[cthalupa]

It isn't a political issue to not do studies that require doing things that actively and intentionally put people at things we know are highly likely to put them at risk of physical harm. The world decided this was unethical long before the current political climate.

[angelzen]

In masks + covid context it feels like "unethical" is used as a thought terminating cliche.

* The pandemic is affecting 8,000,000,000 people all around the world. A large size RCT enrolls X0,000 participants. For example, the Pfizer covid mRNA vaccine clinical trial had 21,728 placebo participants. For every RCT participant, the RCT results are going to inform the course of action for hundreds of thousands of people. This is to say that such RCTs are extremely valuable given the high infectiousness of the virus.

* The risk to the participants is at worst a moderate increase in the chance of being infected with covid. The covid fatality risk to a healthy adult is small. In the US there have been about 50,000 deaths with covid in <50yo age group. An RCT with 20,000 <50yo people on the placebo arm may see about 3 covid deaths assuming all the placebo participants are going to be infected. Realistically, only a fraction of participants are going to actually be infected with covid, thus there is a good chance every single one of the RCT participants will continue their lives just fine, especially if the study designers are careful to not include people with serious comorbidities.

* Vaccines are available to reduce the death risk by another order of magnitude if deemed necessary. Alas, while the vaccines have strong effects in preventing serious covid, they only have a middling effect on preventing infections [edit: after a few months]. The mask/no mask infection effect remains measurable.

* Covid is endemic. Everyone is at risk to to be infected with covid sooner or later. Wearing a mask may decrease the daily risk by a moderate margin, unfortunately integrated over many days the infection probability approaches 1. The RCT is merely speeding the risk by a moderate margin for the placebo arm participants.

* There is a large pool of potential volunteers that don't (want to) wear masks anyways. Adults have the right to volunteer for risky activities, including activities that may result in death.

[cthalupa]

This is a well written argument, and I don't disagree with the majority of it. However, there is one key point that I do disagree with, and makes the rest of it moot:

>* There is a large pool of potential volunteers that don't (want to) wear masks anyways. Adults have the right to volunteer for risky activities, including activities that may result in death.

This is certainly true. But the difference is that once we begin performing medical studies that ask this of people, the medical industry is now complicit in adults performing risky activities that may result in death and is asking people to do so, or if doing so, to do so for the benefit of medical research. This is a line that has not been crossed by the modern medical research industry as it has been long decided that this extra pressure, however small, is a lever they do not want to pull because it is fundamentally incompatible with 'Do no harm.'

It isn't 'do no harm, except a little when we think it might outweigh the downsides'

It's a line I don't think we should cross. I understand why someone would disagree with that.

[angelzen]

The null hypothesis is the natural state of humanity, without medical intervention.

[lern_too_spel]

The hypothesis for why masks work is due to the laboratory-measured reduction in transmission from the host. The only way to test this is to have a large population where most do not wear masks or most do wear masks. You will not find enough volunteer to make such a test possible. Individual mask wearing does not test this hypothesis.

[timr]

This is a fantastic comment. Thank you for breaking it down.

[GekkePrutser]

But what if those people volunteer?

[vishho]

I feel like I am going insane. Pure psychopathy or scientism to want randomized controls for studying infection of a deadly virus. Absolutely disgusted. No wonder we had a lab-leak...