Just because something is bad, does not mean your intervention is good
That Millions died from COVID is lamentable, but toddler masking doesn't help
This week on the Sensible Medicine podcast, John Mandrola told me about a great RCT of ECMO in cardiogenic shock. The study showed that ECMO— extracorporeal membrane oxygenation— failed to improve outcomes in shock + MI.
The study was run against all odds— many felt it was unethical, unnecessary or both. They thought ECMO must save lives. That isn’t true. But the part of the story that caught my attention was the 30 day death rate in both arms:
Half of all people died in 30 days.
There is a persistent argument in medicine that you can’t subject an intervention to randomization if the outcomes are dire. 50% death rate in 30 days is insanely high! This study shows precisely why you MUST subject it to randomization. Just because outcomes are dire, doesn’t mean your intervention helps. If a plane is crashing, you can slaughter a chicken, but don’t think you are helping anyone.
When it comes to COVID19 there are many variations of this argument
7 million people died, which is far worse than masking a toddler.
Yes, sure, people dying is worse than masking a toddler, but masking toddlers did not change the death rate. It was just a separate, stupid thing we did.
Many kids lost a parent, which is worse than school closure.
Of course, for an individual kid losing a parent is worse than closure, but closure did not prevent any parents from dying. Closure was a separate, stupid thing we did.
Influenza kills many people, ergo influenza vax mandates are a small price to pay
No one has shown that vax mandates for the population writ large lower influenza death rates, and Cochrane reviews are sobering.
And, the list goes on
Just because things are bad, or the disease is worse than the intervention, doesn’t mean the intervention helps, or should be done.