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February 23, 2023 |
With the traditional ringing of the bell we bring this meeting to order!
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Welcome to this week’s meeting of the eClub of the State of Jefferson.
I am Bob Gibson, President of the Rotary eClub of State of Jefferson. Welcome to this week’s meeting. I hope this finds you well.
As your President-elect for Rotary year 23-24, I spent this last weekend at the PNW PETS, up in Washington. As most of you are aware this is the training for new Club Presidents. I have attended two PETS prior to this. My first PETS was in 1986 in Cheyenne, Wyoming. The last time I attended PETS was in 1991 at Sea-Tac. Much has changed. I am truly impressed with how Rotary changes and updates its approach to remain relevant with the current environment.
Four days of classes and meetings gave me plenty to consider. Going into the weekend, I wondered how much of the training would be relevant to an eClub like ours. I found much to bring back. It reinforced my commitment to make our service projects the thread that holds the fabric of our Club together. The importance of membership was emphasized repeatedly. I “advertised” our Club in many sessions, as a great resource for Rotarians finding the schedules of a traditional club to be challenging. Fellowship was discussed. I believe we are on the right track with our Coffee Chats.
The Keynote speakers were extraordinary. I will be sharing some of their discussions in upcoming weeks. Because the PNW PETS is the largest PETS in the Rotary world, it attracts really heavyweight speakers. The information presented over the four days was extraordinary. Thank you for the privilege of representing the Rotary eClub of the State of Jefferson.
Finally, as some of you already know, PDG Dick Olson passed away last week. Dick was District Governor in 1991-92, the same year I was President of the Lincoln City Club. Dick’s passion for the Rotary Foundation, service, and Rotary in general was contagious. He was an inspiration to many in District 5110.
Thank you for your interest in our Club and your commitment to “Service above Self.”
Enjoy the meeting.
If you have any questions or comments, I am available. My e-mail address is: bob@bluewaterphoto.net.
email president@StateOfJeffersonRotary.org
Global Peace Conference March 4, 2023 online
See details in the Rotary Moment
District Training Assembly March 28, 2023, Cottage Grove
District Conference, May 6-7, 2023
Rotary responds to earthquake in Turkey, Syria
Turkey and Syria were struck by a devastating earthquake on 6 February that has killed tens of thousands of people, destroyed thousands of homes and other structures, and left people across the region without shelter in bitterly cold winter weather. The Rotary world responded to this catastrophe immediately. Rotary leadership has activated our disaster response efforts, communicated with the affected districts, and encouraged governors in those regions to apply for disaster response grants. In addition, our project partner ShelterBox and service partner Habitat for Humanity are working on their responses. Find out how you can have the greatest impact.
ShelterBox is an official partner project with Rotary International designed to help provide immediate emergency assistance before traditional relief organizations can reach disaster areas due to logistic obstacles. ShelterBox accomplishes this with advance-sponsored boxes/kits (such as from our club), which are pre-positioned in regional warehouses around the world, and are then deployed by participating air forces (including the USAF and RAF) and charter companies immediately into a disaster area. These kits are disaster and area-specific, intended for short-term survival with the most basic necessities to support a family unit of up to ten with approximately ten days of food, water, shelter, heating, tools - until the traditional disaster relief organizations can reach the affected area.
Our club initially took this on as a worthwhile international project; to date we have sponsored five boxes and one kit. All but one of the five boxes we sponsored have been deployed to assist in disaster areas around the world:
2012 Niger - floods
2012 Lebanon - Syrian refugee crisis
2015 Nepal - earthquake
2016 Syria - civil war
2017 Puerto Rico - Hurricane Irma
We have $30.00 towards another Shelter Box (cost is $1,000). Will you help us reach this goal?
February is Peace and Conflict Prevention / Resolution Month
Today, over 70 million people are displaced as a result of conflict, violence, persecution, and human rights violations. Half of them are children.
We refuse to accept conflict as a way of life. Rotary projects provide training that fosters understanding and provides communities with the skills to resolve conflicts.
Peace is a cornerstone of Rotary’s mission. By carrying out service projects in this area of focus and supporting Rotary Peace Fellowships and scholarships, you become part of Rotary’s effort to address the underlying causes of conflict, such as poverty, discrimination, ethnic tension, lack of access to education, and unequal distribution of resources. During Peace building and Conflict Prevention Month in February, review Rotary’s brochure about our peace efforts and find ways to get involved in building more stable, peaceful communities.
Rotary creates environments of peace
As a humanitarian organization, peace is a cornerstone of our mission. We believe when people work to create peace in their communities, that change can have a global effect.
By carrying out service projects and supporting peace fellowships and scholarships, our members take action to address the underlying causes of conflict, including poverty, discrimination, ethnic tension, lack of access to education, and unequal distribution of resources.
Our commitment to peacebuilding today answers new challenges: how we can make the greatest possible impact and how we can achieve our vision of lasting change. We are approaching the concept of peace with greater cohesion and inclusivity, broadening the scope of what we mean by peacebuilding, and finding more ways for people to get involved.
Rotary creates environments where peace can happen.
Rotary’s Four Roles in Promoting Peace
Rotary and its members are:
- Practitioners: Our work fighting disease, providing clean water and sanitation, improving the health of mothers and children, supporting education, and growing local economies directly builds the optimal conditions for peaceful societies.
- Educators: Our Rotary Peace Centers have trained over 1,300 peace fellows to become effective catalysts for peace through careers in government, education, and international organizations.
- Mediators: Our members have negotiated humanitarian ceasefires in areas of conflict to allow polio vaccinators to reach children who are at risk.
- Advocates: Our members have an integral role as respected, impartial participants during peace processes and in post-conflict reconstruction. We focus on creating communities and convening groups that are connected, inclusive, and resilient.
Register now for the Third Global Peace Conference!
Submitted by eClub Rotarian Carol Fellows
Do you care deeply about your community and are looking for ideas to bring about positive change?
Join us on 4 March 2023 for the third 24-hour online Global Peace Conference: an exciting, interactive convergence of thought-provokers, peacebuilders and everyday people building peace in their spheres of influence.
CLICK HERE TO VIEW THE FULL AGENDA
The theme of this year’s conference is “Strengthening Our Peacebuilding Community”. This theme is an extension of our desire to connect our planet with people power, towards a peaceful and just existence for all. This year’s 24-hour conference has programming in four global geographical regions, with plenaries and skill-building sessions, covering all time zones across the globe and enabling anyone, anywhere, to participate.
This volunteer-led initiative of Rotary Peace Fellows and other members of the broader Rotary peace ecosystem is based on the premise that everyone has the power to change the world. We work in civil society, academia, and government. We work in conflict resolution, sustainable development, and business. We are change makers in our community wherever we are based across the globe, and have a passion to transform conflict into growth and potential.
This 24-hour Global Peace Conference is not a typical academic conference or business networking opportunity. Our value is in dialogue and in collaboration, so everyone—YOU included—has a part to play in making our conference meaningful.
The event will feature:
- Local peacebuilders from all over the world
- Interactive sessions at all time zones
- Ample opportunity for training and networking
Join us by registering above!
The conference is free of charge thanks to the generosity of volunteers and donors from the Rotary peace community, including Carol Fellows and Tim Bewley.
Got Questions? Questions about Global Peace Conference
Sincerely,
Global Peace Conference Co-Chairs:
Priyanka Borpujari
Frances Jeffries
Florence Maher
RPFAA Board:
Rukmini Iyer
Derran Moss
George Ngwane
Choosing the Right Path toward Polio Eradication
List of authors.
- Konstantin Chumakov, Ph.D., D.Sci.,
- Christian Brechot, M.D., Ph.D.,
- Robert C. Gallo, M.D.,
- and Stanley Plotkin, M.D.
The recent declaration of a public health emergency in New York State after a case of paralytic poliomyelitis caused by a circulating vaccine-derived poliovirus (cVDPV), along with cVDPV detection in wastewater both in New York and in London, is a sobering reminder that polio still represents a threat even in countries that have not seen it for decades.1 Silent circulation of poliovirus was not unexpected: such circulation was previously observed in countries using inactivated polio vaccine (IPV). Unlike oral polio vaccine (OPV), IPV does not induce the robust mucosal immunity that is important for preventing circulation. The continued circulation of wild and attenuated polioviruses suggests that the approach used by the polio-eradication campaign needs reevaluation.
The Global Polio Eradication Initiative (GPEI), launched 34 years ago, aimed to eradicate poliomyelitis by 2000.2 The chosen strategy was to stop circulation of wild polioviruses, following the successful example of smallpox eradication. The task, however, turned out to be much more challenging than eradicating smallpox had been, since there are hundreds of asymptomatic poliovirus infections for each paralytic case that occurs, which substantially complicates critical surveillance. Aside from challenges inherent in vaccine delivery in some countries, another reason for the failure to eradicate polio were outbreaks caused by cVDPV strains that emerged from viruses used in OPV.3 Thus, to actually eradicate poliovirus, the use of OPV must also be stopped.
The conundrum was how to withdraw OPV that was essential to eradication efforts without jeopardizing their success. Stopping all immunizations after the disease is eradicated, as was done with smallpox, is a nonstarter because it’s impossible to ensure that no live virus remains loose anywhere in the world, and polio can easily be synthesized in laboratories. The absence of virus circulation and paralytic cases cannot be sustained without universal and comprehensive population immunity. The lack of immunity would result in global vulnerability, and reintroduction of the virus could start a pandemic with potentially catastrophic consequences. A preview of this scenario was provided by the 2016 switch from trivalent to bivalent OPV that omitted the serotype 2 OPV (OPV2) component4; this move created immunity gaps that led to the dramatic proliferation of mutated type 2 viruses. In contrast to what modeling had predicted, the targeted use of monovalent OPV2 to control outbreaks only seeded additional ones, creating a Catch-22.
Fortunately, the visionary thinking of some scientists as well as public health experts at the Bill and Melinda Gates Foundation and the World Health Organization (WHO) resulted in concerted efforts to develop a more genetically stable strain of vaccine poliovirus. The resulting novel OPV2 was introduced for outbreak control in 2020 and was found to be more stable than the original serotype 2 Sabin strain.5 More than 500 million doses have been distributed, and the vaccine has seeded no cVDPV outbreaks. Similar genetically stable strains of serotypes 1 and 3 were created and are undergoing clinical evaluation.
This important development fostered hope that cVDPV outbreaks that occur primarily in Africa and south central Asia might soon be controlled. But the New York case and the discovery of the silent circulation of poliovirus in high-income countries that use IPV demand reassessment of our approach to polio eradication. Although IPV provides excellent protection against paralytic disease, it does not prevent silent circulation of the virus that can eventually infect unimmunized and immunocompromised people. We need to develop new long-term immunization policies that will not only protect vaccinees from paralytic disease but also minimize silent circulation of polioviruses.
The current plan is to withdraw bivalent OPV within 3 years after the circulation of wild type 1 poliovirus is stopped, and then continue immunizations with IPV only. Unlike the 2016 switch from trivalent to bivalent vaccine, the decision to withdraw OPV should be made not on the basis of the perceived absence of poliovirus circulation, but rather on the basis of availability of ample supply of IPV and the readiness of vaccine-delivery infrastructure.
According to the recommendation of the WHO Strategic Advisory Group of Experts on Immunization, the IPV-only phase should continue for 10 years after the withdrawal of OPV, at which time the question of whether polio immunization may become optional can be discussed. This plan may be the biggest flaw in the current strategy, because it is imperative to maintain the highest possible population immunity level indefinitely. Putting off the decision until the distant future sends a number of wrong messages.
First, setting a time horizon for the elimination of polio vaccines discourages manufacturers from investing in research and development of better vaccines. There are several options for such vaccines. Genetically stable novel OPV might be the best solution for countries with high poliovirus transmission. Inexpensive and easy to deliver, it would create comprehensive immunity that would protect people from paralysis and minimize virus circulation without triggering cVDPV outbreaks. Highly effective combination vaccines such as hexavalent vaccines containing IPV along with diphtheria–tetanus–pertussis, Hemophilus influenzae type b, and hepatitis B antigens could be most useful for high- and middle-income countries. In addition, there are several innovative polio vaccines in development — for example, some based on virus-like particles, mucosal vectored vaccines, and RNA vaccines. But unless a clear signal is sent to vaccine manufacturers, these innovative products will never reach the market.
Second, cessation of polio vaccination sends a wrong signal to the general public that vaccination against polio is not needed if there is no detected virus circulation, thereby contributing to vaccine hesitancy and immunity gaps.
There are serious scientific questions that must be addressed if we are to formulate future immunization policies tailored to different parts of the world. High-income countries will most likely continue using IPV-containing combination vaccines, but is there also a role for novel OPV to close the gaps in mucosal immunity and stop silent virus circulation? What is the best policy for middle- and low-income countries, and how can a sustainable scheme for supporting the vaccination programs in resource-limited countries be created?
All these policy decisions must be based on solid science. In the past, the GPEI’s strategic thinking was guided by a scientific advisory committee, but that committee was disbanded years ago, in part because of the perception that science was no longer needed because eradication was just around the corner. This wishful thinking has prevailed for the past 30 years and has proven counterproductive.
The original 1988 World Health Assembly declaration called for eradication of poliomyelitis, emphasizing that “eradication efforts should be pursued in ways which strengthen the development of the Expanded Programme on Immunization as a whole, fostering its contribution, in turn, to the development of the health infrastructure and of primary health care.”2 We believe the GPEI should revert to the declaration’s original intent of eradicating the disease by creating universal immunity to polio rather than continue pursuing viral eradication that has been unsuccessful. It is important to engage the entire scientific and public health communities in developing a rational and sustainable future polio-immunization strategy. We urge the WHO and all their partners, including Rotary International and the Bill and Melinda Gates Foundation, to initiate an open dialogue with scientists about the strategy for preventing polio.
Save the Date! June 7th, 2023 to participate in Navajo Solar light installations.
Housing is limited. Contact John Allman to reserve your space and to get more information.
By David M. Warmflash, MD
(Photo By http://www.medicalarchives.jhmi.edu/portlarg/thomasv.jpg, Fair use)
Have you heard of a Blalock-Thomas-Taussig shunt for rerouting subclavian arterial blood to the lungs as palliation for cyanotic congenital heart disease (CHD)?
Most clinicians know this technique as the Blalock-Taussig (BT) shunt, named for two of its inventors: Alfred Blalock, a surgeon who began performing the procedure in the 1940s, and Helen Brooke Taussig, who came up with the general idea for the shunt and is remembered as the founder of pediatric cardiology.
But the BT shunt would never have seen the inside of an operating room as early as it did if not for Vivien Theodore Thomas.
Over the course of a career recounted in the 2004 television movie Something the Lord Made, Thomas developed detailed surgical procedures and helped train generations of surgical residents. Yet his name was not attached to the BT shunt, because he lacked formal medical training and for another reason: He was African American.
Born August 29, 1910, in Louisiana, Thomas and his family moved to Nashville, Tennessee, where he grew up hoping to be a physician. Talented with his hands, he started working as a carpenter to earn money for college after graduating from high school in 1929.
(Photo left Public Domain)
The Great Depression thwarted his plans, but he landed a job in a surgical laboratory at Vanderbilt University in 1930. There he met Blalock, a graduate of Johns Hopkins Medical School, who was directing the lab.
Lacking a college degree, Thomas was classified at Vanderbilt as a janitor. But his exceptional manual dexterity and enthusiasm soon had him working effectively at the level of a postdoctoral researcher increasingly vital to Blalock's work.
One of these projects was an effort by Blalock to develop a canine model to study pulmonary hypertension. Blalock and Thomas devised a procedure to connect the right subclavian artery to the right pulmonary artery. This connection provided extra blood to the pulmonary vasculature. The feat, while not particularly helpful to the research at the time, would become paramount a few years later when Blalock returned to Hopkins, bringing Thomas along as his assistant.
Baltimore was not in the Deep South, but Thomas was still subject to racial discrimination, so again he was classified as a janitor. Moonlighting to make ends meet, he would occasionally bartend at Blalock's parties, serving drinks to the surgical residents he'd been teaching during the day.
Eventually, the famed neurosurgeon Walter Dandy donated money to get Thomas a raise. Later, Thomas' demonstrated surgical skill with the laboratory animals prompted local veterinarians to send cases to him. Eventually, he had so many referrals, that effectively he was operating a veterinary surgical clinic in his spare time.
Helen Taussig entered the picture soon after Blalock and Thomas arrived at Hopkins. Caring for "blue babies," children with cyanotic CHD, Taussig had made some pathophysiological observations, especially among children with tetralogy of Fallot. Importantly, Taussig noticed that these children had milder disease if they happened to have another abnormality: a patent ductus arteriosus (PDA).
For babies born with cyanotic shunting, a PDA provides an advantage, Taussig realized, giving oxygen-deficient blood entering the aorta from the left ventricle a second chance to go through the lungs. Today, neonates diagnosed with cyanotic CHD in utero or immediately at birth receive prostaglandin E1 (PGE1) to keep the ductus arteriosus patent on purpose.
In the 1940s, Taussig didn't know about PGE1, nor did she have fetal ultrasonography at her disposal to identify cyanotic CHD prior to birth. But she could auscultate with a stethoscope to determine whether the ductus arteriosus in a child was patent or closed. Most audible around the upper left sternal border, a PDA causes a telltale continuous murmur called a machine murmur, because it revs up during systole and down (but still audible) during diastole, a bit like an annoying leaf-blower. The murmur disappears if and when the ductus arteriosus closes.
Taussig proposed that surgeons create an artificial shunt that would be physiologically similar to a PDA but would remain open reliably. She compared it to a plumber "changing around the pipes."
Hearing this, Blalock and Thomas remembered their experiments in dogs with pulmonary hypertension. Connecting the right subclavian artery to the right pulmonary artery, or the left subclavian to the left pulmonary artery, they could produce a left-to-right shunt to compensate for the cyanotic shunting children with tetralogy of Fallot were experiencing. To get it right in a human patient, the procedure had to be tweaked carefully in the lab.
The two men went to work on the dogs, but whenever something was not quite right, Thomas would tweak the procedure in the lab. Thomas would then guide Blalock through the modified technique.
In 1944, Blalock opted to move forward with a human patient. Although this move was criticized as being too risky, it forced Thomas to improvise much of the equipment based on his lab experience. Eileen Saxon, a 15-month-old child with tetralogy of Fallot, was selected as the first candidate. Being a lab assistant, Thomas assumed that he was supposed to stay out of the operating room. But after scrubbing in to operate, Blalock decided that he needed Thomas in the room to guide him. Standing on a stool behind Blalock, Thomas led Blalock through certain steps of the operation. When everything was anastomosed as needed for the shunt, Blalock loosened the hemostats that had been keeping the subclavian and pulmonary circulation separate, and immediately Eileen went from cyanotic to pink.
Although the operation prolonged Eileen's life by only a few months, the team learned new things that allowed other blue babies to live longer, including that they could later perform a second shunt on the opposite side. Hopkins became a center for operations on blue babies from around the world and, over the decades, technology and a multitude of procedures would enable surgeons to correct tetralogy of Fallot and other cyanotic CHD extensively. The BT shunt is still used today, in a slightly different form, as part of initial palliation, buying time prior to stepwise repair with optimal timing.
In 1964, as Blalock approached the end of his life, he remarked that his biggest regret was having not sent Thomas to medical school. Meanwhile, Thomas kept working in the Johns Hopkins surgical department long after Blalock's retirement and death, and in 1976 the university awarded him an honorary doctorate. It was a doctorate of laws, not medicine, but it meant Thomas' students could finally call him "Doctor" — and also "Professor," as he was also added to the medical school faculty, where he remained until his death in 1985.
Among the many surgeons Thomas trained, possibly the most famous was Denton Cooley, a pioneering cardiac surgeon of the middle to late 20th century. Present as an intern in the now famous Operating Room 706 during the procedure on Eileen in 1944, Cooley reflected on Thomas' surgical talent decades later.
"Even if you'd never seen surgery before, you could do it because Vivien made it look so simple," Cooley noted in 1989, without hesitating to compare Thomas' skill to that of Blalock himself. "Dr. Blalock was a great scientist, a great thinker, a leader, but by no stretch of the imagination could he be considered a great cutting surgeon. Vivien was."
David M. Warmflash, MD, is a freelance health and science writer living in Portland, Oregon. His recent book, Moon: An Illustrated History: From Ancient Myths to the Colonies of Tomorrow, tells the story of the Moon's role in a plethora of historical events, from the origin of life to early calendar systems, the emergence of science and technology, and the dawn of the Space Age.
weekly@StateOfJeffersonRotary.org
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.
But there are a lot of methodological decisions that go into a meta-analysis, and Cochrane brings its own set of assumptions to that table: they tend to exclude many studies as low-quality, and tend to be conservative in declaring that an effect exists.
A few weeks ago, a Cochrane team published “Physical interventions to interrupt or reduce the spread of respiratory viruses,” their latest review of the evidence for masking and hand-washing, and whether they reduce flu-like illness (including Covid-19). Thanks to COVID, the debate over how well masks work against respiratory illness has gone from a niche disagreement to a question on which everyone in the country now has an opinion. It’s a question ripe for a good, rigorous meta-analysis.
What we know about masks and COVID
Nearly all of us wore masks at one time or another, and many of us still do. Did that even help?
It doesn’t seem like it, according to the Cochrane review: “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.”
Some observers have taken this as a final, authoritative conclusion on the matter, an opinion shared by the man behind the review. “There is just no evidence that they make any difference. Full stop,” Tom Jefferson, the study’s lead author, said in an interview. Even fitted N95 masks in health care settings, the interviewer asked? “It makes no difference — none of it.”
I think Jefferson — an Oxford University epidemiologist who has a number of eccentric and flatly nonsensical opinions about Covid-19, including that it didn’t originate in China and may have been circulating in Europe for years before its global emergence — is overstating his case. There is something we can learn from the Cochrane paper, but it’s as much about the process of science as it is about the effectiveness of masks.
First, the reasons I don’t totally buy the Cochrane review’s conclusions:
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.
Furthermore, neither of those studies looked directly at whether people wear masks, but instead at whether people were encouraged or told to wear masks by researchers. If telling people to wear masks doesn’t lead to reduced infections, it may be because masks just don’t work, or it could be because people don’t wear masks when they’re told, or aren’t wearing them correctly.
There’s no clear way to distinguish between those possibilities without more original research — which is not what a meta-analysis of existing work can do.
Digging into the research on masks and COVID
Those studies that did take on COVID and masks directly often painted a different picture than the broader conclusions from the meta-analysis.
One of the largest studies of mask-wearing during the COVID pandemic was conducted in Bangladesh, with more than 170,000 people in the intervention group and similar numbers in the control group. The authors studied a series of public announcements and mask distributions which raised the frequency of mask-wearing. In the end, around 40 percent of the experimental group wore masks, compared to around 10 percent in the control group.
The result, the study found, was a substantial reduction in the share of people with Covid-19-like symptoms, and in antibodies that would suggest a Covid-19 infection: “In surgical mask villages, we observe a 35.3% reduction in symptomatic seroprevalence among individuals ≥60 years old ... We see larger reductions in symptoms and symptomatic seropositivity in villages that experienced larger increases in mask use.”
That looks like pretty substantial evidence that mask-wearing reduces Covid-19! And this article is one of only two studies of mask-wearing included in the Cochrane review which happened during the Covid-19 pandemic. The other, a study in Denmark, assigned people to wear masks (though, of course, not all of the people told to wear masks did so consistently or correctly) and had a control group that generally did not wear masks. The group that was told to wear masks had slightly lower infection rates than the group that didn’t wear masks, but the sample was too small for the effect to be significant.
Given that — one study finding very solid evidence for the benefits of masks, and one finding limited but encouraging evidence — how did Cochrane arrive at its conclusion that mask wearing “probably makes little or no difference?” Because their meta-analysis mixes these studies with many more pieces of research that were conducted before Covid-19 and found little effect of masks on the transmission of other illnesses like influenza.
Science is full of judgment calls
The new Cochrane review paper strikes me, and may strike you, as something of a scientifically irresponsible way to represent these findings. It gets at one of the core challenges of science: There is no methodology that can straightforwardly find answers in messy study data without many judgment calls by scientists, who are humans with their own strength, weaknesses, and eccentricities. A meta-analysis, after all, can’t meta-analyze itself.
“I was really surprised that the Cochrane group let this go through,” Jake Eaton, a public policy and global health researcher who was the lead researcher on a Cochrane review of childhood nutrition, told me. “The fact it’s looking at masks across different settings and with different diseases makes it really tricky. Cochrane reviews are very good if you really want to assemble the most rigorous evidence and say, ‘Do we have a conclusive signal that this works?’ This is something of a perverse use of a Cochrane review.”
The big problem is the sheer scope of the question: not “does masking reduce COVID transmission during a pandemic?” but “does masking help against all respiratory illness across contexts?” Because of the questions it chooses to consider and the ways it chooses to aggregate its evidence, it has arrived at a mask-skeptical conclusion with limited applicability to the hot-button question we all care about: whether there’s evidence for masking during high-transmission periods in the Covid-19 pandemic.
We want science to be objective and impartial, for scientists to get the same answers regardless of their starting worldviews. On some questions, like the efficacy of antibiotics against bacterial infections, the evidence really is overwhelming. But on some, like masks, it’s limited.
And I do think the government bears some responsibility for poor communication about masks: this is an intervention where evidence is limited and suggestive, not a sure thing. But I’m also frustrated by the way this quite bad meta-analysis has been seized on as proof that masks don’t work.
How you interpret limited evidence depends substantially on where you start. A meta-analysis is a useful tool, but the results it gets will be substantially informed by how the question is posed and which research is included in answering it. There often aren’t easy answers even to seemingly easy questions, and there sometimes aren’t any answers — even to questions that we care about deeply and that have been studied in some depth.
A version of this story was initially published in the Future Perfect newsletter.
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