Open scientific discourse is especially critical during a public health crisis such as a pandemic. Academics should be free to pursue knowledge wherever it may lead, without undue or unreasonable interference. It is deeply troubling when scientists try to limit rather than engage in scientific debate.
Last week, anonymous posters with the portrait of Stanford University Professor of Medicine Dr. Jay Bhattacharya were plastered on kiosks around the Stanford campus, linking him to COVID deaths in Florida. Even though cumulative age-adjusted COVID mortality is lower in Florida than in most other large states, these smears appeared.
Taking it one step further, the chair of Stanford’s epidemiology department, Professor Melissa Bondy, circulated a petition among faculty members demanding that the university president exercise his obligation “to clarify for the faculty the limits of public pronouncements when proclaiming on public health policy.”
The petitioners are upset that “several Stanford faculty members have publicly advocated for policies for others that are contrary to those the university has adopted” and that “these recommendations are disturbing and contrary to public health standards; they foster uncertainty and anxiety and put lives at risk.”
While insidiously not naming anyone, the petition explicitly targets Bhattacharya by quoting his answer to a question from Florida Gov. Ron DeSantis about masks on children. He responded that “there is no high-quality evidence to support the assertion that masks stop the disease from spreading.” To deserve trust, scientists must be honest about what is and what is not known, and we agree with Bhattacharya.
Randomized trials provide the best available research evidence to inform health-care decisions and are considered the gold standard for determining intervention effects. But no randomized studies have shown that masks in children are effective. Instead, there are observational studies of uneven quality that reach conflicting conclusions.
For example, a widely publicized observational study from Duke University showed very little COVID in North Carolina schools with mask mandates. Shockingly, the study did not have a control group to compare schools with and without masks. By comparison, Sweden also had little COVID in children and teachers without using masks in their schools.
While adults differ from children, there have been two randomized COVID studies evaluating masks on adults. Based on the 95 percent confidence intervals, surgical mask wearers in Denmark were between 23 percent more likely and 46 percent less likely to be infected by COVID.
In a Bangladesh study, surgical masks reduced symptomatic COVID infections by between 0 and 22 percent, while the efficacy of cloth masks led to somewhere between an 11 percent increase to a 21 percent decrease. Hence, based on these randomized studies, adult masks appear to have either no or limited efficacy.
Essential to evidence-based medicine is the ability to reflect uncertainty, which is why confidence intervals are preferable to a single-point estimate. To overcome authority and opinion in determining the best health interventions, critical thinking and debate are essential to determine what works in what settings. According to the James Lind library, which promotes high-quality evidence summaries in medicine:
Ignoring uncertainties about the effects of treatments has led to avoidable suffering and deaths. To reduce this suffering and premature mortality, treatment uncertainties must be acknowledged and addressed, first by reviewing systematically what is already known, and then in well-designed research to reduce continuing uncertainties.
The wisdom of relying on high-quality evidence is evident from hard-won experience. In the history of medicine, conventional wisdom not backed by randomized evidence has turned out wrong when trials are run.
Most European countries do not mask their young children, and the United Kingdom’s government has “determined that it is no longer necessary to recommend the additional precautionary face-covering measures” in educational settings. It is hard to understand how any scientist can claim there is high-quality evidence that masks on children are an effective public health measure. But, whatever one’s views on the matter, that is a debate that should be encouraged.
Public health requires that scientists openly discuss their differences about the quality of available studies and data. When living up to their ideals, universities support such discussions by providing a forum for scientists to engage respectfully with one another without having to worry about silencing campaigns. Silencing debate will lead to ever more distrust in public health.
Faculty petitions can be especially harmful. When circulated by a department chair, junior faculty members will feel pressured to sign. Even worse, it sends a message that open discussion and disagreement is not appreciated. The Stanford petition is unlikely to silence Bhattacharya, but unless there is a strong rebuke, it may have a sinister effect on other faculty members who are reasonably concerned about their careers and livelihoods.
Stanford University’s striking motto is “The Winds of Freedom Blow.” It is tragic that other stronger winds are now passing through the Stanford campus that are destructive for science and the global scientific community.