Cochrane masking review reveals how academics are absolute hypocrites

by Vinay Prasad | Feb 8, 2023

The reception to the Cochrane update on masks and other physical interventions to prevent the spread of sars-cov-2 has been disappointing.

First of all, there is no question that randomized trials better estimate treatment effect than observational research. This is especially true when masks take on a religious quality that segregates with wealth and sociopolitical beliefs. Pima and Maricopa county are not comparable. The have different levels of precaution, vaccination and voting. An anecdote of a hairdresser in Marin county is not evidence. It wasn’t long ago that we all knew that. Except the CDC.

Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020 | MMWR

Second, and I cannot stress this enough, if you want to excuse negative results by citing non-compliance, you have it backwards. Compliance is part of your intervention. A diet that advises people to just eat nothing till they are skinny will fail. You cannot then blame it on non-compliance. You need to offer a diet that is sustainable.

Third, ‘the absence of evidence is not evidence of absence’. This excuse was trotted out to say that the Cochrane review did not conclusively prove masks don’t work. Largely those who offered this claim pointed to the broad 95% confidence interval for masks on the endpoint of flu or COVID. It includes some values compatible with benefit.

On my substack, I argued this argument was insincere, and drew a parallel to a discredited practice’s confidence interval. But here, I can do you one better. Which one of these confidence intervals is masking for COVID, and which is ivermectin for COVID?

That’s right. Ivermectin for COVID19, a failed therapy. (PS: it is a failed therapy). And listen to how people talk about it. As if only the worst type of person would continue to advocate for it. Further testing is pointless. And to be honest, I AGREE WITH THOSE CONCLUSIONS. So here is the answer:

That’s right. In order to be consistent you have to treat masking and ivermectin the same. Neither has any credible data it works. Every excuse you make about masking, an Ivermectin zealot can make

It was bioplausible | It was bioplausible

People were non-compliant | They didn’t give the right dose

They didn’t mask at home | They didn’t start it early enough

The confidence interval did not exclude meaningful benefit | The confidence interval did not exclude meaningful benefit

We need more trials | We need more trials

Nearly no one is consistent here.

Both masking and ivermectin failed to show how they might help people in a timely fashion. Both are failed interventions. One is a the panacea of right wing zealots and the other of left wing zealots.

In biomedicine and public health, in times of crisis, you get some period of time to show how an intervention might work, and if it doesn’t: pack your bags. Stop talking. Move on.

Community masking failed. The only people who saw it coming were people who read all the pre-pandemic randomized evidence, who read all the RCTs during COVID, and people who didn’t lose their marbles in times of crisis.

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