This post first appeared at Common Dreams on February 25, 2023.
Labeling a newspaper column an “opinion” doesn’t create a license to play fast and loose with facts.
All of my op-eds for the New York Times have gone through rigorous fact-checking with a conscientious Times editor. Apparently, columnist Bret Stephens is exempt from any such requirement. The Times should alert its readers to his special status so they can protect themselves.
For years, the science of masking to minimize the spread of airborne viruses, including COVID, has been settled. But Stephens’ February 21 column mischaracterized a recent review of other researchers’ studies to push his anti-masking views. In the process, he made the Times a megaphone for broadcasting incomplete, misleading, and dangerous assertions as if they were facts.
Stephens began his column by describing the Cochrane Library’s January 30, 2023 review as the “most rigorous and comprehensive analysis of scientific studies on the efficacy of masks for reducing the spread of respiratory illnesses — including Covid-19.” Then he wrote that one of the study’s 11 authors, Tom Jefferson, said its conclusions “were unambiguous.”
We’ll return to that one.
Quoting Jefferson, Stephens continued, “‘There’s just no evidence that they’ – masks – ‘make any difference.’”
How about high-quality N-95 masks?
Again, quoting Jefferson, Stephens wrote, “‘Makes no difference – none of it.’”
Stephens then quoted Jefferson on the futility of using masks in conjunction with many other accepted medical precautions – hand hygiene, physical distancing, or air filtration: “‘There’s no evidence that many of these things make any difference.’”
Stunning statements – and flat-out wrong. Even Cochrane’s review undermined Jefferson’s draconian certainty. The “plain language summary” accompanying the published review began with this “Key message” about its findings: “We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.”
“Uncertain” is a far cry from “unambiguous.”
Then again, Jefferson has been wrong before. In March 2020, he said of COVID, “[T]here does not seem to be anything special about this particular epidemic of influenza-like illness.” In July 2020, he asserted that COVID may have been lying dormant around the world, rather than originating in China. And for years, he has been hostile toward masking.
Garbage In, Garbage Out
Stephens used Jefferson’s comments to introduce his larger argument: “Mask mandates were a bust.” As he attacked the CDC’s “mindless adherence to its masking guidance,” Stephens failed to mention the growing body of medical and scientific literature lambasting those misusing Cochrane’s review to undermine masking generally.
First, Cochrane’s was not a new scientific study. It retrieved and combined data from separate trials that varied greatly in “quality, design, populations, and outcomes” in what scientists call a “meta-analysis.” But combining such apples, oranges, grapes, peaches, and pears can create problems.
That’s why the 11 Cochrane authors themselves warned: “The variable quality of the studies hampers drawing any firm conclusions.”
Second, most of the actual trials in Cochrane’s review tested only mask effectiveness at preventing infection in the wearer. They ignored the potential benefits of face masks in preventing the spread of infection to others. In fact, buried in Stephens’ op-ed is his telling admission:
“[T]he analysis does not prove that proper masks, properly worn, had no benefit on an individual level.”
Third, Cochrane’s authors acknowledged that in their assessment of community-wide masking effectiveness, “Relatively low numbers of people followed the guidance about wearing masks or about hand hygiene, which may have affected the results of the studies.”
How can anyone conclude from clinical trials that masks don’t work when most people in the trials didn’t wear them, much less wear them correctly?
Likewise, some of the studies in Cochrane’s review relied on participants to self-report their mask usage. That’s a big problem. In a study of masking in Kenya, 76% of participants self-reported masking in public, but the actual observed masking rate was only 5%.
The Cochrane Review Itself Repeatedly Acknowledged Its Limitations
As a group, Cochrane’s authors themselves listed the many limitations of their review that accounted for “the observed lack of effect of mask-wearing”: poor study design, lower adherence to mask-wearing (especially among children), the quality of the masks used, and more.
Commenting on Cochrane’s review, one medical fact-checker observed, “Each of these factors increases the risk of bias, reducing the reliability of [Cochrane’s] conclusions. In addition, while some studies confirmed the type of [COVID] infection by a laboratory test, many others relied on self-reporting to assess both mask-wearing and infection, further increasing the risk of bias.”
All of which explains why Cochrane’s authors collectively expressly discounted their own conclusions about the effectiveness of population-level masking: “The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.”
Again, the authors’ “plain language summary” accompanying the review noted: “Our confidence in these results is generally low to moderate for the subjective outcomes related to respiratory illness….”
In less technical terms: “garbage in, garbage out.”
The New York Times’ failure to fact-check Stephens on this critical public health issue has real-world consequences. It prolongs needless controversy over whether wearing masks protects individuals from COVID when the proven fact is that they do. As a result of Stephens’ rant, some people will decide not to wear a mask, even in high-risk settings. Some people will become ill. Some people will be hospitalized. Some people will die.
For me and the millions of immunocompromised households in America, this is especially personal. To a great degree, our health depends upon others wearing masks to protect us, as well as them, in high-risk settings. We’re on the front lines of a war that Americans can win. But Bret Stephens and the New York Times have erected another misinformation obstacle to victory over the pandemic.
Waiting for Stephens’ Next Epiphany
Maybe someday Stephens will change his mind, as he did with climate change. For more than a decade, he was a leading climate-change denier. While still at the Wall Street Journal, he wrote in 2008 that global warming was “a mass hysteria phenomenon.” A year later, he said that the intellectual methods of “global warming true believers” were “instructively similar” to Stalin’s.
But in August 2022, Stephens’ trip to Greenland’s melting glaciers resulted in “fresh thinking” that produced a lengthy op-ed for the Times. He opened his eyes and changed his mind:
“I always said to myself, that I should never be afraid to change my mind in public, even on subjects where I’ve taken, you know, I’ve really put a stake in the ground. So that was, that was how that long 6,000-word giant piece came to life….”
Using the thin reed of the latest Cochrane Library review, Stephens has put another bad stake in the ground. Someday he might change his mind. But the country can’t afford to wait the years that it took for his epiphany on global warming.
Visiting COVID patients in an ICU might accelerate his awakening. Perhaps Stephens could bring along another New York Times columnist without public health qualifications who has downplayed COVID repeatedly – David Leonhardt.
If they believe what Stephens led his readers to conclude on February 21, they won’t wear masks. And they’ll encourage the doctors and nurses in attendance to remove theirs.
Great post Steve. Jerry Esrick
Thanks, Jerry. I hope all is well with you and your family.