Amid an ongoing pandemic and outbreaks of influenza and RSV caused by airborne viruses, arguing over the virus-blocking power of masks remains one of the COVID era’s signature follies. Disconcertingly, despite decades of evidence of their efficacy, some of the disagreement comes from a few in the medical field itself, misusing science and endangering lives.
Medical assertions of exclusive “ownership” over the science of masks when they are used during a pandemic ignore the fact that they represent a well-understood engineered solution, with decades of widespread and successful use behind them. Demands to reject this evidence reflect a failure to recognize and respect interdisciplinary expertise that has undercut the global pandemic response.
This effort included establishing a “hierarchy of evidence,” the idea that some types of evidence are more useful to medical decision-makers than others. Expert opinion and observational studies are at the bottom of the pyramid, randomized trials in the middle, and at the top, systematic reviews of these trials, where researchers compile and review several clinical trial results to make broader, more conclusive statements as happens with Cochrane review.
For masks, are randomized trials an appropriate way of evaluating a basic engineered safety system in the first place? We don’t rely on such trials for seat belts, bike helmets or life jackets, and the oft-cited randomized trial of parachutes is an old running joke. Why is that so hilarious? What do the engineers know that doctors don’t?