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nopie  1yr ago (vinayprasadmdmph.substack.com)   Edited 1yr ago   3294 thread views

Cochrane review is out and masks have weak evidence that they are not effective

vinayprasadmdmph.substack.com

This one is against rationalists because when Scott wrote his review that masks could be effective many of us trusted it.

I don't blame Scott for failing this one because doing review of hundreds of studies is hard and one person can hardly do it. But this clearly shows that rationalist way of thinking has no special formula, they can be easily mistaken and fall by accepting general consensus just like any other person.

I was impressed when Scott did his review about masks. I trusted it because there was no other clear evidence available. Cochrane hadn't done its review yet and NICE guidelines were silent on the issue. We vaguely knew from previous studies that masks are not effective, The WHO had said so. Suddenly everyone flipped and it was not because the evidence had changed. We simply wanted to believe that masks work and we mocked those who said “no evidence that masks help”.

Even with the belief that masks work, I never wanted mask mandates. I preferred recommendations only, so that no one was penalized or prohibited entry, travel etc if one doesn't want to wear mask. Scott unwillingly had been a catalyst for governments to introduce mask mandates and all this heavy handed approach has been for nothing.

Now we are back to square one, the evidence about masks is weak and it does not support their use even in hospital settings. We can all reflect now what happened in between during these 2 or 3 years. When I realized that Scott's review is clearly insufficient as evidence, I asked some doctors if they have any better evidence that masks work. Instead of getting answer I was told not to be silly, parachutes don't need RCTs and accused me of being covid denier for nor reason. Many so-called experts were making the same mistake as Scott by looking at the issue too emotionally. It is time to get back to reality and admit that it was a mistake and we should have judged the issue with more rational mind.

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I've always wondered if they realized:

  1. Lockdowns aren't going to get rid of COVID

  2. We've turned some decent percentage of the population paranoid

  3. We need that population to start doing things again or we kill the economy

  4. Masks work! Just wear a mask and you are safe to go around making and consuming Economics inputs and outputs!

But maybe that is too conspiratorial...it really was a huge switch though. The stated reason was that they realized the amount of presymptomatic/asymptomatic spread, but lots of illnesses have huge periods of presymptomatic spread (Influenza and RSV, notably), so not sure why that would have resulted in a change.

That is both the correct amount of conspiratorial, but far too competent. What actually happened was:

  1. Lockdowns aren't going to get rid of COVID

  2. We've turned some decent percentage of the population paranoid

  3. We must do something

  4. Masks are something

Never attribute to incompetence what you can attribute to principal agent problems. High level politicians are incredibly competent... at politicking. There's a whole host of complicated social skills involved in phrasing your words the right way, appealing to a core of voters in your party, playing nice with other politicians and the political party backing you, fundraising, and deflecting criticisms of incompetence. And the people who actually get elected to top positions are nonrandomly the best of the best at these things, or they get quickly replaced by someone who is better.

Object level issues like "what policies will minimize both the death rate and economic harms of COVID" are secondary to things like "what policies will make my constituents vote for me again?" or "what policies does my political party that I am beholden to want me to support?" There's a nonzero correlation, actual good policies are slightly more likely to be visually appealing and/or get bipartisan support, but the politics is the actual target they are optimizing for. And from that perspective, they did an excellent job: the majority of politicians who supported mask mandates have been re-elected, and those who weren't probably lost for unrelated reasons that wouldn't have changed if they had promoted better policies. If they appear incompetent, it's because the metric you're using to measure success isn't the same one they're using.

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