The Best Argument Public Health Should be Stripped of Power is The CDC Ran Zero Cluster RCTs
Zero cluster trials... think about it
During the pandemic, there were countless questions for which we needed better data. Should kids wear masks? Should we advise community n95 masking? Should we advise 3 vs 6 ft distancing (no distancing or other distances)? Should we cohort classes? Does hepa-filtration slow covid spread? How about cracking windows? Plexiglass?
For most interventions that involve behavioral change among people, the ideal study is a cluster RCT. This can measure whether the intervention slows spread among a group of people, when any, some or all comply with it. And it measures spread in the whole group, not just those proscribed the intervention.
Even if you steadfastly believe community masking works (hypothetically). A cluster RCT of surgical vs. n95 might make sense. Or if you believe everyone should wear an n95, a trial of kf94s (more comfortable perhaps) vs. n95s might make sense. If you think masking is silly, one arm should be no mask recommended. But the bottom line is that every single person can think of some study to lower uncertainty. There is a study for everyone from covid nihilist to zealot.
Yet, during this time, the US CDC ran zero cluster randomized trials.
Zero.
Not on a plane, not on a train, not in your house, not with a— ok maybe they did some mouse studies.
How can anyone justify this? Countless questions and the preeminent federal agency in charge ran ZERO cluster RCTs. They answered zero questions.
We will leave the pandemic knowing nothing about whether universal intermittent cloth mask airplane mandates slow spread of coronaviruses. Yet, many “experts” act as if they know—substituting arrogance for knowledge.
The CDC could have tested it, but did not. And not just for one question, they failed THOUSANDS of times.
This, I think, is the strongest reason, public health and specifically the CDC should be stripped of powers. A federal agency that makes policy that refuses to conduct studies is not one that follows science. It follows politics.
The CDC failed the American people and the world. Not running a single cluster RCT during the entire pandemic is the greatest failure of the agency. Like a bus driver who refuses to turn on the wipers in a storm, they were totally blind to what was in front of them, and made no effort to improve their situation.
"I am the science." With that attitude, who needs data? Before the pandemic, my attitude toward the CDC, FDA, Big Pharma, etc. was "they're not perfect, but I'll generally give them the benefit of the doubt." How wrong I was. I no longer have any confidence in their policies and pronouncements. Unfortunately, this extends to some of my personal health care providers who continue to hold these policies as gospel either because they believe them or have to in order to keep their job. I'm not sure which reason is more disappointing.
They ran none because all previous studies showed no significant effect for community measures, because "community" measures are never applied at home and that's where most transmissions occur...