether what you are doing is in the best interests of science.
All I'm doing is telling you what Cochrane themselves says of the review they published, and in this case, I happen to agree with them. I'd be happy to change my mind, once someone delivers better evidence. Tom Jefferson and the rest of the review's authors weren't able to do that with this review due to the numerous problems with the evidence they had to work with and the lack of other evidence to draw from. Not a huge deal. Let's see the viable RCTs people come up with and the quality of the evidence they get from them, then we'll see what the review says.
It has also not been demonstrated that source control can be used to reduce community transmission (though I realize that your point is not about community transmission).
The reasons for not funding / performing such a RCT continue to astound - the demagoguery of comparing masks to parachutes notwithstanding.