As scientists, our goal should be to get rid of garbage, says Trisha Greenhalgh of Oxford University.
Scientific COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.
In May, Trisha Greenhalgh was angry when several prominent British scientists rebelled against a report from the Royal Society recommending face masks to control the spread of COVID-19. Scientists argued that support for the scientific literature for the effectiveness of masks was insufficient, and the British government, at their initiative, refused to mandate masks from the general public.
Finding perfect evidence can be the enemy of good policy. Greenhalgh, a doctor and medical delivery specialist at Oxford University, starred in the Boston Review. Like a parachute to jump off an airplane, it’s time to act without waiting for evidence of randomized controlled trials.
The voice of the plague
Greenhalgh is a firm believer in evidence-based medicine. She wrote a best-selling book on the subject and her work earned the highest honors in her country. However, in recent years she has grown critical of what she considers to be the privilege of randomized controlled studies of clinical experience and close observation. She claims that COVID-19 has revealed that the limitations of evidence-based medical masks are a strong case.
The real tension in public health, says Tom Inglesby, head of Johns Hopkins University’s Center for Health Security, in the absence of strong evidence of whether it is appropriate to take action. Large-scale interventions such as masks are very difficult to study. However, the limited evidence of the proposed mask can reduce the amount of virus transmitted from one person to another by more than 90%. And Greenhalgh argues that it should be enough to motivate public health interventions that are cheap and generally risk-free. Hundreds of thousands of lives were lost before many governments introduced mandatory masking.
Chas Bountra, Oxford’s professor of brokerage medicine and vice-chancellor of innovation, said he might have lost more lives if it weren’t for Greenhalghs’ tireless mask promotion, which ultimately helped beat policymakers. She faced strong opposition, he says. Not all scientists would have had the courage.
Greenhalgh says she was born with an insatiable appetite for academic challenges and an aversion to following the rules. I was almost kicked out of secondary school for stealing my dog and bringing it to class, she says.
Warned by teachers that the University of Cambridge doesn’t admit to blatant young women of the same kind, she nevertheless applied and was interviewed. I myself made a suit because I didn’t have the right clothes, she recalls. Her interlocutor, biochemist Tim Hunt, is going to win a Nobel Prize in Physiology or Medicine (notorious for his criticism of women in science in 2015), and he lowered his head and asked me seven questions. When he told Greenhalgh shed that all the answers were wrong, she asked him for an explanation, and we went through the problems one by one until she fully understood her error. Before I started my research, I settled in Cambridge because I didn’t know the right answer. It’s about how to ask questions and how to find answers.
After studying Social and Political Sciences in Cambridge, Greenhalgh studied medicine at Oxford, followed by a career in primary care with a focus on endocrinology research and a passion for education. In 1999, noting that disadvantaged students couldn’t afford to attend international primary care courses, she designed and operated the UK’s first fully online master’s degree program for ten years, attended by hundreds of doctors and nurses from around the world. I’m often humbled by their passion to improve the quality of care in extremely difficult situations, she says.
Greenhalgh is not afraid to challenge traditional wisdom. For example, in the most read and shared 2014 paper in The BMJ history, she presented a hypothetical case of a 74-year-old woman who prescribed high doses of statins to lower cholesterol. A common side effect of muscle pain statins, which interferes with hobbies and athletic performance. The Greenhalghs point is that the prescribing doctor followed the protocol but did not explain how the patient lived her life. Greenhalgh wrote that these scenarios provide a good example of evidence-based tails shaking clinical dogs.
She says Eivind Engebretsen, a philosopher at the University of Oslo, who has worked with Greenhalgh for several years. And she firmly opposes the claim that more research is needed, the most abused and unanalyzed statement in academic vocabulary. All we need is more thinking, she says.
With the mask debate intensifying late this spring, Greenhalgh joined data scientist Jeremy Howard at the University of San Francisco to launch a website (www.masks4all.co) that transforms public opinion around the world. The accompanying blog has millions of views and has been translated into 21 languages. Jeremy came up with the slogan that it was a piece of cloth, not a landmine, which drew attention to the pretty ridiculous framework some anti-maskers created, Greenhalgh says. After that, the media and policy makers called.
In one TV appearance, a politician argued that the front door was the best barrier to COVID-19, so the mask was unnecessary. Greenhalgh agreed that it was true, but if you don’t want people to be sealed off forever, you’d better turn that front door aside, shrink it to the size of your hand, and make it double. Layer of cloth.
Greenhalgh, whom one critic called the High Priest of the UK’s masking campaign, joined the World Health Organization (WHO) committee to study the behavioral aspects of wearing a mask, such as whether it affects other dangerous behaviors. What is clear is that the people of the WHO Committee did not seem to understand the complete evidence base. However, Greenhalgh continued in early June, along with the U.S. Centers for Disease Control and Prevention and the UK Public Health Center, where the WHO turned away from claims that masks were potentially harmful in support of masks. I think the lesson here is not to give up.
Greenhalgh argues that COVID-19 has made the collaboration between science and the humanities and social sciences even more important. For example, take a vaccine. Greenhalgh enrolled as a test subject for Oxfords’ promising vaccine candidate and argued that carefully controlled studies were essential before the vaccine was released to the general public. Unlike masks, vaccines and treatments can have dangerous drawbacks, she points out.
However, she is well aware of the human factor. If people are too afraid to use the vaccine, even the best vaccines will not work, and she decided to alleviate the problem through advocacy and public speaking. She says innovation is not enough. Empathy also plays an important role. Science sits awkwardly in a society where truth no longer matters, she says. As scientists, our goal should be to get rid of garbage.
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