Excllent article! Thank you, Doctor Leap. I believe I have observed the Dunning-Kruger Effect both in Academia and the Medical System.
The firm belief by most Medical Doctors that life on Earth "evolved through random, undirected processes" (See: "primordial soup") is an excellent example of the Dunning-Kruger Effect.
The firm belief by most Medical Doctors that "clinical depression" is caused by a "chemical imbalance" in the brain of a "maladjusted" person, INSTEAD the result of our Sick Social Darwinian Society's negligent or abusive circumstances, is a definitely related example of the Dunning-Kruger Effect.
Thanks Anthony! I think the 'chemical imbalance' thing is a great example. We don't ever check the levels of those chemicals, do we? So much suffering from social ills. Thanks so much for your comments.
You are welcome, sir. It is an honor to read your reply. If more physicians had your combination of compassion and grit, we would have an effective healthcare system.
July 30, 2023 This commentary is by Lee Russ of Bennington, a retired legal editor who was the lead editor/author of both the third edition of “Couch on Insurance” and the Attorneys Medical Advisor.
Lee Russ: In health care, it’s 10 to 1 against us
SNIPPET:
There are now 10 health care administrators for every doctor: “The ratio of doctors to other healthcare workers is now 1:16, up from 1:14 two decades ago. Of those 16 workers for every doctor, only six are involved in caring for patients — nurses and home health aides, for example. The other 10 are in purely administrative roles.”
Ed i think you are a bit off conflating DKE with uneducated covid deniers , and suggesting agnosticism stems from an adherence to unreplicable science. Neither you nor i base our clinical practice on one small unreplciated study, but yes we both take statins. The science that we base most all of our daily pragmatic decisions on, and many/most public policy decisions on, IS and has been replicable. Obviously that was stretched a bit during covid and things had to be decided quickly and with even more limited data than usual. That said you of all people know real and deadly Covid was EVEN for those not young or infirm . And we do have much more data now, including efficacious of vaccines and public flash measures, as well as the unintended consequence of a massive unprecedented social experiment (lockdowns) It turns out, and the data DOES increasingly corroborate, some people are at very bare risk not only from deaths from covid, but really serious chronic illness with long covid. And it does turn out, on balance, closing down schools is not a good idea. Children aren’t very vulnerable as a group ,a subgroup-Mae teens has an higher icidence myocarditis rom the vaccine (BUT still lower than a comparable unvaccinated control peer group !!) and the unintended consequences are still being studied appreciated. But, it turns out older and immunocompromised people are probably even more vulnerable than we first suspected So it’s not an issue of inadequate science or fraudulent science,its a political and public health trade off. And actually, we KNOW , from REPLICABLE, reliable studies what we should do the next time-keep schools open, require N-95 mask and restrict visiting in hospitals (its very clear universal mandated enforced and meticulous mask wearing in hospitals not only reduces transmission by at least a third, but serious illness among staff alone by ten percent.)require masking in public transportation and large indoor venues - do we really say to every person over age 65 and younger than 2, or has diabetes or is a cancer survivor, transplant patients etc-they cant eave their home because the young invulnerable find it too in on int to ears a mask on buses, or inside food stores ?? Heh lets get real down on public health and be selfish and allow ten year olds to buy guns….masks in Madison square garden, but not Yankee stadium should no longer be controversial. But because the the people you describe we won t be able to do the right thing next time will we ? They dont need to be humored -no, they DON’T know what they are talking about. Don’t feed the beast. Faucet, Birx, BIden and yes even trump know what to do the next time around-its called medical science. Those who ignore it are the REAL arrogant and selfish. I always remind some of my MAGA friends, Jesus would certainly wear a mask next time in any indoor public venue right ?
Actually I wasn't talking about honoring the opinion of COVID deniers (I think I made that clear in my example), and I wasn't trying to address vaccination or masking, etc. I'm simply saying that sometimes we don't know what we don't know and that can cause harm. And honestly, people in medicine did sometimes ignore the suffering wrought by lock-downs and other measures, for instance the terror of seniors dying all alone, and suggested that those who didn't comply were rather simpletons. That unprecedented social experiment had some pretty dire consequences and hopefully next time those in the driver's seat will be more careful. We continue to be awfully careless in things like agriculture, policing and energy policy. Look, I believe in using the science. But we both know that science can be wrong. Mostly through the appropriate trial and error but sometimes through deception and for financial reasons. It's why residency directors wanted us to be suspicious of drug reps! I suspect we're on the same page here, in the end. I really appreciate the time you take to comment! Please keep it up. It means a lot.
There isn’t a single RCT study that shows masking helps prevent transmission and illness. So...how is it clear? I’ve worked in a nursing home for 3 years and absolutely *no one* rigorously follows the masking protocols. While your desire to protect the vulnerable is commendable, it’s also batshit crazy to push forever masking (not only because there is no data to show that it helps) to save people from a
Adele-I wont call your insistence on an RCT (triable unfeasible if not unethical esp during. A Novel pandemic) to wear masks in any circumstances a straw man, and I will stipulate there is no definitive RCT study proven efficacy, as long as you will stipulate there is no a single RCT study that shows non-efficacy, and there are a number of solid , non RCT studies that show clinically, as well as statistically meaningful reductions in transmission and when studied, morbidity. Now of course you can insist that transmission doesn't translate into disease, but that’s simply fatuous. COVID doesn't arise spontaneously, it HAS to be transmitted typically by someone actively infected, whether symptomatic or not. Yes , I concur No one “ follows mask protocols …..because they are NOT enforced . It’s not thats it unfeasible from a resource or even training standpoint, its a matter of “inconvenience” by vaccine deniers, libertarians, and yes doubtlessly many waiting on the rapture and a return to a WASP dominated country (my own ethnicity by the way) You do raise a ‘straw man’ when you decry forever masking for , presumably, everyone. Nobody argues for that anymore. With over a million premature deaths from COVID in the US alone, what is the big deal wearing a mask in bus , basketball game, airport or airplane during a pandemic ?? But public health is un “Ahmurican” isnt it ? Please send me your design for an RCT that will convince you a properly worn mask , properly enforced, with a non-efficacy null set that will cause you to ‘submit’ to simple, mildly inconvenient public health measures. Which is more tragic, that you have to wear a mask on a bus or an 80 year old, or even 1 year old, should die from Covid ? Or more specifically, lets make it real. 10 million airline passengers have to wear masks for a few hours while sitting in order to save 1,000 lives ?
Have you not had Covid? I’ve had it 3 times and everyone I know has either had it or been exposed. I think it’s disingenuous to say that wearing a mask will save lives. There is *no* proof of that. Like, none. Also, there is a free and available vaccine. If you believe in it so deeply, why don’t you believe it can protect people from dying of Covid? You don’t even believe your own bullshit.
Denial just aint a river in Egypt, is it ? And why do I feel safe in assuming you voted for Donald Trump twice ? Just askin’…
1. No- quite possibly because i was vigilant wearing N95 ? But heh covid is no big deal right ? Those million deaths are a hoax, or they all died from other illnesses ad just had positive covid tests ?
2. “Everyone” ? Ok let’s trade anecdotes- what better way to establish public policy for 350 million citizens , right ? within my extended family and close colleagues, ie where I can obtain reliable histories ,N of roughly 50, 8 cases, all apparently from contact with children in household ..also What does “exposed” mean ?
3. It IS proven when masks are worn properly transmission is reduced. And If transmission doesn't occur, how can you contract /die from from covid.?
4. U until a month ago the available vaccine only partially effective against new mutations of Covid. Too soon to assess new vaccines effectiveness. And do you support mandatory vaccination ? Because if we dont achieve large measure of herd immunity, Covid remains endemic for long times infecting many.
But I feel we are dealing in ‘truthiness” at this point of the dialogue. You’ve made it clear you wont accept any study to show effectiveness. Science is Fake news right ? Left wing conspiracy ?Am I to conclude you don’t believe covid caused large numbers of excess and premature deaths ? Or that covid is not transmitted by pulmonary vectors ? Of that Covid causes serious morbidity in vulnerable populations (in total well over 70 million US citizens in these groups) That n-95 masks are not even partially effective against against viral transmission ? And , i repeat, would you even accept a decent RCT showing some degree of effectiveness ? What does it take to accept the minor inconvenience of wearing masks on say airplanes during a pandemic ?
Of course masks dont work if people dont wear them. The same is true for vaccines. But you strain at tendentiousness in your arguments, desperate to show reasonable public health measures are futile so you can freely roam around in public and infect others ? What right do you are to do that ?
I wont accuse you of not “believing your own bullshit” - Indeed by all appearances you do believe your own bullshit.
2. This is America. No one should have the right to force their crazy superstitions on anyone else. If you believe masks work, then wear them! Just don’t try to use Government to enforce silly measures.
3. No. That was my point. Masks have not been shown to reduce transmission. Not even a little. You are better off just buying a rubber bracelet that has been blessed by your local shaman. It would be about as effective as wearing a mask.
4. I’ve had the vaccine. Since then, I got sick with Covid. After my booster, I got it two more times! The vaccine doesn’t protect against any strain and it doesn’t reduce transmission. It may have lessened my symptoms, but who can be sure? Given that the vaccine doesn’t really inoculate people, I don’t think they should be mandatory.
5. We aren’t in a pandemic anymore. It’s been three years. It’s over, my dude. Life has to go back to normal. You can’t say you believe in science and then insist that science (actual studies that establish causality) doesn’t matter. I guess it’s a value judgement. I looked at the numbers in May of 2020 and stopped being scared of Covid. You decided to spend three years scared of what, for the overwhelming majority of people, is a nasty cold. That’s your choice! Just don’t impose your anti-science, superstitious neuroticism on the rest of us.
Given that proper mask protocol is rarely, if ever followed, how would you know if they work or not? Prior to 2020, it was widely understood that they don’t really protect from airborne viruses. I would argue that a non-RCT study cannot be solid or compelling given the existence of a multitude of variables. I don’t think it’s crazy to argue that correlation doesn’t equal causation.
Great column as usual. You write eloquently on the things I just think about . Especially the burden on the poor of many of our Green policies. Many of my friends virtuously drive a $70,000 Tesla while my maid feels lucky to buy a $500 clunker to get to work. What happens to her if the planned mandates take effect? Public transportation? Where I live, it’s practically non existent. And inflation in gas prices and groceries affect the poor disproportionately. Those who used to be champions of the poor and downtrodden, now seem to care more for their issues than they do for actual people just trying to get by.
Thank you Pam! I appreciate your kindness. When everyone is compelled to buy an EV, what will the poor do? Especially the rural poor? My patients already can't get to their out of town follow up appointments or visit their sick relatives. I fear that social and technological advances, rather than closing the gap between rich and poor, simply will continue to widen it.
Seven studies took place in the community, and two studies in healthcare workers. Compared with wearing no mask, wearing a mask may make little to no difference in how many people caught a flu-like illness (9 studies; 3507 people); and probably makes no difference in how many people have flu confirmed by a laboratory test (6 studies; 3005 people). Unwanted effects were rarely reported, but included discomfort.
N95/P2 respirators
Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people) or respiratory illness (3 studies; 7799 people). Unwanted effects were not well reported; discomfort was mentioned”
RE: The Cochrane report-widely misinterpreted by lay people,
does not address the question, “does masking reduce Covid).Ita dresses the question ‘does mask AVAILABILITY (including non n95masks ) and information reduce COVID ?” Its finding-a statistically not significant 5% reduction- is not surprising. As you know, mask wearing is haphazard in most unmandated situations , so it is unsurprising that comparing a group of people who receive N95 masks but dont wear them effectively, or those that religiously wear surgical but not n95 masks, to a group or overall population that doesnt wear masks , will not show a difference !
It is , of course , a meta analysis of RCTs . I won’t be impugning the integrity or qualifications of the authors, but it is really essential to understand how these Studies are conducted and analyzed.. Lay people aren’t capable of this analysis when it’s complex. Yes science is complex as you point out.)
1.it included studies that had no controls (its gobsmacking a paper could therefore allege to be a study of randomized “controlled” studies. I don’t know why there were not excluded . Manifestly they should have been. We can only speculate as to why.
2. The less consistent study protocols are between RCTs, even well conducted they are, the more skepticism one must have about such a meta- analysis .of course this ess is inherent in any meta analysis, but there is a continuum. If we are talking an identical study in say New York and Boston, thats pretty close. If we study Lagos and Dallas, there are a host of variables, even beyond the obvious ethnicity , that aren't being controlled, thats an issue . In brief, combining even well conducted real RCTS is problematic when the protocols / patients studied are
dissimilar in major ways .
3. A very significant problem arises in that they combined studies that did not always use N95 masks , or wear them continuously , or under appreciated exposure. To illustrate, you could meticulously wear an effective n95 mask in an infected patients room but EASILY acquire covid when you took it off in the hospital cafeteria, elevators , hallways. The prevalence in a hospital during Covid, and the viral burden beyond rooms WTH negative pressure (many ORS and some ICUs) is wildly different than other low burden ventures.
4. There are certainly multiple studies that show among health care workers , continuous properly fitted N95 mask wearing is quiet effective at reducing transmission, which is why you will see strong voluntary adherence inmost hospitals. You don’t have to a date it to people with high exposures who know how to wear them and know its works.
5. I’m not arguing the pandemic continues - I am concerned though that the spread fo Covid right now is substantially higher and growing faster than most people , especially those outside the Health community appreciate. I’m not accusing them of denial or being willfully obdurate. Or misinformed. indeed, because we no inter track covid , who could really know ? Reflect however, it is a tautology that if we don't track it there are no “cases” right ? I don know why we are scared to know whats out there. O , I forget , if we did we’d have to do something public health wise wouldn’t we.The horror.
I don’t disagree per se masks did not work . Compliance was too weak for it to work in most these studies . But one can’t conclude n95 masks “dont work.” We can argue over there we should make n95 masks mandatory and it what situations, but that is inevitably a political , cost benefit analysis decision regardless of how strong the science is. This is true for ANY public health issue, where to draw the line. Yours is far too extreme. It’s obvious strict adherence to warning fitted n95 masks in hi prevalence situations is quiet effective re transmission and morbidity. Hence my reasonable advocacy of mana dated mask wearing certainly in health care facilities, and essential public transportation-buses.subways. You would not be required to do anything, of fined or incarcerated , just refused admission/entry to a hospital, bus or subway. We can argue over whats more important -the inconvenience of masks on airlines and airports , trains, train stations etc, but it seems quite selfish -but not “crazy” - to argue wearing a mask for few hours trumps is too inconvenient for heathy travelers that the geriatric, transplant and cancer patients should not be able to travel outside of their city/metro area while a Covid burns for 2-3 years. But I’m not going to die on that hill. America has far more than its share of solipsistic citizens. Whether we say “masks work” or “masks don’t work” we must both caveat “it depends.” I’m not hearing that from you.
In both these studies, causation is established after the fact. They had a theory and found the data the prove it. Do you know what else people had to do when they started masking? Washing hands constantly and social distancing. People who were prone to wearing masks anyway were likely to be more cautious.
Excllent article! Thank you, Doctor Leap. I believe I have observed the Dunning-Kruger Effect both in Academia and the Medical System.
The firm belief by most Medical Doctors that life on Earth "evolved through random, undirected processes" (See: "primordial soup") is an excellent example of the Dunning-Kruger Effect.
The firm belief by most Medical Doctors that "clinical depression" is caused by a "chemical imbalance" in the brain of a "maladjusted" person, INSTEAD the result of our Sick Social Darwinian Society's negligent or abusive circumstances, is a definitely related example of the Dunning-Kruger Effect.
https://soberthinking.createaforum.com/gallery/soberthinking/1-170422173058-779150.jpeg
And Jesus said, For judgment I am come into this world, that they which see not might see; and that they which see might be made blind. -- John 9:39
https://soberthinking.createaforum.com/gallery/soberthinking/1-170422160740-7281012.jpeg
Thanks Anthony! I think the 'chemical imbalance' thing is a great example. We don't ever check the levels of those chemicals, do we? So much suffering from social ills. Thanks so much for your comments.
You are welcome, sir. It is an honor to read your reply. If more physicians had your combination of compassion and grit, we would have an effective healthcare system.
July 30, 2023 This commentary is by Lee Russ of Bennington, a retired legal editor who was the lead editor/author of both the third edition of “Couch on Insurance” and the Attorneys Medical Advisor.
Lee Russ: In health care, it’s 10 to 1 against us
SNIPPET:
There are now 10 health care administrators for every doctor: “The ratio of doctors to other healthcare workers is now 1:16, up from 1:14 two decades ago. Of those 16 workers for every doctor, only six are involved in caring for patients — nurses and home health aides, for example. The other 10 are in purely administrative roles.”
Full article:
https://soberthinking.createaforum.com/who-can-you-trust/profits-over-patients-in-the-'health'-care-field/msg1208/#msg1208
https://soberthinking.createaforum.com/gallery/soberthinking/1-240422195351-10031471.jpeg
Ed i think you are a bit off conflating DKE with uneducated covid deniers , and suggesting agnosticism stems from an adherence to unreplicable science. Neither you nor i base our clinical practice on one small unreplciated study, but yes we both take statins. The science that we base most all of our daily pragmatic decisions on, and many/most public policy decisions on, IS and has been replicable. Obviously that was stretched a bit during covid and things had to be decided quickly and with even more limited data than usual. That said you of all people know real and deadly Covid was EVEN for those not young or infirm . And we do have much more data now, including efficacious of vaccines and public flash measures, as well as the unintended consequence of a massive unprecedented social experiment (lockdowns) It turns out, and the data DOES increasingly corroborate, some people are at very bare risk not only from deaths from covid, but really serious chronic illness with long covid. And it does turn out, on balance, closing down schools is not a good idea. Children aren’t very vulnerable as a group ,a subgroup-Mae teens has an higher icidence myocarditis rom the vaccine (BUT still lower than a comparable unvaccinated control peer group !!) and the unintended consequences are still being studied appreciated. But, it turns out older and immunocompromised people are probably even more vulnerable than we first suspected So it’s not an issue of inadequate science or fraudulent science,its a political and public health trade off. And actually, we KNOW , from REPLICABLE, reliable studies what we should do the next time-keep schools open, require N-95 mask and restrict visiting in hospitals (its very clear universal mandated enforced and meticulous mask wearing in hospitals not only reduces transmission by at least a third, but serious illness among staff alone by ten percent.)require masking in public transportation and large indoor venues - do we really say to every person over age 65 and younger than 2, or has diabetes or is a cancer survivor, transplant patients etc-they cant eave their home because the young invulnerable find it too in on int to ears a mask on buses, or inside food stores ?? Heh lets get real down on public health and be selfish and allow ten year olds to buy guns….masks in Madison square garden, but not Yankee stadium should no longer be controversial. But because the the people you describe we won t be able to do the right thing next time will we ? They dont need to be humored -no, they DON’T know what they are talking about. Don’t feed the beast. Faucet, Birx, BIden and yes even trump know what to do the next time around-its called medical science. Those who ignore it are the REAL arrogant and selfish. I always remind some of my MAGA friends, Jesus would certainly wear a mask next time in any indoor public venue right ?
Actually I wasn't talking about honoring the opinion of COVID deniers (I think I made that clear in my example), and I wasn't trying to address vaccination or masking, etc. I'm simply saying that sometimes we don't know what we don't know and that can cause harm. And honestly, people in medicine did sometimes ignore the suffering wrought by lock-downs and other measures, for instance the terror of seniors dying all alone, and suggested that those who didn't comply were rather simpletons. That unprecedented social experiment had some pretty dire consequences and hopefully next time those in the driver's seat will be more careful. We continue to be awfully careless in things like agriculture, policing and energy policy. Look, I believe in using the science. But we both know that science can be wrong. Mostly through the appropriate trial and error but sometimes through deception and for financial reasons. It's why residency directors wanted us to be suspicious of drug reps! I suspect we're on the same page here, in the end. I really appreciate the time you take to comment! Please keep it up. It means a lot.
There isn’t a single RCT study that shows masking helps prevent transmission and illness. So...how is it clear? I’ve worked in a nursing home for 3 years and absolutely *no one* rigorously follows the masking protocols. While your desire to protect the vulnerable is commendable, it’s also batshit crazy to push forever masking (not only because there is no data to show that it helps) to save people from a
Adele-I wont call your insistence on an RCT (triable unfeasible if not unethical esp during. A Novel pandemic) to wear masks in any circumstances a straw man, and I will stipulate there is no definitive RCT study proven efficacy, as long as you will stipulate there is no a single RCT study that shows non-efficacy, and there are a number of solid , non RCT studies that show clinically, as well as statistically meaningful reductions in transmission and when studied, morbidity. Now of course you can insist that transmission doesn't translate into disease, but that’s simply fatuous. COVID doesn't arise spontaneously, it HAS to be transmitted typically by someone actively infected, whether symptomatic or not. Yes , I concur No one “ follows mask protocols …..because they are NOT enforced . It’s not thats it unfeasible from a resource or even training standpoint, its a matter of “inconvenience” by vaccine deniers, libertarians, and yes doubtlessly many waiting on the rapture and a return to a WASP dominated country (my own ethnicity by the way) You do raise a ‘straw man’ when you decry forever masking for , presumably, everyone. Nobody argues for that anymore. With over a million premature deaths from COVID in the US alone, what is the big deal wearing a mask in bus , basketball game, airport or airplane during a pandemic ?? But public health is un “Ahmurican” isnt it ? Please send me your design for an RCT that will convince you a properly worn mask , properly enforced, with a non-efficacy null set that will cause you to ‘submit’ to simple, mildly inconvenient public health measures. Which is more tragic, that you have to wear a mask on a bus or an 80 year old, or even 1 year old, should die from Covid ? Or more specifically, lets make it real. 10 million airline passengers have to wear masks for a few hours while sitting in order to save 1,000 lives ?
Have you not had Covid? I’ve had it 3 times and everyone I know has either had it or been exposed. I think it’s disingenuous to say that wearing a mask will save lives. There is *no* proof of that. Like, none. Also, there is a free and available vaccine. If you believe in it so deeply, why don’t you believe it can protect people from dying of Covid? You don’t even believe your own bullshit.
Denial just aint a river in Egypt, is it ? And why do I feel safe in assuming you voted for Donald Trump twice ? Just askin’…
1. No- quite possibly because i was vigilant wearing N95 ? But heh covid is no big deal right ? Those million deaths are a hoax, or they all died from other illnesses ad just had positive covid tests ?
2. “Everyone” ? Ok let’s trade anecdotes- what better way to establish public policy for 350 million citizens , right ? within my extended family and close colleagues, ie where I can obtain reliable histories ,N of roughly 50, 8 cases, all apparently from contact with children in household ..also What does “exposed” mean ?
3. It IS proven when masks are worn properly transmission is reduced. And If transmission doesn't occur, how can you contract /die from from covid.?
4. U until a month ago the available vaccine only partially effective against new mutations of Covid. Too soon to assess new vaccines effectiveness. And do you support mandatory vaccination ? Because if we dont achieve large measure of herd immunity, Covid remains endemic for long times infecting many.
But I feel we are dealing in ‘truthiness” at this point of the dialogue. You’ve made it clear you wont accept any study to show effectiveness. Science is Fake news right ? Left wing conspiracy ?Am I to conclude you don’t believe covid caused large numbers of excess and premature deaths ? Or that covid is not transmitted by pulmonary vectors ? Of that Covid causes serious morbidity in vulnerable populations (in total well over 70 million US citizens in these groups) That n-95 masks are not even partially effective against against viral transmission ? And , i repeat, would you even accept a decent RCT showing some degree of effectiveness ? What does it take to accept the minor inconvenience of wearing masks on say airplanes during a pandemic ?
Of course masks dont work if people dont wear them. The same is true for vaccines. But you strain at tendentiousness in your arguments, desperate to show reasonable public health measures are futile so you can freely roam around in public and infect others ? What right do you are to do that ?
I wont accuse you of not “believing your own bullshit” - Indeed by all appearances you do believe your own bullshit.
1. Ad hominem attack based on tribalism.
2. This is America. No one should have the right to force their crazy superstitions on anyone else. If you believe masks work, then wear them! Just don’t try to use Government to enforce silly measures.
3. No. That was my point. Masks have not been shown to reduce transmission. Not even a little. You are better off just buying a rubber bracelet that has been blessed by your local shaman. It would be about as effective as wearing a mask.
4. I’ve had the vaccine. Since then, I got sick with Covid. After my booster, I got it two more times! The vaccine doesn’t protect against any strain and it doesn’t reduce transmission. It may have lessened my symptoms, but who can be sure? Given that the vaccine doesn’t really inoculate people, I don’t think they should be mandatory.
5. We aren’t in a pandemic anymore. It’s been three years. It’s over, my dude. Life has to go back to normal. You can’t say you believe in science and then insist that science (actual studies that establish causality) doesn’t matter. I guess it’s a value judgement. I looked at the numbers in May of 2020 and stopped being scared of Covid. You decided to spend three years scared of what, for the overwhelming majority of people, is a nasty cold. That’s your choice! Just don’t impose your anti-science, superstitious neuroticism on the rest of us.
The big deal is that masking is silly and ineffective.
Given that proper mask protocol is rarely, if ever followed, how would you know if they work or not? Prior to 2020, it was widely understood that they don’t really protect from airborne viruses. I would argue that a non-RCT study cannot be solid or compelling given the existence of a multitude of variables. I don’t think it’s crazy to argue that correlation doesn’t equal causation.
Highly contagious virus that they’ve likely already been exposed to multiple times.
Great column as usual. You write eloquently on the things I just think about . Especially the burden on the poor of many of our Green policies. Many of my friends virtuously drive a $70,000 Tesla while my maid feels lucky to buy a $500 clunker to get to work. What happens to her if the planned mandates take effect? Public transportation? Where I live, it’s practically non existent. And inflation in gas prices and groceries affect the poor disproportionately. Those who used to be champions of the poor and downtrodden, now seem to care more for their issues than they do for actual people just trying to get by.
Thank you Pam! I appreciate your kindness. When everyone is compelled to buy an EV, what will the poor do? Especially the rural poor? My patients already can't get to their out of town follow up appointments or visit their sick relatives. I fear that social and technological advances, rather than closing the gap between rich and poor, simply will continue to widen it.
This ties in nicely to my Truth series I am working in. I might reference this article or cross-post if you don't mind.
https://open.substack.com/pub/nbts/p/truth-part-1?r=9ghy2&utm_campaign=post&utm_medium=web
Res ipsa loquitur …
Try these
https://jamanetwork.com/journals/jama/fullarticle/2789302
https://www.nejm.org/doi/full/10.1056/NEJMe2213556
https://jamanetwork.com/journals/jama/fullarticle/2768532
Per the Cochran report,
“Medical or surgical masks
Seven studies took place in the community, and two studies in healthcare workers. Compared with wearing no mask, wearing a mask may make little to no difference in how many people caught a flu-like illness (9 studies; 3507 people); and probably makes no difference in how many people have flu confirmed by a laboratory test (6 studies; 3005 people). Unwanted effects were rarely reported, but included discomfort.
N95/P2 respirators
Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people) or respiratory illness (3 studies; 7799 people). Unwanted effects were not well reported; discomfort was mentioned”
So, the established wisdom in the scientific community up until 2020 ended up actually being correct. Masks largely don’t work.
RE: The Cochrane report-widely misinterpreted by lay people,
does not address the question, “does masking reduce Covid).Ita dresses the question ‘does mask AVAILABILITY (including non n95masks ) and information reduce COVID ?” Its finding-a statistically not significant 5% reduction- is not surprising. As you know, mask wearing is haphazard in most unmandated situations , so it is unsurprising that comparing a group of people who receive N95 masks but dont wear them effectively, or those that religiously wear surgical but not n95 masks, to a group or overall population that doesnt wear masks , will not show a difference !
It is , of course , a meta analysis of RCTs . I won’t be impugning the integrity or qualifications of the authors, but it is really essential to understand how these Studies are conducted and analyzed.. Lay people aren’t capable of this analysis when it’s complex. Yes science is complex as you point out.)
1.it included studies that had no controls (its gobsmacking a paper could therefore allege to be a study of randomized “controlled” studies. I don’t know why there were not excluded . Manifestly they should have been. We can only speculate as to why.
2. The less consistent study protocols are between RCTs, even well conducted they are, the more skepticism one must have about such a meta- analysis .of course this ess is inherent in any meta analysis, but there is a continuum. If we are talking an identical study in say New York and Boston, thats pretty close. If we study Lagos and Dallas, there are a host of variables, even beyond the obvious ethnicity , that aren't being controlled, thats an issue . In brief, combining even well conducted real RCTS is problematic when the protocols / patients studied are
dissimilar in major ways .
3. A very significant problem arises in that they combined studies that did not always use N95 masks , or wear them continuously , or under appreciated exposure. To illustrate, you could meticulously wear an effective n95 mask in an infected patients room but EASILY acquire covid when you took it off in the hospital cafeteria, elevators , hallways. The prevalence in a hospital during Covid, and the viral burden beyond rooms WTH negative pressure (many ORS and some ICUs) is wildly different than other low burden ventures.
4. There are certainly multiple studies that show among health care workers , continuous properly fitted N95 mask wearing is quiet effective at reducing transmission, which is why you will see strong voluntary adherence inmost hospitals. You don’t have to a date it to people with high exposures who know how to wear them and know its works.
5. I’m not arguing the pandemic continues - I am concerned though that the spread fo Covid right now is substantially higher and growing faster than most people , especially those outside the Health community appreciate. I’m not accusing them of denial or being willfully obdurate. Or misinformed. indeed, because we no inter track covid , who could really know ? Reflect however, it is a tautology that if we don't track it there are no “cases” right ? I don know why we are scared to know whats out there. O , I forget , if we did we’d have to do something public health wise wouldn’t we.The horror.
I don’t disagree per se masks did not work . Compliance was too weak for it to work in most these studies . But one can’t conclude n95 masks “dont work.” We can argue over there we should make n95 masks mandatory and it what situations, but that is inevitably a political , cost benefit analysis decision regardless of how strong the science is. This is true for ANY public health issue, where to draw the line. Yours is far too extreme. It’s obvious strict adherence to warning fitted n95 masks in hi prevalence situations is quiet effective re transmission and morbidity. Hence my reasonable advocacy of mana dated mask wearing certainly in health care facilities, and essential public transportation-buses.subways. You would not be required to do anything, of fined or incarcerated , just refused admission/entry to a hospital, bus or subway. We can argue over whats more important -the inconvenience of masks on airlines and airports , trains, train stations etc, but it seems quite selfish -but not “crazy” - to argue wearing a mask for few hours trumps is too inconvenient for heathy travelers that the geriatric, transplant and cancer patients should not be able to travel outside of their city/metro area while a Covid burns for 2-3 years. But I’m not going to die on that hill. America has far more than its share of solipsistic citizens. Whether we say “masks work” or “masks don’t work” we must both caveat “it depends.” I’m not hearing that from you.
In both these studies, causation is established after the fact. They had a theory and found the data the prove it. Do you know what else people had to do when they started masking? Washing hands constantly and social distancing. People who were prone to wearing masks anyway were likely to be more cautious.