In Science, Things do not “work” Unless the Evidence Can be Consistently and Repeatedly Shown to Support the Claim
Real science is never settled, and anyone who has certainty on such things is not qualified to discuss it.
An MD writes in reference to the substack article by Vinay Prasad below, which critiques Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses.
Anon MD writes:
The acronyms EBM and RCT stand for Evidence-Based Medicine and Random Clinical Trial. These continue to be the gold standards for what we should adopt or abandon in medicine. Behind these are a large group of statistical interpretations , with rankings as to quality of data, size of study, and surety of conclusions, among other things.
All of this stuff can and sadly does get manipulated by people, docs, researchers, politicians, etc to try and influence a policy or behavior or treatment protocol based on this stuff.
The data on masking has gotten so intertwined and obscured by political agendas from all directions that its hard to objectively figure anything out anymore. Frankly I think we now have better solid info on ivermectin and hydroxychloroquine than we do on masking.
I am a firm believer in RCTs, and RCTs for much more than medicine. But there’s always some jerk who wants to put their finger on the scales and someone who will refuse the evidence of even a statistically perfect and controlled RCT. Politicians I think are the worst, but there are many many other groups fighting for second place.
It seems so simple. Do the RCT, share the results in an open forum and if the assumption is disproved, abandon and move on. Ha! Like that is ever going to routinely happen. No one trusts anyone anymore, politicians and those with an axe to grind must always be right, and government institutions all routinely lie for their institutional benefit (and have done so since government was invented).
What we need are Shroedinger politicians who can be both right and wrong on both sides of an issue at the same time. If you do the mathematical logic analysis you can show that no matter what they will always be right. That should make them happy and sure to be elected.
God help the rest of us.
...I thought a lot about what I said and I do think the research process more in the US than anywhere else has become corrupted by those with power and a financial stake. Add on top of that the concept that lies and BS are protected free speech under the Constitution and there is no integrity left. My parents were scientists and I grew up in that world. The federal government more than any other payer funded open research regardless of the potential outcome. Pretty much the only directed research was military. As the years have passed, the government a) wants positive results only, b) only wants positive results in the topics congress is interested in, and c) if they had their way all research would be funded by private enterprise rather than taxpayer dollars.
Segue to today and that’s what we’ve got. Yes, Big Pharma and Big Ag fund research. But if a thread shows something that doesn’t prove their monied supposition, or even worse, totally disproves it, that research will never see the light of day and the researchers and their teams are all constrained under watertight NDAs that threaten their livelihood if not very existence if they so much as fart the wrong way. About the only time something will wiggle its way out is if there is a lawsuit and the discovery involves volumes of seemingly useless material that gets scanned by a smart junior attorney with time on their hands and finds an ill-advised or thought-to-be private Post-It note or email thread. Either that or someone spills the beans on their deathbed 50 years after the fact.
WIND: this communication above caught my special attention in light of recent communication a COVID front-line physician who dismisses the Cochrane study.
The viewpoint difference between doctors is striking. And some still think studies they read in ideological journals like Nature are credible—as if there is impartial judgment on submitted articles—nothing works like that, not in science, not anywhere.
2023-03-15, by Vinay Prasad. Emphasis added.
A Cochrane Report Tells the Truth, But Many Are not Ready to Hear It
Recently, Cochrane & the internet has blown up over the Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses report — specifically the masks portion— and it has already become another riving chapter in the EBM history books. Here, I walk you through the play by play, and leave you with a 5 take home lessons.
The latest update of the Cochrane Report came out on Jan 30, 2023. The first author is Tom Jefferson, who has worked on this protocol since 2006 (remember… 2006). Cochrane, once again, examined all the randomized trials of masking, and came to 2 main conclusions. Let me quote them.
“Compared with wearing no mask in the community studies only, wearing a mask may make little to no difference in how many people caught a flu-like illness/COVID-like illness (9 studies; 276,917 people); and probably makes little or no difference in how many people have flu/COVID confirmed by a laboratory test“
“More high‐quality RCTs are needed to evaluate the most effective strategies to implement successful physical interventions in practice, both on a small scale and at a population level. It is very unfortunate that more rigorous planning, effort and funding was not provided during the current COVID‐19 pandemic towards high‐quality RCTs of the basic public health measures.”
In my words:
- the best data fails to show a benefit, and
- we needed more trials. Too bad you all (CDC, WHO, and NIAID) f*&D that up. If that sounds familiar, it is because I said that: here and here and here and hereand here, pretty much all damn pandemic, I was a broken record and said just that, over and over.
How did I come to the same conclusion as Cochrane?
Because anyone worth their salt in EBM would reach that same conclusion. It is basic critical appraisal and reading. I even published my own review, which is one of those links above.
After the report came out, the criticism was immediate. Mask advocates claimed that the report did not prove masks don’t work, but just failed to find benefit. They said a large confidence interval meant that masks could work. The absence of evidence is not evidence of absence.
The problem with this argument was that this is a new standard— just for masks. I pointed out that medicine often abandons practices if RCTs fail to find benefit, even as the lower bound of the 95% CI is compatible with values that would constitute benefit. I show that here and here. Using 2 disparate examples.
Tom Jefferson himself gave an interview. In that interview he dropped this bombshell:
“In early 2020, when the pandemic was ramping up, we had just updated our Cochrane review ready to publish…but Cochrane held it up for 7 months before it was finally published in November 2020.” He added: [WIND: ovvious signs of inappropriate machinations]
...In other words, it is clear, Cochrane leadership was meddling with the Cochrane review. The unspoken message was clear: They did not want people saying masks lack evidence.
In conclusion, Cochrane’s EIC has disgraced herself, mask advocated sabotaged the conduct of RCTs now claim they wanted more, and Tom Jefferson might be one of the last principled scientists around. Now read the actual review and learn some EBM.
WIND: I stand by my position that I asserted more than two years ago after first recommending masks, until solid repeatable evidence shows otherwise: masks as worn by the public were and are ineffective.
Further, I hypothesize that under some circumstances (hyper common!), the filthy and/or inappropriately handled and/or reused and/or poorly-fitted masks might increase transmission. That is not supported by any evidence yet, but the real-world mask usage I saw makes it my default operating assmption.
The whole “it’s for your own good” approach to science has killed millions, and I am talking about science before COVID. Human nature never changes, and institutions seem only to decline in integrity.