The truth is I wear a cloth mask and I quite like it
Prior to the pandemic, Drs. Adam Cifu and Vinay Prasad wrote an excellent book called Ending Medical Reversal. During the pandemic, Dr. Prasad created medical reversals. For example, in May 2021 he said:
For somebody who’s already been fully vaccinated, they can wear the mask out of solidarity or in a symbolic sense, but their wearing a mask indoors is not benefiting anyone else. There’s an infinitesimally low probability of even having an infection that can be detected on a PCR test, let alone being able to spread it to someone.
The next year he said:
This was not Dr. Prasad’s only medical reversal involving masks. In January 2021, he wrote an article titled Throw Away Your Mask After COVID Vaccination? in which he said:
The truth is I wear a cloth mask and I quite like it.
Although, Dr. Prasad quite liked wearing a cloth mask in 2020, since then he has staged a relentless crusade against masks, vaccines, and all other measures to limit viruses. His core opposition to these measures isn’t that they don’t “work”, although he will often frame it that way.
Vinay Prasad is Wrong About Masking
Many of my prior articles have discussed the techniques he Dr. Prasad uses to spread misinformation. I’ve discussed how he judges studies by whether he likes their results and how he omits unwanted information to mislead his readers. Until recently, Dr. Cifu hasn’t cared about Dr. Prasad’s medical reversals. He’s only been bothered that anyone would dare point them out. So it was with interest that I read Dr. Cifu’s recent article Vinay Prasad is Wrong About Masking, which picked up on many of the themes I’ve documented previously.
Both Drs. Cifu and Prasad wrote about a study in the BMJ titled Personal Protective Effect of Wearing Surgical Face Masks in Public Spaces on Self-Reported Respiratory Symptoms in Adults: Pragmatic Randomised Superiority Trial. This was a randomized-controlled trial (RCT) in Norway from 2/10/2023 to 4/27/2023 that concluded:
Wearing a surgical face mask in public spaces over 14 days reduces the risk of self-reported symptoms consistent with a respiratory infection, compared with not wearing a surgical face mask.
The benefit was small, the absolute risk difference was only 3.2% (3,300 fewer infections per 100,000 people). However most people who still mask today wear n95 respirators, which are “are significantly more effective than medical or cloth masks” according to one recent review. Moreover, this study did not show the value of masking for an individual who is dedicated to wearing one, as Dr. Cifu stated, but rather to a group of people randomized to wear one in public spaces for just 14-days, in Norway, in early 2023. RCTs of interventions measure how well the intervention works and how well a group of people can adhere to that intervention. An intervention that is effective for an individual if used properly, is ineffective for a community if almost no one uses it. As Professor Raywat Deonandan put it:
The military never did any RCTs to prove that gas masks work in the battlefield. They relied on lab testing. That’s because they could depend on near perfect user compliance. That’s what RCTs for engineering interventions really measure: compliance.
It turns out that most people in this RCT didn’t wear a mask in public for 14-days. Among participants in the intervention arm, only 25% reported always wearing a mask, and 53% ate in a restaurant. Given that most people couldn’t wear a mask in public just for 14-days, even as part of a study, this implies masks were effective for the minority of people who consistently wore them.
The main reason why people didn’t like wearing masks was interesting. They didn’t like being treated as social pariahs. The study found:
The most reported adverse effects were unpleasant comments from other people.
Dr. David Gorksi and I’ve previously discussed how Dr. Prasad and other doctors shamed and pathologized strangers for wearing masks or taking any steps to avoid COVID at all. I don’t know if they had an influence in Norway, but this mockery contributed to a culture where people felt uncomfortable wearing masks in public.
This study does not prove masks work
As he’s done throughout the pandemic, Dr. Prasad rejected this RCT because he didn’t like what it found. He wrote an article titled A New Mask Randomized Trial Shows That Masks Work? in which he predictably answered:
This study does not prove masks work.
There will never be a study that will lead Dr. Prasad to conclude masks or any other mitigation measure “works”.
In his critique of Dr. Prasad, Dr. Cifu echoed a prior criticism of mine about how Dr. Prasad obscures unwanted information. Dr. Cifu wrote:
You’ll notice that I actually link to the paper here. Something not done by my colleague. Suspicious…
He also accused Dr. Prasad of “moving of the goalpost” and contradicting what he used to believe. Dr. Cifu wrote that:
Dr. Prasad made exactly the opposite argument on page 137-138 of Ending Medical Reversal when we discussed data supporting Tamiflu.
Others also noticed that Dr. Prasad reversed himself regarding medical reversals. They found this “super disappointing.”
Dropping masks, quarantines, distancing, and all other mitigations will allow children to develop the kind of broad immunity gained by living a normal life.
However, Dr. Cifu also wrote this:
If you go into this article convinced that masking is worthless, you can dismiss the results as Vinay did.
This reveals that while Dr. Cifu is belatedly catching onto some of the rhetorical techniques Dr. Prasad uses to mislead his readers, he has yet to grasp Dr. Prasad’s fundamental philosophy regarding most viruses. Dr. Cifu wrote his article based on the quaint assumption that doctors agree it is generally good to avoid pathogens that can make us and our children sick.
Dr. Prasad disagrees. Don’t take my word for it. Just read Dr. Prasad’s own words. His article Should We Let Children Catch Omicron?, written with Allison Krug just after the pandemic’s deadliest month for children, said:
Parents must consider that exposures are how we best protect our children against the variants of the future. In fact, it is reckless to let children age into a more serious encounter with a disease best dealt with while younger… For children, getting sick and recovering is part of a natural and healthy life… Exposures are how we best protect our children against the variants of the future… Immunity is built through illness.
He proposed using sick, unvaccinated children as human shields to theoretically protect more vulnerable adults. He said:
Shielding kids from exposure only increases their future risk. This is partly why the UK does not vaccinate against chickenpox. Serious complications from the disease are rare among children, and the circulating virus allows adults to be naturally boosted against reactivation-driven shingles. By rebuilding population immunity among the least at-risk, moreover, we help buffer risk for those most vulnerable.
There are safe and effective vaccines for both chickenpox and shingles, both of which can be dangerous and unpleasant. Children don’t have to get infected to theoretically serve as human shields for adults.
This article favorably quoted Professor Francois Balloux who said:
I’m not sure how to convey this message in a half-acceptable way. But, if the objective were to send SARCoV2 into endemicity, then healthy kids have to be exposed to the virus, ideally earlier than later. This is not ‘eugenism’; it is bog-standard infection disease epidemiology.
He similarly quoted an editorial in the BMJ that said:
Once most adults are vaccinated, circulation of SARS-CoV-2 may in fact be desirable, as it is likely to lead to primary infection early in life when disease is mild, followed by booster re-exposures throughout adulthood… This would keep reinfections mild and immunity up to date.
This article advocated removing masks and all other mitigations precisely because this would “allow” children to get sick. It said:
Dropping masks, quarantines, distancing, and all other mitigations will allow children to develop the kind of broad immunity gained by living a normal life.
I Am Going to Mask Because I Want to Get Fewer Colds & Other Flawed Ideas
In another essay, titled I Am Going to Mask Because I Want to Get Fewer Colds & Other Flawed Ideas, Dr. Prasad shamed and ridiculed anyone who wanted to stay healthy. He said the best way to avoid feeling sick was to get sick. He said:
We may even feel worse when we get sick having lost some cross immunity the longer we postpone things.
He warned of dire consequences of stopping viruses, fearing that worse variants might arise if we didn’t give them opportunities to infect us. He wrote:
That would only mean we are selecting for fitter viruses. Viruses that can spread with less and less breath.
He speculated that preventing infections could cause cancer and autoimmune disease, even though viruses can cause cancer and autoimmune disease. He wrote:
There is the arrogance that avoiding colds and flu is good for us. Of course it is the case that getting sick is unpleasant, but our knowledge of immunology and the body is so primitive we should not conclude that avoiding it is ‘good for us.’ We have no idea if that is true in the long run. It is natural to be infected repeatedly with respiratory viruses— if we got fewer infections what would that mean for auto-immunity for cancer? We have no idea if we would actually live longer or healthier lives trying to dodge seasonal runny noses and coughs.
Sickness was health. Parody accounts picked up on this.
Of course, no one is trying to dodge seasonal runny noses and coughs, though Dr. Prasad framed it that way to make people appear hysterical. As everyone knows, some people are trying to dodge SARS‑CoV‑2, the virus that killed over 1.1 million Americans and injured millions more. Currently it is impacting the Olympics and generating headlines like this from Dr. Prasad’s hometown newspaper: California is Still Getting Crushed by COVID. When Will it End?
There’s obviously no evidence that people who are trying to avoid COVID are endangering their health, though doctors who claimed to value data and evidence were just perfectly willing to just spitball out loud that maybe, perhaps COVID-avoiders would one day get cancer and autoimmune disease as a consequence of their behavior.
In contrast, there is evidence that repeat COVID infections are not always the harmless colds they are made out to be. One recent study found:
That severe infections from the virus that causes COVID-19 tend to foreshadow similar severity of infection the next time a person contracts the disease… About 27% of those with severe cases, defined as receiving hospital care for a coronavirus infection, also received hospital care for a reinfection.
I have never seen Dr. Prasad express the slightest hint of concern that repeat COVID infections may have any consequence, another example of a trend I discussed previously where doctors treated theoretical harms with more gravity than actual harms from COVID.
Beyond this, Dr. Prasad was very perturbed that a tiny fraction of people tried to avoid COVID. He felt they were ridiculous, blameworthy, and deserving of scorn. His article concluded:
Covid19 did infect neurons— just not in the way people think. A tiny fraction of people can’t get back to normal. They are suffering from long pandemic. They still entertain magical thinking. It would be tolerable if they didn’t continue to try to interfere with the lives of others. But they can’t help themselves. It’s important to remind them that they may also be deeply incorrect.
Imagine being this upset that a very small number of strangers tried to avoid a virus.
The Benefits of Having a Natural Measles Infection
None of these arguments were new. I was very familiar with them. The idea that viruses protect against other disease is actually an old bit of anti-vaccine magical thinking. Anti-vaccine doctors regularly spoke about the “benefits” of measles and HPV before the pandemic. This was rightly called quackery before 2020. To pick one example amongst many, American Loon #783 Dr. Suzanne Humphries wrote an article titled The Benefits of Having a Natural Measles Infection, which claimed that measles treats kidney disease and cancer. She said:
A look into the medical literature of the past shows us that wild measles may indeed have afforded immunologic advantages to those infected… Why not just let wild measles circulate and do the job nature intended at the time of life it was intended, which leads to 65 years of immunity and no need for life-span vaccination? And probably reduces the chance of developing cancer during later life.
Compare that to what Dr. Prasad said.
Like @VPrasadMDMPH, I believe avoiding getting sick is not necessarily good for your health
Opponents of birth control don’t object to condoms because they think they are worthless, and pro-infection doctors don’t object to mitigation measures because they think they are worthless. As I wrote previously, Pro-Infection Doctors Didn’t Honestly Question Whether Mitigation Measures Slowed COVID. They Sought To Undermine Them Precisely Because They Slowed COVID. Though Dr. Prasad has created many medical reversals, they’ve all been in the service of his one unwavering belief: viral infections should be encouraged in most people and measures that limit them aren’t worthless, they’re bad by definition. That’s why even if a 100 flawless RCTs showed masks drastically slash infections, Dr. Prasad wouldn’t say they “work.”
In the worldview of We Want Them Infected doctors, avoiding getting sick is not necessarily good for your health. As such, measures that “work” are those that let viruses infect unvaccinated children and young people. Before doctors can have dialogue about whether masks or other mitigation measures “work”, they need to have a shared understanding of that word. In a rebuttal to Dr. Cifu titled Adam Cifu is Wrong About Masking Dr. Prasad said:
Maybe it’s a good thing to get colds, and avoiding them is silly.
Hopefully, Dr. Cifu will explore that in a future article about his colleague.