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Comment by NoPie | Hacker News Reader

That is generally not true.

In fact, often clinical trials are statistically analysed by intention-to-treat, including all people who have been randomised even if they later don't receive the treatment.

Per-protocol-analysis (including only people who follow the study protocol) can also be used but it is more prone to bias.

Besides, with masks it is not simply wearing or not wearing a mask. Even a very diligent mask wearers may wear it in a way that makes it less effective without being aware of that.

In short, when the doctor prescribes a medicine it is important to understand the factors why the patient may not take the medicine as prescribed. If the real life situation is that most people take medicine in a way that makes it ineffective and so much that the clinical trial cannot find significant effect, then he shouldn't prescribe it. It is just a waste of resources and giving people false hopes.

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> In fact, often clinical trials are statistically analysed by intention-to-treat

Fair! That said, intention-to-treat is more likely to greatly underestimate the efficacy of a treatment when non-adherence is expected to be high/isn't being monitored.

> In short, when the doctor prescribes a medicine it is important to understand the factors why the patient may not take the medicine as prescribed.

I agree, but the solution is to help the patient overcome those barriers not to throw out the medication. It's to give people the information and tools they need to follow the treatment. People who wear masks could be trained on how to properly fit them, take them on/off, store them, replace them, etc. The real life situation around masking included basically none of that. "Wear a mask" was basically all people were told.

It doesn't make sense to fault/dismiss masking if a large part of the population isn't wearing them because they were tricked into believing that masks don't work or that masks will actually make them sick, and another large part of the population wears them, but wasn't shown how to do it correctly.

It's important to be aware that those things are going on within the population, but the next step from there is still "educate the public" and not "abandon all efforts at masking" - at least not until a more accessible alternative which is also as effective as masking becomes available

The population was told that masks certainly work, in certain areas mandates made sure that compliance is very high >95%.

If we still could not find reliable evidence that masks are effective, then the policy makers should be told that.

There is very little you can do to improve mask wearing technique. We certainly explained these things to doctors, it made no difference in results. If you want to make more controlled studies, you can do that. Don't hold your breath however.

No, we should not continue requiring wearing masks because you are only doing that out of hope. That's not how we do things in medicine. It would be unethical. There are many medicines that show effectiveness in the lab but fail in clinical trials. We don't demand for those medicines to be used until we find more effective alternative. Many unknown factors could cause ineffectiveness in clinical trials, we don't need to understand all of them, just the fact that the drug failed to demonstrate effectiveness and safety in real life settings.

>> a more accessible alternative which is also as effective as masking becomes available

The point is masking was not effective. It has not shown effectiveness anywhere in the real world.

There is very much plenty of fairly reliable evidence that masks work. And the better the compliance the better they work. In nurse studies you get much better results than in population studies, for instance. Now that I'm looking I'm hard pressed to find any studies that go against this conclusion.

https://jamanetwork.com/journals/jama/fullarticle/2776536

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/

https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15401

https://bmjopen.bmj.com/content/5/4/e006577

Have you looked at Cochrane review?

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