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founding
May 3, 2023·edited May 3, 2023

Vinay, you are too nice. Topol (with whom we both have personal interaction) is an idiot -- through and through. His knowledge level on many topics (including epidemiology) is way BELOW sophomoric. A kindergartener would be ashamed of most of the things he says. It is perhaps one of the saddest commentaries on medicine that he holds the position he does. Scripps stopped getting all referrals from me when he took that spot. He has done them no favors.

This article is on my list for worst top 10 articles over the past five years (and there have been so many bad ones, that is a hard place to be). The premises are wrong; the reasoning is wrong; the conclusions are actually dangerous.

You are usually frank, but this deserves much harsher treatment than you gave it. Articles like this do us all a world of damage.

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The clear purpose of the STAT article is to make the case for not doing studies that might not support already-in-place public policy. That’s it; there is no science in the article at all. As the article admits, “Such research sows confusion that erodes trust in science, misleads policymakers, depletes social capital, and squanders critical resources. We believe that many of these studies should never have been done at all, reserving resources for studies that could improve health outcomes… Such studies can confuse people who want to know how effective face masks are, while emboldening people who are already completely convinced that face masks are ineffective — and are looking for grounds to sow doubt about them.“ So that’s the point… any nuance in the results of a study, that don’t fully support a policy in place, should not be published, because nuance “sows confusion” and “erodes trust in science.” Just have “experts” tell people what to do, and suppress anything that doesn’t provide absolute evidence for existing policy.

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By the logic of this STAT article, newspapers in the 1920s and early 1930s should have never published investigative pieces on organized crime, and how it was fueled by the illegal alcohol trade, because it would “sow confusion” about and “erode trust” in Prohibition.

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My masking is still at the mercy of the covid numbers reported in the county. Despite most testing at home (if at all), at a certain arbitrary number of positives reported to the DOH I wear a mask for the week. If it falls below that level the next week they mask police give me a reprieve. Very scientific!

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When oh when will these BS papers to justify their erroneous narrative cease. The fact, people like Topol say the things he does with impunity is insane. The only silver lining I see is that in talking with my patients, they are VERY skeptical of anything the talking heads of the administration say and what the MSM parrots.

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Topol=Still a tool

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A few suggestions here. Please define your terms when you reference “mask”, as “masking” is a huge umbrella term.

SARS CoV2 is airborne, and much more contagious than the original wild type. Surgical and cloth masks are therefore rendered obsolete we can agree. This is what most RCTs study, and which you are invoking to undermine “masks”, right? Or am I misunderstanding because your terms are not defined here in this post?

KN95, N95, and other properly fit respirators absolutely do work, even for SARS CoV2. They work for individuals in the community, on planes, and in tight poorly ventilated quarters. This is how I have personally not become sick, despite being in 100 square-foot rooms for the past three years with multiple patients with Covid, some of them not wearing masks for up to 40 minutes while we’re together and they are presymptomatic by a day or less.

“N95 masks are designed to remove more than 95% of all particles that are at least 0.3 microns (µm) in diameter. In fact, measurements of the particle filtration efficiency of N95 masks show that they are capable of filtering ≈99.8% of particles with a diameter of ≈0.1 μm (Rengasamy et al., 2017). SARS-CoV-2 is an enveloped virus ≈0.1 μm in diameter, so N95 masks are capable of filtering most free virions, but they do more than that.”

A well fitting mask/respirator of N95 quality absolutely works. These can also be called masks. Hospital fit tests and prior experience with respiratory precautions for all sorts of contagious diseases in hospitals give us ample decades of experience, too. Call for more studies of this if you will.

Ideology-driven use and denigration of the word “mask”, without pointing out to your readers that N95/99s are at one spectrum and cloth masks are at the other does a disservice to your elderly, immunocompromised, and other readers who might otherwise spare themselves a case of Covid. Or spare others. Because of reductionist arguments like the one presented here I am frequently having to educate patients who tell me “masks don’t work.” It’s not that reductionist, agreed?

And ad hominem attacks on Topol, Fauci, and others do a great job of inciting anger, intolerance, and perhaps violence against these figures who are also trying to communicate and help others. Ok to disagree with them and point out their shortcomings. But your conclusions are not perfect here either, and they invite people to openly challenge healthcare workers and others who mask with hostility and disdain as they chose to wear a mask, preferably a real mask.

At this point “masking” is a choice, that’s fine, but masking exists along a continuum.

If you can cite any RCTs or other quality evidence that I’ve missed about N95 masks not working, please let me and your readers know so that I can review (and educate myself as well.)

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And yet, UC Davis continues to demand masks.

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What covid policies and the state of science they are based on should remind us all, is that it is very easy to fool ourselves into believing what we want: we aren't as rational as we would like to believe. Witchcraft, voodoo, elixirs and spells are alive and well in modern medicine.

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We must teach the current crop of young physicians and in training the proper critical approach to data analysis and manuscript critiques. Vinay has the tools but so many others do as well. Students need to be exposed to improper studies and conclusions WITHOUT the sometimes value-laden interpretations of possible explanations (idiocy, political bias, Big Pharma, etc.). The key is to refine our current clinical databases and our health beliefs. As I have suggested in the past, the absence of valid, large studies proving the efficacy of masks in preventing the spread of respiratory viruses does NOT prove that masks are always ineffective. Perhaps, the right studies have not yet been done. I believe that, at best, such studies are likely to show minimal to zero efficacy. The NIH needs to get its act together and fund key studies.

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May 4, 2023·edited May 4, 2023

I guess no one here is going to address the questions raised by my comment: (1) Do we need an RCT to establish that if you keep SOME DISTANCE (TBD) from an infected person(s), your chances of catching COVID will be reduced? and (2) Do we need an RCT to establish that wearing SOME QUALITY MASK/RESPIRATOR (TBD) for SOME % OF THE TIME (TBD) will protect you? If not, scientists/doctors need to be more precise in their communications. Obviously, under some circumstances, distancing and masking can protect individuals; we just need to define the parameters.

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Dr. Prasad's critique of the STAT paper could be improved if he addressed the following question in a footnote or an addendum: Do we need an RCT to establish that some form of distancing and/or correctly wearing a certain quality mask will mitigate the effects of -- if not prevent -- COVID for an individual patient who is compliant 100% of the time? Please see also Gandhi et al.: Masks Reduce Viral Inoculum of SARS-CoV-2 (July 2020).

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