5 ms·

> Actually we did from the decades surgeons wore masks to prevent the spread of airborne diseases. Funny you should say that. There were randomized controlled

by timr 3y ago

> Actually we did from the decades surgeons wore masks to prevent the spread of airborne diseases. Funny you should say that. There were randomized controlled trials on exactly this question prior to 2020. Guess what the outcomes were? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480558/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480558/ (Notably, this review is from 2015...it is not subject to the ridiculous politics of Covid.) > However, overall there is a lack of substantial evidence to support claims that facemasks protect either patient or surgeon from infectious contamination. More rigorous contemporary research is needed to make a definitive comment on the effectiveness of surgical facemasks. Also, rather (in)famously, a review saying the same thing was censored from the web in spring 2020, because...reasons. While I'd personally love to see extensive, rigorous investigation of this question, simply repeating "masks work", or "people didn't do it correctly" (your current argument) when all of the current high-quality evidence suggests otherwise doesn't inspire confidence in those of us who actually use the scientific method.

classichasclass 3y ago
Are you actually suggesting we should have surgeons unmask in an operating theatre and see if the rate of post-op infections go up? I'd like to see that get through an IRB. This is the same mentality that says every current vaccination should be compared against saline placebo.
- Sporktacular 3y ago
  No, I think they're more saying that until studies prove with certainty that surgical masks work with 100% effectiveness, doctors should not feel the inconvenience of having to wear them.
  - classichasclass 3y ago
    The specific claim quoted was for surgeons, though. I don't see how this can be tested without having them mask off in the OR.
    - Sporktacular 3y ago
      True, but I don't see them proposing something so irresponsible by a surgeon. Just everyone else.
- NoPie 3y ago
  Actually we could. Maybe we won't do such studies because they are irrelevant because avoiding spitting into the surgical opening is a reason good enough. But then we cannot claim that masks during the surgery prevent the spread of airborne viral diseases. But if we needed to guard for them and the good evidence is lacking, then not testing would be unethical. Yes, even covid vaccine today could be compared with placebo, for example, in children. Europe never mandated covid vaccine for children and today in the UK they cannot even get the vaccine unless in a risk group. The US however recommends covid vaccine for children without the evidence that it makes any difference today. It definitely should be tested in trials before such recommendations. I don't think that IRB would reject such studies. At the start of pandemic everybody was saying that doing human challenge trials by infecting healthy volunteers would be unethical. And yet the UK did them. The red tape takes time and I can understand that during pandemics we may need to act quickly and cannot test everything. But in principle we can and do need to all kinds of trials to obtain proper evidence.
  - classichasclass 3y ago
    As you say, COVID was an outlier because of the urgency of the situation and the newness of it. We don't have either situation with OR hygiene, and if we're wrong and OR masks actually are doing something preventive, then we would be doing harm to the patients involved relative to the inconvenience to the surgeon. The vaccine question was about vaccines in general, much as RFK Jr is talking about doing. Again, with the weight of long experience on how well they prevent diseases in mind, it would be unethical to expose a kid to that by giving them a placebo shot. Measles is pretty benign but not totally so. See a case of SSPE in your career and you'll never forget it.
    - NoPie 3y ago
      If we already have strong evidence that the current vaccine is effective, then I agree, we don't need to to do another placebo controlled studies. But very often in medicine we don't have any evidence besides our beliefs.
Sporktacular 3y ago
"All of the high quality evidence" If the claim masks don't work didn't come from the same people who said isolating didn't work, I might take them seriously. I might not just see it as motivated reasoning or another lame effort to discredit or cast suspicion on authorities. If it didn't come from the same conspiracists who see nefarious censorship everywhere or people who only see their personal rights being infringed over our social obligations to each other, I might take them seriously. Or I could take them seriously if they understood the risk of confirmation bias by cherry picking preferable information when credible contradicting studies or meta-studies exist (like this one that states "The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts." https://pubmed.ncbi.nlm.nih.gov/33431650/ https://pubmed.ncbi.nlm.nih.gov/33431650/ ). Or the risk of socially promoting that one-sided certainty. Or if they just understood the precautionary principle that if in the face of competing evidence, we could potentially all benefit from taking the more cautious approach at the risk of minor personal inconvenience, I might take them seriously. But I don't because they aren't serious people. And they aren't even slightly interested in applying the scientific method. And they don't realise they are in the loud, unreasonable minority who have a megaphone they would never have had before the Internet, and they don't feel obliged to use that power responsibly. With time and education I hope they will dwindle in number, or at least shut up a bit.
- NoPie 3y ago
  >> If the claim masks don't work didn't come from the same people who said isolating didn't work, I might take them seriously. It didn't. The claim came from Cochrane group. So, are you taking it seriously now?
  - Sporktacular 3y ago
    Yes. And the reasonable criticisms of it too. And the people I'm referring to continue to misinterpret the claim to twist it to their own ends. Individually masks reduce infections. En masse, even more so.
- timr 3y ago

by timr 3y ago

classichasclass 3y ago

Are you actually suggesting we should have surgeons unmask in an operating theatre and see if the rate of post-op infections go up? I'd like to see that get through an IRB. This is the same mentality that says every current vaccination should be compared against saline placebo.

Sporktacular 3y ago
No, I think they're more saying that until studies prove with certainty that surgical masks work with 100% effectiveness, doctors should not feel the inconvenience of having to wear them.
- classichasclass 3y ago
  The specific claim quoted was for surgeons, though. I don't see how this can be tested without having them mask off in the OR.
  - Sporktacular 3y ago
    True, but I don't see them proposing something so irresponsible by a surgeon. Just everyone else.
NoPie 3y ago
Actually we could. Maybe we won't do such studies because they are irrelevant because avoiding spitting into the surgical opening is a reason good enough. But then we cannot claim that masks during the surgery prevent the spread of airborne viral diseases. But if we needed to guard for them and the good evidence is lacking, then not testing would be unethical. Yes, even covid vaccine today could be compared with placebo, for example, in children. Europe never mandated covid vaccine for children and today in the UK they cannot even get the vaccine unless in a risk group. The US however recommends covid vaccine for children without the evidence that it makes any difference today. It definitely should be tested in trials before such recommendations. I don't think that IRB would reject such studies. At the start of pandemic everybody was saying that doing human challenge trials by infecting healthy volunteers would be unethical. And yet the UK did them. The red tape takes time and I can understand that during pandemics we may need to act quickly and cannot test everything. But in principle we can and do need to all kinds of trials to obtain proper evidence.
- classichasclass 3y ago
  As you say, COVID was an outlier because of the urgency of the situation and the newness of it. We don't have either situation with OR hygiene, and if we're wrong and OR masks actually are doing something preventive, then we would be doing harm to the patients involved relative to the inconvenience to the surgeon. The vaccine question was about vaccines in general, much as RFK Jr is talking about doing. Again, with the weight of long experience on how well they prevent diseases in mind, it would be unethical to expose a kid to that by giving them a placebo shot. Measles is pretty benign but not totally so. See a case of SSPE in your career and you'll never forget it.
  - NoPie 3y ago
    If we already have strong evidence that the current vaccine is effective, then I agree, we don't need to to do another placebo controlled studies. But very often in medicine we don't have any evidence besides our beliefs.

Sporktacular 3y ago

"All of the high quality evidence" If the claim masks don't work didn't come from the same people who said isolating didn't work, I might take them seriously. I might not just see it as motivated reasoning or another lame effort to discredit or cast suspicion on authorities. If it didn't come from the same conspiracists who see nefarious censorship everywhere or people who only see their personal rights being infringed over our social obligations to each other, I might take them seriously. Or I could take them seriously if they understood the risk of confirmation bias by cherry picking preferable information when credible contradicting studies or meta-studies exist (like this one that states "The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts." https://pubmed.ncbi.nlm.nih.gov/33431650/ https://pubmed.ncbi.nlm.nih.gov/33431650/ ). Or the risk of socially promoting that one-sided certainty. Or if they just understood the precautionary principle that if in the face of competing evidence, we could potentially all benefit from taking the more cautious approach at the risk of minor personal inconvenience, I might take them seriously. But I don't because they aren't serious people. And they aren't even slightly interested in applying the scientific method. And they don't realise they are in the loud, unreasonable minority who have a megaphone they would never have had before the Internet, and they don't feel obliged to use that power responsibly. With time and education I hope they will dwindle in number, or at least shut up a bit.

NoPie 3y ago
>> If the claim masks don't work didn't come from the same people who said isolating didn't work, I might take them seriously. It didn't. The claim came from Cochrane group. So, are you taking it seriously now?
- Sporktacular 3y ago
  Yes. And the reasonable criticisms of it too. And the people I'm referring to continue to misinterpret the claim to twist it to their own ends. Individually masks reduce infections. En masse, even more so.
timr 3y ago