6 ms·

Things seem "obvious" until the best available evidence doesn't support them. As a physician, I had a hard time understanding the ferocity with which some of m

Things seem "obvious" until the best available evidence doesn't support them. As a physician, I had a hard time understanding the ferocity with which some of my colleagues defended the "science" of masking when the Cochrane review(s) -- largely held to be the pinnacle of evidence-based-medicine -- were so underwhelming. I never had a problem with people arguing for them based on face validity (hehe), personal preference, that they "might" help, were "better than nothing," or any number of softer reasons. Don't get me wrong -- as a physician I wore an N95 every shift, because I believe that the odds that they might help were much greater than the odds that they might harm. (And because my hospital's N95s are much more comfortable for me than our surgical masks, and other trivial reasons.) But I had a hard time finding other physicians who were both steadfastly convinced of the incredible benefits of masking and also had taken any time to try to find or read the available literature on the topic. https://www.cochrane.org/news/featured-review-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses https://www.cochrane.org/news/featured-review-physical-inter... > Medical or surgical masks > > Seven studies took place in the community, and two studies in healthcare workers. Compared with wearing no mask, wearing a mask may make little to no difference in how many people caught a flu-like illness (9 studies; 3507 people); and probably makes no difference in how many people have flu confirmed by a laboratory test (6 studies; 3005 people). Unwanted effects were rarely reported, but included discomfort. > > N95/P2 respirators > > Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people) or respiratory illness (3 studies; 7799 people). Unwanted effects were not well reported; discomfort was mentioned.

aredox 2y ago
The Cochrane review is underwhelming because it is mediocre[0]. And its main author is far from dispassionate: "The study's lead author, Tom Jefferson of the University of Oxford, promoted the misleading interpretation. When asked about different kinds of masks, including N95s, he declared, “Makes no difference—none of it.” In another interview, he called mask mandates scientifically baseless." When the main author is misleading about the conclusions of his own report, you have to wonder how good his work was. But if you want just arguments over data rather than doubting Jefferson on a personal basis, this paper[1] makes a compelling argument that the RCTs in the Cochrane review itself are good enough to make the argument masking works. GAVI has also a good answer to Cochrane[2]. [0] https://archive.ph/FlApv https://archive.ph/FlApv [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484132/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484132/ [2] https://www.gavi.org/vaccineswork/yes-masks-reduce-risk-spreading-covid-despite-review-saying-they-dont https://www.gavi.org/vaccineswork/yes-masks-reduce-risk-spre...
- n8henrie 2y ago
  > The Cochrane review is underwhelming because it is mediocre I would consider the article you're referencing less than mediocre. "The Cochrane review didn't show what we expected it would show because their standards are too high." They are not conflating "absence of evidence" -- readers are. I think it's odd how often people reference the Bangladesh study as evidence supporting masks, apparently without having read it. Ultimately, I think masks probably do have a statistically significant benefit. I also think that if the rigorous studies (yes, I mean mostly RCTs) to date have been underpowered to show this benefit, that the effect size is likely to be small enough to make the costs of bickering potentially nullify those benefits. I still wear an N95 every shift.

aredox 2y ago

The Cochrane review is underwhelming because it is mediocre[0]. And its main author is far from dispassionate: "The study's lead author, Tom Jefferson of the University of Oxford, promoted the misleading interpretation. When asked about different kinds of masks, including N95s, he declared, “Makes no difference—none of it.” In another interview, he called mask mandates scientifically baseless." When the main author is misleading about the conclusions of his own report, you have to wonder how good his work was. But if you want just arguments over data rather than doubting Jefferson on a personal basis, this paper[1] makes a compelling argument that the RCTs in the Cochrane review itself are good enough to make the argument masking works. GAVI has also a good answer to Cochrane[2]. [0] https://archive.ph/FlApv https://archive.ph/FlApv [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484132/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10484132/ [2] https://www.gavi.org/vaccineswork/yes-masks-reduce-risk-spreading-covid-despite-review-saying-they-dont https://www.gavi.org/vaccineswork/yes-masks-reduce-risk-spre...

n8henrie 2y ago
> The Cochrane review is underwhelming because it is mediocre I would consider the article you're referencing less than mediocre. "The Cochrane review didn't show what we expected it would show because their standards are too high." They are not conflating "absence of evidence" -- readers are. I think it's odd how often people reference the Bangladesh study as evidence supporting masks, apparently without having read it. Ultimately, I think masks probably do have a statistically significant benefit. I also think that if the rigorous studies (yes, I mean mostly RCTs) to date have been underpowered to show this benefit, that the effect size is likely to be small enough to make the costs of bickering potentially nullify those benefits. I still wear an N95 every shift.