A JAMA research letter finds a mask does not lower Spo2 on pulse oximetry

Please allow me to explain why doing this paper is a bad idea; Why it doesn't help; Why it fuels division; Why it is a waste of time & opportunity cost

Why it is misguided

[THREAD]

First, Let us be clear about what folks critical of masks claim:

Some claim it lowers O2 (yes),
others that is retains CO2,
some claim it is uncomfortable,
loses a human connection,
does not slow sars-cov-2 spread,
and is unpleasant to wear if you are exerting yourself.

This paper tackles just one of the many claims made by those resistant to masks:

Does it lower o2 on a pulse ox?

It does not address Co2 retention (you need a blood gas or ET Co2 for that), nor the many other reasons given to not wear a mask

Before this study was run, no one who routinely reads JAMA believed masks lower pulse ox o2.

It's an absurd claim.

If it were true, surgeons would desaturate during lengthy operations.

They don't

There are 5 reasons why publishing this 'research' in JAMA is a bad idea:

1. It addresses only 1 of several reasons folks who do not wear masks provide. IF you debunk one, you still need to debunk the others;

Moreover, more objections can continually be manufactured, do you want to spend your life debunking them all?

Are you willing to repeat this study with arterial blood gases? (to rule out CO2 retention)

And, won't you concede that wearing a cloth mask is uncomfortable if you truly exert yourself?

Or do you want an RCT with Patient Reported outcomes?

How far are you willing to go?

2. Is a person who believes masks lower O2 the sort of person who will be persuaded by a JAMA research letter, or is this, as I said, rebutting Tucker Carlson on Fresh Air with Terry Gross

I doubt it persuades folks who hold this view.

They can reply: JAMA is fake news, QED

3. If you instead wish to take this seriously... The trial did not meet its target enrollment, and limitations include excluding folks unable to wear a mask (which many mask resistant folks may claim would includes them)

Moreover, it does not gauge subjective symptoms. Did not corroborate pulse ox with blood gas, nor did it measure quality of life.

In fact, a critic would say that pulse ox is a BIAS SUSCEPTIBLE endpoint, so we should use blood gas instead

You can retake a pulse ox till you get your desired result = bias susceptible

See also work on renal artery denervation and BP

Does any person seriously want to do a blood gas instead?

Will that pass an IRB?

4. Is this what researchers should be doing with their limited time (opportunity cost)

Should they be debunking such claims, or use their time to advance causes that do need data?

5. A cynical person would say that even writing this paper is emblematic of naked covid academic opportunism that plagues the journals, preprint serves, and cable news.

In short, I think it is a misguided precedent to let the the most irrational person in our society set our research agenda.

I think it is fighting a war that you lose the moment you enter the battle

You will persuade no one who is not already on the team

You have not actually addressed all of the concerns masks critics have made

You further polarize an issue that needs depolarization

You preach to the choir

And worst of all, you want the precious page space of JAMA with nonsense, while many of us are doing real science

So I asked this poll in the AM, and the only right answer is DON'T DO IT https://twitter.com/VPrasadMDMPH/status/1322554145203658755?s=20

And last thought, there is a broader conversation about pseudoscience we need to have

Listen here, if you liked this thread https://soundcloud.com/plenarysession/ep230

@drjohnm @venkmurthy @mikejohansenmd

PS: @drjohnm is one of the kindest people alive; if you are going to hate on his criticism of this paper, you reveal more about yourself than him