The Fallacy of Masking

Wearing masks is a rather touchy, sometimes dangerous subject. There are individuals on both sides of the argument. Unfortunately, I work in an industry where those on one side are heroic humanitarians and those on the other are villains. Typically, such things don’t worry me, but in these days of cancel culture, it can be detrimental to one’s career, and by extension, one’s livelihood. As such, the essay below is a sanitized version of the original. When I first penned this piece, many weeks ago now, I was mad. Mad at still wearing a mask at work more than two years after two-weeks to flatten the curve. Masking was supposed to be a temporary solution to help ease the infection rate. Somehow, it has become standard operating procedure in healthcare culture and it’s chipping away at my soul. Fortunately, my wife stepped in after viewing what I had written and told me to take a breath. She said “_____ isn’t going to like that”. She was right, of course. They weren’t going to like it. So, I stepped away for a couple of weeks before coming back to complete the task.

TLDR; masks don’t work, they are unnecessary, and they’re a nuisance. You need read no further if you wanted to know my opinion.

When someone tells you that masking prevents COVID-19, you know one of two things: 1) they are ignorant, which is common, or 2) they are being disingenuous and selective with their information, which is also common. There are no other options available.

Do masks prevent disease? No, at least not to any appreciable amount I can find. Do they prevent transmission? No, not with any certainty. Do they decrease severity of disease once inoculated? No. Do they reduce viral load in the air? Maybe, but it depends on what you read and how that information is used. “Airborne viral load” doesn’t seem to corollate to inoculation, much less severity of disease, hospitalization, or mortality. In short, viruses get past masks, even N95s tapped to one’s face. I’m not kidding. ().

If you would just “follow the science”, Jerry. The battle cry of anyone that wants me to put one on. But does “the science” really support it? Not that I can find. There is data suggesting that they help and evidence saying they don’t. How can that be? It happens all the time. The problem is that most available data supporting or refuting the practice is weak. Studies suffer from poor design, confounding variables, and in some cases, outright bias.

“The science” argument assumes that science is always right. We should all know better. Science changes all the time. Science, by its very design, is never right or wrong. It is nothing more than a system of collecting data and applying it to a given construct. The best we can do with science is collect information and make decisions based on what we know combined with personal experience. Humans have been doing it this way for an exceedingly long time. Science is ever changing, providing data at one point in time from which we can only move forward. If anyone ever tells you that science “proves something once and for all,” you should run away.* The best we can hope for from scientific endeavors is to find information that supports or refutes our thoughts. That’s it, nothing more.

“1500 years ago, everybody “knew” that the earth was the center of the universe. 500 years ago, everybody “knew” that the earth was flat. And 15 minutes ago, you “knew” that humans were alone on this planet. Imagine what you’ll “know” tomorrow.” – Kay, Men in Black

Unfortunately, rational behavior and the search for enlightenment and understanding went right out the window with COVID-19. I cannot explain why because this has not happened before in my lifetime. I believe the phenomena is unprecedented. Even in the face of overwhelming common sense – and sometimes supporting data – people continue to do things that defy logic. There are two things I learned a long time ago that seem applicable: 1) smart people can be really dumb, and 2) people is power are not necessarily the smartest people in the room.

But Jerry, they’re doing it for your own good. Be careful letting someone else determine what is best for you, especially when that someone else may have a personal stake in your compliance. Forcing folks to do certain things – outside of having laws to prevent society from slipping into chaos – is a path from which we cannot return. People that gain power rarely ever give it back. And people that concede control of their own lives concede everything.

“The nine most terrifying words in the English language are: I’m from the Government, and I’m here to help.” – Ronal Reagon.

If you are genuinely concerned about how best to control exposure to pathogens, do not listen to a politician, do not talk to your doctor, and whatever you do, do not listen to me. Instead, seek the advice of someone that specializes in minimizing risk associated with exposure to dangerous things. I am of course speaking about Industrial Hygienists. Those folks know a thing or two about limiting exposure to hazards.

“[The] science and art devoted to the anticipation, recognition, evaluation, and control of those environmental factors or stressors arising in or from the workplace, which may cause sickness, impaired health and well-being, or significant discomfort among workers or among of the citizens of the community” .

In general, Industrial Hygienists support the notion that masking is not the answer. Their hierarchy of controls, which we use in pharmacy to handle hazardous drugs, is all about dilution and elimination of the threat through engineering controls (dilution, destruction, containment), administrative controls (limiting time exposed), and PPE (respirators, not masks). It is all about turning over the air in the space you are in and not hanging out with people that have active disease. Ever heard of an HVAC system? How about negative pressure rooms? Air Changes Per Hour (ACPH) anyone? Any healthcare professional reading this will be familiar with the concepts. We use them all the time in the hospital to control infectious diseases, at least as long as I have been in healthcare.

As I dig further into the question of masking, I find more data suggesting that these things can cause more harm than good ( Why is it that no one wants to talk about that? If someone tells you to do something and it causes harm, it would be wise to take a moment to assess the situation.

There is at least some evidence suggesting that masking children has led to reduced learning, reduced development, and physical, emotional, and social harms. My daughter is a speech language pathologist. She works for both a school system and a hospital. Ask her what it has been like for the last couple of years working with masked children. I can hear the frustration and concern in her voice when we talk about it. I feel bad for the families that will have to deal with the repercussions of this for years to come. It is heartbreaking. The value of a child’s health should never be placed below that of an adult. The adult protects the child, not the other way around.

But Jerry, if we can save just one life it will all be worth it. I hear this a lot when I oppose masking. It’s a strawman argument, perpetuating the idea that “anti-maskers” don’t care if people die from COVID. Simply not true. I don’t want anyone to die. It’s a terrible, deeply disturbing thing. However, humans simply don’t live with “zero risk” in mind. There are many examples of people doing things every day that come with inherent risk. If our society was designed to “save everyone” we would wear clothing made of bubble wrap, limit cars to 25 miles per hour, force people to wear helmets while walking on busy streets and eliminate all forms of air travel. You know, going down in a Boeing 747 over the Atlantic Ocean, albeit rare, is 100% fatal. Eliminating air travel is the way to go, no question about it. It would all be worth it if we could just save one life. Can you imagine a world like that? No? Neither can I.

As humans, we make decisions every single day based on risk and benefit. I am willing to risk the transatlantic flight to visit a beautiful foreign country. Others are too. It is how we live.

With that said, I am as guilty of perpetuating the nonsense as anyone. I have always considered myself a strong man, capable of making tough decisions even in the face of extreme adversity. I have had my share over the years. Well, here I sit, writing about being “forced” to wear a mask. To my shame and embarrassment, I caved to the masking issue as soon as my livelihood was threatened. It turns out that my moral and ethical values are worth exactly as much as my salary. My failure to “stick to my guns” has given me pause to reflect on many of my beliefs and where I truly stand. It turns out that cowardice comes in many forms.

In closing, I find no issue with people that choose to wear a mask. Go for it, it is a personal choice. I respect that. All I ask in return is the same courtesy. You do your thing and I’ll do mine. Perfect harmony.

*I have had many people tell me that science proves that God does not exist. I find that argument amusing. By saying such a thing, they propose that all science for all time has been completed and there is nothing more to learn.

Rethinking Chromebooks

A couple of years ago, I tried switching from a Windows laptop to a Chromebook. It didn’t work. At the time, I was simply too entrenched in my specific needs to make the switch. Things have changed since then. For over a year, I’ve been using an ASUS Chromebook Flip C302 as my primary computing device. Besides having a mouthful of a name, it’s a great little machine. The combination of it plus my Samsung Note 9 has been nearly perfect. I say nearly perfect because I recently ran into an issue where my Chromebook couldn’t cut it. Some will call it an edgecase, but it created a problem nonetheless.

I recently found myself in need of a resume. I have one, sort of. It’s been years since I actually needed a resume, so I haven’t really stayed on top of it. I tried building one from scratch, but quickly realized that it was garbage, so I hired a professional. This particular professional, like many others, uses Microsoft Office, specifically Microsoft Word to create documents. I wasn’t concerned. As a Chromebook user and Microsoft Office 365 subscriber, I assumed everything would be seamless. I mean, I could simply use the web version of Word, right? Yes and no. It turns out that the online version of Word doesn’t play all that well with all desktop versions of Word.

The resume contained a lot of formatting that didn’t translate well from the desktop to the web version. My attempts to make edits and leave comments from within the web version were a disaster. Formating got destroyed, things disappeared from the page, and I quickly became frustrated. Within a day of going back and forth with the author of my new resume, I realized that I had found an instance where a Chromebook simply wouldn’t cut it.

Sooo, what’s a guy to do? I haven’t purchased a Windows laptop for myself in nearly five years. I literally started digging through my computer graveyard, i.e. the closet for one of my old machines. There were plenty to choose from. In the end, I ended up using an old 15.6-inch Sony VAIO to edit and complete the resume. The VAIO is a bit long in the tooth, but it’s a nice big machine to type on. I appreciate the screen real estate for going back and forth between documents, notes, etc. It worked out quite well.

In the end, I received a new resume and went on my merry way. However, it made me realize that as much as I like my Chromebook, the platform still “isn’t there” yet. At least not for me. For Chromebooks to be truly mainstream, this type of thing can’t happen. At least not as long as such a large number of folks continue to use Microsoft Office as their content creation suite of choice. I understand that this is as much Microsoft’s fault as Googles, but when given the option, it seems logical to stick with a Windows machine for the immediate future.

Consider this, I can use Chrome on a Windows machine to seamlessly do everything I can do on a Chromebook. I can’t do the opposite, at least not seamlessly. I’m sure the Chromebook zealots — and Microsoft haters — will disagree, but it doesn’t change the fact that my struggles were real. As PC laptops continue to get better, and Chromebooks continue to become more expensive, a decision that used to simple is much more complicated now. This is especially true now that Microsoft has embraced Chromium in their new Edge browser.

Given that one can purchase a nice Windows laptop from Lenovo, Dell, HP, or Microsoft for around the $1000 price point, it makes spending $800-$1000 on a nice Chromebook a tough sell. I’ll continue to use my Flip for now — as I said above, it’s a great little machine — but I’m currently on the hunt for a new Windows laptop. I’ve narrowed my search down to a select few machines from Microsoft and Lenovo.

Study questions what we consider an ‘adherent’ patient

MedicalXpress: “A study at Universidad Miguel Hernández (UMH) in Elche shows that patients defined automatically as “adherent” by dint of collecting their prescriptions each month are not necessarily any better than their “non-adherent” peers at actually taking their medication…. The main finding, then, was that lack of adherence even among those patients who regularly collected their medication was as high as 32%, based on in-pharmacy physical testing and questionnaires.”

Adherence was best when medications didn’t interfere with daily activities. Surprisingly patients taking five or more different medications were better at following their prescribed treatments. Also surprising was that the study shows that “patients are more likely to stop taking their medication if changes are made to the appearance of either the packaging or the medication, with adherence dropping most significantly when changes were made to the size, shape or colour of the pill itself.” Crazy.

NFC packaging for medications

NFC is good for more than figuring out how much liquor you have.

NFC World: “The two companies [Thinfilm and Jones Packaging] are collaborating to integrate Thinfilm’s NFC OpenSense technology into paperboard pharma packaging and establish key manufacturing processes for production on Jones’ high speed lines.” In addition “the work…will also include the integration of ferrite shield labels with the NFC OpenSense tags. This will enable NFC to function on metalized packaging such as blisters …”

Pretty cool stuff. By using NFC in the packaging, the simple tap of an NFC-enabled phone will allow you to authenticate the product, as well as track individual items. Would be neat to tie this into IV labels somehow.

Saturday morning coffee [August 22 2015]

“Don’t accept that others know you better than yourself. Work joyfully and peacefully, knowing that right thoughts and right efforts will inevitably bring about right results.” – James Allen

The mug below comes from the University of Arizona in Tucson. I was there earlier in the week doing some research on a project. In fact, I’m sitting in a hotel in downtown Phoenix this morning as I write this. I’ll be heading home later today. I saw this mug in a display case in the U of A bookstore. It’s an awesome looking mug. I wanted one, but couldn’t bring myself to purchase it because, well, you know, my daughter is a UCLA cheerleader. Having a U of A mug in the house would be akin to blasphemy. It really is a beautiful mug though.

Continue reading Saturday morning coffee [August 22 2015]

Saturday morning coffee [March 14 2015]

“There is nothing in which people more betray their character than in what they laugh at.” – Goethe

So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The mug below comes straight from Voodoo Doughnuts in Portland, OR. My wife and youngest daughter were up North last week visiting colleges. They surprised me upon their return with a box of Voodoo Doughnuts and this mug. The doughnuts were delicious.

Continue reading Saturday morning coffee [March 14 2015]

Inhaled Corticosteroid Adherence and Emergency Department Utilization Among Medicaid-enrolled Children with Asthma [article]

J Asthma. 2013 Jun 5. [Epub ahead of print], Rust G, Zhang S, Reynolds J.

Objectives: Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population.

Methods: We conducted a retrospective study among Medicaid-enrolled children aged 5-12 with asthma in 14 southern states using 2007 Medicaid Analytic Extract (MAX) file claims data to assess adherence and outcomes over the three months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller to total asthma drug claims ratio.

Results: Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller to total drug ratio greater than 0.5 over the next 90-days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department visit (AOR 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller to total asthma drug ratio greater than 0.5.

Conclusion: Real-world adherence to long-term controller medications is quite low in this racially-diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and emergency department utilization.

Posted online on June 5, 2013. (doi:10.3109/02770903.2013.799687)

Two things to consider:
Continue reading Inhaled Corticosteroid Adherence and Emergency Department Utilization Among Medicaid-enrolled Children with Asthma [article]

Ideas, Vision, Innovation: Fantasy vs. Reality

Simply put, I think you need an idea and a vision to be innovative. Sounds simple enough.

I’ve read that good ideas are hard to come by, vision even harder and innovation rare. I don’t buy it. I believe innovation is difficult, but probably not for the reasons you might expect. On the other hand I don’t believe that ideas are hard to come by or that vision is rare.

I think ideas are like change in your pocket and you tend to collect more than you think. If you’re like me, and I believe most people are, you probably have several ideas every day about changing how something is done, how to make something better or what the next big thing should be. You know what I mean. All those moments throughout the day when you say something like “what if they…” or “why didn’t they…” or even “wouldn’t it be cool if …”. You know what I’m talking about, like “wouldn’t it be cool if they filled marshmallows with hot fudge”. Yes, yes it would.
Continue reading Ideas, Vision, Innovation: Fantasy vs. Reality

Great response to “Why pharmacy continues to fail”

The Cynical Pharmacist (TCP) dropped by my site and left a great comment in response to my  Why pharmacy continues to fail. I don’t know who TCP is, but I hope to meet him in person some day. I get the impression that we would have some great dinner conversation; some pharmacy related, some not.

You can see more of his musings on Twitter – @TheCynicalRPH

TCP makes some great points in his comment, and in my opinion his thoughts reflects the sentiment of many pharmacists practicing in the real world. I was going to refer you to the comment, but felt it would be better to post the meat of it below:

Continue reading Great response to “Why pharmacy continues to fail”

Quick hit: Confusion over industry terminology

I had an interesting conversation with a colleague earlier today. We were talking about a feature set for a new product that we have due out later this year. Some of the language being used to describe a certain feature, and how it would be used, was causing quite a bit of confusion for me. So I tried to clarify things a bit. After a brief email exchange it turned out that I knew exactly what he was talking about; healthcare and especially pharmacy simply use different words to describe the process.

I recommended that we use the pharmacy specific lingo, but I was told no because it wasn’t the industry standard. I found that quite interesting because we build products for pharmacy, i.e. that is the industry we’re in. However, the terminology used for this particular process is different outside the pharmacy world. Still with me? Good.

So, the question becomes does one conform to the terminology in the market segment you’re in, i.e. pharmacy, or do you ignore the pharmacy terminology and go with the “standard”? My gut reaction would be to go with the standard – after all I preach standardization all the time – however, if one does that you end up talking to pharmacy people that have no idea what you mean. You know, everyone has that deer in the headlights look with everyone standing around wondering what the heck is going on. And to top it off, no one asks for clarification because they’re afraid it might make them look stupid. We’ve all been there. I know I have.

So, based on what I just said above I think you have to conform to the industry you’re in. In other words, use the pharmacy terminology, standard or not.