Arguments about face masks and Covid-19 reflect broader methodologic debates within medical science

There has perhaps been no issue as contentious in Covid-19 as face masks. The most contentious scientific debate has been between those who argue that “there is no scientific evidence”, by which they mean that there are no randomized controlled trials (RCTs), versus those who argue that when the evidence is considered together, “the science supports that face coverings save lives”. It used to be a ‘given’ that to decide whether a particular factor, either exogenous or endogenous, can cause a particular disease, and in what order of magnitude, one should consider all reasonably cogent evidence. This approach is being increasingly challenged, both scientifically and politically. The scientific challenge has come from methodologic views that focus on the randomized controlled trial (RCT) as the scientific gold standard, with priority being given, either to evidence from RCTs or to observational studies which closely mimic RCTs. The political challenge has come from various interests calling for the exclusion of epidemiological evidence from consideration by regulatory and advisory committees.