Arguments about face masks and Covid-19 reflect broader methodologic debates within medical science

Neil Pearce,Jan Paul Vandenbroucke

doi:10.1007/s10654-021-00735-7

Abstract

There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that “there is no scientific evidence”, by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, “the science supports that face coverings save lives”. It used to be a ‘given’ that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.

Highlights

There has perhaps been no issue as contentious in Covid-19 as face masks
3 Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark that there is a strong hunch based on knowledge of humans falling from altitudes. It used to be a ‘given’ that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence: several types of epidemiologic studies, clinical studies, laboratory studies, and sometimes socio-economic studies
The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard

Summary

Introduction

There has perhaps been no issue as contentious in Covid-19 as face masks. Their benefits and drawbacks are endlessly debated politically, and scientifically. The most contentious scientific debate has been between those who argue that “there is no scientific evidence”, by which they mean that there are no randomized controlled trails (RCTs), vs those who argue that, admittedly, there is no single definitive study, but when the evidence is considered together, “the science supports that face coverings save lives” [1]. Advocates of the latter approach would argue that there is no RCT evidence that parachutes save lives [2], but. Similar views have been expressed at high levels of the current British Government [12]

Evidence synthesis

The challenge from vested interests

What is to be done?