VP, in the absence of actual RCTs how do these docs go around shouting #MASKS WORK!!!
I feel like the medical profession writ large either has no idea what an RCT is, or pays no attention to whether they exist for (fill in the blank) recommendation.
Basically, my entire impression of doctors is eroded. And it ain’t coming back anytime soon. These people are out of their minds — truly driving blind, and appealing to authority to CYA.
They got Gish Galloped. Everyone did. They mistakenly thought that 100 bad studies finding a weak signal must mean the evidence is strong, never realizing that if after data drudging 100 times you still come up with such weak evidence you are in fact dealing with pseudoscience.
This is how all pseudoscience spreads. It skips RCT and jumps straight to retrospective case control studies. Next thing you know because some people who agreed to be tested in a salon didn’t catch Covid in April of 2020 “the science is settled”.
Now we are stuck in a strange “Emperors Clothes” situation where I suspect physicians are nodding in agreement out of imposter syndrome fear or something.
I don’t know for sure. It’s clear they’re not actually reading these studies though. They are downright embarrassing.
And any phD, DrPH, or MPH who uncritically passed along nonsense like the Kansas Mask Study should be ashamed of themselves and lose whatever (if any) credentialing they have.
All I did was read a few books about the low fat diet to appreciate how unhinged/adrift from reality medical culture can get in the absence of decent RCTs + the proliferation of shitty epidemiology.
It’s just impossibly frustrating to watch the same movie unfold in real time.
It would be fascinating to see an analysis of whether official pronouncements on controversial interventions (masks, off-label drugs primarily for early treatment, Remdesivir) seem consistent in light of the available scientific evidence for each. It seems quite likely that the answer is no. My impression is that all 3 types of interventions should have been studied more carefully/thoroughly (primarily by funding large studies with gold-standard designs).
In fact there are many studies on early treatments that show promising results, but the narrative opposing them has made it impossible for such tests to be mentioned in American media or to be funded. You are correct that this deficiency is a black eye for any "I follow the science" public health officials.
There are those that shout. There are those who will loose their license to practice--their livelihoods--if they deviated any way from what public health institutions are saying and recommending. Therein lies the problem. The medical boards are not applying rigorous dialogue and debate to the topic. To them, there is no nuance, there is only obedience.
Let's see how mad people really are at the judge. The same day of her decision every major airline dropped the requirement. Multiple viral videos show people cheering, flight attendants singing. When asked whether people should mask on airplanes, Biden - the executive sponsor of the mandate that had been overturned - said, "it's up to them." The administration took two days to even suggest they would appeal the ruling and, still, will do so *without asking for a stay.* Most of the coverage of the administration's thinking says they are concerned they will lose on appeal because the judge's decision was, you know, right.
Vinay, No thinking person could dispute what you have written here. But as I have pointed out many times, there is an extensive literature on the general lack of utility of masks, especially with regard to viruses. This has been well known for years. Pretending that we need new studies starting from "ground zero" for something already well studied and disproven might be interesting, but is almost guaranteed to be unproductive. How many times does the same thing need to be demonstrated? I really wish you would drop the "bioplausible" thinking on masks. The sun circling the earth was "geoplausible" and every bit as wrong.
For those interested, here are some curated references that I expect you will find generally persuasive on the silliness of the mask conversation.
If you want to look at real world data from the covid years, I suggest the book Unmasked by Ian Miller. Can get from any of the usual booksellers.
In fact, even Monica Gandhi, (also from UCSF), a reasoned writer but generally a shill for the diktats of the government, cowrote a piece in the Chronicle this week that said flatfootedly "...MASKS DO NOT WORK". Her point was why are we even discussing this any more? For once I agree with her.
If Monica has come around then why are we tolerating CDC announcing (just moments ago) that the judge's opinion will be appealed because "requiring masking in the indoor transportation corridor remains necessary for the public health". It has nothing to do with public health and everything to do with trying to retain capricious power over everyone JUST BECAUSE THEY THINK THEY CAN. I agree with Vinay and Monica and any thinking physician (there are an amazing number that just follow this advice blindly...so sad) that this has to stop.
And it will take us to stop it. I have not worn a mask yet (full disclosure: I carried one a few times) and will not wear one now irrespective of what CDC says -- in fact, one can generally assume at this time that if CDC says it, it is a lie. What a really sad state of affairs from a once useful agency.
Incidentally, everyone I know is thrilled with the judge.
I hope you were an MD on some advisory committee for some school board...if not you should have been (or should be this fall if a school board seeks advice!) You speak the truth! The MDs (Univ. of WI hospital system) on our District's medical committee in 2020 and esp. in 2021 PUSHED masks hard.....even leading into fall 2021 created a power point (right before a Board vote on masks)....on masking and WHY it works...and why masks shouldn't be optional in schools...because of how you then can't conceivably contact trace, etc etc etc. basically the tone from these MDs were..."if you vote to make masks optional in our schools you are an idiot".....no one asked them evidence based questions (they probably had no clue what to ask and how)....no one questioned it...it was pushed hard and then they voted the way the MDs said (or face embarrassment, etc). So sad...no other MDs to say wait...I disagree...and this is why. So sad!
Vinay, I know you consider yourself to be a progressive and I am not one of those but I could probably support you for political office. You and Marty Makary might be able to make a difference. Why not team up with Mike Shellenberger?
And meanwhile here in Canada we are keeping our mask mandate for planes. What are we trying to prove, with this ignorant virtue signaling? Oh wait, maybe I shouldn’t care I can’t fly anyway here. They won’t let the unvaxxed on a plane. Science!!! Vinay I appreciate your anger. We all need to use our anger to help demand justice.
Bravo Dr. Prasad. The only thing that will fix this is credible experts like yourself holding their feet to the fire. It's outrageous, thank you for saying so, and please don't stop.
IT'S is a contraction meaning It Is. ITS is a pronoun. Before you come back with a snarky rejoinder that I am "being a pedant", consider that this kind of flub detracts greatly from your impact. You make this error often, and there are others of different pedigree. Proof read your stuff, please ! I agree that CDC has failed miserably and in multiple ways.
Dr Lee, I have posted in a long succession of Vinay's pieces that he desperately needs a copy editor. I even volunteered (I have been a journal editor many times and he does not write enough to be a burden). He does not read these comments (I am persuaded) and as near as I can tell does not think he needs copyediting (per an email conversation). It is really too bad because it does detract from excellent work.
He is shooting himself in the foot. I have been around the block a few times (retired professor at a major medical school, on multiple editorial boards, etc.) and my only conclusion is that he is either arrogant (which I doubt) or truly still in the "late amateur" phase of his career. A very meticulous attitude regarding how one speaks or writes generally is highly correlated with meaningful "success" in any highly technical field. I will say it again -- he is shooting himself in the foot.
The RCTs don't really matter what matters is the CDC's authority to mandate anything not covered by law as in Title 42. And as far as masks go, the data are in provided by Ian Miller who can be found on Twitter and on SubStack if you don't wish to buy his book. On a population scale the masks were not useful in practical terms. You can complain about how the masks were worn or their quality but at scale they fail to do much about the spread. Aside from creating a social culture that offends some and makes others happy, the masks are pointless theater.
I saw someone eating in a restaurant today, mask off of course. He was also unmasked while waiting for his food to arrive. Then right before he went outside he put the mask on.....
It is so bad that even if masks did work, and even if there was RCT trials to support it, I would be against letting the CDC have any kind of authority ever again. Health officials have proven themselves extraordinarily myopic and there's a reason why they have been ignored by everyone up until recent history
Interesting take, VP, as always. Society and social contracts are complex. Seems like so many forces were involved, some incredibly powerful. You have the POTUS, Fauci, a large portion of the political party in charge proclaiming that masks work. Large parts of traditional media unquestioningly carrying this message. How many of your colleagues were silent voices? Other voices attacked and/or silenced by big tech and institutions. Decisions pushed through FDA. The normal checks and balances of society failing. CDC…maybe at best, the “fall guy.”
VP, in the absence of actual RCTs how do these docs go around shouting #MASKS WORK!!!
I feel like the medical profession writ large either has no idea what an RCT is, or pays no attention to whether they exist for (fill in the blank) recommendation.
Basically, my entire impression of doctors is eroded. And it ain’t coming back anytime soon. These people are out of their minds — truly driving blind, and appealing to authority to CYA.
I wasn’t looking for this.
They got Gish Galloped. Everyone did. They mistakenly thought that 100 bad studies finding a weak signal must mean the evidence is strong, never realizing that if after data drudging 100 times you still come up with such weak evidence you are in fact dealing with pseudoscience.
This is how all pseudoscience spreads. It skips RCT and jumps straight to retrospective case control studies. Next thing you know because some people who agreed to be tested in a salon didn’t catch Covid in April of 2020 “the science is settled”.
Now we are stuck in a strange “Emperors Clothes” situation where I suspect physicians are nodding in agreement out of imposter syndrome fear or something.
I don’t know for sure. It’s clear they’re not actually reading these studies though. They are downright embarrassing.
And any phD, DrPH, or MPH who uncritically passed along nonsense like the Kansas Mask Study should be ashamed of themselves and lose whatever (if any) credentialing they have.
All I did was read a few books about the low fat diet to appreciate how unhinged/adrift from reality medical culture can get in the absence of decent RCTs + the proliferation of shitty epidemiology.
It’s just impossibly frustrating to watch the same movie unfold in real time.
It would be fascinating to see an analysis of whether official pronouncements on controversial interventions (masks, off-label drugs primarily for early treatment, Remdesivir) seem consistent in light of the available scientific evidence for each. It seems quite likely that the answer is no. My impression is that all 3 types of interventions should have been studied more carefully/thoroughly (primarily by funding large studies with gold-standard designs).
In fact there are many studies on early treatments that show promising results, but the narrative opposing them has made it impossible for such tests to be mentioned in American media or to be funded. You are correct that this deficiency is a black eye for any "I follow the science" public health officials.
There are those that shout. There are those who will loose their license to practice--their livelihoods--if they deviated any way from what public health institutions are saying and recommending. Therein lies the problem. The medical boards are not applying rigorous dialogue and debate to the topic. To them, there is no nuance, there is only obedience.
Let's see how mad people really are at the judge. The same day of her decision every major airline dropped the requirement. Multiple viral videos show people cheering, flight attendants singing. When asked whether people should mask on airplanes, Biden - the executive sponsor of the mandate that had been overturned - said, "it's up to them." The administration took two days to even suggest they would appeal the ruling and, still, will do so *without asking for a stay.* Most of the coverage of the administration's thinking says they are concerned they will lose on appeal because the judge's decision was, you know, right.
I think a lot of the anger is performative.
Vinay, No thinking person could dispute what you have written here. But as I have pointed out many times, there is an extensive literature on the general lack of utility of masks, especially with regard to viruses. This has been well known for years. Pretending that we need new studies starting from "ground zero" for something already well studied and disproven might be interesting, but is almost guaranteed to be unproductive. How many times does the same thing need to be demonstrated? I really wish you would drop the "bioplausible" thinking on masks. The sun circling the earth was "geoplausible" and every bit as wrong.
For those interested, here are some curated references that I expect you will find generally persuasive on the silliness of the mask conversation.
https://relevantdata.substack.com/p/the-most-important-mask-studies-a?s=r
If you want to look at real world data from the covid years, I suggest the book Unmasked by Ian Miller. Can get from any of the usual booksellers.
In fact, even Monica Gandhi, (also from UCSF), a reasoned writer but generally a shill for the diktats of the government, cowrote a piece in the Chronicle this week that said flatfootedly "...MASKS DO NOT WORK". Her point was why are we even discussing this any more? For once I agree with her.
If Monica has come around then why are we tolerating CDC announcing (just moments ago) that the judge's opinion will be appealed because "requiring masking in the indoor transportation corridor remains necessary for the public health". It has nothing to do with public health and everything to do with trying to retain capricious power over everyone JUST BECAUSE THEY THINK THEY CAN. I agree with Vinay and Monica and any thinking physician (there are an amazing number that just follow this advice blindly...so sad) that this has to stop.
And it will take us to stop it. I have not worn a mask yet (full disclosure: I carried one a few times) and will not wear one now irrespective of what CDC says -- in fact, one can generally assume at this time that if CDC says it, it is a lie. What a really sad state of affairs from a once useful agency.
Incidentally, everyone I know is thrilled with the judge.
I hope you were an MD on some advisory committee for some school board...if not you should have been (or should be this fall if a school board seeks advice!) You speak the truth! The MDs (Univ. of WI hospital system) on our District's medical committee in 2020 and esp. in 2021 PUSHED masks hard.....even leading into fall 2021 created a power point (right before a Board vote on masks)....on masking and WHY it works...and why masks shouldn't be optional in schools...because of how you then can't conceivably contact trace, etc etc etc. basically the tone from these MDs were..."if you vote to make masks optional in our schools you are an idiot".....no one asked them evidence based questions (they probably had no clue what to ask and how)....no one questioned it...it was pushed hard and then they voted the way the MDs said (or face embarrassment, etc). So sad...no other MDs to say wait...I disagree...and this is why. So sad!
Yup , I have ZERO confidence in the CDC, NIH and WHO!
At least there is a judge that has the integrity to do her job. But oh my goodness she was appointed by Orange Man Bad.
Vinay, I know you consider yourself to be a progressive and I am not one of those but I could probably support you for political office. You and Marty Makary might be able to make a difference. Why not team up with Mike Shellenberger?
Great idea! This sounds like a dream team of rational thought.
Well said & written...I agree 100% with your evidence-based approach.
Vinay, you’re speaking like a....scientist! What is this? We live in clown word. Thank you.
And meanwhile here in Canada we are keeping our mask mandate for planes. What are we trying to prove, with this ignorant virtue signaling? Oh wait, maybe I shouldn’t care I can’t fly anyway here. They won’t let the unvaxxed on a plane. Science!!! Vinay I appreciate your anger. We all need to use our anger to help demand justice.
Bravo Dr. Prasad. The only thing that will fix this is credible experts like yourself holding their feet to the fire. It's outrageous, thank you for saying so, and please don't stop.
IT'S is a contraction meaning It Is. ITS is a pronoun. Before you come back with a snarky rejoinder that I am "being a pedant", consider that this kind of flub detracts greatly from your impact. You make this error often, and there are others of different pedigree. Proof read your stuff, please ! I agree that CDC has failed miserably and in multiple ways.
Dr Lee, I have posted in a long succession of Vinay's pieces that he desperately needs a copy editor. I even volunteered (I have been a journal editor many times and he does not write enough to be a burden). He does not read these comments (I am persuaded) and as near as I can tell does not think he needs copyediting (per an email conversation). It is really too bad because it does detract from excellent work.
He is shooting himself in the foot. I have been around the block a few times (retired professor at a major medical school, on multiple editorial boards, etc.) and my only conclusion is that he is either arrogant (which I doubt) or truly still in the "late amateur" phase of his career. A very meticulous attitude regarding how one speaks or writes generally is highly correlated with meaningful "success" in any highly technical field. I will say it again -- he is shooting himself in the foot.
Vinay, how do your colleagues at UCSF feel about your activism?
The RCTs don't really matter what matters is the CDC's authority to mandate anything not covered by law as in Title 42. And as far as masks go, the data are in provided by Ian Miller who can be found on Twitter and on SubStack if you don't wish to buy his book. On a population scale the masks were not useful in practical terms. You can complain about how the masks were worn or their quality but at scale they fail to do much about the spread. Aside from creating a social culture that offends some and makes others happy, the masks are pointless theater.
I saw someone eating in a restaurant today, mask off of course. He was also unmasked while waiting for his food to arrive. Then right before he went outside he put the mask on.....
VP,
It is so bad that even if masks did work, and even if there was RCT trials to support it, I would be against letting the CDC have any kind of authority ever again. Health officials have proven themselves extraordinarily myopic and there's a reason why they have been ignored by everyone up until recent history
What an excellent, incisive commentary!
Interesting take, VP, as always. Society and social contracts are complex. Seems like so many forces were involved, some incredibly powerful. You have the POTUS, Fauci, a large portion of the political party in charge proclaiming that masks work. Large parts of traditional media unquestioningly carrying this message. How many of your colleagues were silent voices? Other voices attacked and/or silenced by big tech and institutions. Decisions pushed through FDA. The normal checks and balances of society failing. CDC…maybe at best, the “fall guy.”