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by DanBC 2209 days ago
In healthcare there's a bunch of stuff that sounds plausible, and then we do the research, and we find that it doesn't help or it causes harm.

Evidence based medicine isn't there to stop crystal healing. It's there to work out whether knee arthroscopy is better than placebo. (For some patients it isn't).

Masks have a plausible mechanism of action. But they also have plausible mechanisms of harm: they may reduce social distancing; people touch their face more often when wearing a mask; most people don't know how to put on or take off the masks; most people don't have a safe place to store the mask when it's not being worn; etc. We don't know if the benefits outweigh the risk, because we don't have good quality evidence yet.

Here's some papers:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

> Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty).

Here they say that distancing does work. But when talking about N95 masks they only say "could" work, and for cloth masks they say they have low certainty. Later in the paper they say they need more and better evidence for masks.

https://www.publish.csiro.au/hc/pdf/HC15950

Have a look at the table on page 2. They've looked at RCTs and they've found no benefit for masks. They go back and look at other data and they claim to find a benefit, which is why masks are recommended for HCPs.

When you say "it's transmitted by inhaled droplets" you didn't say how it's caught, and here it's clear that you think it's by breathing in those droplets. That's one route. The other is via the eye. Or the droplets land on surfaces and are transferred by hand to the eye or nose or mouth.

https://www.cmaj.ca/content/188/8/567

> Transmission of acute respiratory infections occurs primarily by contact and droplet routes, and accordingly, the use of a surgical mask, eye protection, gown and gloves should be considered appropriate personal protective equipment when providing routine care for a patient with a transmissible acute respiratory infection.

When someone coughs the droplets are expelled in a range of sizes. Some of these are trapped by cloth masks, but not all.

https://www.cidrap.umn.edu/news-perspective/2020/04/data-do-...

1 comments

The Lancet's credibility is kind of in the toilet right now thanks to publishing that Hydroxychloroquine study that appears to have had the data pulled from thin air
> The Lancet's credibility is kind of in the toilet right now thanks to publishing that Hydroxychloroquine study

This statement is utterly absurd. The credibility of an entire scientific journal with nearly 200 years of operation is not shaken by accepting a scientific paper that after being subjected to peer review didn't held to scrutiny.

This line of critisicm reveals a profound ignorance regarding the whole scientific establishment. I mean, only someone entirely ignorant and oblivious to the whole scientific process would assume that passing the review stage of a scientific journal is a rubber-stamp of approval that all observations and ideas and conclusions represent the final and unquestionable proof. That's now how it works. Papers are published to expose ideas to peers and thus subject them to scrutiny. Some ideas don't pan out, some might be misguided, and there might even be some instances of straight pure scientific fraud. But that's not what the aim of the acceptance process, is it?

The upside of this sort of case is that suddenly we have random people caring about science and the scientific process. It's a shame though that they don't educate themselves on the very basics and instead are more interested in dragging institutions through the mud.

It looks bad right now, yes, but Lancet and NEJM both had the two studies retracted, and both will carry their reputation.

Retractions happen in all sorts of journals. Sadly, they will keep happening. Journals need to impose a page limit, alas a paper cannot describe its methodology down to every last detail, peer review can only do so much when you have bad actor intent on passing through.

This blip aside, it doesn't take away the fact NEJM and Lancet both have a history of being great sources of information, indeed they are still _the_ place doctors go to to get informed. I don't see that changing.