4 ms·

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

by 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.
      - autoexec 3y ago
        > In fact, often clinical trials are statistically analysed by intention-to-treat Fair! That said, intention-to-treat is more likely to greatly underestimate the efficacy of a treatment when non-adherence is expected to be high/isn't being monitored. > 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. I agree, but the solution is to help the patient overcome those barriers not to throw out the medication. It's to give people the information and tools they need to follow the treatment. People who wear masks could be trained on how to properly fit them, take them on/off, store them, replace them, etc. The real life situation around masking included basically none of that. "Wear a mask" was basically all people were told. It doesn't make sense to fault/dismiss masking if a large part of the population isn't wearing them because they were tricked into believing that masks don't work or that masks will actually make them sick, and another large part of the population wears them, but wasn't shown how to do it correctly. It's important to be aware that those things are going on within the population, but the next step from there is still "educate the public" and not "abandon all efforts at masking" - at least not until a more accessible alternative which is also as effective as masking becomes available
        3y ago

by NoPie 3y ago

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.
    - autoexec 3y ago
      > In fact, often clinical trials are statistically analysed by intention-to-treat Fair! That said, intention-to-treat is more likely to greatly underestimate the efficacy of a treatment when non-adherence is expected to be high/isn't being monitored. > 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. I agree, but the solution is to help the patient overcome those barriers not to throw out the medication. It's to give people the information and tools they need to follow the treatment. People who wear masks could be trained on how to properly fit them, take them on/off, store them, replace them, etc. The real life situation around masking included basically none of that. "Wear a mask" was basically all people were told. It doesn't make sense to fault/dismiss masking if a large part of the population isn't wearing them because they were tricked into believing that masks don't work or that masks will actually make them sick, and another large part of the population wears them, but wasn't shown how to do it correctly. It's important to be aware that those things are going on within the population, but the next step from there is still "educate the public" and not "abandon all efforts at masking" - at least not until a more accessible alternative which is also as effective as masking becomes available
      - 3y ago