SGU Episode 919

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SGU Episode 919
February 18th 2023
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SGU 918                      SGU 920
Skeptical Rogues
S: Steven Novella
B: Bob Novella
C: Cara Santa Maria
J: Jay Novella
E: Evan Bernstein
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AUTHOR, _short_description_
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Introduction

Voice-over: You're listening to the Skeptics' Guide to the Universe, your escape to reality.

S: Hello and welcome to the Skeptics' Guide to the Universe. Today is Wednesday, February 15^th, 2023, and this is your host, Steven Novella. Joining me this week are Bob Novella...

B: Hey, everybody!

S: Cara Santa Maria...

C: Howdy.

S: Jay Novella...

J: Hey guys.

S: ...and Evan Bernstein.

E: Good evening folks!

S: We're recording a date early back to our usual Wednesday recording because Cara you're going out of town this weekend. Where are you going?

C: I am. So this weekend I am headed to Portland, Oregon for the conference for the American Clinicians Academy on Medical Aid in Dying. It's actually called the National Clinicians Conference on Medical Aid and Dying. However creative. So NCCMAID is going to be in Portland Oregon this weekend. It's sponsored by the American Clinicians Academy on MAID and also Death with Dignity. And I'm going because of course, I think I've mentioned on the show before, my dissertation topic is an existential... Do you guys want to know the actual title of my dissertation?

B: Yeah, yeah.

S: Sure.

E: Absolutely.

C: It is: Choice and dignity in death. An existential hermeneutic phenomenological inquiry into the psychological experience of Medical Aid in dying.

J: What is hermeneutic?

B: Hermeneutic? I know that word.

E: Who's Herman Nudick?

C: Who's Herman? Herman Nudick?

B: I know that's a great word. I learned that couple of years ago.

C: It is a great word. So hermeneutics is a, it's a discipline, it's a process, it's a methodology but also a theory of interpreting text. So you'll often read about it with respect to like biblical texts or like old philosophical texts. So it comes from philosophy but it's often applied in qualitative psychological research as well. So it's existential hermeneutic and phenomenological. These are just different approaches to doing a qualitative as opposed to a quantitative inquiry. Which is something that I did not know existed before I started my PhD. Every study I've done in the past my undergrad thesis, my master's thesis. Any papers that I've ever been a co-author on they were all quantity creative. Classic quantitative science. This degree or this PhD thesis is very different for me. It's qualitative, so I'm not looking at population level data I'm doing deep dives with individual people to try and get the gist, the qualia, the meat out of their experience. Because Medical Aid in Dying is right now, it's just rare. It's only legal in 11 jurisdictions. 10 states and DC and just not that many people utilize it. So yes there are some population level statistics. We can look at the data and go this many people use it and this many people who use it have this type of cancer but to really get into the why of it all and how of it all, a qualitative investigation is a little bit more meaningful given the landscape, so that's what I'm doing.

J: Cool. That sounds awesome Cara.

C: Yeah yeah, I'm excited.

B: You want to know where I heard of hermeneutics?

C: Where?

B: One of my favorite super short stories by Ted Chiang, Catching crumbs from the table. It actually had to do with metahumans in human society that were creating these amazing inventions and discoveries but they were so far advanced that they really couldn't explain the science to normal people. So normal scientists who were almost out of a job at that point because of all these discoveries that the metahumans were making, they created the hermeneutics interpreting the scientific works of metahumans to try to understand what they can from these metahumans that were beyond comprehension. Fascinating short story. Highly, highly recommended. Very very short by the way, five minute read.

C: And what a great use of that term.

B: Yes.

C: Turning it on its ear but also it's exactly what it is. I love that. And I didn't mention to you guys. We had mentioned before we started rolling. Next week I am leaving to do a trip to the Middle East with a group of psychologists, post-docs and trainees at the University where I am doing my internship right now. So we're going to be traveling to Jordan and spending some time in a university there to help train some students. We're going to be spending time in a shelter for women and children who are victims of violence and then we're also going to be spending I'm assuming the bulk of our time is going to be in a Syrian refugee camp. And we don't know yet about the influx of displaced individuals post earthquake. So there may be, obviously we just have to be kind of light on our feet and there may be some changes to our schedule. But we're going to be there mostly offering assessments and interventions like psychological assessments and interventions for these sensitive populations because they just really don't get nearly enough mental health support. So I will tell you guys obviously all about it when I get back. And I think I will be missing one recording.

S: Right right.

C: While I'm away.

S: So this is like Psychologists Without Borders, that sort of thing?

C: A little bit. Well you know that Doctors Without Borders has a psychologist section and that my hope is that once I'm licensed that's kind of one thing I would like to do with my career is spend some time working for Doctors Without Borders.

S: Yeah we'll definitely look forward to a full report when you get back.

C: Yeah.

Quickie with Jay (5:23)

• US shooting down UFOs is a 'deadly mistake' - Uri Geller

S: Jay you're going to start us off with a quickie. We're going to give a little bit of an update about all these UFOs the government is shooting down.

E: Boom boom boom like Space Invaders, right?

J: So as you guys know, UFOs have been in the news again and oddly and sadly and and with a huge head of frustration they're growing in interest again. We've seen a lot of things change in the last 20 years since the internet. You get a couple of air balloons up there and the next thing you know the whole world is going nuts like thinking that they're from another planet or whatever. So what has happened recently if you haven't been reading the news is that there was a Chinese balloon, they claimed that it was a weather balloon but the U.S claims that it was a spy balloon. And the U.S shot it down and then there were three other. We can't call them balloons. I'm calling them airships. Three other things that the U.S has recently shot down. People are talking about it. There's been a lot of talk about whether or not these are alien spacecraft for Christ's sake. So what's going on here? So there's a little history behind actually the modern sentiment towards UFOs/UAPs whatever the hell you want to call them. This goes back to a U.S senator named Harry Reid about 15 years ago. Reid was very interested in UFOs and he started allocating budget so the Pentagon would have more more money to spend studying the "issue".

C: Really?

J: Yeah.

C: So that is Harry Reid?

E: Yeah Harry Reid.

S: Yeah, that's true.

E: He has been a long proponent of the extraterrestrial.

C: And it was from an extraterrestrial perspective, not like a we need military like I'm very concerned other you know, this is a-

J: It was kind of like a pet project of his, he was interested-

C: But he was interested because he thought they were aliens?

E: Because of alien, right. Aliens.

C: Not because it's a national security issue.

J: Yes.

E: Right.

J: Good clarification.

J: That's good. It was good, that's a good point. I didn't realize that it was unclear there. Yes this guy seems to be a UFO nut. Okay so in 2020 the U.S Navy released several videos that showed footage of UAPs. You guys remember this? We talked about this on the show. UAP means unidentified anomalous phenomenon-menonenon. So that happened in 2020 and then in 2021 the office of the Director of National Intelligence, which is in the United States, released an assessment of the government's files on UAPs. And in short this report didn't give the true believers the smoking gun that they wanted causing even more suspicion that the US government was hiding something. So there's this massive belief that the US is hiding all of this proof. And it's all coming out now, right Steve?

S: It's all coming in. I did hear an interview with with someone who was representing the government who said about the three, not the Chinese spy balloon but the three subsequent balloons that they shot down or whatever they are. They said that you know we're still investigated, at this point we only know one thing they're not aliens. That's the only thing she was willing to commit to.

J: So now you fast forward to today. US Government, they shutdown the Chinese spy balloon. They shot down these three other unidentified airships and there's a lack of information from the government on all these things because that's what they have to do. Anybody that's reasonable isn't going to be like how can they not tell us every single detail about all this stuff. It's very likely that there's something sensitive when it comes to national security with all this stuff. So they're not going to come out giving all their information which is a ridiculous idea to begin with. Because they're not being incredibly open about everything that there has, and there's any reason to think that probably the most unlikely thing that could happen in the world of physics would be an alien finding Earth, traveling to Earth and then remarkably and ridiculously letting balloons. Is this the height of alien technology? Is balloon technology?

B: Remarkable.

J: Right Bob? I mean if they came here they wouldn't be sending balloons into our atmosphere guys. It would be something cool.

S: But the thing is for the last 50 years or more they've been saying that why haven't they revealed themselves to us. Well they're biding their time. They're softening us up and letting us get used to the idea for 50 years. Of course they always think like they're just about to come out but it never ever happens because they don't exist.

E: See the pattern? See?

J: And as much as I would be horrified if aliens did visit the Earth there would be something extraordinarily remarkable about it and I'm not, I can't say I'm like, I mean am I against it? I don't know. I mean I guess in the big scheme of things I'd rather have it not happen because of the potential threat to the earth.

S: This it would it would either be the best or worst thing that ever happened to us.

E: As Carl Sagan said though. When it happens you'll have no doubt about what is going on.

S: Right.

E: It will not be mistaken for a balloon.

B: No subtle anal probes.

E: No blobsquatch. Right it's not gonna be anything like that. It's gonna be something more like maybe Independence Day for example. In which you have these 15 mile long ships overhead.

B: Although they won't be doing what those ships did because that was really stupid.

E: We hope not.

C: Because it was stupid.

E: We hope not. We hope not.

S: More like Arrival I would say.

J: And then, not that I want to talk about this schmuck but Uri Geller then opens up his mouth and is, I can't even understand what his point is.

B: He's still alive?

J: Yeah he's still alive.

S: But Jay he is a self-professed UFO expert.

J: Yeah.

S: So there you go.

J: I know it, yeah, don't doubt what he says.

C: This is the psychic surgery guy, right?

S: No not psychic surgery.

E: Spoon bender.

S: Spoon bender.

E: And the metal bender.

E: The mediocre close-up magician who presents himself as a psychic.

C: Gotcha gotcha gotcha.

J: Yeah. So what we have here is a very interesting situation where there's a lot of hardware up in the sky. That's basically it. That's what we're dealing with.

S: Yeah but the reports are that at any given moment there are thousands of balloons high altitude balloons with scientific experiments and other civilian stuff going on. As well as government stuff going on but totally benign. At any given time there's thousands up there.

E: Not to mention the runner away party balloon which does happen and does get mistaken as alien craft. Mick West did a video recently on just that in which this, someone was shooting video out of a, someone on a commercial airline. So they what, they traveled about 35-38 000 feet?

B: Something like that.

E: And something went, they had their phone on. They were recording out the window. Something went zipping by, oh my gosh, what was that at 38 000 feet? Well Mick West and his people were able to basically analyze the video and it was a party balloon. In fact they found the website in which the cells that exact party balloon "Happy graduation" or whatever it said on it. But when you're up at that altitude, you're going that fast and you're passing something at those speeds of 400-500 miles per hour and it goes zipping by-yeah you could mistake something like that easily as some sort of alien craft that's zipped by your plane.

C: Right because when you hear hooves think aliens.

E: But my point is even these party balloons can get up to the altitudes, cruising altitudes for commercial planes which approaches not quite but up to 40 000 feet.

News Items

On-Demand Male Contraceptive (13:18)

• 'On Demand' Male Contraceptive Pill Could Switch Your Sperm Off For a Day

S: All right Cara tell us about this male contraceptive.

C: Yes. Okay so (laughter) Male contraceptives. This is quite a controversial, I don't know, is it controversial? I'm curious just I want to pull you peoples. When was the last time that a male contraceptive hit the market?

E: You mean like a new invention a new-

B: 12 years ago?

E: A new product?

C: Hit the market. That actually hit the market.

J: A decade ago.

B: Actually hit it?

C: Male contraceptive.

E: You mean the prophylactic, the condom?

B: Any kind.

C: Yes. Yes Evan, it was the condom.

B: 20 years?

C: No. The condom.

B: Oh, Jesus.

E: Condoms has been around for thousands a years.

B: That was the last time?

C: Yeah probably 100 like a couple hundred years ago yes when they started to be marketed.

B: I've read of multiple attempts but I guess none of them.

C: Multiple attempts, no successes. Yeah so the condom and what is the other option available to men?

B: Abstinence?

E: Vasectomy.

C: Abstinence (laughs).

B: Which works very well thank you.

C: The condom and vasectomy are basically the two options available to sperm producing individuals to prevent pregnancy. So all of the contraceptive options that are, not all, but condoms and vasectomy are there for those with the uterus, right? So it's really incumbent on the individual who can get pregnant to take the steps to prevent the pregnancy. At least that's how the system has worked for a very very long time. But of course there are a lot of scientists who are interested in developing male contraceptives. And so before I talk about this new possibility that we may see on the horizon which is the news article that I'm citing I actually did a little bit of a dive into what else is in the works. And so there's some kind of interesting things that are being studied right now. Probably the most promising is a hormonal option that was developed I think at the University of Washington and it's a gel. They said it's about the consistency of hand sanitizer. It's a clear gel.

E: Is it a spermicide?

C: No. It's to be rubbed on the shoulders.

E: Interesting. So it's topical.

C: It's a topical gel that actually because it's a hormonal gel it actually interrupts the signals between the brain and the testes and basically reduces the sperm count. And once it gets below a certain threshold then pregnancy is no longer possible. Now the problem or maybe one of the downsides of an approachment is that it's you have to use it daily for a long period of time before it becomes effective.

E: You build it up.

C: Just like the pill, right? You can't just take the pill once, you have to take that every day, it's the only way it'll work. But that looks like we're probably about, how long do you think we are from that probably hitting the market?

J: A very long time.

C: Maybe about five to ten years.

B: What's the projected efficacy?

C: They're still working on the efficacy. They know that it's safe, they're working on the efficacy now. And so it's still in clinical trials. We're still far off target. What may actually come to market faster though is not a drug. It's a non-hormonal approach that's not technically a drug. It would technically be called a medical device and FDA approval for medical devices is just faster than it is, the process is faster than drug trials are. So it may be that even though this is less far along it has the potential to hit the market sooner and it's actually a hydrogel kind of like a little plug that gets inserted into the vas deferens. And it's sort of an alternative to vasectomy because even though vasectomy is fast and cheap and relatively low risk it's not always reversible. Whereas this hydrogel would be reversible. So it'd be basically like plugging the vas deferens, now sperm that's produced and and kind of working its way out is going to be blocked before it gets to the urethra and yeah that reduces the risk of pregnancy there. So that may make it to market before even the topical. There are also pills that are being developed and there are injections that are being developed. Now they all have their pluses and their minuses. Part of the reason why do you guys think we don't have a male birth control?

J: Well I would think that it's because because men don't want to-

E: Don't want to limit their-

J: It's a selfish thing, you know?

C: Yeah but what's selfish? Why? What about birth control [inaudible].

J: They don't want to be inconvenienced.

C: So you think it's about a convenience? But do you think that's enough reason that something wouldn't have made it to market yet?

J: I honestly don't know I mean I would just think first that there would be it would be a selfish thing where they're conscious or unconscious by men.

E: Or they've done research showing that 99.99 of men don't want anything to do with this.

C: Okay.

E: Something like a marketing or for economic reasons it wouldn't it would never pay off.

C: That's a really open question still right now actually. And then uh Bob I heard you and I don't think you were trying to be funny but what did you say in the background there?

B: It's hard? It's hard to do.

S: It's difficult.

C: It's difficult. It's difficult to develop a male birth control because they're very different systems. So individuals who produce sperm produce literally millions of them a day and the testosterone cycle is just different. Individuals who produce eggs have a monthly cycle and there's a window of ovulation and there's also a window of the ability to to ovulate. Physically there are years in which those who produce eggs produce eggs and ovulate and after which they they go through menopause and they no longer can get pregnant. And also let's talk about risk benefit and this is the part that actually peeves me a little bit but I get it at the same time. Who carries the highest risk when it comes to pregnancy?

B: What do you mean? Women.

E: I mean wouldn't it be women?

C: Yeah the person who's going to carry-

E: Yes the egg-

C: Exactly. So who carries the highest risk? The person who actually has a risk of potential harm or death from the pregnancy itself.

E: Sure.

C: And the men or those producing sperm do not carry that risk unfortunately. If you're looking at them as individual discrete entities the onus and the burden has always been on those who actually carry the child and so the choices have always been on those who carry the child. But a lot of researchers are starting to say we need to stop looking at individual people as discrete entities and we need to start looking at couples as dyads. Because yes the risk benefit analysis, the bar has to be really high. We're talking almost no side effects because most men wouldn't put up with any side effects because why take that risk if the benefit is not there, right? They're not carrying the child.

B: Right, right.

C: And so that's always been the calculus but now a lot of researchers are calling for a more dyad focused approach. That some of the risk benefit that's being borne by the person producing sperm is to protect the person who carries the child because it's a dyad now as opposed to just looking at the individual. So lots to consider as I dive into you the this kind of newest flavor of what they're calling a male contraceptive. And they're actually calling it an on-demand male contraceptive and that's why this is sort of really enticing. We are very far away from this ever potentially hitting the market. This has only been studied in mice. So keep that in mind this is an experimental study we have not even gone to human trials yet. But it's really cool. So this drug is actually basically it targets, there's an enzyme called soluble adenyl cyclase. An adenolol cyclase, soluble adenolol cyclase is sort of like the signal that tells sperm to swim. So if it's blocked the sperm stops swimming. And when sperm don't swim sperm don't fertilize eggs. And they found that this worked, when they gave it to the mice it worked within 30 minutes to an hour and it was a hundred percent effective within the first two hours. And then the effectiveness starts to weigh. I think it dropped down to 91 within hour three and then after 24 hours the sperm was completely normal again. So the hope here, and this is pie in the sky because we have no idea if this is going to work in people. We have no idea if this is going to have all sorts of side effects but the hope here is a single non-hormonal pill that works in under an hour and lasts 6 to 12 hours. And this has so many good things going for it if it works. Number one, as the person who has the potential to carry the child you observe your sexual partner take the pill in front of you. It has that same thing that condoms have where it's like I don't need to trust that you've been doing this every day because I just saw you do it and I know how it works.

B: And you can't slyly not take the pill in mid-act.

C: Right exactly like I guess you could but obviously it's gonna really give that kind of sense of comfort to the partner. And also it's fully reversible. In the mice so far it doesn't seem to have long-term effects. They do know that men, like actual human men who are infertile who had their adenyl cyclase enzymes switched off permanently as like a I guess a experimental treatment they had an increased rate of kidney stones. But the researchers are like yeah but that was a permanent change to the enzyme. This is impermanent it's only going to be when they take the pill so they're not even all that concerned about that. But we're sort of jumping ahead because we're still just talking about mice. They hope that they're going to hold human trials within three years so we're still probably talking about a decade away from an actual product to be on the market. But if it can pass all of the steps which is a huge huge if it's really interesting this idea of an on-demand pill. And going back to what you were talking about Evan, will men take this? I think they'd be much more likely to take this type of birth control. Viagra is a big big seller and so I think pharmaceutical companies would actually bite because it's also hard to get pharmaceutical companies interested in contraceptive products for those who produce sperm because there is a big question of are they even going to use it and are they going to use it appropriately. Because we always talk about even with birth control pills now. It's 90 whatever seven percent effective when used as directed.

E: Well, right.

C: You have to take it.

E: But isn't there a threshold? I mean it's one thing to put on a condom. It's another thing to rub medicine onto you that's going to impact your hormones. So these are two different things.

C: Wildly different, absolutely.

E: And therefore people, a sperm producing person might think, maybe have some reservations about it.

C: Absolutely. And I mean it's so cringy and I find myself always having to bite my tongue as somebody who has been on birth control my entire life and dealt with the ridiculous side effects that can come from birth control that it's just like a necessary evil that so many of us are willing to take. And then I have to remember it's because ultimately, sadly, biologically we also carry the vast majority of the risk. But it would be nice if we started to see that an appreciation of the fact that that risk is actually shared and that those who produce sperm, their life is affected too.

E: Oh yes.

C: Sadly it's probably a little bit easier for them to issue responsibility in that situation but absolutely their life is affected too. And so kind of moving into that view of the dyad could be a new way to approach this problem. But hey this on-demand pill sounds really cool. So fingers crossed because I think just the more options available that are safe and effective the better.

E: That's for sure.

S: Yeah I think it's a complicated question in terms of why but I think you hit upon one major reason is that since women are the ones who are at risk of getting pregnant they need to know.

C: Absolutely we need to know. And so it is really worrisome. Even if a guy told me that he had, I mean not anymore since I don't have of a uterus but back in the day even if a partner told me that he had a vasectomy, I might be more like okay I believe you. But maybe I'll want to see the paperwork. But he was like yeah I rubbed this gel on my shoulders every day don't worry you can't get pregnant I'd be like uh-huh, you're still using it a condom.

E: Well because I mean there are other reasons to use console.

C: Also, yes absolutely there are other reasons to use condoms.

E: Disease mitigation.

C: I more mean, do whatever, I'm talking about a situation in which those reasons are less of a concern. I just don't know if I would trust that that a dude would do that every day. There's no way for me to know.

S: Yeah yeah. All right thanks Cara.

C: Yep.

Mask Update (26:59)

• Masks Revisited

S: So guys I want to give you a bit of a update on wearing masks to prevent covid.

B: Oh boy.

S: Yeah. The question that seems to never go away. Now I'm writing about this because there was a recent Cochrane systematic review of a blinded controlled trials. And they concluded that the evidence is not sufficient to conclude that masks work.

E: So the conclusion was inconclusive?

S: No that's the way you have to state it. They basically said they don't work.

C: Or that we don't have enough evidence to say that they work?

B: What are you talking about?

S: Yeah what am I talking about? So this study of course has gone all over the right wing media and has is now the go-to link for all people on the anti-masker or masking skeptic side.

C: It's so sad there's a word for it. Anti-masker.

S: Yeah. So I've had this link thrown at me a dozen times in the last couple of weeks just in the comments on various blog posts. But it's a good example of how to like evaluate a study to decide is what this really saying and how does this fit into the overall picture of the evidence. I think the most common way the study is misrepresented, and this has been by both journalists and commenters as people in the street, is that it shows that mask mandates don't work. Actually didn't even look at the data on mask mandates. But you might be saying but Steve if masks don't work how could mask mandates work? They're actually two completely different questions. It's possible that masks work but mandates don't. It's also possible that masks don't work but mandates do, because it changes people's behavior in other ways.

B: Right.

S: People who wear masks may also socially distance or avoid crowds or they might think this means the epidemic is bad otherwise there wouldn't be a mandate so I better engage in this other good behavior. So that's why. But having said that let's just back up a little bit and put this one study into perspective. So let's talk a little bit about the different kinds of evidence. If we're going to ask the question do masks work. Specifically do masks reduce the risk of contracting covid-19 we could broaden that to do they work to reduce the risk of catching respiratory viruses. We could focus that a little bit more and say respiratory viruses that spread through droplets versus aerosolized spread. So the droplets would be the way covid-19 spreads. We could look at just physically what's happening with masks. We could look at controlled studies. We could look at observational studies. We could look at epidemiological data like population based data. So let's look at these different kinds of evidence and see what we find. So first of all does wearing a face mask reduce the spread of droplets? And therefore the spread of viruses and people who are sick and are breathing and coughing or whatever. And the answer is clearly yes. So if we just look at like does it affect the droplet spread the answer is yes. Surgical masks work better than cloth masks. N95 masks work better than surgical masks in terms of just reducing droplets. The spray of droplets is much reduced. So just from a basic science plausibility perspective it seems like it should reduce the risk of spreading infected droplets. Does it work to actually reduce the risk of contracting respiratory illnesses or covid-19. Here the data is mixed and it depends on how you look at it. Well why would it be mixed? Either it works or it doesn't work. Well, how do we define works in a research study. There has to be a statistically significant effect. And one of the ways that an effect size may be too small to reach statistical significance is that the thing that you're treating is too rare. Because there's there is there's only so much of an effect size to have. That's basically what in my opinion why antidepressants clearly work for major depression but it's hard to show that they work from mild to moderate depression.

C: I also think it's a function of the they're being heterogeneity in the population of people that they're trying to treat.

S: Yeah absolutely. But just on the, well there's much less of an effect size to have therefore you need many more people, much larger studies to reach statistical significance. So just it's an artifact of just the baseline. Pre-covid, and we talked about this interestingly pre-covid, the data on masks in the general population generally did not show statistical significance because if you're just walking around the general population your risk of catching a respiratory virus is so low. Just that baseline, there's not much of a benefit to get from wearing a mask and therefore it's hard to detect even if it was highly effective you would need to do massive studies to show it. Statistically significantly.

B: Expensive, massive studies.

S: That's one thing we have to think about. What was the risk of the population that they were studying? What was the baseline risk? If it was low then that might obscure the effectiveness of the masks. We also have to ask well how are they determining whether the masks are effective or not? Meaning, are they counting self-reported cases of the flu or covid or whatever? Are they only doing laboratory confirmed cases? Are they using epidemiological data, population based data to see just how many people are getting admitted to hospitals or are being diagnosed with it. What is their end point that they're using. And then you can ask okay well are you are you tracking are people wearing the masks properly? If masks work when worn properly but everyone's wearing it around their chin then as a public health intervention they don't work, right? So what are you trying to ask? Are you doing an intention to treat analysis where you're saying what's the efficacy of telling people to wear a mask versus what's the efficacy of people actually wearing a mask properly. So because all these different studies are actually asking different questions and looking at different kinds of data, looking at the data in different ways they come up with different answers. All right so what kind of studies did this recent Cochrane review look at. So first it looked at very heterogeneous set of situations. A lot of times the studies were involved were in hospital settings, some were in the general population. Some were not during the pandemic, some were during other respiratory virus outbreaks, so not during covid-19. Some were of covid-19. But they did restrict it to controlled interventions which is good but it also excludes a lot of data. Because a lot of the studies they included looked at situations where there was a low Baseline risk of getting an illness, meaning it wasn't during a pandemic. They probably would not show a statistically significant effect. The lead author on the trial by the way is a guy who's basically already on record as being dubious of mask wearing. Also dubious of the flu vaccine. This guy Tom Jefferson.

C: That's really worrisome.

S: Yeah it's very worrisome.

E: So he had a bit of an agenda to it?

S: Yeah. Not the most objective guy to be put in charge of this review.

C: And the truth is when you're doing a meta-analysis or like a huge systematic review you can't blind yourself to it. You can't. There's going to be bias in how you interpret because when you do a systematic review or meta-analysis you are the arbiter of what goes into the analysis and what gets thrown out because the data is not good enough.

S: Yeah and it certainly seemed like a lot of cherry picking to me to be honest with you. I wrote about this on Science-Based Medicine so you could go you go very deep into the analysis of it. So it's really not a great study. It really didn't address the question. It didn't address the question of mandates. It really used a biased sampling I think of studies looking at ones where we don't expect masks to show a statistically significant effect. The only one they've really looked at in a hospital setting where people would be at high risk compared surgical masks to N95s but not to no mask.

B: What? Why wouldn't that be tossed? Geez.

S: Well you could see why they wouldn't do that. You wouldn't randomize people to not wearing any mask during a pandemic but that's fine. But then you can't conclude that masks don't work because it could mean that the difference between a surgical mask and an N95 was not enough in order to see a statistically significant difference. Plus we're talking about healthcare professionals who let me tell you are careful in other ways. Having been in a room with a patient with documented covid I could tell you we're damn careful. And I managed to get through all of my inpatient service over two years without getting covid from the hospital because of all the things that we do and I could 100% see why I wouldn't make that much of a difference if you wore one kind of mask or another although we all we always wore N95s. So this is like a typical thing, you obscure an effect because you're doing a lot of other things. It's like the healthy population effect. You're basically minimizing your risk or you're taking a whole bunch of other effective treatments. The one treatment you're trying to isolate is going to be diluted out, you're not going to see a statistically significant effect. So it really wasn't a great review but it also did not look at all kinds of data, especially the kinds of data that show that masks do work. So for example let's look at the data on mask mandates, which is really what we're talking about here right. We want to know what should the what should policies be around it. And the data there is actually the among the most solid that mask mandates work. United States alone, we have 50 states, that's 50 experiments. And you could compare a lot of data about states that like otherwise had similar populations or similar exposures or whatever. And you could look not only can you compare one state with a mandate to another one without a mandate. You can compare a state to itself pre and post mandate and also after lifting the mandate. So it's like multiple times over and over again we get to see in multiple different states what happens when we initiate a mandate. What happens when we ease up the regulations. And there's a very clear signal that infection rates and hospitalizations plummet when you have a mask mandate in place. And they go back up when you remove it. And the data shows that pretty clearly. It's almost to the point of well who cares if it's the mask almost because it's the clearly.

B: Something's working.

S: Clearly the policy works. We also have the fact that the flu basically went away for two years during the covid pandemic. That whatever we were doing completely prevented the spread of the flu. Like 99%, the numbers dropped to almost flatline.

C: And then am I wrong or did it come roaring back?

S: It came roaring back. Mainly because we lifted the restrictions. People are not doing the things that we were doing during the pandemic. But also we lost two years of exposure so we're a little bit more of a vulnerable population. So there's a there's actually a rebound effect.

C: But it was probably a behavioral rebound effect too.

S: Yeah, maybe.

C: Where people would be so tired of being smart and careful that now they're just like not at all.

S: And if you look at population based data it also shows a pretty robust effect. About a 19% decrease in the reproduction number, the R number of spreading the virus around. So pretty robust data to show that masks work physically, they work at a population level, they work at a mandate level. Especially when combined with social distancing. And also here's another thing the review only looked at the person wearing the mask getting sick. It did not at all look at the effect of people who are sick wearing masks. But we know that it works both ways and it's most effective when everyone's masked. Including the spreader and the spreadee. But the data did not look at that at all. So again it's another big hole in the data here.

C: I mean that's like the general usage in in most Asian countries. That's kind of obviously, you don't want to get sick all the time but you also you know wouldn't have a good quality of life if you had to wear a mask 24/7. So to be safe when you're sick wear a mask.

S: Definitely when you're sick.

E: Or stay home.

S: When you're sick, yeah.

E: Don't go to the office.

S: Isolate and wear a mask, absolutely.When you're in crafts it's also, during a pandemic it's also a good idea to wear a mask or during flu season or whatever. If you're a vulnerable population you should be more aggressive in wearing a mask and distancing. So I think if you look at all the data not just this one crappy review which really isn't a very good review and is very narrow and it's the way it was looking at the data and its conclusions. It doesn't show that masks don't work. But I think what we can conclude if we look at all the data is that wearing a mask when you're in public during a high risk of spread reduces the risk of getting a respiratory virus and of spreading a respiratory virus if you're somebody who's carrying. Also during a pandemic of a respiratory virus mask mandates are an effective public health measure, that's a pretty clear thing. And if you look at all the data I think that there is a dose response curve where N95 masks work the best and cloth masks not so much, surgical masks somewhere in the middle. But the most important thing is how you're wearing the mask. It has to cover your nose and the mouth and it has to have a good fit. Assuming it's like the kind of mask that's a mask that's effective in preventing droplet spread at all, right? So it can't just be like this wispy cloth mask. It has to be a good mask and you've got to wear it properly. Especially when you combine it with social distancing, it's extremely effective. But of course the anti-maskers now have their Cochrane review that they could point to, to make their dubious claims. Which they are all over the internet now. Which is unfortunate.

E: Shame.

S: And again it's like, it takes you this long to explain why it doesn't say what they say it's saying.

E: Right.

B: So what do you say when someone throws a link at you and you don't want to spend 20 minutes?

S: Well now I just linked to my Science-Based Medicine article.

E: That's Science-Based Medicine, baby. Go there. I go there. It's one of my first go-to's when it comes to these kind of questions.

S: One sentence reply and a link. Partly why I wrote it because I wanted to just have it there. But yeah, it's tricky. And of course a lot of people email me you go how do I know if this study is legitimate or not? It's tricky, it's hard.

E: That is a fair question.

S: It's not easy, there's no one simple trick to know if it's good or not. There's a bunch of red flags you could look at but you have to have a basic working knowledge of how evidence works. How scientific evidence works.

E: And just because something's Cochrane don't it's not necessary appropriate.

S: There's a lot of crap.

E: Lancet!

S: A lot of crap comes out of the Cochrane reviews.

E: Lancet, we've seen problems with that, we've seen, it happens everywhere so you can't just go by the publication.

C: It's such a hard thing about reading complicated scientific literature. It's at a certain point you have to kind of have done the work to be a scientist to be able to read complicated scientific literature.

B: That's when you defer to consensus.

E: Right and therefore almost everybody is non-qualified. And you have to defer to the experts.

C: There is a certain point where unfortunately we have to say, how do you, these are some tools and tricks but ultimately what is the gold standard, have the skill to read the article. Which you're never going to be able to do because you spent your entire career training for something else.

S: And even experts can get it wrong if they have a bias. Because you could say where do you set your threshold of evidence? You could always arbitrarily set it higher and think I'm just requiring good evidence, evidentiary standards. But if you are biased in where you set that standard you could make anything seem negative. Because everything's always relative.

C: Which is why it's also so important to have a good understanding of philosophy not just science.

S: That's true.

J: Good point Cara.

E: And be aware of your own biases.

Rogue Blackhole (44:05)

• Astronomers Spot a Rogue Supermassive Black Hole, Hurtling Through Space Leaving Star Formation in its Wake

S: All right Bob tell us about this rogue black hole tearing through the universe.

B: So what do you call-

E: What?

B: -what do you call a supermassive black hole combined with Steve's co-hosts?

S: Rogue black hole.

E: Supermassive black hole rogue.

B: Which is what astronomers have likely discovered because it seems to be creating stars in its wake as it rushes away from its former home galaxy. This is from researchers from Canada, Australia and the USA. Specifically Pieter van Dokkum, professor of astronomy and physics at Yale University. Steve tell him I said hi.

S: Will do.

B: Supermassive black holes they're, we've talked about them before. They're among the most massive black holes in existence from hundreds of thousands to billions of times the mass of our sun. With potential event horizons rivaling the scale of our solar system. Truly magnificent things. You may hear the term ultra massive black holes. Some astronomers use that to refer to black holes greater than 5 billion although it's not standard but I think it should be because I like it.

E: Is there an uber massive black hole?

B: No, there isn't. Ultra would be nice if that became if I came into uh wide use. So super massive black holes, they're commonly found domicile that the centers of galaxies. That's pretty much where you always hear of them. But there are scenarios that could allow them to be unceremoniously ejected elevating themselves to rogue status. And this can happen in multiple ways but all of those ways start with a galaxy merger. And these happen all the time. Our very own Milky Way has undergone at least five major mergers in history that we can detect. Sure there have been more. All right so now so we're talking about merging galaxies to start off this this talk about rogue supermassive black holes. So where's the fun in two merging galaxies. It's really not in the stars. It's really the real action, the real action happens when the two central black holes come close enough during the merger to start their ever-shrinking orbital dance. That dance releases gravitational waves which are stolen from their angular and their linear momentum drawing them ever closer and closer ending in a merger. And that merger emits the now famous and distinctive chirp that our gravitational wave detectors can now see. Did you know that this orbit emerging process can also result in what's called a black hole kick? Ever hear of a black hole kick? I had not.

E: No.

B: Or it's also called the gravitational radiation recoil. Fascinating. That can happen when a black hole, when two black holes that emerge they have certain asymmetries. Say from like mass is one example. That can cause the gravitational radiation that's released to be in a preferred direction and kind of acting like a rocket of sorts and that could fairly easily cause a newly merged black hole to reach escape velocity from a low mass globular cluster. If you look at these globular clusters a lot of them don't have central black holes. This may be the reason why they don't but they're low mass and it's kind of relatively easy to be ejected it. Very rarely something happens that's it's a black hole kick but it's called the super kick and it's it's a much more energetic one as you could imagine. And that could cause a supermassive black hole to get to, get this, 5 000 kilometers per second is how fast it could eject a supermassive black hole. This isn't like a planet. This is like a supermassive black hole traveling like I'm gonna start going at 5 000 kilometers per second, thank you. Flying out of having enough escape velocity to escape a large galaxy becoming a rogue. So how cool is that.

E: It depends, is that thing going to destroy us? That's not cool.

B: But the thing is as cool as that is and I wanted to go in a little detail because that's so fascinating that's very rare. The most likely cause of a rogue supermassive black hole is probably the same binary pair that are merging and doing their dance but sometimes they orbit each other so long it could be a billion years potentially. They turn, it becomes a threesome when yet another galaxy merger happens and then you have three supermassive black holes in orbit. And these three body interactions, they're obviously fun but sometimes one of them gets jealous and the next thing you know one of them is hightailing it out of the out of the galaxy at high velocity to become a rogue supermassive black hole. That's how they think it it happens most often. Okay so then how do you detect one of these guys. It's not easy-

E: Stars.

B: Yeah but if you're ejected from a galaxy, what's really around you? You're not going to have all these stars zipping around you like we're there at the center. So it's not easy to detect them but it's doable. One way is to see its interaction with the CGM. Now it's a new initialism for you CGM and it does not stand for computer generated meatballs. It stands for circumgalactic medium.

C: I like that.

B: I don't remember we're coming across that before. A circumgalactic medium. And that's the area that immediately surrounds a galaxy. There's the the diffuse gas that's between the stars just doesn't end at the edge of the apparent galaxy. It doesn't end right there. It slowly thins out like Earth's atmosphere. It slowly thins out so you can have a huge area around a galaxy that's about 200 times more dense than the truly extra galactic space that's much farther out. So you've got this dense but hard to detect area and so what the researchers found from the Hubble Space Telescope images was essentially an unidentified linear feature in the CGM. It's a line basically. So they hypothesize that this line or linear feature could be the wake of a rogue black hole that was essentially plowing through the relatively dense ionized gas in this circumgalactic medium. So you got that? It's ejected from the galaxy, it's going through this circumgalactic medium and it's creating a wake. It's so massive that it's creating a wake even within this relatively you know kind of diffuse gas. It's creating a wake behind it that's detected as this linear feature this line within the CGM. So that's what they detected. But detecting a linear feature in a hubble space image isn't very persuasive in and of itself so of course you had to look deeper. So they looked for another feature that their models predict uh in the wake and one of those and what's predicted was these knots of shocked gas that can cool and form stars. So this gas is plowed into and within the wake itself you can have these areas of shocked gas that kind of does that just cools down and has changed in some ways so that it can cool and form stars. So not only when they looked, not only did they find these star knots which I love that word. I think I made it up myself but I may have come across it. So they found these star are nuts but not only that they were the right age and they had the right metallicity and even the dust quantities that they detected were all expected when they went to their models and they've determined what should they have. They were pretty much right around where they needed to be. So fairly, more than fairly convincing, that's pretty convincing. But of course they wanted to be even more confident so they realized that they would have to look back at the galaxy itself and they realized that if a supermassive black hole was ejected at high velocity from the center of a galaxy there should be detectable morphological changes within the galaxy. It's going to leave a path. It's going to have some effect and when they looked at the galaxy that's exactly what they found. They found these weird patterns and things happen to the galaxy that could have been happened by a supermassive black hole being ejected. It kind of made sense. So what else was left for them to do? Well one other thing that all good scientists should do is they you look at other possible explanations. And they looked at them for example black hole jets could potentially cause some of what they're seeing. Black hole jets could cause shocked gas in the CGM and it could also create stars but they looked at that and they ruled out the jets. There were many many reasons why the black hole jets couldn't explain what they were seeing. So a black hole, a rogue black hole interpretation fits the observations better than anything else. So what are they going to do in the future. It's interesting advance and interesting paper but it's not perfect. What could make it better? And what could make this better is to prove this rogue supermassive black hole theory is unambiguous evidence of the black hole itself. In all of this stuff I've talked about never found the smoking gun, there's the actual supermassive black hole itself. And if they did find it that would pretty much later rest. It would be like yep this is it. They found a supermassive, they found a rogue supermassive black hole. This is fairly definitive at this point even though they're, I think they're quite certain now but I think they would definitely be maximally certain if they found that. And that would be really cool because a rogue billion solar mass black hole cruising through space giving birth to stars in its wake is just kind of awesome and I want these things to be real so I hope they are.

E: Okay but not too close to us.

B: We're safe, we're safe. That would be cool though if in any of the mergers that the milky way had that we had another supermassive black hole that was ejected. And imagine if we if we found it at some point like look over there, there's a supermassive black hole that was probably ejected from the milky way, that would have been cool. But I think most of our mergers have been with dwarf galaxies so I don't think they would have exceptionally huge supermassive black holes. But still it would be cool.

S: I wonder what percentage of the intergalactic stars were formed intergalactically by things like that versus just ejected from galaxies.

B: Well I mean they couldn't get too far away because once you're outside the CGM though then there probably wouldn't be enough of the gas available to cause a wake that would get formed into those star knots. I think you'd have to be within the CGM to make that happen. At any in extra galactic stars, that's what you're talking about?

S: Yeah.

B: They're just probably rogue stars that were ejected-

S: That was also my [inaudible].

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