Interesting! Thanks for sharing. There’s something about mask use that veers into the ideological
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Replying to @BillHanage
Indeed! Lack of RCTs are cited as a reason not to mask despite other evidence, but then evidence for harms and worries is all without citations and mostly hand-waving. Then, handwashing for COVID has less RCT evidence but nobody worries about that (but, of course, let's do it!).
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Replying to @zeynep
It’s definitely too nuanced for Twitter, but there is something interesting about what counts as evidence, and how to make decisions when you don’t have all the evidence you’d like. RCTs if possible are great, but they’re not the *only* source of evidence.
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Replying to @BillHanage @zeynep
I think some of the issue is that most academics aren’t courageous enough to take a stand on the evidence without a gold standard RCT to back them up. The sum total of the evidence backs up
@zeynep’s points. But too many are afraid of the very small chance masks could backfire.2 replies 0 retweets 2 likes -
Replying to @ZoeMcLaren @zeynep
I think you’re probably right for at least some academics. I would always prefer high quality evidence myself, but recognize it may not be available on the time scale I need
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Replying to @BillHanage @ZoeMcLaren
Disagree a bit. The quality of the "for" evidence needed is related to the evidence for harms. Almost all the alleged harms were either baseless, or there was evidence to the contrary (from decades of research). We had enough "for" evidence—especially given lack of harms.
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I'm risk-averse myself, when it comes to evidence. For example, I'd been tweeting to be wary of the HCQ harms arguments from that observational Lancet study (long before it was retracted) because.. Exactly. Not highest quality evidence, given they unblinded RCTs & found no harms.
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Look at this new preprint. They find, quite unsurprisingly, that masks *increase* distancing. I've been arguing this for months based on social science evidence! This is what you'd expect, not false sense of security nonsense. But all this was disregarded. https://arxiv.org/pdf/2005.12446.pdf …pic.twitter.com/k7f0ZiQQ4s
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I don't think problems was lack of high-quality evidence—though sure, we can't have RCTs. Rather: the evidence that was there was dismissed; evidence free hand-waving was allowed for harms; and unresonable evidentiary standards were only held for masks, not for say, hygiene.
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An aside: why can't we have an RCT, with an encouragement design and IV specification? Eg provide free masks, cluster-randomised by workplace? This seems doable and important.
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I had this exact discussion early on with people on how to try but I couldn't see an ethical context or a workable framework during a pandemic. Rich countries? People will mask up, cost little issue. Poor countries? Given evidence "for" side, how do you withhold? Plus, not blind.
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Here in Toronto lots of employees are not wearing masks, incl shops. Maybe pay people to wear them? No need to withhold from the control group in an encouragement design. Agree not blind, but that means you capture the full effect incl behavior change which is also interesting.
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The problem is masks for source-control is a community-wide intervention, controlling for egress, not ingress. So the RCT design wouldn't make sense with individual level measurement (and why a lot previous health-care research isn't applicable despite WHO being stuck on them).
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