The inflated promise of science education

One of the ways I read a certain now-infamous communication from a surgeon general was (a) we need the limited supply of n95s for medical staff (b) we think there are better measures the public can take to protect themselves and (c) we're not confident the public can wear them correctly.

(a) made sense, though there's always the temptation to think "maybe I too should have a few."

(b) can't get the virus if you're keeping away from people, or in a strict bubble. Same logic as abstinence/monogamy and STDs. Though the policy proved to be even less popular than extended runs of abstinence and monogamy, hence the inevitable interest in prophylactics.

(c) What? I was kindof insulted, personally. And thought that represented an insulting view of the public.

BUT after learning about fit testing, trying it on my own, and struggling to keep a consistent fit that passed a test.... yeah. I had to admit I was not a natural at wearing an n95. And as for the public, all of us have seen people wear masks sloppily, or pull them down to sneeze, or any number of other behaviors that entirely defeat the purpose. Who has confidence that most people would wear an n95 in a way that passes a fit test?

Of course, badly-fit n95s probably provide better marginal protection than well-fit cloth masks, so maybe they should be an acceptable public intervention when available, but I doubt they'd protect the public as well as they do medical staff that's learn to fit them.

Which makes the infamous announcement arguably correct, although it remains a communication failure. But then again, the more complex you make a communication, the more poorly it scales, and "masks work if you wear them correctly and here's how you determine this" might already be ineffective.

Then, it was "maybe if we all cover our mouths [with literally whatever] and don't cough all over everything in every store every day, there will be an overall reduction in spread of germs". [Blue: Masks Save Us From COVID! Red: They just said Masks Don't Work! Blue: Yes they do! Science changes! (The Science had not changed) Red: Well, it's not protecting you, the wearer. Blue: Masks protect us all! Red: No they don't! Blue: Science Denier!, etc, etc.]

Another source of Works vs. Doesn't Work - anecdotes (and perhaps more) from subway passengers, allergy patients, etc. tend to indicate they feel better when wearing a surgical mask, which I don't find astonishing. I saw many comments asserting the effectiveness of surgical masks against inhalation (of a virus) based on these "idk I think my allergies were kinda better this year" observations.

On the other hand, no foreman would allow their workers to tear down drywall or fiberglass or whatever (read: dust) with a simple cloth or surgical mask - OSHA mostly requires N95's (+/- the exhale vent). These construction-type N95s are great to protect the wearer, but are obviously less effective (but better than nothing) against protecting passers-by from the wearer.

The scenario for which "Masks Work" is basically a hands-free covering-your-mouth-when-you-cough, but without that last half of the sentence, it's easy to see how many of the trades workers called bullshit - "I can't hang drywall or sand my boat without an N95, but I have to wear this shitty mask when I walk from my house to my mailbox?"

"Masks Work! Learn the Science™!", etc, etc.

The sad thing is that this is like a 15-minute conversation - tops - as part of hospital and jobsite orientation. Tons of new hires with only a HS Diploma/GED go through this talk every week with relatively little confusion. The Science/use cases haven't significantly evolved beyond the old PPE powerpoints, which I assume were deemed "too technical" by some PR person, leading to the kind of Science that fits on a bumper sticker.

It reminds me of a high school algebra teacher cheering on this girl that was struggling with quadratic equations or something; she was up at the chalkboard and suddenly had an epiphany, saying something like "oh! I get it! now I just plug in X and divide!", to which he jokingly responded "We plug in toasters, not variables", and it was like her eyes glazed over and her brain imploded. "Toasters?! Where did the toasters come from!?" There was just no coming back from that brief moment of confusion, at least that day, for that problem.

> Evidence from 14 trials on the use of masks vs. no masks was disappointing: it showed no effect in either healthcare workers or in community settings. We could also find no evidence of a difference between the N95 and other types of masks but the trials comparing the two had not been carried in aerosol-generating procedures.

Perhaps The Science™ did change a bit, particularly with regard to public policy, but I don't think anyone except the headline-skimming public and adults who still pull their shirt up over their nose when someone farts expected masks to do much of anything. It was always a kind of improvisational measure, as Science™ of course already knew the correct answer to be D) None of the above.

The 2003 SARS studies in particular have been used in wilderness/disaster medicine as evidence for a lecture that goes something like this: "Stateside, you'll mostly always have enough top-notch equipment to go around, but should you find yourself in a clinic in sub-Saharan Africa, rural SE Asia, etc. during a disease outbreak, a surgical mask is probably better than nothing. Sure, you're fucked without a PAPR, and if there are no surgical masks available, perhaps wrapping a bandana or some gauze around your face (and/or saying a prayer) will keep you from dying, who knows. Good luck; have fun!"

The difference between "things that sometimes work for certain patients/scenarios" and "things that we can prove work well enough to justify forcing on an entire population" is also relevant, and why I say I don't think <strike>Science</strike> Medicine has learned much from this - the answer has always been "use the correct mask for the situation", and these masks have never been the correct mask.

This[1], for example, is one of those best-effort hacks one keeps in their toolbox, and anyone using it knows it's sub-par. No ortho would be surprised that their cell phone vibrator diagnosis didn't match the X-ray (and likely, neither would their patient) - but after six months of "Cell Phones Are X-Ray Machines" articles, the public is gonna be upset when they finally realize they aren't.

> You mean, like the CEMB has?

No, this one: https://www.ox.ac.uk/admissions/undergraduate/student-life/d...

[1] https://www.wemjournal.org/article/S1080-6032(13)00261-5/pdf

Medicine vs. Quackery didn't really differentiate in the mind of the public until sometime between antibiotics and advances in trauma care (and CPR, to a lesser extent) in the mid-21st century. Things like antibiotics, X-rays, naloxone, tourniquets, hip replacements, "actually" work. Like work work, in a way that is visible and relatable in simple mechanical terms. Nothing like the Ghosts In The Blood and The Mysteries of The Poppy Seed of our ancestors.

Unfortunately, there's simply not a whole lot to do about a whole lot of things, other than essentially rest, eat well, stay hydrated (no alcohol), smoke fewer cigarettes, and maybe something to ease the discomfortable symptoms. This can be barely acceptable for a physician to say, let alone a press secretary, let alone one from The Bad Team.

Headaches[1] and anesthesia[2], as counterexamples, are not as straightforward. Note the number of ridiculous* headache treatments across time and space, as well as the number of "Science Has Solved Anesthesia!" articles[3] (it has but a first significant piece to the puzzle).

But these really only affect the individual and don't spread like a communicable disease (or ransomware, Big Homo, witchcraft, etc.), so they're also bad examples in a way. Humanity gets really weird when we can't see (and/or shoot) The Problem - Spooky Actions At A Distance or something, idk. Things also get controversial in the area of what the AHA classifies as IIB or III[A] recommendations[9], where there are different shades of "doesn't work", only one of which is really harmful.

Anyway, all of this is to say that there's a certain common-sense value to certain things [4,5,6,7,8], if only the appearance of doing something to appease a scared and generally-ignorant public.

The measures themselves are also mostly common-sense, and designed in parallel ("Swiss Cheese Model") with the knowledge that they won't all be followed all the time, and are targeted and measured over large aggregates (states, counties, 100k people, weeks, months). Nobody is necessarily harmed by someone not wearing a mask, because its benefit is probabilistic by design.

But there's always that group of people, usually with exceptionally little knowledge of the subject area at hand, who insist that, e.g., construction workers must wear gloves and safety goggles while eating lunch (the sign does say "PPE must be worn at all times"!), that life jackets must be worn even on shore, and so on, who are so self-assured/righteous in their ignorance that not only are they unafraid, but feel compelled to push their ignorance on everyone else, because they misunderstand things so badly.

This seems to be the real crime, which made everything more authoritarian than it needed to be. Consent is predicated on being informed, and it's no surprise people felt all kinds of ways about having to make major life changes based on flimsy evidence, especially all of the overly-simple, factually-incorrect (but probably well-meaning) statements made - again, mostly not by Scientists writing Science -but blue checkmarks, journalists, the Tumblrati, etc.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353082/ [2] https://www.pnas.org/doi/10.1073/pnas.2004259117 [3] https://www.futurity.org/general-anesthesia-sleep-brains-neu... [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ [5] https://www.bmj.com/content/363/bmj.k5094 [6] https://healthjournalism.org/blog/2019/02/breakthrough-resea... [7] https://acumenmd.com/blog/seriously-use-a-parachute/ [8] https://www.futuremedicine.com/doi/10.2217/cer-2021-0171 [9] https://www.wikidoc.org/index.php/File:Classofrecommendation...

Your adversary may die in that bunker. But there's an entire economic system that got your opponent to enter the position and believe in it.

then we can do an itemized bill disclosing who paid for the study again with a link to the entity explaining why they did and a comment section with the finances for professionals only.

Have fines depending on the size of the org and the size of the audience and require retractions, updates and/or disclosure of the objections raised.

That way it would be hard to publish that chocolate helps losing weight (as the funding is revealed) but if you manage to do it the citations by others would eventually link to retractions.