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‪“If you can buy an 80% chance of stopping a deadly pandemic for the cost of having to wear some silly cloth over your face, probably that’s a good deal”‬ The

‪“If you can buy an 80% chance of stopping a deadly pandemic for the cost of having to wear some silly cloth over your face, probably that’s a good deal”‬ The reason the CDC didn’t previously recommend face masks could’ve been because of a lack of RCT. But in order to do that, they would have had to expose subjects to disease without face masks which wouldn’t make sense. Goes to show there has to better ways for judging the viability of something without resorting to a strict binary of “do or do not”

SilasX 7y ago
That’s exactly the point he makes by bringing up the lack of RCTs regarding jumping out of a plane with/out a parachute.
pdonis 7y ago
> Goes to show there has to better ways for judging the viability of something without resorting to a strict binary of “do or do not” It's not just a question of how to judge but who makes the judgment. Part of the point of the article is that wearing a mask seems like something you should be able to conclude is a good idea based on common sense; you shouldn't need to wait for an expert to tell you, and if the expert is telling you something that seems to conflict with common sense, you shouldn't automatically disregard common sense.
- tomp 7y ago
  I find conflict of interest a much better indicator of truthfulness than common sense. In this case: doctors wearing masks conflicts with doctors recommend people don’t wear masks.
  - pdonis 7y ago
    Not necessarily. Doctors are exposed to a different set of risks while on the job than ordinary people going about their business. And common sense already tells you that it's a good idea to take precautions when working with sick people, so the fact that doctors wear masks while ordinary people going about their business don't have to should not come as a surprise. That's not to say that doctors (and others) can't have reasons other than "masks don't work" for recommending that people (other than other doctors) don't wear masks. Just that doctors wearing masks themselves, by itself, is not enough to know that their recommendation for ordinary people not to wear masks is unreliable. You need more information.
seemslegit 7y ago
Lack of RCT is a crutch (in this case), the practical reason is that as hard as it is to get face masks now it would have been much harder if the entire population was scrambling for them in the early days of the pandemic and given the US size, purchasing power and worldwide visibility it would have made it more difficult world-wide - all Western countries did the same, de-emphasized masks as they were imposing a lockdown and are now emphasizing them when planning for gradual release.
- williamstein 7y ago
  The article claims to refute your statement by pointing out that "The CDC has been singing the same tune for the past ten years. Swine flu, don’t wear masks. SARS, don’t wear masks. They’ve been really consistent on this point. But why?" This text in the article has several links.
  - seemslegit 7y ago
    https://slatestarcodex.com/blog_images/masks_cdc.png https://slatestarcodex.com/blog_images/masks_cdc.png Seems pretty consistent with my point - if masks weren't believed to be effective they would not be recommended "if unavoidable" , a use / don't use recommendation is not the same as a scientific finding of efficacy - it almost always factors in an implicit cost-benefit analysis of exactly the kind SSC advocates for. Case in point - all countries are now recommending (and in some places legally requiring) masks and not because a bunch of RCTs were conducted in the last two months.
Karrot_Kream 7y ago
I disagree. I think the CDC did actually perform a cross-benefit analysis on masks during the initial segment of the outbreak. Given the not-incontrovertible, yet positive, efficacy of masks, combined with the implications of a PPE shortage for healthcare workers meant that there probably was a calculated decision made to not recommend masks. Though at this point, without some more transparency, I'm not sure what we can say about the CDC's decisionmaking here.
- polemic 7y ago
  Potentially, but then surely a Cost/benefit analysis would strongly encourage the CDC to stockpile them in advance too? Perhaps nations need strategic PPE reserves.
- roenxi 7y ago
  > not sure what we can say about the CDC's decisionmaking here. We can say "gee, we should appoint more truthful bureaucrats". It isn't a crazy guess that (for this pandemic) a useful mask for a normal everyday person is anything that puts something in front of their face that makes it a little harder to breath and baffles the air currents. There may be a shortage of proven face masks but there is no shortage at all of things that could be sewn up to cover faces and deaden air currents. The cost is tiny vs the risk of it not working. Officials who are more worried about preventing a response to the potential crisis than the potential crisis should not be in charge if there is a potential crisis. We want people to change their behaviors if there is a crisis. Ideally even before the evidence in overwhelming that there is a problem.
  - kd5bjo 7y ago
    The cost of recommending masks is that a large minority of people will decide they need the best mask to protect themselves, and buy them up thus depriving the healthcare workers of them. Yes, in an ideal world, the entire situation would be spelled out and only those people who are truly at higher risk would acquire some of the limited supply of more-effective masks. For that to work, however, requires a sense of community and level of trust in government that has been in short supply in the US in recent years. These factors were also in play for swine flu and the other potential pandemics the article examined CDC rsponses for. In a crisis, officials have to base their decisions on current conditions, not on what they should ideally be. Restoring trust in government is extremely important, but can’t be accomplished in the timescale necessary to be useful for this crisis.
paganel 7y ago
Honest question, are there many people out there who find wearing a mask "silly"? Yes, they can be sometimes uncomfortable in terms of ease of breathing but to be honest I don't find them silly at all, they serve a purpose, just like an umbrella serves a purpose, it would be stupid of me to laugh of someone holding an umbrella while it's raining outside.
- DoofusOfDeath 7y ago
  I haven't noticed any of my acquaintances saying that mask-wearing is silly. But I have noticed many people not observing social distancing and stay-at-home requests. Perhaps if those people ignore the guidance because they're not convinced it's important, those same people would judge mask-wearing to be a waste of effort. Perhaps another issue is people who have heard that wearing cloth masks mostly prevents you from getting others sick, and some of them just can't be bothered to make small sacrifices for the speculative benefit of strangers?
- lonelappde 7y ago
  It's worse than "silly", it's "Oriental".
nullc 7y ago
One thing this analysis misses is the crystals. As in: The CDC is a huge government bureaucracy that employs (and cannot swiftly fire) enormous numbers of people from diverse backgrounds. If RCTs aren't the standard, well then why not also wear crystals to ward off the virus? They're inexpensive, and they couldn't hurt-- you can probably find a poorly controlled study to support it too. The CDC is not human, it is a meat-and-paper-political-machine. You cannot understand it's actions under the same framework you'd use to judge another person. The CDC must contain internal defenses against hokum which are much stronger than any person needs to personally have. So why does the CDC sometimes provide overly conservative advice even when doing so causes death? For the same reason the scorpion stings: it's in its nature. It's far from clear to me that a CDC which did make a more prudent facemask recommendation would actually be a better organization overall. Sure, it would have gotten this one right, but it would have likely given other bad advice as a result.
- SilasX 7y ago
  >As in: The CDC is a huge government bureaucracy that employs (and cannot swiftly fire) enormous numbers of people from diverse backgrounds. If RCTs aren't the standard, well then why not also wear crystals to ward off the virus? They're inexpensive, and they couldn't hurt-- you can probably find a poorly controlled study to support it too. Alexander's discussion of parachutes gave some good heuristics for when you should trust common sense vs require an RCT, which explains why his advice doesn't generalize to advocating crystals. The heuristic was basically that you should trust common sense when a) there's a solid scientific model of the key dynamics, b) the purported remedy is cheap, and c) the costs of not stopping the threat are disproportionately high. Crystals meet b)[1] and c) but fail a) -- we don't have a validated model of crytal/virus interactions. In contrast, we know that (some) viruses (including this one) spread through unimpeded airflow, and masks impede said airflow. We know that high-speed impacts between your body and the ground are deadly, and parachutes demonstrably slow the falling speed of objects. Thus, you should go with common sense in the absence of an RCT for parachutes and masks but not crystals. [1] They might fail b) depending on the particular charlatan!
  - nullc 7y ago

SilasX 7y ago

That’s exactly the point he makes by bringing up the lack of RCTs regarding jumping out of a plane with/out a parachute.

pdonis 7y ago

> Goes to show there has to better ways for judging the viability of something without resorting to a strict binary of “do or do not” It's not just a question of how to judge but who makes the judgment. Part of the point of the article is that wearing a mask seems like something you should be able to conclude is a good idea based on common sense; you shouldn't need to wait for an expert to tell you, and if the expert is telling you something that seems to conflict with common sense, you shouldn't automatically disregard common sense.

tomp 7y ago
I find conflict of interest a much better indicator of truthfulness than common sense. In this case: doctors wearing masks conflicts with doctors recommend people don’t wear masks.
- pdonis 7y ago
  Not necessarily. Doctors are exposed to a different set of risks while on the job than ordinary people going about their business. And common sense already tells you that it's a good idea to take precautions when working with sick people, so the fact that doctors wear masks while ordinary people going about their business don't have to should not come as a surprise. That's not to say that doctors (and others) can't have reasons other than "masks don't work" for recommending that people (other than other doctors) don't wear masks. Just that doctors wearing masks themselves, by itself, is not enough to know that their recommendation for ordinary people not to wear masks is unreliable. You need more information.

seemslegit 7y ago

Lack of RCT is a crutch (in this case), the practical reason is that as hard as it is to get face masks now it would have been much harder if the entire population was scrambling for them in the early days of the pandemic and given the US size, purchasing power and worldwide visibility it would have made it more difficult world-wide - all Western countries did the same, de-emphasized masks as they were imposing a lockdown and are now emphasizing them when planning for gradual release.

williamstein 7y ago
The article claims to refute your statement by pointing out that "The CDC has been singing the same tune for the past ten years. Swine flu, don’t wear masks. SARS, don’t wear masks. They’ve been really consistent on this point. But why?" This text in the article has several links.
- seemslegit 7y ago
  https://slatestarcodex.com/blog_images/masks_cdc.png https://slatestarcodex.com/blog_images/masks_cdc.png Seems pretty consistent with my point - if masks weren't believed to be effective they would not be recommended "if unavoidable" , a use / don't use recommendation is not the same as a scientific finding of efficacy - it almost always factors in an implicit cost-benefit analysis of exactly the kind SSC advocates for. Case in point - all countries are now recommending (and in some places legally requiring) masks and not because a bunch of RCTs were conducted in the last two months.

Karrot_Kream 7y ago

I disagree. I think the CDC did actually perform a cross-benefit analysis on masks during the initial segment of the outbreak. Given the not-incontrovertible, yet positive, efficacy of masks, combined with the implications of a PPE shortage for healthcare workers meant that there probably was a calculated decision made to not recommend masks. Though at this point, without some more transparency, I'm not sure what we can say about the CDC's decisionmaking here.

polemic 7y ago
Potentially, but then surely a Cost/benefit analysis would strongly encourage the CDC to stockpile them in advance too? Perhaps nations need strategic PPE reserves.
roenxi 7y ago
> not sure what we can say about the CDC's decisionmaking here. We can say "gee, we should appoint more truthful bureaucrats". It isn't a crazy guess that (for this pandemic) a useful mask for a normal everyday person is anything that puts something in front of their face that makes it a little harder to breath and baffles the air currents. There may be a shortage of proven face masks but there is no shortage at all of things that could be sewn up to cover faces and deaden air currents. The cost is tiny vs the risk of it not working. Officials who are more worried about preventing a response to the potential crisis than the potential crisis should not be in charge if there is a potential crisis. We want people to change their behaviors if there is a crisis. Ideally even before the evidence in overwhelming that there is a problem.
- kd5bjo 7y ago
  The cost of recommending masks is that a large minority of people will decide they need the best mask to protect themselves, and buy them up thus depriving the healthcare workers of them. Yes, in an ideal world, the entire situation would be spelled out and only those people who are truly at higher risk would acquire some of the limited supply of more-effective masks. For that to work, however, requires a sense of community and level of trust in government that has been in short supply in the US in recent years. These factors were also in play for swine flu and the other potential pandemics the article examined CDC rsponses for. In a crisis, officials have to base their decisions on current conditions, not on what they should ideally be. Restoring trust in government is extremely important, but can’t be accomplished in the timescale necessary to be useful for this crisis.

paganel 7y ago

Honest question, are there many people out there who find wearing a mask "silly"? Yes, they can be sometimes uncomfortable in terms of ease of breathing but to be honest I don't find them silly at all, they serve a purpose, just like an umbrella serves a purpose, it would be stupid of me to laugh of someone holding an umbrella while it's raining outside.

DoofusOfDeath 7y ago
I haven't noticed any of my acquaintances saying that mask-wearing is silly. But I have noticed many people not observing social distancing and stay-at-home requests. Perhaps if those people ignore the guidance because they're not convinced it's important, those same people would judge mask-wearing to be a waste of effort. Perhaps another issue is people who have heard that wearing cloth masks mostly prevents you from getting others sick, and some of them just can't be bothered to make small sacrifices for the speculative benefit of strangers?
lonelappde 7y ago
It's worse than "silly", it's "Oriental".

nullc 7y ago

One thing this analysis misses is the crystals. As in: The CDC is a huge government bureaucracy that employs (and cannot swiftly fire) enormous numbers of people from diverse backgrounds. If RCTs aren't the standard, well then why not also wear crystals to ward off the virus? They're inexpensive, and they couldn't hurt-- you can probably find a poorly controlled study to support it too. The CDC is not human, it is a meat-and-paper-political-machine. You cannot understand it's actions under the same framework you'd use to judge another person. The CDC must contain internal defenses against hokum which are much stronger than any person needs to personally have. So why does the CDC sometimes provide overly conservative advice even when doing so causes death? For the same reason the scorpion stings: it's in its nature. It's far from clear to me that a CDC which did make a more prudent facemask recommendation would actually be a better organization overall. Sure, it would have gotten this one right, but it would have likely given other bad advice as a result.

SilasX 7y ago
>As in: The CDC is a huge government bureaucracy that employs (and cannot swiftly fire) enormous numbers of people from diverse backgrounds. If RCTs aren't the standard, well then why not also wear crystals to ward off the virus? They're inexpensive, and they couldn't hurt-- you can probably find a poorly controlled study to support it too. Alexander's discussion of parachutes gave some good heuristics for when you should trust common sense vs require an RCT, which explains why his advice doesn't generalize to advocating crystals. The heuristic was basically that you should trust common sense when a) there's a solid scientific model of the key dynamics, b) the purported remedy is cheap, and c) the costs of not stopping the threat are disproportionately high. Crystals meet b)[1] and c) but fail a) -- we don't have a validated model of crytal/virus interactions. In contrast, we know that (some) viruses (including this one) spread through unimpeded airflow, and masks impede said airflow. We know that high-speed impacts between your body and the ground are deadly, and parachutes demonstrably slow the falling speed of objects. Thus, you should go with common sense in the absence of an RCT for parachutes and masks but not crystals. [1] They might fail b) depending on the particular charlatan!
- nullc 7y ago