6 ms·

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 y

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.

jMyles 3y ago
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?
- gadders 3y ago
  And to be fair to Jefferson and Heneghan they have repeatedly called for proper RCTs to be run.
  - jMyles 3y ago
    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.
    - jMyles 3y ago
      * researchers and clinicians
- autoexec 3y ago
  > 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;" That sentence is not in question. It doesn't exist anywhere in the review. Please read the review yourself. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... Here is the link to the full PDF: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/pdf/full/en https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... 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." You can find that here: https://www.cochrane.org/news/featured-review-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses https://www.cochrane.org/news/featured-review-physical-inter... > 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.ED000149/full 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.
gadders 3y ago
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.
- autoexec 3y ago
  > 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.
  - gadders 3y ago
    Please show me the changes made to the report in response to the editor's political intervention.

jMyles 3y ago

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?

gadders 3y ago
And to be fair to Jefferson and Heneghan they have repeatedly called for proper RCTs to be run.
- jMyles 3y ago
  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.
  - jMyles 3y ago
    * researchers and clinicians
autoexec 3y ago
> 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;" That sentence is not in question. It doesn't exist anywhere in the review. Please read the review yourself. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... Here is the link to the full PDF: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/pdf/full/en https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... 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." You can find that here: https://www.cochrane.org/news/featured-review-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses https://www.cochrane.org/news/featured-review-physical-inter... > 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.ED000149/full 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.

gadders 3y ago

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.

autoexec 3y ago
> 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.
- gadders 3y ago
  Please show me the changes made to the report in response to the editor's political intervention.