[astrange]

It is a good example of it, eg anything American doctors would’ve told you about wearing face masks was wrong until it wasn’t (and the CDC director is still telling people not to wear N95s), they still give terrible diet advice like telling diabetics to eat more carbs, and so on. Doctors are quite bad at making reasonable decisions when they don’t have an RCT in front of them.

[prepend]

> CDC director is still telling people not to wear N95s

This is an interesting point. The statement I read from her is saying that N95s are hard to wear for long periods of time, so people will wear them improperly. So the overall adherence is higher with cloth coverings and have a net higher benefit.

She’s not saying “don’t wear n95s” she’s saying “we don’t recommend it because...”

This is an important distinction.

Also N95s have to be fit tested to be effective. So randos buying N95s and wearing them will frequently not work.

[astrange]

> Also N95s have to be fit tested to be effective. So randos buying N95s and wearing them will frequently not work.

That was the excuse doctors were giving me in March that they all suddenly dropped. Are N95s without perfect fits worse than cloth masks, which don't have fit tests either? Are they better than no masks? Was Facebook wrong to stock up on N95s for employees during wildfire season?

> So the overall adherence is higher with cloth coverings and have a net higher benefit.

This is one of the worst things public health experts seemed to just be totally wrong about. They were obsessed with "risk compensation", where if you make things safer in the wrong way people will act riskier so it doesn't help. But this doesn't actually seem to happen.

[prepend]

> Are they better than no masks?

This is the important question. Well are they? I’ve seen a lot of people wearing N95s and almost every one of them are wearing them incorrectly. Is this better than a cloth mask? I don’t know. But having huge gaps on the bridge of one’s nose where air flows is really bad to reduce risk. And my favorite is seeing them work with beards that prevent a seal.

I can’t find any tests of cloth mask vs bad n95. Saying “common sense” as the reason is not a compelling reason to try to get 300M people doing something.

[VectorLock]

>Also N95s have to be fit tested to be effective. So randos buying N95s and wearing them will frequently not work.

I don't think this is true. No box of 3M N95 masks I've ever bought has said anywhere "failure to fit test this mask renders it ineffective." 3M Aura masks have an instruction video on how to maximize the fit, but thats just a bit on how best to adjust the little metal bit that clamps around the nose.

An ill-fit N95 that might not be perfectly adjusted to conform is still way better than a cloth mask which isn't intended to seal at all.

[prepend]

Not completely ineffective, but ineffective at filtering the designed 95%. Here’s NIOSH’s page [0] defining fit testing and why it’s important. You don’t see this warning because it’s on NIOSH’s site, just like you don’t see the definition of all the stuff and just have the certification is for your test.

Some masks are just incompatible with some faces, it’s greaT that Aura’s have an instruction video, that doesn’t mean it will work for all people.

> An ill-fit N95 that might not be perfectly adjusted to conform is still way better than a cloth mask which isn't intended to seal at all.

I think you’re probably right. But I don’t know of a study that tests this because N95s are measured as conforming to spec, not when they are worn improperly without a seal at the nose and chin. I hope we get some info on this.

The Dirextors (and Fauci’s) comments weren’t about this though, they mentioned how N95s are uncomfortable and thus hard to wear consistently. Try wearing an N95 for 6 hours of school. Especially without training. I think the recommendation for cloth masks is because of the ability for people to wear them.

So the recommendation is not based around optimal standards of use, but around likely use.

This doesn’t mean that N95s don’t protect people. I wear them in public. I’m just trying to correct GP’s criticism that someone the CDC director’s comments are incorrect or illogical.

[0] https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part...

[chosen1111]

thank you for your candid and informative reply

i always find it fascinating to hear people's take on science and medicine

especially when conclusions that have weight reach politically hazardous territory

[Dirlewanger]

Yup. Your average PCP/internist is good at one thing: analyzing your symptoms and directing you toward someone who actually can help you.

Not saying that a yearly check-up isn't beneficial (it is), just that they shouldn't be prescribing Type 2 diabetes medications on the spot (and getting kickbacks) and instead should tell the patient to stop stuffing their faces so much.

[astrange]

Well, the advice specifically is more like "dear Type 2 diabetics, don't forget that if you eat less than 200g of carbs every day, you'll die of heart attacks from that evil saturated fat".