Clinical trials Medicine Skepticism/critical thinking

The Cochrane mask fiasco: Does EBM predispose to COVID contrarianism?

Earlier this month the Cochrane Collaborative was forced to walk back the conclusions of a review by Tom Jefferson et al that had been spun in the media as proving that “masks don’t work.” Tom Jefferson himself has been problematic about vaccines for a long time, but the rot goes deeper. What is it about the evidence-based medicine paradigm that results in misleading conclusions?

A week and a half ago, the New York Times published on Opinion piece by Zeynep Tufekci entitled Here’s Why the Science Is Clear That Masks Work. Written in response to a recent Cochrane review, Physical interventions to interrupt or reduce the spread of respiratory viruses, that had over the last month been widely promoted by antimask and antivaccine sources, the article discusses the problems with the review and its lead author Tom Jefferson, as well as why it is not nearly as straightforward as one might assume to measure mask efficacy in the middle of a pandemic due to a novel respiratory virus. Over the month since the review’s publication, its many problems and deficiencies (as well as how it has been unrelentingly misinterpreted) have been discussed widely by a number of writers, academics, and bloggers, including Steve Novella, as well as Katelyn Jetelina and Kristen Panthagani, Gideon Meyerowitz-Katz Jason Abaluck, among others.

My purpose in writing about this kerfuffle is not to rehash (much) why the Cochrane review was so problematic. Rather, it’s more to look at what this whole kerfuffle tells us about the Cochrane Collaborative and the evidence-based medicine (EBM) paradigm it champions. After all, the authors cited above do an excellent job of that, although they do miss a lot of important context about the Cochrane Collaborative, Tom Jefferson, and the EBM paradigm under which Cochrane operates and that it has successfully promoted as the “gold standard” of scientific and medical evidence. I want to ask: What is it about Cochrane and EBM fundamentalists who promote the EBM paradigm as the be-all and end-all of medical evidence, even for questions for which it is ill-suited, that can produce misleading results?

This is a topic that I used to write about on a regular basis, both here and at my not-so-secret non-pseudonymous other blog regarding the EBM paradigm’s application alternative medicine interventions, where EBM has never truly been able to definitively conclude that magical interventions—e.g., homeopathy, reiki, “energy healing” like therapeutic touch, and intercessory prayer—don’t work because the RCTs were “equivocal.” Back in the day, we used to call EBM’s failure to consider the low to nonexistent prior probability as assessed by basic science that magic like homeopathy could work its “blind spot.” Jefferson’s review, coupled with the behavior of EBM gurus like John Ioannidis during the pandemic, made me wonder if there’s another blind spot of EBM that we at SBM have neglected, one that leads to Cochrane reviews like Jefferson’s and leads EBM gurus like Ioannidis to make their heel turns so soon after the pandemic hit, which, truth be told, did catch me by surprise.

First, let’s look at how the review was used and misused. Much of how it was received was predictable, although, before Tufekci’s article, I had seen little discussion of Tom Jefferson himself. Let’s just say that it did not surprise me that he was the first author of the Cochrane mask review, for reasons that will soon become apparent.

The usual suspects do their usual thing with the Cochrane review

Before I “go meta”—not that Meta!—it’s necessary to emphasize that not even this not-so-great review ever actually concluded that “masks don’t work.” Rather, it only concluded that the evidence is uncertain. Naturally, not being about nuance, antimaskers referenced the Cochrane systematic review as definitive scientific evidence that “masks don’t work,” even to the point of being cited in a Congressional committee hearing to put CDC Director Dr. Rochelle Walensky on the defensive over mask mandates. Elsewhere, many of the usual suspects were Tweeting and posting proclamations like this:

Oh, goody. The usual libertarian argument about any public health intervention being incipient fascism. Where have we seen that one before?

I could go on and on, as there are thousands of Tweets like this, as well as likely thousands of posts on various other social media with variations of the very same message, specifically that the “gold standard” of evidence, a Cochrane systematic review, “proved” that “masks don’t work.” Indeed, perusing the triumphant gloating on social media from ideological sources opposed to COVID-19 interventions, including masks and vaccines, I was struck by how often they used the exact phrase “gold standard” to portray Cochrane as an indisputable source, all to bolster their misrepresentation. As Tufekci reports, this misrepresentation must have finally rattled Cochrane’s leadership, as they finally issued a statement:

Now the organization, Cochrane, says that the way it summarized the review was unclear and imprecise, and that the way some people interpreted it was wrong. “Many commentators have claimed that a recently updated Cochrane review shows that ‘masks don’t work,’ which is an inaccurate and misleading interpretation,” Karla Soares-Weiser, the editor in chief of the Cochrane Library, said in a statement. “The review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses,” Soares-Weiser said, adding, “Given the limitations in the primary evidence, the review is not able to address the question of whether mask wearing itself reduces people’s risk of contracting or spreading respiratory viruses.” She said that “this wording was open to misinterpretation, for which we apologize,” and that Cochrane would revise the summary. Soares-Weiser also said, though, that one of the lead authors of the review even more seriously misinterpreted its finding on masks by saying in an interview that it proved “there is just no evidence that they make any difference.” In fact, Soares-Weiser said, “that statement is not an accurate representation of what the review found.”

There is now a statement on the Cochrane website, as Tufekci notes:

There are also a number of other interesting things about this review, but first let’s look at why I was not in the least bit surprised to learn who the first author was. It also led me to wonder now, as I did in 2009 and 2013, why the Cochrane Collaborative still employs him.

Methodolatry at Cochrane, or: Meet the new Tom Jefferson, same as the old Tom Jefferson

We have met that lead author before. His name is Tom Jefferson, and I (and others) have been writing about his antivax-adjacent utterances intermittently since 2009, as I will discuss later. What really stood out in the NYT article—and, given his history that I will relate— is that soon after his Cochrane systematic review was published Jefferson gave an interview to Maryanne Demasi, a journalist who has been over the years devolved into an antivaccine propagandist, as one can easily see merely by perusing her Substack, which is where she first published her interview with Jefferson, and how many times she is positively cited by antivax sources. Her interview with Jefferson was widely picked up by the usual suspects in the antivax social media ecosystem, such as the Brownstone Institute and Robert F. Kennedy, Jr.’s Children’s Health Defense. Unsurprisingly, Demasi is also a contributor to the Brownstone Institute website, as is Tom Jefferson himself, something that has only been rarely mentioned in the reporting about this review.

In the interview, Jefferson made very confident proclamations, like:

There is just no evidence that they [masks] make any difference. Full stop. My job, our job as a review team, was to look at the evidence, we have done that. Not just for masks. We looked at hand washing, sterilisation, goggles etcetera…


There’s no evidence that they [masks] do work, that’s right. It’s possible they could work in some settings….we’d know if we’d done trials. All you needed was for Tedros [from WHO] to declare it’s a pandemic and they could have randomised half of the United Kingdom, or half of Italy, to masks and the other half to no masks. But they didn’t. Instead, they ran around like headless chickens.

First of all, as Steve Novella, Katelyn Jetelina and Kristen Panthagani, Gideon Meyerowitz-Katz, Jason Abaluck, and others have pointed out, the study doesn’t say that there is “no evidence” that facemasks “do work.” They pointed out that it was a specific set of studies examined and that the conclusion was that the uncertainty in the data is high.

I also facepalmed when I read Jefferson’s simplistic (to the point of being simple-minded) pronouncement about randomized clinical trials (RCTs), wanting to respond: Tell me you don’t understand the ethics of RCTs without telling me you don’t understand the ethics of RCTs. Also, tell me you don’t understand the logistics of doing a randomized clinical trial this massive without telling me you don’t understand the logistics fo doing an RCT this massive. I will discuss these issues more near the end of this post, but first I need to set up the discussion.

There is a pattern that I (and others at my favorite other blog) been observing about Jefferson for a very long time, in which he is much more circumspect with his conclusions in the systematic reviews he writes for Cochrane but then gives interviews to sympathetic journalists in which he makes pronouncements like the ones he made in his interview Demasi; for instance, during the last pandemic, H1N1 influenza in 2009, he all but came out and stated, “The flu vaccine doesn’t work.” It’s his schtick, apparently. Jefferson is much less definitive in his Cochrane conclusions and includes the necessary shortcomings and caveats, likely because peer reviewers insist on it in academic articles, but then says what he really thinks in interviews, where there is no peer review. Sometimes, he’s even appeared with utter quacks like Gary Null to falsely claim that flu vaccines aren’t safe in pregnancy and that statins don’t work.

I once referred to his schtick this way:

…he insinuates that the flu vaccine doesn’t work while never actually saying that you shouldn’t get it. He maintains plausible deniability, while trashing the vaccine left and right. What he says in public also differs from what he says in his Cochrane reviews, as I’ve pointed out before. For his reviews, he has to stick to the evidence, and peer reviewers have to be satisfied. When he’s talking to journalists, he can let his freak flag fly higher and, as I put it, go full mental negative on the flu vaccine.

Which brings us back to my purpose in writing this.

I had been meaning to write about the Cochrane systematic review on masks almost since it was first published, but somehow other things kept getting in the way, including a personal family health emergency that I mentioned six weeks ago that has stabilized but is ongoing. I simply didn’t have the time to delve deeply, and then when I finally did others had already written about the systematic review.

However, in the back of my mind, another angle that no one had covered (much) kept percolating. I’ve noticed over the last three years a tendency for scientists who were known primarily before the pandemic as strong advocates of evidence-based medicine (EBM), devolving into promoters of COVID-19 denial, antimask, anti-public health, and even antivaccine pseudoscience. Think Dr. John Ioannidis, whom I used to lionize before 2020. Think Dr. Vinay Prasad, of whose work on medical reversals and calls for more rigorous randomized clinical trials of chemotherapy and targeted therapy agents before FDA approval we generally wrote approvingly.

Basically, what Jefferson exhibited in his almost off-the-cuff claim that massive RCTs of masks should have been done while a deadly respiratory virus was flooding UK hospitals was something we like to call “methodolatry,” or the obscene worship of the RCT as the only method of clinical investigation. I’ve long pointed out how methodolatry leads the EBM paradigm to be too open to alternative medicine, but it turns out that it might also lead to COVID contrarianism. So let’s take a trip down memory lane, back to the early days of this blog, before moving on to discussing methodolatry in the context of Jefferson’s studies and how many EBM fundamentalists have embraced COVID-19 minimization and antivax-adjacent takes.

EBM and “complementary and alternative medicine” (CAM)

Longtime regular readers remember that a common theme that I picked up from my favorite other blog is the difference between evidence-based medicine (EBM). Over there, we introduced the concept of science-based medicine (SBM). Indeed, in Steve Novella’s very first post introducing the blog 15 years ago, he described the difference between EBM and SBM this way:

Within the practice of medicine there is already a recognition of the need to raise the standards of evidence and the availability of the best evidence to the practitioner and the consumer – formalized in the movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has its limitations. Most relevant to this blog is the focus on clinical trial results to the exclusion of scientific plausibility. The focus on trial results (which, in the EBM lexicon, is what is meant by “evidence”) has its utility, but fails to properly deal with medical modalities that lie outside the scientific paradigm, or for which the scientific plausibility ranges from very little to nonexistent.

We spent much of the first year of the blog’s existence, and, rather than reinvent the wheel yet again, I will quote liberally from some of these old posts. Indeed, a few weeks later, Dr. Kimball Atwood expanded on the concept of what we mean by “science-based medicine” as opposed to EBM:

Some might be surprised to find that EBM is not synonymous with “science-based medicine.” Although based on previous, evolving standards of clinical trial designs, statistics, epidemiological methods and other pertinent tools, EBM is a semi-formal movement within modern medicine that has existed for fewer than 20 years; it comprises sets of guidelines for assessing evidence, which will be discussed further below.


To many in this era of EBM it seems self-evident that all unproven methods, including homeopathy, should be subjected to such scrutiny. After all, the anecdotal impressions that are typically the bases for such claims are laden with the very biases that blinded RCTs were devised to overcome. This opinion, however, is naive. Some claims are so implausible that clinical trials tend to confuse, rather than clarify the issue. Human trials are messy. It is impossible to make them rigorous in ways that are comparable to laboratory experiments. Compared to laboratory investigations, clinical trials are necessarily less powered and more prone to numerous other sources of error: biases, whether conscious or not, causing or resulting from non-comparable experimental and control groups, cuing of subjects, post-hoc analyses, multiple testing artifacts, unrecognized confounding of data due to subjects’ own motivations, non-publication of results, inappropriate statistical analyses, conclusions that don’t follow from the data, inappropriate pooling of non-significant data from several, small studies to produce an aggregate that appears statistically significant, fraud, and more.

A few years later, Dr. Atwood wrote a multipart article asking Does EBM Undervalue Basic Science and Overvalue RCTs? (Hint: the answer is yes.) He also wondered whether it is a good idea to test highly implausible health claims. (Hint: the answer is usually no, at least not using RCT efficacy trials of the sort placed near the very top of the EBM pyramid of evidence, just under systemic reviews, evidence syntheses, and meta-analyses of RCTs.) As I like to ask: Which of the following is more likely, that a 30C homeopathic solution of…something…that has been diluted on the order of 1037-fold more than Avogadro’s number and thus is incredibly unlikely to contain even a single molecule of that something has a therapeutic effect or that the RCTs concluding that it does reveal the problems and biases in clinical trials?

As I also like to say, the usual p-value of 0.05 designated for a “statistically significant” finding contributes to the problem. Remember that p<0.05 means simply that there is a 5% chance that the difference between control and experimental groups could be observed under the null hypothesis; i.e., that the two groups are not different. As a result, in practice one can estimate that, under ideal circumstances, with perfectly designed and executed RCTs, by random chance alone 5% of RCTs will produce “positive” results; i.e., a difference between the two groups with a p-value less than 0.05, or “significant.” Of course, in the real world, RCTs are not perfect, either in design or execution, and the number of “false positives” is therefore likely considerably higher than 5%. Yet, basic science alone tells us that a 30C homeopathic remedy is indistinguishable from the water used to dilute it, which means a placebo-controlled RCT is testing placebo versus placebo and “positive” results show us nothing more than the noise inherent in doing RCTs.

I also like to caution: EBM is correct that “first principles” in basic science cannot tell you whether a treatment works or not. RCTs are indeed necessary in the vast majority of cases. History is littered with treatments that appeared as though they should be effective based on preclinical in vitro and animal models but failed to pan out in clinical trials. However, in contrast, if basic science tells you that a treatment modality is impossible, that (like homeopathy) such a treatment would require that multiple well-established laws and theories of chemistry and physics be not just wrong, but spectacularly wrong, in order for it to have a chance of “working,” then that should be enough. You should be able to conclude on basic science first principles alone that the treatment can’t work, because it violates scientific findings so old and well-established that it would take a body of evidence equal to or greater than the body of evidence that supports those findings to be able to overturn them. In such a case, RCTs should not be necessary. Indeed, they would arguably be unethical, because a major ethical requirement for clinical trials is that the treatment being tested be grounded in good science with a prior plausibility suggesting benefit based on what is known at the time of the trial.

But what about COVID-19? Guess what? What has happened since the pandemic hit suggests to me that EBM also undervalues epidemiology compared to RCTs.

EBM during the pandemic: A different flavor of methodolatry?

Let’s revisit what Jefferson said in his interview with Demasi, because it’s important to my discussion of methodolatry. Basically Jefferson’s statement saying that the WHO should have just done RCTs of masks in the UK and Italy was perhaps the most blatant manifestation of “methodolatry,” a term used to describe the EBM tendency to view RCTs as the only valid method of clinical investigation and to devalue to an inappropriate degree any evidence that does not come from an RCT, that I can recall having seen in a long time. Indeed, Jefferson’s blithe suggestion of “Why didn’t they just do RCTs of masks?” during the chaos of a pandemic crashing into two major countries demonstrates just how methodolatry ignores practicality. (So easy!) It ignores expense, as Jefferson did when he suggested such huge RCTs. It ignores ethics, as Jefferson did when he actually suggested that an RCT of masks for a respiratory virus at the beginning of a pandemic that was flooding hospitals in Italy and the UK with very ill and dying patients, overwhelming the healthcare resources of the two countries.

Tufekci notes this problem in her article:

Why aren’t there more randomized studies on masks? We could have started some in early 2020, distributing masks in some towns when they weren’t widely available. It’s a shame we didn’t. But it would have been hard and unethical to deny masks to some people once they were available to all.

Actually, given the prior probability based on basic science that masks can block the respiratory droplets that transmit viruses like SARS-CoV-2, it is arguable that even what Tufekci proposed would have been unethical, as there would have been no clinical equipoise, an absolute requirement for an RCT to be ethical. Basically, as I’ve discussed before, clinical equipoise is genuine uncertainty whether an intervention is likely to help the experimental group compared to a control group not receiving it. As Tufekci notes:

Scientists routinely use other kinds of data besides randomized reviews, including lab studies, natural experiments, real-life data and observational studies. All these should be taken into account to evaluate masks. Lab studies, many of which were done during the pandemic, show that masks, particularly N95 respirators, can block viral particles. Linsey Marr, an aerosol scientist who has long studied airborne viral transmission, told me even cloth masks that fit well and use appropriate materials can help.

Also, once again, carrying out RCTs of masks on a general population is incredibly difficult, which usually leaves epidemiological evidence as the best available evidence, which EBM claims to be all about:

Perhaps the best evidence comes from natural experiments, which study how things change after an event or intervention. Researchers at Mass General Brigham, one of Harvard’s teaching hospital groups, found that in early 2020, before mask mandates were introduced, the infection rate among health care workers doubled every 3.6 days and rose to 21.3 percent. After universal masking was required, the rate stopped increasing, and then quickly declined to 11.4 percent. In Germany, 401 regions introduced mask mandates at various times over three months in the spring of 2020. By carefully comparing otherwise similar places before and after mask mandates, researchers concluded that “face masks reduce the daily growth rate of reported infections by around 47 percent,” with the effect more pronounced in large cities and among older people.

Also note Jefferson’s dismissive tone, how he characterizes doctors and public health officials as “running around like headless chickens” because evidence was uncertain. Now, don’t get me wrong. Mistakes were made, as they say, in the heat of the initial confrontation with the novel coronavirus. Hydroxychloroquine was embraced by many hospitals in the US (including one where I worked and another major one in my city) as a standard of care in March 2020 based on very sketchy evidence and little more than the word of the Chinese government that it appeared to work, only to be found not to work as the pandemic’s first summer was drawing to a close.

Still, I’d be willing to bet that Jefferson belongs to what SBM contributor Dr. Jonathan Howard likes to call the “laptop class,” a term borrowed from Great Barrington Declaration (GBD) co-author Dr. Jay Bhattacharya when he railed against pandemic restrictions that in reality describes Dr. Bhattacharya himself, as well as his co-authors and nearly all of the GBD promoters. Let’s just say that I doubt that Dr. Jefferson went anywhere near COVID-19 wards to treat patients, as Dr. Howard did in New York City early in the pandemic. His “laptop class” status leads me to wonder what Dr. Jefferson would have recommended in March 2020, had he had actual “skin in the game” rather than just an intellectual interest in what EBM shows regarding pandemic restrictions?

Actually, we have an idea, given that in April 2020, Jefferson co-authored an article arguing tha there was no point in nonpharmaceutical interventions (NPIs) and mitigations to slow the spread of COVID-19 and railed against “lockdowns”:

Because there are no licensed treatments for COVID-19 non-pharmaceutical interventions, management of complications and early recognition of those deteriorating and most likely to benefit from hospitalisation, should be the mainstay of management. Changing the emphasis from hospitals to the community could avert a disaster for the wider population. Care in the home setting restricts movements of the infected. All those with a fever and a cough should stay at home; they could be prescribed pulse oximeters, and oxygen could be delivered to severely affected cases; rescue antibiotics prescribed along with daily video-monitoring could be used to detect deterioration. In the older population, the mildly ill and the recovering, food supplies should be delivered at home. Older Patients admitted to hospital are at greater risk of delirium, pressure sores, adverse effects of new medications, malnutrition and hospital-acquired infections. [6] An older person admitted to hospital runs the risk of never seeing the light of day again. This is probably the clearest message coming from Italy. Lockdown is going to bankrupt all of us and our descendants and is unlikely at this point to slow or halt viral circulation as the genie is out of the bottle. What the current situation boils down to is this: is economic meltdown a price worth paying to halt or delay what is already amongst us?

Masks, I note, are not “licensed,” nor do they require a license. Also note Jefferson’s complete disconnect from the actual dire situation “on the ground” in April 2020. He suggests these policies as though they could easily be implemented immediately and would not require considerable planning of weeks to months. In addition, one can already detect a significant bias against masks and other NPIs in favor of a “let ‘er rip” fatalism that six months later became the basis of the GBD. That same month, he questioned whether COVID-19 pandemic was actually a pandemic at all, rather than just a long respiratory illness season, arguing that because during a pandemic the proportion of deaths among the young should increase COVID-19 couldn’t be a true pandemic. I kid you not. He concluded:

The data support the theory that the current epidemic is a late seasonal effect in the Northern Hemisphere on the back of a mild ILI season. The age structure of those most affected does not fit the evidence from previous pandemics. The outbreak does, however, fit with the WHO’s definition of a Pandemic. This definition does not help explain the age structure of those most affected, and how this differs from that of seasonal outbreaks. The definition of a pandemic remains elusive. What would Sherlock have made of all this?

I daresay that Sherlock Holmes would have sharply and sarcastically criticized Jefferson’s “reasoning,” such as it is, the way he often did with his friend Watson’s attempts to figure out a case. Seriously, if you were arguing in April 2020 that COVID-19 was just a bad “seasonal” flu-like illness, you lost the plot three years ago.

Methodolatry beyond Cochrane and Jefferson: When is epidemiology sufficient?

Jefferson is not alone among EBM gurus who took a major heel turn during COVID-19 to turn into contrarians who claim that NPIs like masks don’t work and that the COVID-19 vaccine should not have been authorized for children under an emergency use authorization because, supposedly, COVID is “not a danger” to children, even though around 1,800 children—a very large number for pediatrics!—have died of COVID since the pandemic hit, making it a leading cause of pediatric death. It is a number that is, on a population basis, roughly the same as the 400-500 deaths from measles that occurred every year before the first measles vaccine was licensed in the early 1960s. Back then, nearly every physician correctly believed that several hundred pediatric deaths a year were such a bad thing that the toll justified developing a vaccine and instituting the mass vaccination campaign in the 1960s that ultimately reduced the number of measles deaths a year to zero or single digits. Since COVID-19, a number of EBM fundamentalists think that a similar death toll among children is acceptable until and unless there are massive RCTs testing vaccination and then boosters in children.

Indeed, these EBM doctors calling for RCTs über alles don’t seem to realize that they are recycling exactly the same arguments that antivaxxers used to make against the measles vaccine, or vaccines against chickenpox or whooping cough, before the pandemic, all in the name of calling for ever larger, more impractical, and expensive RCTs of every conceivable combination of vaccination and boosters. Does any of this sound familiar? Those of us who remember countering the antivaccine movement before the pandemic remember antivaxxers routinely calling for huge, expensive, and impractical RCTs of variants of the entire vaccine schedule in order to determine whether vaccines cause autism or all the other things that they blame vaccines for. I’m not saying that EBM fundamentalists like Jefferson and Prasad are antivaxxers (although they certainly echo longstanding antivax tropes with a distressing frequency and seem immune to correcting themselves when it is pointed out that they are echoing longstanding antivax tropes). What I am saying is that there seems to be something about EBM that leads its most visible and vocal promoters down a path towards sounding like antivaxxers. I realize that my saying this is likely to piss some people off, likely people I even respect, but it is an observation that has been increasingly difficult for me to discount.

Again, let’s go back to the evidence pyramid of EBM:

EBM evidence pyramid, similar to that of Cochrane
The EBM evidence “pyramid.”

We used to routinely note that basic science considerations are relegated to the very bottom of the pyramid, as “level 5 evidence” consisting of “expert opinion without explicit critical appraisal, or based on physiology, bench research or ‘first principles.'”” It is true that epidemiology is higher on the pyramid—just below RCTs!—but for some reason, among EBM fundamentalists, that doesn’t seem to translate to any more respect than EBM gives basic science when it considers RCTs of homeopathy or energy medicine. Indeed, Jonathan Howard has documented how the response of self-proclaimed EBM adherents to proposed policies to vaccinate or boost children is always to say that there are “no RCTs” and to call for huge, impractical RCTs before recommending such interventions.

Indeed, look at Vinay Prasad writing at the Brownstone Institute and his Substack, you’ll see a similar attitude, although does give a slight amount of leeway:

  1. In an emergency situation, if governments mandate or advise individual level behavioral interventions (e.g. masking), those entities should have generated robust data in 3 months (cluster RCTs) to demonstrate efficacy, or the intervention is automatically revoked. Some may argue 3 months is too short, but if it is truly a crisis warranting emergency proclamations, then you should see a signal in 3 months, and governments can expand sample size to ensure prompt results.
  2. If a trial is positive that does not mean the policy continues forever, but must be debated (net benefit/ net harms/ tradeoffs) by the body politic.

Three months to generate robust RCT evidence? You can tell that Dr. Prasad has probably never actually gotten a clinical trial protocol funded and approved by an institutional review board (IRB) as principal investigator. Even under emergency situations, you might— if you’re lucky—manage to randomize in 2-3 months. However, you won’t have robust evidence of anything yet. Prasad has yet again demonstrated his methodolatry at its most ridiculous.

Does EBM attract or contribute to contrarianism?

Don’t get me wrong here. The EBM paradigm is not wrong. Rather, it is seriously limited by, yes, methodolatry. Its entire framework assumes that RCTs are at the very strongest form of clinical evidence, thus putting aggregations of RCTs (e.g., meta-analyses, Cochrane systematic reviews, and other forms of systematic reviews) at the very top of the EBM pyramid. There is no doubt that EBM is correct that, in general, the best way to determine the efficacy of a drug or vaccine is a well-designed RCT. Far be it from me to imply otherwise! Moreover, I have echoed calls for more scientific rigor in drug approval, in particular the RCTs used to support the drug approval.

There are caveats, of course. the entire EBM model assumes that there is scientific plausibility. (Remember, that was one of the problems with EBM that we used to point out all the time with respect to clinical trials of homeopathy that could lead to misleading results.) In addition, it assumes that such a trial would be ethical. If one wanted to contest my criticism here, one could argue that EBM fundamentalists like Jefferson ignore the absolute requirement that a clinical trial be ethical and the relative requirement that it be feasible in favor of their worship of the RCT as the only valid method of clinical investigation that can produce definitive results.

Moreover, Cochrane meta-analyses are notoriously tricky to do. First of all, you have to decide what the question is. Then you have to decide what studies out there address the question. Then, for the case of something like masks, you have to realize that you will, by the time you go through the literature and apply EBM standards to them, looking the highest quality RCTs, you will be looking at only a small, highly select part of the literature. While this is fine for new drugs and asking if they are efficacious, for a multifactorial question like whether masks slow the spread of COVID-19 at the population level, a large amount of compelling and high quality scientific evidence could well be excluded because the EBM model demands it.

Yet, as I like to point out, no EBM adherent seriously doubts that smoking and tobacco can cause lung cancer, heart disease, and a host of other maladies, despite the inconvenient fact (to the EBM paradigm) that there is not and never will be an RCT testing whether smoking causes these conditions because such a study would be profoundly unethical. Epidemiology has always been and remains sufficient to lead to a conclusive conclusion that smoking causes lung cancer, for instance. Similarly, although there are RCTs that are cited as evidence that vaccines don’t cause autism, in reality it is nearly all epidemiology that leads to the conclusion that vaccines do not increase the risk of autism. No RCTs are required to reach these conclusions in a scientifically rigorous fashion, as is the case for a large number of other medical questions.

Even Cochrane seems to accept a lesser level of evidence in the midst of a deadly pandemic:

Brown, who led the Cochrane review’s approval process, told me that mask mandates may not be tenable now, but he has a starkly different feeling about their effects in the first year of a pandemic. “Mask mandates, social distancing, the other shutdowns we had in terms of even restaurants and things like that — if places like New York City didn’t do that, the number of deaths would have been much higher,” he told me. “I’m very confident of that statement.”

Based on what, I wonder? There were no RCTs of mask use against COVID-19 in March 2020. So how could he possibly know? I’m not saying he was wrong, but it would appear that even Cochrane editors will abandon their strict adherence to the EBM paradigm in the breach.

It occurred to me as I was wrapping up that one potential shortcoming of my argument is that so many of these methodolatrists tend to be very selective what conclusions to them require RCTs and what conclusions can be accepted without them. I cite again Vinay Prasad, who is very dismissive of epidemiological evidence for assessing the effectiveness of, for example, masks to prevent the spread of COVID-19 or of vaccination and/or boosters for COVID-19 in children, but will accept crappy dumpster dives into the Vaccine Adverse Event Reporting System (VAERS) database and various other epidemiological studies to conclude that myocarditis from the vaccines in adolescents and young men is an unacceptable risk.

And yet…I don’t think that ideological misuse of the EBM paradigm is the explanation. It is undoubtely true that some of these EBM fundamentalists do indeed do exactly that, calling for impossibly rigorous RCTs for interventions that they do not support while accepting much lower quality evidence to fear monger about low probability complications of those interventions. However, I can’t help but wonder if there is something about the EBM paradigm that either attracts contrarians or facilitates those predisposed to contrarianism to descend further into it. EBM certainly emphasizes uncertainty in evidence and conclusions, which is a good thing for skeptics to do when the question is a new drug. However, this skepticism can become unhealthy and misleading when coupled with the attitude, “If it’s not an RCT, it’s crap” or “Anything other than RCT evidence is crap.” EBM adherents will vigorously deny that they think that, but the conclusions coming out of Cochrane and touted by its most zealous adherents suggest otherwise.

Fifteen years ago, I actually had to be convinced that the EBM model valued RCT evidence over everything and therefore discounted basic science to an unreasonable degree when that basic science showed that an intervention like homeopathy or energy healing was impossible. Once I realized that this assessment was correct, i saw examples everywhere, mainly in the world of CAM. What I never suspected until now is that that same blind spot seems to contribute to an attitude that we can’t know anything with sufficient certainty to act, even in the middle of a pandemic.

I also note that 13 years ago, we noted that Cochrane might be finally starting to “get it” with respect to SBM as opposed to EBM when some EBM bigwigs actually started to concede that further studies might not be necessary for interventions like homeopathy. Unfortunately, I’ve seen little evidence that this “getting it” has stuck. Now I think that the evidence pyramid has had another malign effect during the pandemic, the devaluation of what is often the form of evidence most suited to address relevant questions given resources, medical ethics, and practicality, questions such as whether masks and other NPIs decrease the spread of COVID. Basically, more and more EBM seems to have one tool, and you know what they say about having only one tool and that tool is a hammer. The result was the Cochrane mask fiasco.

Fifteen years ago, the concept of SBM was introduced, primarily as a “fix” to EBM that would restore the consideration of basic science and the prior probability it estimates for highly implausible treatments. Based on what I’ve seen from EBM thought leaders during the pandemic, I’m wondering if another fix is in order from SBM. I will admit that I am not yet sure what that fix should be yet, but I will be contemplating the question.

I also know that Tom Jefferson’s reaction to all the criticism is not a good look, as he rapidly declared himself as the persecuted victim and that it was an “open season on scientists” like him. He also bemoaned the statement issued by Cochrane as having been cowardly and coerced, while Maryanne Demasi predictably asked whether Cochrane “sacrificed” its researchers to appease critics and Paul Thacker immediately pivoted to attack Zeynep Tufekci personally in order to try to discredit her, because, as I like to say Thacker gonna Thack. It’s who he is. Unsurprisingly, Dr. Prasad also spins a conspiracy theory about how a “Cochrane Report tells the truth, but many are not ready to hear it,” writing quite tellingly that “nyone worth their salt in EBM would reach that same conclusion” that masks don’t work.

That might actually be the problem. While such conspiratorial responses are expected from cranks and ideologues like Demasi and Thacker, it apparently has not occurred to Dr. Jefferson, Dr. Prasad, or any other EBM fundamentalist that maybe—just maybe—it is the EBM paradigm itself that is the problem.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

60 replies on “The Cochrane mask fiasco: Does EBM predispose to COVID contrarianism?”

There sort of was a study of masked vs. not masked – the Democratic leaning vs. Republican leaning communities in the USA. But to be fair, the variables of other NPI and also vaccination need to be included, too. The urban Democratic places suffered more at first (2020), but they (we) took this seriously more than the rural Republican places with predictable consequences. After rollout of the vaccines, it was the Republican places that suffered most because a higher percentage disregarded public health advice.

Ron DeSantis, July 2021: “If you are vaccinated, fully vaccinated, the chance of you getting seriously ill or dying from COVID is effectively zero,” he said. “If you look at the people that are being admitted to hospitals, over 95 percent of them are either not fully vaccinated or not vaccinated at all. And so these vaccines are saving lives. They are reducing mortality.”

“The demagogue is one who preaches doctrines he knows to be untrue to men he knows to be idiots.”
– H.L. Mencken

Usually the basis is in the first few paragraphs. I’ve read enough of SBM. Please explain “novel respiratory virus”. It’s your premise.

It was a novel, never before seen, coronavirus. However, if you want to be pedantic, I’ll change it to “novel coronavirus.”🙄🤦🏻‍♂️

I remember this story from the beginning of the pandemic. The so-called “mask fiasco” is much broader and is not just Cochrane mask fiasco.

There is no evidence that masks are useful. There is also no evidence that masks are useless. There is NO EVIDENCE AT ALL. All we have is bullhsit.

Before I go on, keep in mind that I am a Covid-antivaxxer but I am not an antimasker, I do not care about them all that much other than I am claustrophobic and cannot wear a mask for a long time past 15-20 minutes.

What alarmed me from the beginning of the pandemic is that no proper mask studies were done at all.

Orac refers to “RCTs” tracking infections and their obvious ethics problems. But there were other ways to ethically measure mask effectiveness. For example, put a Covid-infected person in a room, give him a surgical mask, wait an hour and then measure concentration of the virus. Compare to the same person, occupying a similar room but without a mask. Nothing of the sort was done.

All talk abouit masks was hand wringing, liberal virtue signaling, general insanity, hysterics, and total lack of evidence of anything.

The mask situation was one of the first alarms for me that something is wrong with this “pandemic” and I should be skeptical of everything.

In search of cool Covid stories to share, I trawl a subreddit called /r/COVID19positive. (I was one of the first people to report that Paxlovid was snake oil based on Covid rebounds reported there in the beginning of April 2022).

Many people on that subreddit reported religiously wearing masks and getting infected.

Having been one of the first people to MISTAKENLY conclude that Paxlovid was snake oil based on covid rebound is a poor boast.

Covid rebound is a thing, yes. But it’s not “Paxlovid rebound,” because it’s not caused by Paxlovid. Itt doesn’t correlate with Paxlovid use.

Paxlovid does reduce death and hospitalization, and maybe the risk of long covid. No, it doesn’t prevent covid rebound, but neither does anything else we’re aware of, other than avoiding infection in the first place.

Also, a lot of people who report rigorously wearing masks are over-estimating that rigor. They may not be lying, but “I always wear a mask” sometimes turns out to mean “I wear a mask around people I don’t know” or “I wear a mask, but it’s not covering my nose” or “but it doesn’t fit my face so there are huge gaps on both sides of my mouth.”

Vicki, remember March or April of 2020 when they recommended cloth or surgical style masks.

They had zero evidence that they would help.

Not only that, but they did not commission any studies to quickly help answer the question whether they work (such as what I mentioned above).

I am sure that extremely advanced masks and space suits “work”. But they recommended to wear surgical style masks with zero evidence.

Three years later, there is still approximately zero evidence and a few unhelpful correlational studies. Same hand wringing and virtue signaling on both sides of the debate about masks.

It is, of course, untrue that there was “zero evidence” in March/April 2020 that surgical masks—or even cloth masks—would help.🙄🤦🏻‍♂️

Igor, I’m sorry if you feel that this pandemic is ‘wrong’.

I have to question a person claiming to be skeptic, while using subreddit to find ‘evidence’ to confirm his bias. Or the irony in your complaining about “hand wringing, liberal virtue signaling, general insanity, hysterics, and total lack of evidence of anything”.

I hope that the next pandemic lives up to your expectations..

Thanks for mentioning the next pandemic. We definitely need to prevent it.

To prevent the next pandemic, we need to punish people who started this pandemic.

This just might do the trick for the next 100 years.

To prevent the next pandemic, we need to punish people who started this pandemic.

Of course there is no good evidence that anybody started this pandemic. Assigning blame to some nebulous group of people as you do is simply another conspiracy theory.

Perhaps the next pandemic might be related to bird flu, caused by keeping to many animals, near heavily populated areas. I’m sure if you go after the farmers, you get The Farmers Defence Force against you.

Igor, you deny actual data and instead seek out feeble lies that match your own predetermined conclusions, yet claim to “love science”.
You clearly don’t love science as you don’t understand it, are unwilling [I believe incapable] of learning the details about anything you talk about, and simply prefer your simple lies in the hope that it will boost your status among the people who oppose vaccinations. I get that in that sense you are no different from folks like labarge, lucas [although lucas may be worse], and so on, but tell us: how did you get to the point where easily debunked lies like yours are preferred over reality?

“..[ although lucas may be worse]..”

I mostly agree with that although Igor may get a few extra points because he has a Substack account and thus, a larger audience.
Choosing whose woo is worst is often fraught with difficulty: does creativity count? Does range count ( more subjects beyond medicine)?
Do they earn money from their “career”? Do they inspire others?

[ although lucas may be worse].

I said that because lucas will get pointed to things that directly contradict his lies and continue to repeat them. Igor seems to just fire crap at one thing and move on to another.

But I do full agree with your comments here and in your other discussions.

@ Idw56old:

Thanks. The feeling is mutual.

Re worst woo
I increasingly find that alties/ anti-vaxxers present an artfully entangled imbroglio of confabulated conspiracies addressing medical/ psychological/ political/ economic issues usually superficially understood by them whilst they blithely “educate” their enraptured audiences:
pro tip: if you’re discussing germ theory, at the very least know how to pronounce ‘Bechamp’ and ‘Pasteur’
or if you’re talking about the brain, know how to pronounce ‘amygdala’ and ‘corpus callosum’
YET they fear monger incessantly and scare listeners away from standard informational sources.

pro tip: if you’re discussing germ theory, at the very least know how to pronounce ‘Bechamp’ and ‘Pasteur’
or if you’re talking about the brain, know how to pronounce ‘amygdala’ and ‘corpus callosum’

You know this, I’m sure, but that can be expanded to any type of woo. I often think of a comment a surgeon made to be a few years ago.

I had a serious DVT in my left leg (we’d been in a bad car accident, I had two very deep bruises in the leg, and my docs laid it off to that). I had surgery to remove some of the clot, was on warfarin for a bit, and all has been well since then.

But after the surgery a colleague at my institution said

You didn’t have to put yourself at risk with surgery and drugs. You could have cleared up your leg with massages and acupuncture.

When I went for a check and related that to my surgeon he said

Is this person a junior faculty member who wants you dead so he can replace you?


kdw56old — That comment on the junior colleague wanting you dead is hilarious.

I had a ‘mild’ pulmonary embolism some years ago likely due to a DVT I hadn’t noticed. I was incredibly lucky it didn’t hit anything vital, but once it got going, it was extremely painful. You might “ask your doctor!” about whether more expensive anticoagulants might be better — I take Eliquis and if doesn’t need to be monitored like warfarin does. My sistern somehow had her warfarin get out of whack and nearly died, so it’s not without risk.


I’m very happy to hear that you avoided a more serious outcome.
As far as this:

You might “ask your doctor!” about whether more expensive anticoagulants might be better

my time on warfarin was short — less than one year. I haven’t had any medication for that since then [checkups show no reason for it] so I’m incredibly lucky.

And yes, the surgeon’s comment was hilarious to me. He is a great guy. I was lucky in that respect as well.

idw56old — No problem on the name. It goes back to my misspelling it myself when I first entered it!

They tapered back my anticoagulants, too, but then the other shoe dropped — transient ischemic attacks, AKA mini-strokes. They never quite figured out exactly why, though there’s an ambiguous indication of a heart defect that would take open-heart surgery to corect, so given the ambiguity I’m holding off on that. Meanwhile, I’m back on a theraputic dose of the high-priced spread.*

Back in the day, margarine commercials were not allowed to use the term “butter”, because of the power of the dairy lobby. “The high-priced spread” was a memorable euphemism for the Dairy Product that Shall Not Be Named.

You seem to be living in a fantasyland where vaccines and masks work.

You probably think that you are smart also.

I live in reality where almost everyone had one Covid, many had multiple Covids, numerous mask-obsessed countries like Hong Kong or Taiwan had several waves of Covid, the pandemic was made worse by vaccinating healthy people etc.

Please open your mind, my friend. Try to read something that does not agree with you (something I try to do daily)

There was no “actual data that surgical masks work”. We all know they do not work and at most slightly extend the duration of time until everyone is infected.

The real purpose of masks was to abuse people into agreeing to take vaccines.

==> Masks can be off (mostly) for fully vaccinated Americans (AHA)

Soon they will approve the spring booster, definitely take that one!

Igor Chudov- you do not have to search very far since here on Orac’s blog, as you are experiencing, there is much to read that does not agree with your view. You should be delighted.

You falsely presume what these follks write are genuine truth statements. They’re not. They’re performances. More specifically, posts here are provocations. They may or may not be as self-conscious as we typically mean by ‘trolling’ or ‘gaslighting’, but the dynamics are similar. The whole point is to elicit debunking, which they will then ignore, thus leaving the debunker fuming or befuddled. It’s ‘owning the smartypants elites’. Refusing and undermining reality is a form of empowerment, which is at the top of the woo-motive pyramid.

@ sadmar:

I’m in total agreement with everything you say.

Alties I survey earn money as well as ego gratification; small timers are in it purely for what they think is comeuppance or pwning the libs/ elites. But surely it must also be to compensate for what they must at some level vaguely recognise as their own lacks.

So where’s that old commenter who used to rail about most of these characters being narcissists? Because I sometimes get the sense that these folks cannot fathom the concept of their lacking anything but the respect, or in the absence of respect, attention they feel they deserve. Even if I wouldn’t label them a narcissist, just a mis/disinformed Dunning Kruger sufferer. A relative who rants about Pfizer shot conspiracy theories claims a need to defend an allegedly well-informed decision against dismissal and disrespect. (But would certainly not go to a left-leaning, pro-public-health website like this one to seek out such disrespect. Those who do might be more likely to be narcissists.)

While I mostly agree with what you say, researchers do find that anti-vaxxers and conspiracy believers are more likely than other people to have narcissistic and paranoid traits.

What I was referring to as vague recognition of their lacks would be constant insistence about the relevance of their own skills and citations of experts with whom they agree who are at odds with most of consensus. If people keeps telling you how great they are at something, it must at some level reflect their uncertainty.
Of course, some are entirely clueless.

Orac refers to “RCTs” tracking infections and their obvious ethics problems. But there were other ways to ethically measure mask effectiveness. For example, put a Covid-infected person in a room, give him a surgical mask, wait an hour and then measure concentration of the virus. Compare to the same person, occupying a similar room but without a mask. Nothing of the sort was done.

Perhaps that’s because it’s a blindingly stupid thing to say.

Something in the back of my head is telling me an experiment like that might have been done, but I can’t even think of the parameters to search for it on Pubmed.

However the salon (non)transmission episode offers a contrary argument which mask opponents never seem to mention. Two salon workers both test positive for SARS-CoV-2. They both wore masks and all their customers word masks. There were about 60 or 70 customers. And none of the customers got Covid-19. I think this was about mid 2020.

But sure. Masks have no effect at all. /s

Something in the back of my head is telling me an experiment like that might have been done, but I can’t even think of the parameters to search for it on Pubmed.

Nor I. How would one recruit participants? How many would be needed to generate something resembling a result? Do they remain silent? Are the chambers devoid of ventilation?

And those are before the data-taking is considered.

In search of cool Covid stories to share, I trawl a subreddit called /r/COVID19positive.

a) You’re not going to get any legitimate data there igor. If you’d actually understood the statistics you claim you took you’d realize that
b) Here’s a term for you: selection bias

How do you even function with a keyboard with your general lack of understanding?

Off topic, but there’s some serious legal thuggery going on Down Under.

A general practitioner in Melbourne with a popular YouTube channel, Dr. Adam Smith decided to take on a naturopath in the Philippines over alleged quackery, and as a result is a defendant in a million-dollar defamation lawsuit which has resulted in huge legal costs for him.

The naturopath in question has (according to Quackwatch) promoted her “natural” supplement, Boston-C as a hugely effective cancer treatment*. Other products she sells include “Pixie Dust” and “Snow White” (you can’t make this stuff up). Authorities in the Philippines closed her “Natural Medical Center” for selling unauthorized supplements, but that of course was due to unwonted persecution by Nefarious Powers That Be.

*Quackwatch reports that the Boston-C Herbal Products website has promised that “the herbal concoction will surely rid the body of cancer”. Boston-C’s listed ingredients include garlic, soursop and bitter melon. It’s also reputedly good for (among other things) liver cirrhosis, emphysema, edema, psoriasis, hemorrhoids and “Prostrate”.

I have to admit: if I were forced to drink something with ingredients like garlic, soursop and bitter melon I would no longer be “prostrate”.

Pixie Dust is PCP and Snow White is cocaine.

It’s actually pretty common for supplement makers to give their products names that imply they are legal drugs. It’s especially true in the bodybuilding community where you’ll see things with names like “Roid Rage.”

“face masks reduce the daily growth rate of reported infections by around 47 percent,” with the effect more pronounced in large cities and among older people.

No confounders whatsoever? Like prior infection, seasonality etc? Give me a break.

I’m with Prasad you get 3 (hell make it 6) months of grace for the intervention. If you can’t bring the evidence -conclusive evidence – after that, then it’s time to drop it. People who still believe in it are free to practice whatever religion they like. This works for masks because they don’t carry the same permanence and risks and mal-incentives that the jabs do. Jabs must be zero risk or fully voluntary.

People who still believe in it are free to practice whatever religion they like.

True, but that has fuck-all to do with science.

This works for masks because they don’t carry the same permanence and risks and mal-incentives that the jabs do.

Yeah, the pain from getting a shot is blinding, right?

Jabs must be zero risk or fully voluntary.

If you looked up “admissions of ignorance about vaccines” in a reference that would be the first thing listed.

“Jabs must be zero risk or fully voluntary.”

Might be worth considering, but only if there’s zero risk of the unvaccinated transmitting a disease that causes serious injury and death.*

*envisioning labarge rolling along in a giant hermetically sealed hamster ball.

Actually is was:
“Depending on the region we consider, we find that face masks reduced the number of newly registered severe acute respiratory syndrome coronavirus 2 infections between 15% and 75% over a period of 20 days after their mandatory introduction. Assessing the credibility of the various estimates, we conclude that face masks reduce the daily growth rate of reported infections by around 47%.”
Different regions had a different reducton rate, and credibility was assessed. There are your confounders.

Thanks, this was a really interesting review.

“Anything other than RCT evidence is crap.”
As an unwashed normie observer (disclaimer), I feel like this was deployed by many on all sides to dismiss all kinds of COVID prevention and treatment approaches that didn’t fit the skeptic’s opinions/analyses. I understand some of these probably deserved that treatment, but just sayin’.

And slightly tangential to the thrust of this piece, one thing this Cochrane kerfuffle revealed is many sober-sounding comments that masking has always been lacking evidence of any effect, even in the operating room (claiming that masking in surgery is more about shielding from blood spatter than controlling infection, the latter for which no evidence has ever been demonstrated?!). This sounds intuitively ridiculous to me, but I have yet to see it addressed directly, maybe because it actually is so baseless as to not be worth acknowledging.

The efficacy of surgical masks on the OR is a completely different issue from COVID masking, the efficacy of which varies with the type of mask and user behaviors like getting the fit right. See Dr. Crislips post yesterday at the Science Based Medicine blog.

Alties ( have recently cited Cochrane to discourage use of masks. If pseudoscientists quote you, you should take note and re-assess perhaps.

Masks have a long history in Asia: they are seen as a polite way to protect other people from your cold or flu, to protect yourself from air pollution ( such as by motorbike riders) and since 2003, against novel viruses like SARS.
Their public may have accepted masks because they have had personal experience avoiding illness and view masks as socially relevant and efficacious unlike some people we know.

Speaking of Covid contrarianism, Antivax Division: a Boston police officer has lost her job for bravely speaking Truth to Power. From the Boston Globe:

“Former Boston police sergeant Shana Cottone failed to assign a protection detail for Mayor Michelle Wu, whose COVID-19 vaccine mandates Cottone railed against for months. On a number of occasions, the 15-year veteran of the department protested in front of the mayor’s home, yelling and screaming through a bullhorn, and on at least one occasion, followed Wu in a car.”*

“Those allegations are just a snapshot of a 38-page summary of an internal affairs investigation against Cottone that the Globe obtained after she was fired last week.”

*sounds like something Steve Kirsch would approve of.

Addendum: this police officer was also victimized by being asked to comply with the law that required her to wear a mask into pizza restaurants. Confrontations ensued.

Police officers are sworn to ‘serve and protect and uphold the law’ the public. So when a police officer decides to ignore the law and fail to protect on their political believes their sacking should be applauded.

… Wow. That’s a pretty pure distillation of the concept of “‘Law and Order’ is a one-way right that I can enforce on others but will never allow to be enforced on me” that’s popular on the right.

And the summary is 38 pages?

I’m reminded of a case I was almost on the jury for, involving a disbarred lawyer stalking and harassing his ex-girlfriend, which by the time I was present had extended to a list of about eighteen charges including multiple breaches of previous court orders.

I saw a question yesterday on a nurse group I belong to asking which work places still require masks at work and has that had any impact on infection rates if lifted.

Most people replied they were still required a mask while at work, a few in the US red states say they are not required, but most still do. A lot of anecdotes about infection rates, but I’d be more interested if anyone was keeping data on than relying on anecdotes.

I should add, we still are required to wear masks here and most of the staff here have not had covid, though all are vaccinated.

I always thought that mask wearing is more of a benefit of others, not the wearer. Generally, it is/was thought that the spread of covid was via airborne water droplets. Most sceptics used the analogy that ‘if your jeans can’t keep a fart in, how do you expect a mask to keep a tiny virus’. Well, wear your jeans over your head, try and spit through them.

OT ( but are charlatans pretending to cure serious conditions ever truly OT at RI?)

Perhaps a doctor/ HCW might want to evaluate this video: Utrice Leid 4 week protocol
18 minutes long video

Briefly, a 70 year old broadcaster who had several serious conditions including cancer and diabetes was “cared for” at a woo-meister’s Florida estate- it seems she and her host ‘couldn’t find a doctor’ (?)
They claim that purely through lifestyle modifications, her problems were reversed and she stopped her meds.
I notice several red flags concerning the written reports and the IV provider’s comments.
Testimonials are a way to recruit followers.

AFAIK she worked in liberal radio focusing upon Black and Caribbean issues.

I wonder why the people who are so enthusiastic about the Cochrane review of masks never mention the Cochrane reviews of hydroxychloroquine, ivermectin, and COVID vaccines. Such strange behavior from the people who call Cochrane reviews the “gold standard.”

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