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nopie  1yr ago (vinayprasadmdmph.substack.com)   Edited 1yr ago   2935 thread views

Cochrane review is out and masks have weak evidence that they are not effective

vinayprasadmdmph.substack.com

This one is against rationalists because when Scott wrote his review that masks could be effective many of us trusted it.

I don't blame Scott for failing this one because doing review of hundreds of studies is hard and one person can hardly do it. But this clearly shows that rationalist way of thinking has no special formula, they can be easily mistaken and fall by accepting general consensus just like any other person.

I was impressed when Scott did his review about masks. I trusted it because there was no other clear evidence available. Cochrane hadn't done its review yet and NICE guidelines were silent on the issue. We vaguely knew from previous studies that masks are not effective, The WHO had said so. Suddenly everyone flipped and it was not because the evidence had changed. We simply wanted to believe that masks work and we mocked those who said “no evidence that masks help”.

Even with the belief that masks work, I never wanted mask mandates. I preferred recommendations only, so that no one was penalized or prohibited entry, travel etc if one doesn't want to wear mask. Scott unwillingly had been a catalyst for governments to introduce mask mandates and all this heavy handed approach has been for nothing.

Now we are back to square one, the evidence about masks is weak and it does not support their use even in hospital settings. We can all reflect now what happened in between during these 2 or 3 years. When I realized that Scott's review is clearly insufficient as evidence, I asked some doctors if they have any better evidence that masks work. Instead of getting answer I was told not to be silly, parachutes don't need RCTs and accused me of being covid denier for nor reason. Many so-called experts were making the same mistake as Scott by looking at the issue too emotionally. It is time to get back to reality and admit that it was a mistake and we should have judged the issue with more rational mind.

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If it was found in RCT trials that the drug does not treat the illness in the treatment group (whatever the reason), it would not get approved.

Most of the reason for that is drugs are expensive, use of a drug is based on belief it works and as such it crowds out other useful treatments, and have high rates of side effects. There's a reason a pharmaceutical to treat a disease requires rigorous testing before FDA approval but 'Ngoko Bean Extract For Psoriasis' doesn't if Ngoko beans are edible. This makes 'not being approved' much less strong as a reason to not wear masks even though, again, the mask mandate didn't do much.

The point here is that when someone has psoriasis why does he need to get the approved medicine if Ngoko bean bean extract could be used instead without prescription? The reality is that we don't know if Ngoko bean extract (and thousands of other remedies offered by snake oil peddlers) works for psoriasis. Obtaining this information can be costly and I can see why no one wants to study Ngoko beans if they cannot be patented.

However, psoriasis is mostly auto-immune disease and if topical treatments do not work, specific monoclonal antibodies can be tried. They are not cheap but that's because the technology to make them is quite complicated.

Yeah, we don't know if ngoko beans work, but we do know they don't hurt, so "using them when it isn't approved" isn't as bad.

No, we don't know if ngoko bean extract don't cause harm. They could easily make psoriasis actually worse.

It is unbelievable today but merely 50 years ago cigarettes were recommended for treating asthma and were sold by pharmacists. Today we know that cigarette smoke actually harm airways and make asthma attacks worse.

The likelihood that ngoko bean extract (ngoko beans don't exist, so let's go with black bean extract) harms you is much much lower than the probability some random normal pharmaceutical like ivermectin harms you, which in turn is much lower than the probability a random never-approved-for-any-indication pharmaceutical harms you. This is because lots of people at black beans as food, already. And masks are less likely to hurt you than black bean extract. This is why wearing a mask without RCTs isn't the same as taking a random pill without RCts.

The likelihood of risk from black bean extract may be lower but not entirely zero. The medicine indicated for psoriasis have high chance of benefit, therefore some potential of harm is usually accepted. But if you don't know if the treatment has any effect, then even small harms are unnecessary.

And it is not a right way to think that black bean extract cannot harm because people have used them in food for so long. The mucosal immunity in the gut works differently from the one on the skin, so we cannot exclude that it is can harm the skin. Yesterday, I got a warning from oculist to not recommend chamomile extract for washing eyes because it can cause allergies in some people. Chamomile tea is fine and people have used chamomile extract to clean eyes for long time as well and yet it probably does nothing and can harm.

Psoriasis patient is not the same as a healthy person. We don't know how he/she would react to untested treatment. The fact that it is plant derived means little because many modern medicines are originally derived from plants. Even antibiotics came from moulds.

Masks can harm, in the UK there was a case when doctors misheard each other due to masks distorting speech and overdosed medicine and patient died. If the benefit of masks is not proven, such harms are unacceptable.

But if you don't know if the treatment has any effect, then even small harms are unnecessary

No. Sufficiently small harms don't matter. I ate black beans this week, exposing myself to the same 'small harm' that I would from eating [an appropriate quantity of] black bean extract. Obviously one wouldn't put it in your eyes. I think psoriasis patients still eat black beans.

Masks can harm, in the UK there was a case when doctors misheard each other due to masks distorting speech and overdosed medicine and patient died

This is like "bananas can harm. Someone tripped over a banana and had a severe concussion".

No, it is not like bananas at all. Some hospital are ending the policy of requiring masks already.

With the treatment for psoriasis, I meant topical treatment in this case.

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