You are guilty of pushing the very misinformation that you claim to be against.
The review itself said:
‘Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness / Covid‐19-like illness compared with not wearing masks… Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza / SARS‐CoV‐2 compared with not wearing masks.’
The fact that the editor-in-chief of Cochrane embarrassed herself due to the pressure of an opinion-piece by a non-expert in the NYT is irrelevant.
If you think that Cochrane revises their reviews based on "pressure of an opinion-piece by a non-expert in the NYT" I doubt any amount of research will change your mind from what you've decided to believe. I think it's clear that Tom Jefferson was embarrassed at being called out for misinterpreting the evidence, but he's plainly wrong that she never provided a reason. She was clear that it was due to the "limitations in the primary evidence", something many others pointed out as well.
Cochrane didn't revise their review, neither did the author so I'm not sure where you imagined that. What happened was the the managing editor issued a statement in response to an NYT op-ed that criticised the review.
And there was no misinterpreting the evidence. He said that there is no evidence that masks work. You can't then say "yeah but there's only no evidence because all the evidence is low quality" because then you are effectively agreeing that there is no evidence.
If people are so confident masks work, do an RCT. That is how science is supposed to work, right? Not guessing something might work and doing it anyway.
> Cochrane didn't revise their review, neither did the author so I'm not sure where you imagined that.
That would have been the part where the editor in chief of the Cochrane Library said that they would, and then did. To quote (again):
She said that “this wording was open to misinterpretation, for which we apologize,” and that Cochrane would revise the summary.
> If people are so confident masks work, do an RCT. That is how science is supposed to work, right?
No it isn't. There are zero RCTs done for all kinds of things that we're confident work. There are many reason RTCs aren't always done. Reasons like "well understood physics" and "ethics" and "unfavorable signal to noise ratios" that would make doing them pointless at best, and harmful in the worst cases. RCTs are only a tool, and like all tools, they aren't appropriate or necessary in all circumstances.
Please, I beg for your sensibility and brief attention here. This issue continues to tear fissures in what seem like otherwise reasonable and literate communities.
The sentence in question is:
"Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants;"
This is very typical wording, and a very typical application of limited data, for a Cochrane review. There's nothing here that jumps out, on first read or after ingestion of all of the primaries, which I'm guessing we've all done multiple times.
I think we all agree with you (and thus, with Soares-Weiser) about the frustration (heck, downright confounding) resulting from the lack of evidence. Top experts from every one of the big 5 have repeatedly called for and proposed RCTs to solve this problem.
...but there is absolutely nothing wrong with looking at these data and concluding that, in each statistically-significant case, masking "probably makes little or no difference to the outcome of" ILI.
Is it possible that a larger, properly-powered RCT will find that some form of N95 application will have some effect on community transmission? Sure. We'd all love to know about that.
It it possible that a larger, properly-powered RCT will find a similar outcome from cloth masks? No. Not unless all of the current data on the matter is completely flawed.
Is it possible that even a small, properly-powered RCT will find statistically significant reductions in individual transmission from source control measures? Yes! That's possible! And that's the topic of this entire thread - we're talking about an individual patient largely confined to an iron lung.
Has that RCT been performed? No.
Can we all agree on at least these limited, well-defined assessments of the available data?
Of course. And John Ioannidis. And Jay Bhattacharya. And Martin Kulldorf. And Stefan Baral. And Sunetra Gupta. And Vinay Prasad. And dozens of other acclaimed researchers who represent the core of the incredible, laudable, essential, dear sciences of epidemiology and evidence-based medicine.
An entire generation of the top experts in these fields were sidelined, and the spotlight suddenly shifted to nervous second-stringers in order to present the appearance of a vibrant debate in front of profiteering media, piped into television screens in the waiting rooms of daycare centers where under-privileged two-year-olds were forced to put cloth across their face for no reason.
It's obvious to everyone, and yet the apperance of debate is still kept up through not only through dishonest pundits, but botnets on reddit and, I fear, even here on HN.
It's wild.
But we'll overcome it. Don't let it get you down. The scientific method endures and it will eventually win out. People are getting more and more literate and younger ages. The facade is nearly finished.
> The sentence in question is:
"Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants;"
In a statement about the review, Lisa Bero (the Cochrane Public Health and Health Systems Senior Editor) says explicitly:
“The results of this review should be interpreted cautiously, and the uncertain findings should not be taken as evidence that these measures are not effective."
> I think we all agree with you (and thus, with Soares-Weiser) about the frustration (heck, downright confounding) resulting from the lack of evidence.
There is not lack of evidence on the effectiveness of masks to prevent/spread illness. There is a lack of evidence on the effectiveness of policy. This is not evidence that those polices are themselves ineffective. Quoting again:
"An updated review of physical interventions by Jefferson and colleagues assesses three commonly recommended interventions: masks, hand hygiene, and physical distancing.[2] They found evidence that masks had limited or no benefit in terms of preventing influenza‐like illnesses or laboratory‐confirmed influenza. However, except for a handful of studies, most of the evidence is from studies examining effects in wearers. An important effect may still lie in how masks reduce transmission of virus to others, which is more difficult to ascertain.[3] Resulting uncertainty in the evidence for public health measures has fed controversies regarding the legitimacy of public health policies involving these measures, with face masks being a special target for criticism.[4, 5]"
"For each measure, though, lack of evidence of effectiveness is not evidence that the interventions are ineffective. Rather, the details of these reviews show why there may never be strong evidence regarding the effectiveness of individual behavioural measures when deployed, often in combination, in a general population living in the complex, diverse circumstances of individuals' everyday lives. Waiting for strong evidence is a recipe for paralysis." (source: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED...)
> Is it possible that a larger, properly-powered RCT will find that some form of N95 application will have some effect on community transmission?
Anything is possible, but it appears that any attempt at such a study would likely result in a failure to uncover actionable data. Reasons for that are explicitly listed in the source above which goes on to state the following: "However, while there is reason to believe in the combined effects of multiple behavioural measures, there is not, and may never be, high‐quality evidence from randomized trials on those effects."
RCTs are a very useful tool, but they aren't the right tool for every circumstance. This appears to be one of those cases. It's fortunate then that we don't need to depend on them in every circumstance. We can have an extensive pool of other types of high quality evidence to draw conclusions from. We have lab tests where we have no issues testing the physics involved in different kind of masks blocking virus-sized particles on simulated inhales and exhales. There have been RCTs involving health care personnel which show that worn correctly and consistently masks work. The effectiveness of masks to help keep people from getting and spreading disease is not really in question. The questions we do have, aren't ones RCTs are likely to help us answer.
If someone comes up with some way to perfectly control, and fully and accurately observe and record the behavior of large populations 100% of the time for the entire duration of the trial, and can do all of that ethically, then you might get the perfect research you'd love to see. Until then, we should focus on what we do know with confidence and what we've learned through other forms of high quality research.
I think any reasonable observer can conclude that we have reached a point in the discussion in which it is evident that you are not participating in good faith.
> That sentence is not in question. It doesn't exist anywhere in the review. Please read the review yourself.
Please don't implicitly accuse me of not having read the material. I read it the day it was published, with the counsel of friends who are experts in the field, who, along with most of their colleagues, have objected to this entire charade all along.
It's hard to imagine that you actually believe that this sentence is not the controversial one; it has been the topic of discussion in circles of epidemiology and evidence-based medicine around the world and is the focus of the clarification you've linked. A simple web search will confirm this.
Moreover - and I presume this was a mistake on your part - the PDF you've linked actually still contains the sentence in question (I assume you meant to sneakily link the revised summary and pasted the wrong URL). I hope this reveals the tactics at work here to any discerning reader. (As I write this, the PDF linked in your comment is: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...)
> RCTs are a very useful tool, but they aren't the right tool for every circumstance. This appears to be one of those cases.
Yes of course those cases exist, and no this isn't one of them. And essentially all of the world's top researchers in evidence-based medicine agree on this point (despite having a wide array of opinions on the underlying question).
We're talking about asking one group of people to put something on their face for a while, and another not to, in a variety of circumstances. Nearly all of the world's top experts have asked for this (including the authors of the review and primaries in question, which together represent tenure at all five of the world's top institutions of medicine) and been silenced, while a group of second-stringers willing to toe the line have been propped up to create the appearance of significant debate. I have no doubt based on your knowledge and articulation that you are well aware of this, and I hope that now anyone reading this far is as well.
Given the decreasing apparent veracity of your statements, I'm choosing as my last message in this thread.
I don't want to be adversarial, but it feels impossible and invalidating to engage in discussion when we can't agree that the sky is blue.
All I can ask is that you contemplate whether what you are doing is in the best interests of science.
If anyone in interested in reading further rebuttal, I suggest this piece by Tom Jefferson (author of the review in question) joined by Carl Heneghan (whom you probably already know, but if not, was the editor-in-chief of the BMJ of evidence-based medicine at the time of the publication in question). [0]
edit: I had originally written a response that dissected the dishonest characterization of the text of the review, but replaced it with the Jefferson / Heneghan piece, which goes directly into the substance, which seems more appropriate.
> Please don't implicitly accuse me of not having read the material.
I didn't intend for my invitation to be an accusation. I'm sorry that I wasn't clearer. I'd publish my own revision if I could. I just wanted to give you the opportunity to see for yourself that the text isn't there. I'd hoped to even make it easy for you, but also for anyone else reading who might be working from outdated information on this topic.
> It's hard to imagine that you actually believe that this sentence is not the controversial one; i
It was a controversial sentence, but mostly because it was poorly/incorrectly worded which is what necessitated it being removed from the text and replaced with something more appropriate. It was exactly because it was misleading so many people that Cochrane has worked so hard to clarify the situation. From revisions, to statements made to the press, to editorials published on their own site, I think they've done everything they reasonably could do to let the public know that the review does not support what was initially said as it was initially phrased. It'd be hard to get more explicit than they have been. "the uncertain findings should not be taken as evidence that these measures are not effective." I don't know what more people want from them. It must be maddening for them to know that for all their efforts what was initially published is still giving people the wrong idea.
> Moreover - and I presume this was a mistake on your part - the PDF you've linked actually still contains the sentence in question (I assume you meant to sneakily link the revised summary and pasted the wrong URL).
Yes, I did link to an outdated version in error. I apologize for that too. I had (and have) enough tabs and browser windows open that it was all too easy to just grab the wrong one by mistake (it's a wonder firefox hasn't crashed on me yet). I corrected it as soon as I noticed but you were too quick for me. This wasn't "sneaky" or some trick. My intent was very much to post the most current and corrected version. What good is it to argue over something that was later corrected? The most recent version is always best to work from, and that's especially true in cases where you know revisions had to be made and the problems with older versions are leading to misunderstandings and confusion.
> Yes of course those cases exist, and no this isn't one of them.
Many people, including experts, disagree with you. Experts can disagree, but if someone thinks they can design a RCT that doesn't suffer from the kinds of problems that others see as being highly likely then they are free to design one, make their case for funding, and run it. Evidence is king. We know this review was deeply flawed because of the lack of high quality evidence. If finding that high quality evidence is possible, then let someone do it already and prove everyone else wrong. That's how science works.
> All I can ask is that you contemplate whether what you are doing is in the best interests of science.
All I'm doing is telling you what Cochrane themselves says of the review they published, and in this case, I happen to agree with them. I'd be happy to change my mind, once someone delivers better evidence. Tom Jefferson and the rest of the review's authors weren't able to do that with this review due to the numerous problems with the evidence they had to work with and the lack of other evidence to draw from. Not a huge deal. Let's see the viable RCTs people come up with and the quality of the evidence they get from them, then we'll see what the review says.
The review itself said:
‘Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness / Covid‐19-like illness compared with not wearing masks… Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza / SARS‐CoV‐2 compared with not wearing masks.’
The fact that the editor-in-chief of Cochrane embarrassed herself due to the pressure of an opinion-piece by a non-expert in the NYT is irrelevant.
You can read the views of one of the reports actual authors here: https://www.spiked-online.com/2023/07/19/the-junk-science-be...