8 ms·

Cochrane review doesn't make this distinction. In medicine you cannot distinguish. It is all about the intervention and not about some theoretical best-case sc

by NoPie 3y ago

Cochrane review doesn't make this distinction. In medicine you cannot distinguish. It is all about the intervention and not about some theoretical best-case scenario. The intervention is to ask people to wear masks. People comply as they do in real real life and then we measure the results. There was no reliable evidence that this made any noticeable difference. Now you can change the intervention – instead of asking and mandating masks as we did, we could educate masks wearers more. Unfortunately we have no evidence that it helps. Perhaps masking could help to an individual wearer? Alas, we didn't collect such evidence either. Some studies are lab based. In those masks had some effect. But that's not how people use masks in real life, so these results don't mean much.

autoexec 3y ago
> But that's not how people use masks in real life, so they don't mean much. I think saying "Using X is effective, but only if you actually use X" is obvious. The thing people want to know is "do masks stop the virus" which is an entirely different question from "How many people will wear masks", which is a different question from "What is the effectiveness of interventions to promote mask wearing"
- NoPie 3y ago
  The first question is pointless for someone responsible for public health. People want the answer to it because they don't want to think about all these related issues and have simplistic idea that they can protect themselves. But chances are their compliance is exactly the same as among people in those studies. Therefore the real question is how effective is the intervention. It will be (or should be) asked by people responsible with public health policies. P.S. Cochrane group is not for giving scientific answers to individual people. Its main aim is to evaluate the evidence of different treatments and provide guidance to policy makers and healthcare authorities.
  - autoexec 3y ago
    If you are responsible for public health and the answer to the first question is "no" then you have no need to ask the other two. Figuring out what we can do to get people to do what works is important too, but it's not the only thing that matters. People can be educated and their habits changed. We have similar problems getting schizophrenics to take their meds and getting communities with high rates of open defecation to use toilets, but nobody suggests that we give up on antipsychotics or sanitation facilities.
    - NoPie 3y ago
      The first answer is too vague to have a meaningful answer in case. Every other treatment in medicine including schizophrenia is tested how it works in practice. It is incurable disease and the treatments have many side-effects. Thus the question becomes not “does this medicine cure schizophrenia” but “does this treatment works better than placebo or another treatment?”. When studies are completed, we gather evidence by monitoring real life experience with this treatment.
      - autoexec 3y ago
        > Every other treatment in medicine including schizophrenia is tested how it works in practice. Medicine is tested according to how it works when people actually take it. People participating in research studies who fail to take their medications (or their placebo for that matter) are kicked from the program and their data is typically discarded entirely.
        NoPie 3y ago
        That is generally not true. In fact, often clinical trials are statistically analysed by intention-to-treat, including all people who have been randomised even if they later don't receive the treatment. Per-protocol-analysis (including only people who follow the study protocol) can also be used but it is more prone to bias. Besides, with masks it is not simply wearing or not wearing a mask. Even a very diligent mask wearers may wear it in a way that makes it less effective without being aware of that. In short, when the doctor prescribes a medicine it is important to understand the factors why the patient may not take the medicine as prescribed. If the real life situation is that most people take medicine in a way that makes it ineffective and so much that the clinical trial cannot find significant effect, then he shouldn't prescribe it. It is just a waste of resources and giving people false hopes.

by NoPie 3y ago

autoexec 3y ago

> But that's not how people use masks in real life, so they don't mean much. I think saying "Using X is effective, but only if you actually use X" is obvious. The thing people want to know is "do masks stop the virus" which is an entirely different question from "How many people will wear masks", which is a different question from "What is the effectiveness of interventions to promote mask wearing"

NoPie 3y ago
The first question is pointless for someone responsible for public health. People want the answer to it because they don't want to think about all these related issues and have simplistic idea that they can protect themselves. But chances are their compliance is exactly the same as among people in those studies. Therefore the real question is how effective is the intervention. It will be (or should be) asked by people responsible with public health policies. P.S. Cochrane group is not for giving scientific answers to individual people. Its main aim is to evaluate the evidence of different treatments and provide guidance to policy makers and healthcare authorities.
- autoexec 3y ago
  If you are responsible for public health and the answer to the first question is "no" then you have no need to ask the other two. Figuring out what we can do to get people to do what works is important too, but it's not the only thing that matters. People can be educated and their habits changed. We have similar problems getting schizophrenics to take their meds and getting communities with high rates of open defecation to use toilets, but nobody suggests that we give up on antipsychotics or sanitation facilities.
  - NoPie 3y ago
    The first answer is too vague to have a meaningful answer in case. Every other treatment in medicine including schizophrenia is tested how it works in practice. It is incurable disease and the treatments have many side-effects. Thus the question becomes not “does this medicine cure schizophrenia” but “does this treatment works better than placebo or another treatment?”. When studies are completed, we gather evidence by monitoring real life experience with this treatment.
    - autoexec 3y ago
      > Every other treatment in medicine including schizophrenia is tested how it works in practice. Medicine is tested according to how it works when people actually take it. People participating in research studies who fail to take their medications (or their placebo for that matter) are kicked from the program and their data is typically discarded entirely.
      - NoPie 3y ago
        That is generally not true. In fact, often clinical trials are statistically analysed by intention-to-treat, including all people who have been randomised even if they later don't receive the treatment. Per-protocol-analysis (including only people who follow the study protocol) can also be used but it is more prone to bias. Besides, with masks it is not simply wearing or not wearing a mask. Even a very diligent mask wearers may wear it in a way that makes it less effective without being aware of that. In short, when the doctor prescribes a medicine it is important to understand the factors why the patient may not take the medicine as prescribed. If the real life situation is that most people take medicine in a way that makes it ineffective and so much that the clinical trial cannot find significant effect, then he shouldn't prescribe it. It is just a waste of resources and giving people false hopes.