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Masks (Still) Work: Debunking (More) Pseudoscience

A Reply to Colleen Huber, NMD

In my last article, with the help of my colleague Jennifer McClinton-Temple, I debunked Denis Rancourt’s “Masks Don’t Work” article, which had been spreading like a pandemic in “anti-mask” circles. But no sooner had I hit “publish” than another (unpublished-non-peer-reviewed) article popped up (literally the same day) to take its place. It was another (so called) “summary of the science,” this time by NMD Colleen Huber. Again, I hesitate to even address it, for fear of adding legitimacy to it. But since a reader asked me to address it, and it’s making the rounds…

A Review of Huber’s Evidence

What she presents is essentially more of the same. Indeed, while Rancourt at least presented some arguments for his views (which I debunked here), all Huber does is present one-sentence summaries of articles that she claims show that masks don’t work (or are dangerous). But she only mentions articles that “support” her theory and ignores those that don’t. Worse still, the articles she says support her position don’t actually say what she claims they do—and, in many cases, they actually openly contradict her conclusion.

For example, she first cites Jefferson et al.'s “Physical Interventions” paper, and quotes the line in the abstract that says “Compared to no masks, there was no reduction of influenza-like illness cases or influenza for masks in the general population, nor in healthcare workers.” Now, that sounds pretty damning. That may be why she mentions it first. But the study is a meta-analysis—a study of existing studies. And Jefferson found those studies to be of poor quality. “Most included trials had poor design, reporting and sparse events.” In fact, Jefferson goes on to conclude the opposite of what Huber suggests:

“Based on observational evidence from the previous SARS epidemic included in the previous version of our Cochrane review we recommend the use of masks combined with other measures.”

What’s more, the article comes with a proviso:

This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

For some reason, Huber left that out.

About the second article she cited, Xiao et al.'s “Nonpharmaceutical Measures,” Huber says:

“This 2020 meta-analysis found that evidence from randomized controlled trials of face masks did not support a substantial effect on transmission of laboratory-confirmed influenza, either when worn by infected persons (source control) or by persons in the general community to reduce their susceptibility.”

But, again, this is a meta-analysis—and, once again, the authors of the study she cites found their quality wanting. Xiao et al. say,

“Most studies [we examined] were underpowered because of limited sample size, and some studies also reported suboptimal adherence in the face mask group.”

The failure of a few flawed studies to show that X is true doesn’t mean that X is false. (That's appealing to ignorance.) And as if to ensure that no one tried to misuse their study, as Huber does, Xiao and the other authors of his study make very clear that their study does not suggest that masks don’t work.

“There are still few uncertainties in the practice of face mask use, such as who should wear the mask and how long it should be used for. In theory, transmission should be reduced the most if both infected members and other contacts wear masks, but compliance in uninfected close contacts could be a problem. Proper use of face masks is essential because improper use might increase the risk for transmission. Thus, education on the proper use and disposal of used face masks, including hand hygiene, is also needed.”

And it goes on and on like this. Huber cites 42 articles in total, and none I (or my colleague) looked at support her position in the way she describes. In fact, at least two authors (of articles "22" and "29") later clarified that they support wearing masks, and that their work doesn't entail that masks don't work. And again, as I pointed out in "The Countless Counterfeits Fallacy," once you debunk a few such arguments, you can establish a pattern and effectively debunk them all. But I challenge you to go through Huber’s article, study by study, and find one reliable example that breaks the pattern.

Inappropriate Appeals to Authority

But the more important question is “why?” If I published a paper that cited even one study that didn’t say what I said it did, I’d be paying for it academically for years. If I did it 42 times in one paper, I’d be drummed out of my profession. But Huber may not face much scrutiny if her readers commit the “appeal to authority” fallacy.

Now, the appeal to authority fallacy is somewhat poorly named. It’s not always fallacious to appeal to authority. A consensus of scientists concluding based on research that something is true is a good reason for a non-expert to conclude that it is true. And trusting your family physician when she, say, diagnoses you with a disease and prescribes a treatment is not fallacious (unless you happen to know that her conclusion is contrary to an established consensus—then you want to seek a second opinion). But sometimes it is fallacious to appeal to authority. Let’s call when someone does this an “inappropriate appeal to authority” and explore a few examples.

One inappropriately appeals to authority when one thinks that the research of a single relevant expert can settle a scientific issue. To really settle a scientific issue, you need almost all the research on a topic (not just some evidence you select) to converge.

A person also inappropriately appeals to an authority when they fail to recognize that the “expert” in question doesn’t actually have expertise relevant to an issue. Linus Pauling, for example, was a Nobel Prize winner in chemistry—but he was not an immunologist. So he was speaking completely outside his area of expertise when he said that Vitamin C can boost your immune system. (It can’t.) Likewise, a physicist (like Denis Rancourt) can tell you about atoms, but isn’t a reliable source about epidemiology (or the effectiveness of masks). Indeed, even medical doctors rely on the work of epidemiologists during an epidemic, because medical doctors don’t have the expertise to study and evaluate the effects of diseases on large populations. A medical doctor is not an “epidemic-ologist.”

It may seem like Colleen Huber, NMD is an expert on epidemiology because she has “MD” by her name. She’s not. Indeed, the “N” before the MD stands for Naturopathic. And in case you don’t know, naturopathy has been described as a pseudoscience. Now, to be fair, some naturopathic doctors have some medical training. But (as the American Academy of Family Physicians points out) Naturopathic Doctors “aren’t as rigorously trained as medical doctors and ... many naturopathic treatments are ineffective and potentially dangerous.” Now you can trust an NMD to diagnose and treat you and your family’s illnesses if you wish. But if an MD doesn’t even have all the relevant expertise needed to settle the issue of mask effectiveness and safety, an NMD almost certainly does not.

Huber actually encourages the reader to make this kind of mistake by using obtuse and confusing prose; the uninformed reader is very likely to read it, get confused, and just throw up their hands, saying, “Well, I didn’t understand all that, but she has an MD by her name. So I’m sure she knows what she’s talking about.”

So, once again, the respected medical consensus is that masks are safe and effective, and public mandates that require them help prevent the spread of COVID—and we should be wary of anyone who tries to claim otherwise. To be fair, it’s usually not good to let something become unquestionable dogma, but there also comes a point when something is so well established, it’s usually not worth your time to entertain arguments to the contrary (e.g., “The Earth is flat!") This is especially true when people display such a propensity for misrepresenting the research of others. If the consensus among respected epidemiologists shifts because of conclusive repeated research, then I’ll change my mind. Until then, I’ll be (1) wary of pseudoscientists encouraging inappropriate appeals to authority in unpublished non-peer-reviewed internet articles, and (2) wearing my mask in public.

Copyright David Kyle Johnson, 2020

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