[Sporktacular]

"We had no evidence that masks help and then we found no evidence."

Actually we did from the decades surgeons wore masks to prevent the spread of airborne diseases. Once we knew Covid was one of them, then even if the protection was one way, it would have reduced infections if everyone wore one.

[timr]

> Actually we did from the decades surgeons wore masks to prevent the spread of airborne diseases.

Funny you should say that. There were randomized controlled trials on exactly this question prior to 2020. Guess what the outcomes were?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480558/

(Notably, this review is from 2015...it is not subject to the ridiculous politics of Covid.)

> However, overall there is a lack of substantial evidence to support claims that facemasks protect either patient or surgeon from infectious contamination. More rigorous contemporary research is needed to make a definitive comment on the effectiveness of surgical facemasks.

Also, rather (in)famously, a review saying the same thing was censored from the web in spring 2020, because...reasons.

While I'd personally love to see extensive, rigorous investigation of this question, simply repeating "masks work", or "people didn't do it correctly" (your current argument) when all of the current high-quality evidence suggests otherwise doesn't inspire confidence in those of us who actually use the scientific method.

[Sporktacular]

"All of the high quality evidence"

If the claim masks don't work didn't come from the same people who said isolating didn't work, I might take them seriously. I might not just see it as motivated reasoning or another lame effort to discredit or cast suspicion on authorities.

If it didn't come from the same conspiracists who see nefarious censorship everywhere or people who only see their personal rights being infringed over our social obligations to each other, I might take them seriously.

Or I could take them seriously if they understood the risk of confirmation bias by cherry picking preferable information when credible contradicting studies or meta-studies exist (like this one that states "The preponderance of evidence indicates that mask wearing reduces transmissibility per contact by reducing transmission of infected respiratory particles in both laboratory and clinical contexts." https://pubmed.ncbi.nlm.nih.gov/33431650/ ). Or the risk of socially promoting that one-sided certainty.

Or if they just understood the precautionary principle that if in the face of competing evidence, we could potentially all benefit from taking the more cautious approach at the risk of minor personal inconvenience, I might take them seriously. But I don't because they aren't serious people. And they aren't even slightly interested in applying the scientific method.

And they don't realise they are in the loud, unreasonable minority who have a megaphone they would never have had before the Internet, and they don't feel obliged to use that power responsibly. With time and education I hope they will dwindle in number, or at least shut up a bit.

[ifyoubuildit]

I was curious what an llm might think about this comment:

> Please rate the following comment from 1 to 5 on how rational it is, how emotional it is, and whether or not the author is making a strong or weak argument:

> Rationality: 3/5 - The author presents a reasoned argument supported by a reference to a scientific study. However, the argument is somewhat undermined by a lack of direct engagement with specific counter-arguments and a generalizing tone about those who hold opposing views.

Emotionality: 4/5 - The comment is emotionally charged, especially in its dismissive tone towards those who disagree with the author's perspective. The language used ("lame effort," "shut up a bit") indicates a strong emotional investment in the topic.

Strength of Argument: 3/5 - The argument is moderately strong. It relies on a credible source and logical principles like the precautionary principle and the risk of confirmation bias. However, it is weakened by broad generalizations about the opposing side and a lack of specific rebuttals to their claims.

That lines up pretty well with how I perceived that. There is a lot of emotion and broad generalizations in these conversations. Is anyone changing their minds about any of this after 4 years of digging into their positions?

[Sporktacular]

"Is anyone changing their minds about any of this after 4 years of digging into their positions?"

LLMs probably don't understand that not everyone is intellectually honest, that conspiracists who ignore a preponderance of expert evidence to insist on their own positions, generally feed on the attention. I'd say that in countering that, sarcasm, caricature and calling attention to the absurdity of their arguments can be more persuasive to others than watching two non-experts debate specific points while carefully select papers ad nauseam. I'd guess others might even identify with the emotion of a commenter's frustration that after years of evidence, discredited positions that unnecessarily risked people's lives continue to be retold.

And I'd hope that others would recognise the expert consensus that masks are effective at scale in flattening the curve, buying time to develop vaccines and hence saving lives, and see the importance of reason over a choice of linguistic flourish. Maybe since an LLM can't understand how sick of the post-truth era we've become you'd want to weigh in on the discussion itself.

[peyton]

My understanding is that flattening the curve was an argument in favor of social distancing and movement restrictions. It predates mask mandates. A properly trained LLM would miss your masking reasoning. See

https://www.nytimes.com/article/flatten-curve-coronavirus.ht...

The bigger problem is an LLM doesn’t have access to things that aren’t written down. Although it may see a bunch of publications popping up declaring “pain is the fifth vital sign” and a bunch of new pain management CME courses, it cannot see the pharmaceutical reps showing up at doctors’ offices to sell Oxycontin.

[Sporktacular]

"flattening the curve was an argument in favor of social distancing and movement restrictions."

I think all those measures in combination were part of an effort to avoid overwhelming hospitals. From https://www.factcheck.org/2023/03/scicheck-what-the-cochrane...

“Community masking is not aimed to prevent everyone from ever getting infected, the aim is to reduce transmission and ‘flatten the curve’, reducing peak healthcare demand, or to work in combination with other measures like social distancing to contain transmission in the short-term.”

[timr]

The Masks4all paper (your link) is neither credible, nor is it a study. It should never have been published.

It is a mashup of a literature review with a bad methodology, and a simulation that adds no new information to the debate. It excludes and/or minimizes randomized clinical trial data when that data doesn't support the desired narrative.

For those who might read this later, the Cochrane collaboration published a high-quality review of masking literature:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

[Sporktacular]

That's one paper out of dozens, feel free to pick another.

“Many commentators have claimed that a recently-updated Cochrane Review shows that ‘masks don’t work’, which is an inaccurate and misleading interpretation,” Dr. Karla Soares-Weiser, the editor-in-chief of the Cochrane Library, said in a March 10 statement. https://www.factcheck.org/2023/03/scicheck-what-the-cochrane...

It's not particularly conclusive, whereas many other sources point to a small increase in protection. Which is important at scale.

[NoPie]

>> That's one paper out of dozens, feel free to pick another.

It is not. It is the review of all available evidence (studies).

[timr]

I picked one. Did you read it, or did you just read the factcheck.org link?

[Sporktacular]

I read a few, none of which seem to be above some criticism. Which is why I'm inclined to let more qualified people synthesise and summarise it all. You however seem certain that you know better than the consensus which is that there is a small advantage to mask usage. But you haven't demonstrated why. Are you an epidemiologist? Serious question.

[NoPie]

>> If the claim masks don't work didn't come from the same people who said isolating didn't work, I might take them seriously.

It didn't. The claim came from Cochrane group.

So, are you taking it seriously now?

[Sporktacular]

Yes. And the reasonable criticisms of it too. And the people I'm referring to continue to misinterpret the claim to twist it to their own ends.

Individually masks reduce infections. En masse, even more so.

[classichasclass]

Are you actually suggesting we should have surgeons unmask in an operating theatre and see if the rate of post-op infections go up? I'd like to see that get through an IRB. This is the same mentality that says every current vaccination should be compared against saline placebo.

[NoPie]

Actually we could. Maybe we won't do such studies because they are irrelevant because avoiding spitting into the surgical opening is a reason good enough. But then we cannot claim that masks during the surgery prevent the spread of airborne viral diseases.

But if we needed to guard for them and the good evidence is lacking, then not testing would be unethical.

Yes, even covid vaccine today could be compared with placebo, for example, in children. Europe never mandated covid vaccine for children and today in the UK they cannot even get the vaccine unless in a risk group. The US however recommends covid vaccine for children without the evidence that it makes any difference today. It definitely should be tested in trials before such recommendations.

I don't think that IRB would reject such studies. At the start of pandemic everybody was saying that doing human challenge trials by infecting healthy volunteers would be unethical. And yet the UK did them. The red tape takes time and I can understand that during pandemics we may need to act quickly and cannot test everything. But in principle we can and do need to all kinds of trials to obtain proper evidence.

[classichasclass]

As you say, COVID was an outlier because of the urgency of the situation and the newness of it. We don't have either situation with OR hygiene, and if we're wrong and OR masks actually are doing something preventive, then we would be doing harm to the patients involved relative to the inconvenience to the surgeon.

The vaccine question was about vaccines in general, much as RFK Jr is talking about doing. Again, with the weight of long experience on how well they prevent diseases in mind, it would be unethical to expose a kid to that by giving them a placebo shot. Measles is pretty benign but not totally so. See a case of SSPE in your career and you'll never forget it.

[NoPie]

If we already have strong evidence that the current vaccine is effective, then I agree, we don't need to to do another placebo controlled studies. But very often in medicine we don't have any evidence besides our beliefs.

[Sporktacular]

No, I think they're more saying that until studies prove with certainty that surgical masks work with 100% effectiveness, doctors should not feel the inconvenience of having to wear them.

[classichasclass]

The specific claim quoted was for surgeons, though. I don't see how this can be tested without having them mask off in the OR.

[Sporktacular]

True, but I don't see them proposing something so irresponsible by a surgeon. Just everyone else.

[indymike]

> Actually we did from the decades surgeons wore masks to prevent the spread of airborne diseases.

I remember asking my dad (who was a doctor who performed surgeries - mostly c-sections and appendectomies - often) about masks, and his answer in the early 80s was interesting:

“It’s mostly to prevent me from getting spit into open wounds and incisions when I'm talking or I have to sneeze or cough. Bacteria is a real problem, and the mask stops that.”

I never really thought much of that until recently.

[classichasclass]

But you can see this go both ways. Ortho surgeons in total procedures have full air filtering due to the large amount of bone dust that's liberated, some of which are very fine particles. No one wants to breathe that in.

Meanwhile, I'll be in TB clinic shortly with an N95 mask on. I've yet to convert my TB test in 17 years.

We absolutely rely on surgical masks not to contaminate the field. But they don't have one way valves, so if we trust the airflow one way, it's logical to trust them for airflow going the other.

[generalizations]

>> “It’s mostly to prevent me from getting spit into open wounds and incisions when I'm talking or I have to sneeze or cough. Bacteria is a real problem, and the mask stops that.”

> so if we trust the airflow one way

Pedantic, but it matters: that's not airflow, that's droplets and spit.

[isolli]

Surgeons don't wear masks to prevent the spread of airborne diseases. They wear them to prevent spittle going into an open wound and to protect themselves from blood splatter.

If they wore masks to prevent airborne diseases, they would wear them when meeting patients, not just during the operation.

[sobani]

The difference is during a regular meeting, the skin is uncut. The skin is a major protection against diseases and the body has a bunch of mechanisms at its regular openings (nose, ears, etc) to protect you.

When you cut through someones skin, you bypass one of the major first lines of defense. Therefor surgeons reduce the risks, for a similar reason why clean their tools before use.

[u32480932048]

One of my pet peeves is the continued use of ambiguous phrases like "masks work" or "masks help" when there are effectively two different mechanisms (inhalation/exhalation).

I suspect the prolonged mass confusion over such an elementary topic will be one for the Science Communicator books.

[titzer]

IMHO the issue is that masks work but masking as a social phenomenon can suffer a number of problems, like non-compliance, partial compliance, poor fit, children, misuse, reuse, damaged masks, cloth masks, needing to eat, and all kinds of factors. So scientific experiments in a controlled setting with one or two people show that masks work as a mechanism, but getting everyone to go along with and practice good masking etiquette might not work so well. So population studies show masks working much worse than their mechanism would suggest they can. Especially when there is intentional non-compliance and protests motivated by culture war battles.

Arguing with people who just spout "masks don't work" and then intentionally are non-compliant (and encourage others to) is like arguing with motivated idiots.

No, masks work, period. Masking only works if people freaking do it.

edit: spelling

[agos]

on the flip side, so much of the Covid discourse was about these fabled policies which would do great things (but required 100% compliance), followed by indignation/panic and hysteria/angry mobs when it turned out that 100% compliance is hard.

[Sporktacular]

We won't need 100% effectiveness and 100% compliance. If they only work at 10% effectiveness, then over a network of thousands, they will measurably save lives.

Studies have shown they work (such as https://pubmed.ncbi.nlm.nih.gov/33483277/), despite the 'ah, yes but only [insert unsupported caveat here]' of some.

[timr]

> No, mask work, period.

...on a mannequin, in a lab, or when used as a filter between two hamster cages. Perhaps. But there have now been plenty of negative studies in hospitals, which really starts to beg the question: if you can't get effective compliance in a hospital, where are you going to get it?

Just to be clear, I was with you right up until the part I quoted. It's fine to say that mechanistic studies show something to be true, but it's totally wrong to leap to the conclusion that these mean anything. If I tell you that you're 100% certain to lose weight if you stop eating, that's True ("Starving works. Period."), but it's not meaningful.

Every failed drug ever tested worked in a laboratory before it went to clinical trials.

[Sporktacular]

Except masks do work. Here:

https://pubmed.ncbi.nlm.nih.gov/33431650/ - "We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation." https://pubmed.ncbi.nlm.nih.gov/33370173/ - "Evidence suggests that the potential benefits of wearing masks likely outweigh the potential harms when SARS-CoV-2 is spreading in a community". Mentions the network effect. https://pubmed.ncbi.nlm.nih.gov/32497510/ - "Face mask use could result in a large reduction in risk of infection" https://www.mayoclinic.org/diseases-conditions/coronavirus/i...

"...on a mannequin, in a lab, or when used as a filter between two hamster cages. Perhaps." No, you are coping hard. The studies above are not done by idiots.

"if you can't get effective compliance in a hospital, where are you going to get it?" Nice pivot, but the subject is whether they work, which they do. Compliance is a different question. That's like arguing that condom effectiveness is low when people don't use them properly. And because the figure is low, let's just conclude condoms are ineffective so people should stop using them altogether.

"Every failed drug ever tested worked in a laboratory before it went to clinical trials." And some actually worked in trials. Your job is to explain which is the better analogy. That unanticipated practical considerations exist does not invalidate every conclusion you dislike.

However, even if masks work slightly, or not at all, even if there are dozens of studies saying so, there is enough conjecture to warrant wearing them anyway just in case. If two equally qualified mechanics disagree on whether to change your brakes, you change your damn brakes. If you don't that's stupid. If you don't and then drive a busload of people, that's criminal.

But masks do work, and they're cheap and barely an inconvenience. The problem is everyone thinks they're smarter than an epidemiologist. Thanks Internet.

[timr]

I'm not getting in an argument about this. You don't understand what you're reading, and you're cherry picking papers based on a poor understanding of data quality. I will say that your first link is the Masks4all (Jeremy Howard) paper, and it is not a reputable scientific publication. It doesn't follow a valid methodology for a literature review, and leaves out/minimizes major RCTs that don't support their pre-determined conclusions.

The second link is not a study, or a meta-review, and contributes nothing. The fourth link is not a scientific paper at all.

The third link is the WHO summary of masking data in mid-2020. It covers the same ground as the Cochrane review (below), but re-weights the data somewhat arbitrarily to achieve the stated conclusions.

The Cochrane review is the gold standard summary of the evidence for public masking, considers all published data, and includes/excludes/weights data based on a rigorous standard for statistical and experimental quality. Please read it.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

[Sporktacular]

You've not refuted anything about your own methodological error or conspiratorial bent, but just cast doubt on the sources I gave. We can do that all day. The Cochrane review is controversial and has pretty clearly been misinterpreted by some. Check out some of the commentary by doctors on FactCheck (https://www.factcheck.org/2023/03/scicheck-what-the-cochrane... - sources included):

- Aggregating the three studies together, he said, “they show a consistent and fairly convincing effect.”

- “Taken together, these two RCTs are consistent with a small reduction in risk,”

- "“To me, this shows that there is a reasonably clear modest benefit to community masking interventions during the COVID-19 pandemic, decreasing the rate of infections in groups of people who are given masks and told to wear them by ~13%," he said. “That’s quite an important benefit in the context of a pandemic.”

I'm not sure why you think your opinion on what constitutes a high quality source is somehow superior to that of the thousands of experts who have concluded otherwise. Unless you are also an epidemiologist and a scholar I'm not convinced your cherry picking is worth more than anyone else's. I'm okay with leaving things up to them. But even if you are, you're in the minority.

Point is: 1) a modest increase protection is amplified by a network effect. There is evidence pointing to that increase.

2) people's lives depend on this, so if there's any uncertainty, do the reasonable, socially responsible thing and put up with the minor inconvenience of a mask, just out of caution

3) I don't need to understand every source as I don't pretend to be an expert. We already have those (that presumably aren't all part of big-mask) and they can and should be trusted to fairly weigh up the available evidence and advise us.

Your motivation to conclude one way just seems irrational, suggesting you aren't an expert either.

[Sporktacular]

If masks only work one way and one infected person is in a train car with 10 uninfected people, then they all get protection if they all wear masks.