New, Buzzy Cochrane Study Sets the “Fools Gold” Standard for Anti-Maskers

By Lambert Strether of Corrente.

“One does not consider the brand to be the guarantee of quality. For us, the quality guarantees the brand.” –Lord Peter Wimsey in Dorothy Sayers, Murder Must Advertise

I didn’t expect to have to drag out my yellow waders for a study from a prestigious brand like Cochrane, but here we are. What is a Cochrane study? A publication of the Cochrane Library, an important institutional player in the field of Evidence-Based Medicine (EBM), whose methods are, in the main, standardized and rigorously enforced,(For EBM, see KLG’s comprehensive takedown here). Vox explains:

With something as complex as masks and respiratory disease, the right tool for the job isn’t one study but many: a meta-analysis of a number of different smaller studies to determine what effect is detectable in aggregate across the body of research.

For medical questions, a major source of high-quality, reputable meta-analyses is Cochrane, a UK-based nonprofit that publishes long and comprehensive meta-analyses of current evidence on medical and therapeutic interventions. It’s a good place to go if you’re wondering if antidepressants work, if blood pressure medications help, if therapy does anything, and lots more. Cochrane reviews are frequently called the “gold standard” for evidence-based medicine.

(“Gold standard,” oft-repeated in the punditry. Hence the headline.) What then is a meta-analysis? From the Cochrane Library itself:

If the results of the individual studies are combined to produce an overall statistic, this is usually called a meta-analysis. Many Cochrane Reviews measure benefits and harms by collecting data from more than one trial, and combining them to generate an average result. This aims to provide a more precise estimate of the effects of an intervention and to reduce uncertainty.

Sadly, in the study we are about to consider — “Physical interventions to interrupt or reduce the spread of respiratory viruses” (January 30, 2023), the selection of trials for the meta-analysis is dubious (all Randomized Controlled Trials, or RCTs), the epidemiology is bad, and various other Cochrane standards have not been met. (Hereinafter, I will call this study “Conly’s Cochrane Study” or “Conly” after the corresponding author, who in my view is the driving force because of his institutional power. We will consider authorship criteria for Cochrane studies below.) While “Conly” itself is cautious in its conclusions — especially if you know how to read Cochrane studies — the uses to which “Conly” has been put by polemicists — uses which some of the authors, being polemicists themselves, must surely have known — are not at all cautious. Bret Stephens, opinionating in The New York Times, was a typical anti-mask voice: “Opinion: The mask mandates did nothing. Will any lessons be learned?”

I did say that “Conly” was “buzzy.” For your delectation, here is a spectrum of opinion, from right to left: Brownnosestone Institute (Robert Malone) (February 2), Reason (February 8), Daily Mail Peter Hitchens (February 18), Spectator (February 10), Bret Stephens, New York Times (February 21), Becker’s Hospital Review (February 10), The Atlantic (February 16), Slate (February 12), The Conversation (February 6), Vox (February 22), Los Angeles Times (February 24), @trishgreenhalgh (February 26), and WSWS (February 22). All this pieces have varying degrees of ferocity ranging from anti-mask triumphalism through colorable fair-minded-ness to — being fair — conforming to my priors starting with The Conversation (masking should be part of a model of “layered protection” against airborne viruses — SARS-CoV2 and whatever comes next — implemented at both the personal and societal levels). The Greenhalgh thread is masterful; consider reading it in full.

Here is the money quote from the first (lead) author, Tom Jefferson, interviewed here, and propagated in the Times by Bret Stephens:

There is just no evidence that [masks] make any difference. Full stop. My job, our job as a review team, was to look at the evidence, we have done that.

The more tendentious studies and triumphalist reaction pieces (Brownnosestone Institute through Slate) either agree with Jefferson, or go into “Well, he has a point” mush-mouth mode. But Jefferson doesn’t have a point. Remarkably, his oft-propagated talking point is contradicted by his own study. From Conly’s Cochrane Study:

“In summary, more high-quality RCTs are needed to evaluate the most effective strategies to implement successful physical interventions in practice, both on a small scale and at a population level.”

“More studies needed” ≠ “no evidence.” (We will address the Cochrane Library’s RCT fetish — there’s no other word for it — below.) More from Conly:

The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions>.

“Hampers drawing firm conclusions” ≠ “no evidence.” (There are many other quotations floating around about “confidence,” which we will address below.)

So, even if we waded no further into Conly, you, the critically-thinking reader, have at least one litmus test when following the discourse: Anybody who quotes Jefferson approvingly on “no evidence,” “full stop” hasn’t read the study, and probably doesn’t know the field.

That said, and with regret, I must pull on my yellow waders and go through Conly in detail. I will show that:

1. Conly’s Cochrane Study Fails as Scientific Communication
2. Conly’s Cochrane Study Fails as Science
3. Conly’s Cochrane Study Fails as Epidemiology
4. Conly’s Cochrane Study is of Dubious Provenance

Section 4 is long, detailed, and unique, but if you, dear readers, have ever participated in a brutal game of office politics, whether corporate or academic, you will enjoy the twist and turns. It’s gonna be fun, OK?

Conly’s Cochrane Study Fails as Scientific Communication

This issue is not particular to Conly, but a failure to translate Conly’s jargon on “certainty” into terms easily understood by lay persons. A usage example from Conly’s Conclusion:

There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect.

But what does Cochrane (hence Conly) mean by “low to moderate certainty”? IM Doc, via email, explains:

When people, even very educated people, outside medicine hear “low-level confidence” or “low-level certainty” they naturally think that it is actually low-level. But that is not at all what these meta scientists mean.

A much much better way of doing it that everyone would understand – is doing it on a 1 to 100 scale. It would not be that hard to do.

Gravity is 100 It is certain.

A flat earth is 0 – It is not certain.

Both have overwhelming and enduring evidence of their position as 0 or 100.

Place your calculations of your findings in between.

What I am saying is if you did something like the masking study on a scale — my guess (and I am guessing — it was a bit of a very sloppy paper) — would be they would call their conclusions about an 85. They are thinking it is 85. The man on the street who does not understand the verbiage would hear “low level confidence” and think 25. Total confusion all the time. They even confuse themselves in conferences quite frequently.

I restated this as follows:

So on “low level certainty,” Cochrane types are mentally measuring downward from 100, and lay people up from zero.

So to a professional, 85 would be “low level,” which a lay person would consider “high level” (which it would be, since an 85 would be good to incorporate into one’s personal protocol, especially for a strategy of layered protection, and even more so for a low cost/no risk measure like masking). However, the lay person does not in fact do this, because when they hear “low level” they think 10 or 20, not 85.

This is a generic failure in scientific communication for Cochrane, not a particular failure for Conly. Nevertheless, a failure it is.

Conly’s Cochrane Study Fails as Science

Conly fails because it considers RCTs only, excluding “mechanistic” evidence, which is often superior. From BMJ, “Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent” (where EBM+ includes mechanistic evidence):

Evidence-based medicine (EBM’s) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday’s research can be mapped more or less unproblematically onto today’s clinical and policy questions. They have significant limitations when extended to complex questions about a novel pathogen causing chaos across multiple sectors in a fast-changing global context. Non-pharmaceutical interventions which combine material artefacts, human behaviour, organisational directives, occupational health and safety, and the built environment are a case in point: EBM’s experimental, intervention-focused, checklist-driven, effect-size-oriented and deductive approach has sometimes confused rather than informed debate.

Putting it very politely. More:

While RCTs are important, exclusion of other study designs and evidence sources has been particularly problematic in a context where rapid decision making is needed in order to save lives and protect health. It is time to bring in a wider range of evidence and a more pluralist approach to defining what counts as ‘high-quality’ evidence. We introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. We propose that the tools and frameworks of mechanistic evidence, sometimes known as ‘EBM+’ when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic.

And from the New England Journal of Medicine, “Evidence for Health Decision Making — Beyond Randomized, Controlled Trials“:

Elevating RCTs at the expense of other potentially highly valuable sources of data is counterproductive. A better approach is to clarify the health outcome being sought and determine whether existing data are available that can be rigorously and objectively evaluated, independently of or in comparison with data from RCTs, or whether new studies (RCT or otherwise) are needed.

The classic case of using an RCT where a mechanistic approach is superior is from the BMJ: “Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.” Here is another example:

And another:

In other words, if we have mechanistic evidence that masks “work,” then masks work:

We don’t need RCTs to solve engineering problems, and whether masks “work” is an engineering problem. It follows that if masks do not work, then the failure is at the level of social relations (“populations”), and those are very difficult to evaluate using RCTs, because there are too many confounders:

But as the Bearded One did not quite say: “Cochrane have only interpreted the populations, in various ways. The point, however, is to change compliance.” And we have well-recognized ways to do this, starting with public relations. (Brownstone’s anti-masking campaign is itself enforcing a form of compliance, against mask-wearing, aided by smearing and shaming from The New Yorker, the New York Times, and sundry other liberal organs). Influencers and celebrities are available. Political figures could model masking appropriately. Mask innovation could be funded. In hospitals, we have entire departments devoted to infection control. Even the CDC, corrupt and incompetent though it is, could weigh in. It’s beyond absurd to claim that masking compliance at the population level cannot be maintained as it was at the beginning of the pandemic. Asia does, after all. And here in the grimmer United States, at least we enforce compliance on cancer stick aerosol-producers in public.

Very difficult, but not impossible:

The differences in incidence were relatively small, but see below at “small gains in protection compound.” (Note that Conly’s abuse of the Abuluk RCT was so appalling that some were led to call for a retraction.)

Conly’s Cochrane Study Fails as Epidemiology

First, Conly fails as epidemology because it adheres to droplet dogma instead of aerosol tranmission. From Osterholm et al., The Center for Infectious Disease Research and Policy:

The Cochrane review by Jefferson et al [here, Conly] states that respiratory viruses spread as follows: “People infected with a respiratory virus spread virus particles into the air when they cough or sneeze. Other people become infected if they come into contact with these virus particles in the air or on surfaces on which they land.”

This is the classic definition of droplet transmission, which focuses solely on symptomatic coughing or sneezing that produce large droplets propelled into the face of someone nearby. This review was also focused on contact transmission, which has been ruled out for SARS-CoV-2 by scientists and public health authorities like the CDC.

There is no mention of airborne or aerosol transmission, the former being defined as inhalation of “droplet nuclei” at long distances from a source, and the latter representing a more up-to-date understanding of infectious particle inhalation both near and far from a source. An RCT by MacIntyre et al showed that even for infections assumed to be droplet transmitted, N95 FFRs prevent infection, while surgical masks do not.32 This again points to the droplet paradigm being incorrect.


The Cochrane review must be considered in the context of the authors’ biases. The authors focused on studies in healthcare settings that compare the “standard of care” for droplet transmission—ie, surgical masks—with an N95 or P2 FFR. However, for scientists who understand that aerosol transmission is an important and most likely the primary mode of transmission for respiratory viruses, a surgical mask would never be the standard of care.

Second, Conly fails as epidemiology because it fails to consider that small gains in protection compound over the life of a pandemic. Trisha Greenhalgh explains:

Conly’s Cochrane Study is of Dubious Provenance

The Cochrane library has rigorous standards for authorship, based on recommendations from the International Committee of Medical Journal Editors (ICMJE). If you will glance again at Conly, you will see a list as carefully ranked and ordered as any procession of Bishops and Cardinals, or any military tatoo: “Tom Jefferson, Liz Dooley, Eliana Ferroni, Lubna A Al-Ansary, Mieke L van Driel, Ghada A Bawazeer, Mark A Jones, Tammy C Hoffmann, Justin Clark, Elaine M Beller, Paul P Glasziou, ✉️ John M Conly.” In this case, the authorship roles we are about to examine are Unlisted Author (Carl Heneghan), First Author (Tom Jefferson, the dude who misstated the conclusions of his own study), and Corresponding Author (John M. Conly at last enters, stage right). Each author is dubious, each in their own way.

Let us begin with Carl Heneghan, who clearly states he is an Unlisted Author for Conly’s Cochrane Study:

The only possibly interpretation of “we” is “we,” the authors of Conly. The difficulty here is that Cochrane Library authorship standards require unlisted authors to be credited. From ICMJE:

All those designated as authors should meet all four criteria for authorship, and all who meet the four criteria should be identified as authors. Those who do not meet all four criteria should be acknowledged—see Section II.A.3 below.

And from that section:

Contributors who meet fewer than all 4 of the above criteria for authorship should not be listed as authors, but they should be acknowledged. Examples of activities that alone (without other contributions) do not qualify a contributor for authorship are acquisition of funding

Heneghan is not so acknowledged on Conly’s “Declarations of Interest” page. (Nor does Heneghan appear in a relevant Google hit.) I don’t know if this calls for a retraction, unlike Conly’s abuse of Abaluk’s Bangladesh masking RCT, but it certainly calls for a correction.

Now let us turn to Tom Jefferson, who plays the role of First Author (because he is listed first; ICMJE does not formally define the role of “first” or lead. In scientific publishing generally, the first author is considered to have made the greatest intellectual contribution to the work). Cochrane Library authors must meet certain standards for transparency, distinct from ICMJE:

Although Cochrane has adopted many of the International Committee of Medical Journal Editors (ICJME) recommendations on disclosing financial and non-financial relationships and activities, and conflicts of interest, this policy differs from that of many journals in the following ways:

  • some types of financial sponsorship and support are forbidden;
  • anyone involved in the creation of Cochrane Library content must disclose their conflicts of interest at the earliest opportunity in the editorial process: for Cochrane Reviews this would be at title registration stage;
  • the first and last authors and at least two-thirds of the author team must be free of relevant financial conflicts of interest;
  • authors must declare relevant non-financial interests.

The difficulty here is that, along with Unlisted Author Carl Heneghan, listed First Author Tom Jefferson writes for the Brownstone Institute (team effort?). I won’t say “conflicted”MR SUBLIMINAL But feel free to think it. What I will say is that because the Brownstone Institute is funded by dark money (“their donor breakdown is unclear“), Cochrane cannot be certain that Heneghan and Jefferson are free from conflict. For example, here is how Jefferson (“TJ”) declared his interests:

TJ: reports declaring an opinion on the topic of the review in articles for popular media

I submit this declaration is wholly inadequate for determining Jefferson’s place in the following web of interest/Flexnet centered on the Brownstone Institute:

Again, I don’t know if Jefferson’s declaration calls for a retraction, but it certainly calls for a correction.

Finally, we come to John M. Conly, Corresponding Author (always referred to as “John M. Conly”). He’s quite the character! Pressed on the putative harms of masking — as opposed to taking precautions not to inhale or transmit an airborne lethal pathogen, mind you — he comes up with…. acne:

(I’m not denying acne is a harm to those who suffer from it, but surely there are workarounds and accommodations?) John M. Conly has also, from his perch at WHO and in Canada’s public health establishment, vociferously opposed recognition that #COVIDisAirborne:

Conly is one of Canada’s most experienced infectious diseases experts who was once head of the department of medicine at the University of Calgary and the medical director for infection prevention at Alberta Health Services.

He also holds considerable global influence in the pandemic as the chair of the WHO’s Infection Prevention and Control Research and Development Expert Group for COVID-19, which makes key decisions on the research that informs the WHO’s recommendations.

“We absolutely know there are situational airborne settings,” he added during the panel discussion. “But to be able to say that it is the only and predominant means, I think we need better scientific evidence.” [as of

Conly was quoted as saying this on Apr 21, 2021. “Ten scientific reasons in support of airborne transmission of SARS-CoV-2” was published in The Lancet on April 15, 2021, and summarized a great mass of already existing evidence. Call me crazy, but I think “one of Canada’s most experienced infectious diseases experts” should be capable of keeping up with the literature. More:

The WHO has been criticized in the past for its reluctance to acknowledge aerosol transmission — or microscopic airborne particles — as a primary driver of the pandemic, and experts say Conly is at the heart of the issue within the organization.

“Frankly, I think he just can’t admit he’s wrong,” said Linsey Marr, an expert on the airborne transmission of viruses at Virginia Tech in Blacksburg, Va.

“He does carry a lot of weight with WHO, and unfortunately I think his thinking is still stuck in what we knew 20 or 30 years ago and hasn’t updated with what we’ve learned since then — and especially what we’ve learned over the past year.”

John M. Conly plays the role of Corresponding Author, defined by Cochrane Library as follows:

The corresponding author is the one individual who takes primary responsibility for communication with the journal during the manuscript submission, peer-review, and publication process…. The corresponding author should be available throughout the submission and peer-review process to respond to editorial queries in a timely way, and should be available after publication to respond to critiques of the work and cooperate with any requests from the journal for data or additional information should questions about the paper arise after publication.

In this case, Corresponding Author = gatekeeper. I submit that a person who not only does not “follow the science” on airborne transmission but tendentiously opposes it is not fit to play this role.

Cochrane defines conflict of interest as follows:

A conflict of interest is defined as a set of conditions that pose a risk that professional judgement concerning a primary interest (such as patients’ welfare or the validity of research) can be unduly influenced (consciously or unconsciously) by a secondary interest (such as financial gain).

The aims of this policy are to identify, prevent, or manage conflicts of interest.

Dubious Unlisted Author Heneghan must be credited so that readers of the Conly study can determine whether he is conflicted or not. Both Heneghan and Jefferson should declare their dubious affiliation with dark-money funded Brownstone Institute, unless Cochrane Library wants to open a door that any other conflicted author could drive a truck through. Dubious Corresponding Author John M. Conly should resign, to be replaced by someone qualified to play the role.[1] Having a droplet goon like John M. Conly be the gatekeeper for a masking paper is like having an phlogiston-advocating alchemist handle correspondence from Lavoisier. Osterholm et al. called this “bias,” and they’re right.


In three sentences: Anti-mask triumphalism is the grift that keeps on grifting. RCTs are not any kind of “gold standard,” nor are meta-studies based on them. And Cochrane should fix the authorship issues with “Evidence for Health Decision Making — Beyond Randomized, Controlled Trials” so readers can tell who’s conflicted. Cochrane’s branding is “Trusted evidence. Informed decisions. Better health.” Will they need to rethink this?

[Pulls of yellow waders] Oof! Now let’s go save some lives!


[1] I don’t view any of this as ad hominem, and in any case I’m not sure ad hominem is so very bad, if used judiciously as a heuristic:

In cases of conflict over paradigms — droplets vs. aerosols, for example — we should give consideration to the possibility that an accumulation of symbolic capital is being defended by the hegemon (see Greenhalgh on Bourdieu here). Indeed, it would be an “extraordinary claim,” albeit implicit, to blithely assume it was not.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. KD

    People don’t know what ad hominem means. It is rarely a fallacy.

    So Nassem Taleb claims, but he is just biased.

    However, ad hominem is a fallacy in logic:

    A fallacy is reasoning that is logically invalid, or that undermines the logical validity of an argument. All forms of human communication can contain fallacies.

    Ad hominem – attacking the arguer instead of the argument. (Note that “ad hominem” can also refer to the dialectical strategy of arguing on the basis of the opponent’s own commitments. This type of ad hominem is not a fallacy.)
    Circumstantial ad hominem – stating that the arguer’s personal situation or perceived benefit from advancing a conclusion means that their conclusion is wrong.[73]
    Poisoning the well – a subtype of ad hominem presenting adverse information about a target person with the intention of discrediting everything that the target person says.[74]
    Appeal to motive – dismissing an idea by questioning the motives of its proposer.
    Tone policing – focusing on emotion behind (or resulting from) a message rather than the message itself as a discrediting tactic.
    Traitorous critic fallacy (ergo decedo, ‘Therefore I leave’) – a critic’s perceived affiliation is portrayed as the underlying reason for the criticism and the critic is asked to stay away from the issue altogether. Easily confused with the association fallacy (“guilt by association”) below.

    On the other hand, if the issue in the argument concerns the authority or reliability of a source, it is not a fallacy to attack the veracity or reliability of the source (“Meta-analysis is not the “gold standard” of reliability, GIGO.” or “Pfizer funded this study, and most of the research they fund is methodologically flawed”).

    Further, the fact that academics ignore everyone who isn’t in their guild actually doesn’t do them a whole lot of good except at creating an echo chamber. Look at economics or international relations or anything else relating to the real world, there is always some academic “consensus” for stupid based on a one-sided diet of examples.

  2. Samuel Conner

    Thank you, Lambert. This is disheartening, but worth knowing.

    It has been said that “science advances one funeral at a time”, but whoever coined that phrase had not observed the most recent history — it may actually require millions of funerals.

    Are Prof. Conly’s concerns about the implications of masking for acne rooted in RCTs or are they based on mechanistic considerations?

    1. lambert strether

      I would speculate that Conly is from the hospital infection control world. In the US, airborne transmission and masking have had no institutional impact at all (as I show for CDC here).

      In note [1], I locate Conly’s resistance to the airborne paradigm (hence resustance to masking) in the accumulation of symbolic capital as a droplet dogmatist.

      However, I would be very surprised to learn, if I dug into the matter, that budgetary considerations did not play a role, as in line items for N95s instead of surgical masks, changes in protocols, reconfiguration of space, etc., as they did for schools (see here).

    2. Raymond Sim

      Early in the pandemic, one of the first things I learned about what’s wrong at WHO is that Conly and some of his pals there have a citation circle: They write papers based on one anothers’ work and handle peer review in-house. It would not suprise me at all if his entire academic output has consisted of fantasy.

    3. Raymond Sim

      Professor Conly’s concerns about acne were expressed more or less in absentia: I don’t think he realized people were allowed to call him on his bs, and he spoke at random.

  3. Raymond Sim

    I wonder if Conly might have a more direct conflict of interest. Is he vulnerable to any legal actions for malfeasance in Alberta?

    I’m going to go check Johnathan Mesiano-Crookston’s twitter.

  4. Realist

    Great work, but the damage has been done. Every armchair twitter epidemiologist now “knows” masks don’t work as proven by this “gold standard” hatchet job.

    It is so frustrating to see such egregious misrepresentations spread unchecked. Yet it is so common now with ukraine, pandemic, inflation, politics… Endless BS everywhere i look.

    My apathy increases each time i see it. There’s just no point fretting and getting stressed out about how broken the world is. We all know the perps will never get their comeuppance, and that in fact they will be richly rewarded. Just leave them all to it.

    I am glad you feel motivated to keep fighting the good fight though!

    1. lambert strether

      You lose until you win! And do note that anybody who avoids accumulating neurological damage from repeated Covid infection will have an advantage that can only compound over time.

      1. Bruce F

        Thanks for your work picking apart this story.
        I’m in the middle of Mike Duncan’s Revolutions podcast on Simón Bolívar and Gran Colombia where the idea of “You lose until you win!” is ever-present. When I listen to the problems faced by men like Bolívar I feel more optimistic about what we’re going through.

    2. eg

      Yeah, I already got this crap study slung at me in a group text by a Covid minimizer — this may be useful in response.

      1. Realist

        There’s an awful lot of incurious and uncritical regurgitation of dishonest takes going on from people who are supposedly so enthusiastic about doing their work research!

      2. Lambert Strether Post author

        > this may be useful in response.

        I conceived of this post as a collection of talking points, to be applied as appropriate. “Never send an M.D. to do an M.E.’s job,” for example. The entire post might be a little daunting for a non-NC person, though a professional or somebody science-minded might like it.

  5. David Anthony

    Anyone can just crank out any garbage study to say masks don’t work or cleaning the air doesn’t matter or whatever and the anti science crowd will scream it’s proof and demand heads. Doesn’t bode well for the new bird flu jumping into humans.

    1. lambert strether

      > Doesn’t bode well for the new bird flu jumping into humans

      No, but at least there is a minority who know how to protect themselves and others and have the tools to do so [insert Margaret Mead quote here].

    2. Noah Bodhi

      Anyone can just crank out any garbage study to say masks don’t work

      The study did not conclude that masks do not work, only that we need more and better studies because the past studies were of poor quality.

      I guess if someone can explain where they are reading that mask do not work I will change my mind.

      (I am not an anti masker and I personally think that N95’s are great way to protect yourself.)

      1. Lambert Strether Post author

        > The study did not conclude that masks do not work, only that we need more and better studies because the past studies were of poor quality.

        Not quite. Past RCTs. RCTs are not the be-all and end-all of trials, and for some disciplines they are completely inappropriate: Engineering, for example. That is why we don’t do RCTs for parachutes and gas masks; we have the laws of physics for that. And whether masks work is an engineering problem.

        Now, if compliance is bad, the masks work, but social relations are broken. For example, if you try to open a can of tuna with a can opener, but the can is upside down, the can opener will indeed “not work.” But it’s nothing to do with the can opener, it’s user error, which we know how to fix, with better UI/UX, documentation, training, etc. And so with masking compliant.

        I don’t want to make a fetish of N95s either; I hope something else better comes along, and there’s a lot of innovation. There would be a lot more, if the malevolent and brutal Biden administration hadn’t shut down on-shore production in favor of cheap-jack Chinese imports that enable hospital monopolies to keep their costs low.

  6. Noah Bodhi

    Reading the study myself I did not come out with the conclusion that masks did not work, rather, there is just not enough data. So that is not saying they do not work. They are just saying the studies are so poor they cannot confirm a conclusion.

    “The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. ”

    There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs. ”

    Cochrane is a great organization and I know that Conly is only weighing the risk vs benefit. If N95’s only slightly lower the rate of infection (too tiny to be statistically significant in a short RCT), yet cause a series of other even minor problems, they might outweigh the benefit of wearing a mask. But we need more studeis to be more accurate about the risk vs benefit.

    This is how research should work. If there is inconclusive evidence based on poor studies, do more and better studies.

    1. Lambert Strether Post author

      > Reading the study myself I did not come out with the conclusion that masks did not work, rather, there is just not enough data. So that is not saying they do not work. They are just saying the studies are so poor they cannot confirm a conclusion.

      Consider reading the post.

      First, studies are not “poor” simply because they are not RCTs; the post gives plenty of reasons why observational studies and engineering are in many cases better than RCTs. “Poor” is Conley’s RCT-fetishist position, which I do not accept. That’s not at all “how research should work.” There are plenty of good studies. Again, do consider addressing the points made in the post; Greenhalgh gives an absolute boatload of good studies in her tweet storm.

      Second, population level RCTs are very hard to do. Nevertheless, one was done in Bangladesh, and the Conly Cochrane study butchered it so badly that the entire study should be retracted. (The effects were modest, a difficulty RCTs is that they take place in a short time frame, but over the longer time-frame of a pandemic, even modest benefits compound). Again, read the post.

      Third, Cochrane is an organization that has been in trouble since 2018; see this from the BMJ (ArvidMartensen), so what you think you know ain’t so. Of course, they have an excellent opportunity to shore up their reputation by fixing the authoring problems I document in the final part. Again, read the post.

      Fourth, you know no such thing about Cochrane, either. The dude is “balanced” infection with a lethal pathogen against acne, which like balancing a feather against a cannonball; you can only do it with your thumb on the scales. It’s also not possible to “balance” anything without a correct theory of transmission, and Conly is a droplet goon. Again, read the post.

      Fifth and finally, if indeed “[r]eading the study myself I did not come out with the conclusion that masks did not work” then it should give you pause that First Author Tom Jefferson emitted a talking point diametrically opposed to your conclusion and his own study, when interviewed. One might almost imagine propagating that talking point was the whole point of the study, as opposed to any serious analysis or science. For this, you only had to read the post introduction, which shouldn’t have been too hard. Oh well.

      I don’t have time to deal with superficially reasonable comments that retail the more polite version of what the Brownnose Institute shills are hawking up. It’s a big Internet.

  7. GramSci

    Hefoic effort, Lambert! Your take looks valid on its face (only RCTs in the meta-analysis?? WTF??), but I’m hitting blanks on both the @trishgreen and @DavidElstrom tweets, which might be dispositive to those not predisposed to trust you.

    I’m not adept at Twit stuff. Are the links malformed? Or censored?

    1. Raymond Sim

      They worked for me. The Greehalgh one is in her pinned tweet, so easily found. Elfstrom’s is from back in 2021, but I can bear witness. I remember like it was yesterday. Conly’s been ‘Dr Acne’ in our house ever since.

    2. Vandemonian

      It seems that Lambert has used a screenshot for the first block of Trish Greeghalgh tweets (hence no link). Clicking on the second second block opens the tweet thread.

  8. tgs

    I live in Brooklyn, NY and commute by subway and bus four days a week to Northern New Jersey where I teach in a community college. I have worn an NK95 mask while traveling and in the classroom. We began teaching on campus in the fall of 2021. I have had many students come down with covid since then. I am vaxxed and boosted with J&J and I wear the mask in all public indoor situations. I have yet to get covid.

  9. Joseph

    In which pro-maskers and anti-maskers trade blows with equal amounts of self-assurance, overstated positions and simplifications.

    Sadly, this is the state of public health discourse now. Two contradictory sets of facts will be presented, and the reader will choose the set that is most psychologically comforting.

    1. Lambert Strether Post author

      > In which pro-maskers and anti-maskers trade blows with equal amounts of self-assurance, overstated positions and simplifications.

      Match for that straw, champ? If you want to throw mud like “overstated positions and simplifications” then you need to make it stick, and simply making the assertion doesn’t won’t do that in the NC commentariat. I hope you find the happiness you seek. Elsewhere.

  10. some guy

    We have a derision-meme for conservatives who have died of covid by courting infection for ideological reasons. It is called the Herman Caine Award.

    We need a derision-meme for liberals who have died of covid by courting infection for ideological reasons.
    We could call it the Rochelle Welensky Award.

      1. some guy

        I wonder if the Fauci Prize shouldn’t be reserved for the most malevolent bad actors . . . like that Public Health person up in British Columbia. Though one could argue that Welensky herself may well deserve a Fauci Prize.

        ” And what’s Fauci’s prize?” some may well ask. Well . . . . having the Prize named after Fauci himself.

  11. Michael King

    Thank you Lambert. I had not heard of Conly but he’s a piece of work. Another monster from Canada. I’m sure he and Bonnie Henry get along just fine.
    Well done tgs!

  12. Bill Malcolm

    Well done. Epic depth. One might argue for an abstract or executive summary and main conclusions, and a point list of findings of your reviews at the start of this essay. It’s a huge wall of words you present, and I’m sure many are daunted by the sheer length and to my eye, not much organization in the critique

    On a more basic level, we might as well abandon filters in building HVAC systems and air cleaner filters in cars, both cabin and engine. It’s obviousn that they do nothing important based on these Herr Dr Professor Conly studies.

    Don’t get a doctor to do an engineer’s job. I’m an engineer, one brother is a doc. His understanding of fluid mechanics is only fair really, mostly decent in a non-scientfically rigorous way in elastic piping like arteries and veins. Why do we have nose hairs? As a filter. If one puts a passive filter over the mouth and nose, both coming and going air from the body is filtered to some extent. It’s both physics and common sense.

    1. Lambert Strether Post author

      > Don’t get a doctor to do an engineer’s job.

      Even more succinctly: “Never send an M.D. to do an M.E.’s job.”

      > why do we have nose hairs

      We have nose hairs so that there is a market for nose hair clippers. What’s wrong with you?

  13. Elizabeth

    Another tour de force, Lambert. Thank you for shredding this “study.” The headlines that “masks don’t work was all over the news in the last couple of weeks. I didn’t bother to read the content since I thought it was just to legitimize not wearing masks. It’s very disheartening to learn of such shoddy work that passes for “science.” What will it take for droplet goons to realize covid is aerolosized. How did science get so crapified? It’s almost become criminogenic.

    1. Lemmy Caution

      The study never said masks don’t work. It said that:

      “…Wearing [Medical/surgical] masks in the community probably makes little or no difference to the outcome of influenza‐like illness.”

      I can think of three reasons this type of mask didn’t make any difference: They were too porous for the Covid virus; people didn’t wear them all the time; and when they did wear them, they were poorly fitted.

      I would say that this study actually supports mask wearing. The authors are merely confirming that the way we went about it with Covid was crap.

      1. Yves Smith

        Straw manning again. Elizabeth said what the news said and her remark is accurate as written. And Jefferson encouraged this take of his work in interviews, as Lambert documented.

        The paper itself looks like a complete exercise in bad faith. As Vox pointed out:

        The review includes 78 studies. Only six were actually conducted during the Covid-19 pandemic, so the bulk of the evidence the Cochrane team took into account wasn’t able to tell us much about what was specifically happening during the worst pandemic in a century.

        Instead, most of them looked at flu transmission in normal conditions, and many of them were about other interventions like hand-washing. Only two of the studies are about Covid and masking in particular.

        You’d expect compliance to be crappy with flu. Who cares about flu, FFS? Not most people. And this therefore was in no way, shape or form a study of Covid mask mandates since they were not included!!!!

        This is a repeated violation of site policies. I note you straw manning again below.

        I trust you will find your happiness elsewhere.

  14. LawnDart

    Trisha Greenhalgh’s article reads like a friggin horror story.

    I’m going to re-read it a couple more times this week, while bearing in mind that her article is not about “droplet vs. aerosol,” but that Our aim is not to contribute to the scientific stand-off between [X] and [Y] theories (we have done that elsewhere), but to analyse why, in the face of considerable evidence in support of [Y], this stand-off is happening and why theories of [X] which dismiss [Y] continue to dominate policy in many settings.

    I found it easier to focus on the meat of the text by using X and Y as substitutes for the two well-known terms, but, while reading this piece I still found that I couldn’t help asking myself that “what the hell were they thinking” question.

    Unfortunately, as your post illustrates, that question is wrong– “were” is wishful-thinking when what they are thinking is still our reality.

    (As sick of the subject as you may be, have you thought about writing a post that utilizes this framework and applies it to the other great topical event of our time?)

    I came across this short piece while trying to track down info on the relation of Bourdieu’s work to the field of psychology, and there were echos within it that seemed familiar to me, for some odd reason…

    Hysteresis and the sociological perspective in a time of crisis

    Hysteresis is a versatile concept for volatile times. Pierre Bourdieu’s sociological use recognises hysteresis in times of dislocation and disruption between field and habitus, ‘in particular, when a field undergoes a major crisis and its regularities (even its rules) are profoundly changed’…

    …This is not a time of business as usual. A ‘feel for the game’ predicated on relationships and regularities of the game and field structures as they were in the past, pre-pandemic, is no longer fit for purpose. Bourdieusian sociology illuminates hysteresis as a kind of maladapted habitus, especially when crises and conflicts become effectively synchronised across fields, as they are in the coronavirus pandemic.

    1. Lambert Strether Post author

      > Trisha Greenhalgh’s article reads like a friggin horror story.

      The Greenhalgh article is long but great. It’s got a ton of analytical tools. And I knew Bourdieu was cool, but I did’t now how cool until I saw Greenhalgh go to work with his tools. It’s great stuff. Brings Thomas Kuhn down to ground level.

      1. podcastkid

        Jumping around here. After reading some Greenhalgh I found this in Lancet…

        “Detailed analyses of human behaviours and interactions, room sizes, ventilation, and other variables in choir concerts, cruise ships, slaughterhouses, care homes, and correctional facilities, among other settings, have shown patterns—eg, long-range transmission and overdispersion of the basic reproduction number (R0), discussed below—consistent with airborne spread of SARS-CoV-2 that cannot be adequately explained by droplets or fomites.6”

        Then I came back to your article…

        ‘This is the classic definition of droplet transmission, which focuses solely on symptomatic coughing or sneezing that produce large droplets propelled into the face of someone nearby. This review was also focused on contact transmission, which has been ruled out for SARS-CoV-2 by scientists and public health authorities like the CDC.

        ‘There is no mention of airborne or aerosol transmission, the former being defined as inhalation of “droplet nuclei” at long distances from a source, and the latter representing a more up-to-date understanding of infectious particle inhalation both near and far from a source. An RCT by MacIntyre et al showed that even for infections assumed to be droplet transmitted, N95 FFRs prevent infection, while surgical masks do not.32 This again points to the droplet paradigm being incorrect.’

        So, if 40-60% humidity is “best” [according to some sources; dry air contributing to other problematic contributors] does that mean that at around 90% a more intense barrage of tiny, tiny water aerosol particles (bearing the virus)…say in a subway car…could up one’s chances of getting infected [and what temperature would augment such?]?

        1. podcastkid

          Seems that “droplet” is used both for coughing and long range aerosols (your first quoted paragraph I pasted above and the one that follows, same source). I didn’t address that confusing aspect.

          After further reading I guess my hypothetical assumption should have been: higher humidity might exert some kind of partial pressure that can help-keep-aloft contaminated [coughed or spoken] water “droplets” up to just shy of 100 microns.

          Is there such a thing?

  15. JBird4049

    Thanks for doing this. Trying to dig through the endless sewer of lies is just depressing. Don’t people understand that they are committing suicide by their stupid need for ego gratification and money?

  16. DJG, Reality Czar

    Allow me to point out how negligent the anti-masker, anti-vaxx position is: Further, I’d venture that the Cochrane study was looking for a certain solution rather than seeking data and following the data toward new ideas. (I include vaccines because some kind of effective vaccine can be developed–provided that crony capitalism meets in end–and because “herd immunity” is another slippery concept.)

    Polio as a counter-case to Covid: Note the information about asymptomatic cases:

    Note the numbers for paralytic polio:

    We already knew that in Japan use of masks keeps down the number of cases of the flu.

    What has gone wrong since the days of polio–and the creativity that went into counteracting it? There is a cultural/political question out there. And it isn’t pretty. Why is neglect now an option in the face of facts that indicate otherwise?

    1. Lambert Strether Post author

      > I’d venture that the Cochrane study was looking for a certain solution rather than seeking data and following the data toward new ideas

      That is the subtext of the Brownnosestone Institute Material in the last part of the post.

  17. PlutoniumKun

    Excellent dissection, but it is very dispiriting to see Cochrane reduced to this. There was a time not so long ago when I would have considered a Cochrane meta study/review to be (for non-specialists) the last word in any argument about medical issues (or to be precise, the ‘current best advice’. Most doctors still think this is the reality.

    Over the past few years we’ve all been able to witness in real time the near total disintegration of scientific integrity over the broad field of public health. Sadly, this means regular people have no option but to, in the cliche used by conspiracy theorists, ‘educate yourself’, which of course is almost impossible when dealing with a wide range of very complex issues.

    I wonder if there is a concern among the PMC that people are beginning to see through the BS. I’ve noticed in my YT/Twitter feeds recently a number of new channels with appealing presentors that seem well funded and supported that are rigorously defending the orthodoxy of the day on health/medical issues. I’m beginning to think they are not very organic.

    We can just be grateful for NC for being one of the very few sites willing to do the digging.

    1. Lambert Strether Post author

      > it is very dispiriting to see Cochrane reduced to this

      I appeal to readers to look at the “Dubious Provenance” section of the post and read it carefully.

      If I am correct, then Conly et al. are playing fast and loose with Cochrane’s authorship requirements. That’s just wrong, to begin with, but it’s also a bad thing for the Cochrane brand. Do we really want Unlisted Authors funded by dark money working on articles where their names — very much against Cochrane’s putatively rigorous standards — do not appear? Does this happen a lot? What if the Unlisted Author were working on articles about cigarettes, and they were funded by R.J. Reynolds?

      1. PlutoniumKun

        You raise excellent points about the authorship, but I am a bit confused about the criteria needed for publishing in the Cochrane database. I’d assumed it had to go through a process of internal peer review and approval to make it an ‘official’ Cochrane review. Or did the authors and their supporters somehow short circuit this or find a loophole?

        1. Terry Flynn

          I can’t speak SPECIFICALLY for official Cochrane reviews. However, I have 25 years of seeing how “ostensibly similarly well credentialed institutions” are gamed by researchers. Some examples of how it was done:

          1. Public health interventions (like vaccination/masking etc) cannot randomise individuals. You must use CLUSTER randomised trials (where the class/school/community is the unit of randomisation). Statistically, MUCH more power is achieved if you recruit more clusters than recruit more participants within existing clusters. Logistically this is harder and researchers can easily fool people who aren’t used to looking how that n=10,000 was achieved.

          2. Point 1. gets much much worse as soon as you get a variable that is a ratio. A normally distributed outcome divided by a normally distributed outcome doesnt conform to the central limit theorem. The variance is UNDEFINED meaning each extra recruit does NOTHING to reduce the variance. Even worse in cluster RCTs – this was my PhD. It is just one reason (of many) why black swan events/fat tails crop up and very conventionally classically trained statisticians and particularly econometricians get poleaxed.

          3. Bayesians of the “empirical Bayesian variety” very conveniently popped up and said “hey! We can help! Use a prior! It can be” flat” if you don’t know much and all will be well. The agenda was driven by people with skills in search of a problem. And they kinda let the cat out of the bag when they revealed that they couldnt deal with cost-effectiveness ratios EITHER. They changed the outcome to make things work. Very suss.

          4. Conflicts of interest. You could work Wed-Fri in your academic position doing work for NICE evaluating a new intervention. Monday and Tuesday you work for big pharma. If it’s in a different area it’s not a conflict of interest. I’m not saying this happens…… But you could do “exchanges” of time/resposibilities with mates.

          5. If all else fails just be a senior academic close to EU decision-making and tell that pesky mid ranking academic (who called you out for lying when you tried to correct his co-author who is “God” in related field and is main source of thanks from an economics “Nobel” prizewinner) quietly at a conference that he is in the cross hairs and that certain important people don’t like him.

          Academia in health is screwed. Partly why I left.

          1. Terry Flynn

            OK I’m grateful my last post passed moderation.

            One point I’m keeping separate but others may well have noticed the point too – WHY HAS BEN GOLDACRE BEEN SO QUIET FOR *YEARS* UNTIL THIS MONTH (he is heavily advertising on twitter an evidence based type position all of a sudden)? OK people take time out. That’s fine. But for someone so “open” this raises questions. We don’t need to know (or deserve to know) details of his personal life but if ANYTHING in his professional life is relevant I wanna know. What is worth the HUGE gap?

                1. PlutoniumKun

                  I recall he took a lot of flack for his Bad Science book in not addressing the distortions caused by Big Pharma, and dealt with it in his next book (which I haven’t read, but was apparently pretty good). I think he was a big advocate for Evidence Based Medicine, although how he squared that up with his knowledge of the influence of Big Pharm I don’t know. But yes, it is curious that he’s been pretty quiet – wasn’t he appointed to a Chair in Oxford?

  18. LAS

    Thank you, Lambert. This is the history of public health, to be always purposely confounded by the efforts of people presenting alternative science. It was the case with lead additives in gasoline, with big tobacco, with the chemical industries, with climate change deniers, and with so many others sowing doubt. The idea is to confuse people into taking no action to protect themselves, or to reign in any practices. So many reifications of the same purpose.

    1. Lambert Strether Post author

      > So many reifications of the same purpose

      Sounds like we’re looking at another page from the neoliberal playbook. I wonder if there are steps, as for privatization?

  19. Bee

    Thanks so much for this, Lambert. Especially meaningful the day after the WSJ’s piece on the Energy Department’s “low confidence” conclusion that covid was indeed a lab leak.

    1. Lambert Strether Post author

      I’m not sure that the Energy Department department uses “low confidence” in the way that Cochrane does, however (or the intelligence community).

      “Low confidence” may just be one of those earworm-like phrases people pick up because it’s suddenly being used everywhere (as for example in the Brownnose Institute’s current propaganda campaign.

  20. orlbucfan

    When Covid first hit in this country, it was a b(family blog) trying to find reliable info on protecting oneself against catching this crap. Fortunately, I learned how to do research years ago. I have followed my protocols for 3 years, have NOT caught any of the bugs, and will continue to do so. Still, dealing with all the mounting white noize is a headache!

  21. Cocomaan

    I’m not really sure why this matters. The pandemic showed that mask wearing will not stay widespread.

    You’ll get an initial period of widespread mask wearing. You saw that in summer of 2020. But now that we are three years into the pandemic, we have about one in twenty or one in thirty people wearing masks, based on my personal observation.

    Mandates do not work in the long term, they have a half life. convincing or expecting people to continue to wear masks at this point is pretty useless. Covid is not lethal enough to get people scared, at least not enough to make people fearful enough to mask after three years.

    The mask debate is effectively over. The only people arguing are in the extreme margins of academia or a fringe of folks still masking in public.

    We can fret over this and that study, but the public moved on a year ago.

    1. davejustdave

      Masking Behavior in England – An Anecdote

      This was posted yesterday on the twitter account of a covid-cautious clergyman, @1goodtern. Tern writes:

      I went for an outdoor pub meal with a friend’s family on Thursday. Both our families have clinically vulnerable members, so we were wrapped up warm and well spaced in a windy part of the beer garden. They had their mother in law with them and she went into the pub to get drinks.

      She masked up to go in, with a decent ffp2 mask. Made a show to the family of crimping the nose bit properly. She went in, and I realised that she wouldn’t be able to carry all the drinks back out on her own, so popped on my own ffp3, and followed in.

      When I got in, she had taken off the mask, and was saying to a friend she had met, “Don’t tell my son outside”. She didn’t notice me standing beside her, waited until she had the first tray of drinks, put her mask back on, and went outside.

      There aren’t many people you can genuinely rely on to do what they’ve said they will do, let alone what they are supposed to do.

      I spoke to the family afterwards. I felt it was right for them to know.

      As you might expect, the replies had many examples of similar behavior. I have declined invitations to family events even when hypothetical prior testing by attendees was mentioned as a precaution to accommodate my own caution – both because I don’t trust the tests and I don’t trust people to tell the truth about taking the tests.

    2. Lambert Strether Post author

      > I’m not really sure why this matters.

      You don’t feel enormous institutional corruption matters? That seems odd.

      > the public moved on a year ago.

      You really think that was spontaneous? Really? Come on.

      1. Cocomaan

        Bad science is all over this pandemic, so this is a minor scuffle and really late in the game.

        I absolutely think the end of masking was spontaneous. From everything I saw, the decline in mask wearing happened on a gradual slope down, with small spikes.

        And seriously, the mask wearing from the start wasn’t even that serious. I got a lecture from someone enforcing a mandate that a tshirt on your face was the same as any other masking.

        Mandates just don’t work. Expecting people to mask up like medical professionals doesn’t work.

        If it helps, think of it like a war. By year three of most wars, countries are falling apart, conscripts are hard to find, economies are in tatters, and popular support wanes. That’s where we are. Most people aren’t interested in a forever war.

  22. Lemmy Caution

    If I’m reading it right, the study Physical interventions to interrupt or reduce the spread of respiratory viruses doesn’t say masks don’t work. It says wearing masks in the community probably makes little or no difference in outcomes.

    It makes three points — two with moderate certainty and one with low certainty:

    Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness (ILI)/COVID‐19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate‐certainty evidence

    Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence

    Harms were rarely measured and poorly reported; very low‐certainty evidence

    The last point, “Harms”, refers to adverse events associated with wearing a mask, such as discomfort. This is the part of the study in which the authors had low confidence in whether there was difference between wearing or not wearing a mask.

    1. Yves Smith

      It appears you did not read Lambert’s post, or if you did, it was not with any care. That’s a violation of site Policies.

      You can conclude NOTHING from these RCTs because they are an inherently flawed approach. They are the ultimate garbage-in, garbage out.

      As for counter-evidence, we have a huge example: Southeast Asia. Mask wearing is common there and still practiced (as I hear from contacts in Bangkok, about 80% maskwearing outside and this is not the crop-burning season). They mainly used the inferior Sinovac. And no, their diabetes rates are comparable too. And yet their Covid case rates and deaths are way way lower than the West.

    2. Lambert Strether Post author

      Please read the post in detail.

      1) You are correct that when Tom Jefferson says that “masks don’t work” “full stop,” he’s just lying about the study that he’s the co-author of. The effrontery is amazing.

      2) However, please look at the discussion in about certainty. IM Doc explains how “low certainty” to a Cochrane maven is likely to mean “high certainty” to a layperson. It’s an enormous failure in scientific communication.

      3) As for outcomes, check the Bangladesh study described by Greenhalgh (an actual community-level RCT that John M. Conly et al. butchered so badly that it should be retracted). The effect is small, but as Greenhalgh points out, small effects compound over the life of a pandemic, and the RCTs take place over too short a time period to detect that. (Another point that the hospital-centric infection control commununity, to which John M. Conly belongs, ignore.)

      1. Lemmy Caution

        I have more to say in response to your reply, but first I have to point out that you keep putting words in Jefferson’s mouth. He never said masks don’t work. Read the quote from him you used in your own post.

        There is just no evidence that [masks] make any difference. Full stop. My job, our job as a review team, was to look at the evidence, we have done that.

        Saying that there was no evidence that surgical masks made a difference is not the same as saying masks don’t work.

        1. Yves Smith

          This is bad faith. “No evidence mask make any difference” = “masks don’t work”. “No evidence is an incredibly sweeping and false claim, again see SE Asia.

          And you have a second leg of bad faith with your surgical masks add on. The study was not limited to surgical masks. And it is known surgical masks are ineffective v. Omicron, but the public has not been told they need to use N95s/KN95. This extends to dental professionals, who are still careful re masking but get their marching orders from the ADA.

          Crappy implementation is the result of terrible messaging, starting with mask using being discouraged in 2020 (when surgical masks were effective, and in the US, going w/o masks being treated as a reward and a proof of being one of the virtuous vaccinated, and then demonized (Rochelle Wallensky’s Scarlet Letter remark).

  23. William Beyer

    The Minneapolis StarTribune ran Stephens’ piece on Sunday. It was so obviously garbage, as is most of Brett’s writing, that I decided not to object to it with a letter to the editors. Also, the field of scientific studies is way beyond my area of expertise. In Minnesota, we hear regularly from Mike Osterholm and trust his judgment. The learned Lambert inspires similar trust. Thank you for the yellow waders treatment. I learned a lot.

    1. William Beyer

      Today’s StarTribune contains not only an editorial reflecting some of Lambert’s concerns, but six letters from readers, after two letters yesterday. Check them out.

      1. Realistic

        That’s interesting, thanks.

        In the comments section of the article it is clear that irreversible damage has been done to majority opinion. #MissionAccomplished

        For me the point of universal masking was to remove the stigma from wearing a mask, so that people who are coughing and sneezing will be doing so into their mask, rather than into my elderly mother’s face.

        This source control aspect of masks seems to have been swept under the rug, most probably because it is collectivist, rather than a individualistic. Cant have everyone working together to solve our problems… That’s a slippery slope!

        1. Lambert Strether Post author

          > Cant have everyone working together to solve our problems… That’s a slippery slope!

          Yep. This whole “public”* thing…. It’s gotta go!

          NOTE * Although I’m not even sure the concept of “public” right any more; backward-looking, perhaps. WikiPedia (sorry):

          The name “public” originates with the Latin publicus (also poplicus), from populus, to the English word ‘populace’, and in general denotes some mass population (“the people”) in association with some matter of common interest.

          So in other words the “public interest” is the intersection of interest between labor and capital (and there are some, looked at dispassionately, i.e. foregoing greed). Not sure that’s working any more.

  24. Boomheist

    Lambert your NC diligence and focus on this whole Covid 19 issue since it began ranks, to me, as the best compilation of data and experience and history as there is anywhere in the cosmos. I find it rather amazing that if “masks don’t work” why do doctors and hospitals continue to wear masks and wore masks for decades before? I just had to go in for an angiogram at Swedish Hospital in Seattle and guess what? Once you were in the building, you wore a mast. Full stop. So did the staff.

    It seems we are simply a lazy, indifferent, sloppy people. We didn;t have the discipline to stop Covid when it began and once we lost it we have been busy sloughing off blame to everyone else. So my question to you is, can you speak to your own personal expertence from your contacts with family, friends, and the public during this time as you have steadfastly taken this plague seriously while it seems many others have decided it is too difficult to handle so therefore must be a leftist conspiracy? Are the anti-vaxxers and anti maskers (btw it would be good for a posting from you on vaxxing effectiveness given the current belief the jabs are poison) blind to logic?

  25. t

    You are truly doing the lord’s work here.

    Regarding mask acne, I am told this is usually what happens to people who have never previously had to take care of their skin which has survived a complex pampering regime of expense/fancy serums and gel moisturizers and plenty of makeup which, in concert, would be toodang much for acne, roscea, or sensitive skin. (Similar to the phenom of people going soap free, using oils to clean their precious facial skin, developing a fungus that makes their face feel dry, using more oils, getting dryer skin, and finally going to a derm who treats the fungus, recommends CeraVe, suggests they never have another stupid facial,and tells them to stop smooshing so much crap into their pores.)

    Probably a few people have mask-related acne for other reasons, but not enough for this to be a thing. In general, if people who don’t have to worry about their skin suddenly have pimples or flaking or dermatitis, either they have a new medical condition or – and this is usually the case – there’s an easy fix.

    1. Lambert Strether Post author

      > Regarding mask acne, I am told this is usually what happens to people who have never previously had to take care of their skin

      Maybe. I’m guessing that if enough people in a community masked, an accomodation or mitigation could easily be devised for the few that mask acne affects. That John M. Conly puts those few ahead of an entire community is extraordinary (though he rationalizes it to himself by denying that Covid is airborne and fighting masking tooth and nail. I realize he is also preserving his symbolic capital as a Big Cheese at WHO, etc.).

  26. Ann

    Lambert, I have run across what I think is a targeted piece on CNN with regard to erythritol. The study equates correlation with causation, and I think CNN has been told to talk it up. [By whom? Big Sugar would be my guess.]

    The study itself looks ok, from Nature Medicine:

    but it is clearly no proof. I can’t find anything wrong with the design, or the authors, but I am most likely missing something. Could you have a look?

    1. Lambert Strether Post author

      > Could you have a look?

      I can, but I don’t think such expertise as I have on Covid makes me an expert on studies generally (since I don’t have an adequate grasp of statistics). Perhaps another reader can take a look?

      I’m very good on institutions, as the final section of this post shows!

  27. marku52

    Cochrane’s director thought that too much pharma $$ was corrupting their reviews.

    Cochrane fired him, and 4 other directors quit in sympathy.

    They are corrupt just like the rest of pharma. I read they also take Gate’s money, another big red flag.

    Here is a BMJ article about the firing.

  28. DrSloperWazRobbed

    I am so grateful for this post. I have loads of anti-mask family and friends so I had seen them post the study. I stood firm in my mind cuz…duh masks are gonna prevent germs going into your face…but I also had no tools to try and figure out what this study was about. Ah, blessed sanity.

  29. Jeff

    This study changed no one’s mind. To the pro mask zealots, it was never up to the rest of us to prove masks didn’t prevent COVID spread. It was up to you to prove they did.

    So far you have no solid evidence to support your claim. You have observational studies which are crap. You don’t like RCTs because RCTs expose the farce.

    We all suffer from confirmation bias. You are no exceptions.

  30. Hana M

    The medical principle of “first do no harm” means that the potential harms of masking in different populations must be carefully weighed. The Cochrane review does not illuminate these downsides but this extensive literature review does. This jumped out at me in the discussion section: “In addition to the question of certification procedures for such fabric masks, it should also be mentioned that due to the extensive mask obligation, textile (artificial) substances in the form of micro- and nanoparticles, some of which cannot be degraded in the body, are chronically absorbed into the body through inhalation to an unusual extent. In the case of medical masks, disposable polymers such as polypropylene, polyurethane, polyacrylonitrile, polystyrene, polycarbonate, polyethylene and polyester should be mentioned [140]. ENT physicians have already been able to detect such particles in the nasal mucosa of mask wearers with mucosal reactions in the sense of a foreign body reaction with rhinitis [96]. In the case of community masks, other substances from the textile industry are likely to be added to those mentioned above. The body will try to absorb these substances through macrophages and scavenger cells in the respiratory tract and alveoli as part of a foreign body reaction, whereby toxin release and corresponding local and generalized reactions may occur in an unsuccessful attempt to break them down [172]. Extensive respiratory protection in permanent long-term use (24/7), at least from a theoretical point of view, also potentially carries the risk of leading to a mask-related pulmonary [47] or even generalized disorder, as is already known from textile workers chronically exposed to organic dusts in the Third World (byssinosis) [172].”

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