The Year Evidence-Based Medicine Died

Blower’s cartoon in today’s Times

A senior research scientist in a pharmaceutical company with over 15 years’ experience in drug research and development, both in biotech and large pharma, has emailed to express his despair about mandatory face masks in schools.

I was moved to write when I read with utter dismay about the decision for masks to become mandatory in Scottish schools, with the rest of the UK probably not far behind.

As a scientist, for me face coverings are emblematic of what has gone completely wrong in our approach to COVID-19. Face coverings are not some “jolly jape” or “what’s the harm” thing, they are an invasive treatment that has been imposed on the entire population based on weak scientific evidence. They also have potential to cause harm both to individuals and the environment; how long before disposable cloth “jelly-fish” start washing up on our beaches? I also believe that in some circumstances they could actually increase the risk of transmission. Simply stating over and over that face-coverings help “stop the spread” without any data, seems to me to smack of “if we say it enough, it will be true”, rather than sound clinical science.

What is so utterly ridiculous is that the potential risks/benefits of face coverings are completely testable with appropriately designed studies and if this was a normal clinical intervention then there would be a justified expectation of just such testing before being was rolled out. I’ve seen people say that holdouts against masks are akin to those who wouldn’t wear seatbelts. But the big difference is that seatbelts were subjected to precisely this kind of rigorous testing, and there was a lot of evidence that they worked, before they became mandatory. Such evidence for face coverings simply does not exist, or has not been published, so scepticism is justifiable given that it is a significant societal change to mandate wearing a face-covering in most public spaces.

Graham Martin et al summed this up in a recent paper: “Well-intended population health interventions can do harm, but the downsides of mandatory face-covering policies have to date been under-conceptualised and under-studied.”

Given the general chaos in policy making, the imposition of lockdown itself and the ongoing issues surrounding screening highlighted by people such as Prof. Heneghan, it appears to me that 2020 is the year that evidence-based medicine died.