Against Mandates, In Favor of Personal Responsibility

image via ImgFlip featuring characters from The Office.

If you know my political leanings, it should be no surprise that I generally oppose government mandates or bans. One reason is that they often provoke a backlash. Social psychologist Robert Cialdini’s Psychology of Persuasion details numerous examples where people’s logical thinking switches off in favor of a more knee-jerk and primitive reptilian response. In chapter 7, he recounts a study¹ involving two groups of two-year-old boys presented with two similar toys with one toy behind a clear barrier. For one of the groups, however, the barrier was too short to really prevent the boys from reaching the toy.

Once both groups were free to access both toys, a striking difference emerged. The group where the barrier was too short preferred both toys equally, but the group that had been effectively blocked from one toy made a beeline straight for that toy! This is perhaps not a surprising result for parents who noticed when one child only starts caring about a toy only when the other child starts playing with it, but it is illuminating nonetheless.

Our defiance for boundaries is basically baked deep into our brains, and no, this is not something we outgrow. Cialdini uses this to explain how marketers can take advantage of us adults by offering sales: “FOR A LIMITED TIME ONLY!” or announcing “ONLY ONE ITEM LEFT!” or providing free previews of a service for a limited time before turning it off. Even if it’s not something we really want, our reptilian brain can often respond irrationally by purchasing an item or service in “defiance” of the impending restriction, and marketers know that this works, which is why they still continue to employ this tactic.

Similarly, when a social media platform removes posts, comments, or videos on a topic due to their spreading misinformation, our reptilian reactance makes it more likely we’ll go to great lengths to reach the forbidden content and perhaps even view the moderation policies as part of a big conspiracy.² And of course, when the government imposes a mask or vaccine mandate, this predictably provokes a similar backlash.

I also believe that people have a right to make their own choices, even if their choices are bad for them. It is for this reason that I oppose seat belt laws as well as laws against eating junk food, drinking, smoking, or drug use. What makes sense for one person might not make sense for someone else because everybody has different tolerance for risk, and any sort of one-size-fits-all policy will be a poor fit for numerous people.

But freedoms shouldn’t be absolute, of course. As they say, my right to swing my arms freely ends where your nose begins³, because then I would be impinging upon your freedom to walk around without being attacked. Things get a bit muddier once you get into an area where actions do not directly cause harm but instead increase the chances of harm. For example, let’s say you are in a room with a pregnant woman. Do you have the right to light up a cigarette? Does she have the right to demand that you respect the safety of her unborn child? Or is the best answer somewhere in between?

There are, of course, many ways to answer that question, and thus numerous policy options to respond to the issue, arrayed across the spectrum between the extremes of a mandate and outright permissiveness, but I would like to avoid the contentious subject of politics for the remainder of this post and concentrate solely on the more practical question of what free individuals ought to do and what choices would make the most sense for them.

So, regarding what you should do, I hope it is clear that giving into reptilian reactance and defying a mask or vaccine mandate for the sake of defying it is not the way to go for the same reason you shouldn’t run red lights. Instead, the first person you should consult is someone you trust who knows more about the issue. No, not me! I’m just a stranger on the Internet. I hope to prove over time that I am interested in the truth regardless of whether it conflicts with my personal beliefs, but to be honest, I don’t think I have done this long enough to warrant your trust quite yet (although I am flattered you’ve read this far).

No, the person you consult when you have any health concerns or questions is obviously your doctor. The most obvious reason is because health is their area of expertise. I’m not saying you should always defer to experts, as they can make mistakes (which is why it can be useful to get a second opinion). But just like you wouldn’t ask your car mechanic to replace your hot water heater, you shouldn’t ask for health advice from someone who doesn’t have a medical background.

More importantly, unlike social media companies, strangers on the Internet, or anyone with a political agenda (e.g., talk show hosts, op ed writers, people testifying to Congress), your doctor’s interests are aligned with yours. Yes, they want to make money, but just like your plumber makes more money in the long run if they fix your plumbing problems reliably, your doctor faces similar incentives. The better care they provide, the better health you experience, the more likely you are to keep them as your doctor, and the more likely to recommend their care to your friends and family. Indeed, the longer you live, the more visits you will make to them over time! So, it is against the financial interests of your doctor to let their personal beliefs get in the way of providing quality service, and any malpractice creates a financial liability as well as bad PR. The incentive for providers to compete on quality (as well as price) is one of the main reasons we won the Cold War, after all.

What do you do if you haven’t yet found a doctor that you trust? Honestly, I would highly encourage you to immediately search for one now, starting by asking your friends, family, neighbors, and coworkers for their recommendations. It’s really, really important for your health to have a good doctor at your disposal. Don’t worry, this page will still be here when you…

Come back! Er… I mean, PAY NO ATTENTION TO THIS INFO ABOUT MASKS!

Okay, if you are still reading, you must be interested in what I’ve found (either that or I’ve mastered the art of harnessing reactance). Quite simply, masks work. Of course, like any protective measure, whether it be seatbelts or bulletproof vests or parachutes, they don’t work 100%, but they will reduce your risk (particularly N95s and surgical masks), and even cloth masks still protect somewhat and significantly help reduce the transmission rate (i.e., protect others). This is important because covid-19 can be transmitted by those who are asymptomatic or presymptomatic.

I’ll get into the specific scientific studies in a bit, but let me first start with the main news source that I rely upon as an investment professional to safeguard our clients’ assets. That is the Wall Street Journal, and they have a great article summing up the science backing the efficacy of masks here:

Researchers from around the world have found many different kinds of masks can significantly reduce the spread of coronavirus, though new studies have shown that some masks are better than others. Many researchers are also now examining the possibility that masks might offer some personal protection from the virus, despite initial thinking that they mostly protect others.

Experts caution that widespread masking doesn’t eliminate the need to follow other recommendations, like frequent handwashing and social distancing.

In the absence of widespread availability of N95 masks—considered among the most effective but typically reserved for health-care workers—transmission can still be reduced with simple and affordable face coverings, the research shows. A case study by Australian researchers published in July in the journal Thorax found that a three-ply surgical mask made of nonwoven material noticeably reduced droplets dispersed while speaking, coughing and sneezing. The surgical mask proved more effective than two-layer and one-layer cotton facial coverings, the researchers found, noting that efficacy diminished as masks grew thinner.

To the right, you can see their diagrams comparing how different types of masks impact the distance traveled by aerosol particles (the means by which covid-19 is transmitted through the air). The article also links three scientific studies.

Randomized Control Trials

One common objection to masks that I’ve seen is the lack of RCTs testing the efficacy of masks. Which confuses me, because while a Remote Control T-Rex would be useful to move around the barrier, most masks have ear loops that would be useless… oh, sorry, RCT in this case referring to randomized control trials (RCT). In such trials, researchers randomly assign subjects to a test group and control group, and these trials are considered the gold standard of scientific studies. These are straightforward to do with medical treatments because researchers can administer a placebo to the control group and make sure volunteers for both groups sign a consent form (unlike toy dinosaurs, people are capable of granting informed consent).

The reason RCTs are difficult to perform for masks is because the “treatment” here doesn’t just affect the wearer, but all of those around them. Indeed, as this literature review points out (and if you read just one scientific paper on this topic, I recommend that it be this one), “Our review of the literature offers evidence in favor of widespread mask use as source control to reduce community transmission,” or in other words, their main benefit is to protect others.

This still makes them worth wearing, but it makes it problematic to perform an RCT because it would not be enough to get consent from the people wearing (or not wearing) the mask. Researchers would need to obtain it from all of the people they would also come into contact with. Indeed, a RCT study that some mask opponents cite when criticizing cloth masks did not test against an unmasked control group, but instead compared cloth masks against surgical masks and found, rather unsurprisingly, that surgical masks performed better.

Fortunately, some researchers in Bangladesh overcame this issue by separating villages into the treatment and control groups. To be sure, this approach is not without cost, but their results were in-line with the above study in finding that surgical masks performed better than cloth masks, but they also found that cloth masks still helped contain the spread. For quicker reading, the lead researcher summarized the results on Twitter, and The Economist also covered the results and added this helpful graphic:

Now, a 5% or 11% reduction may not seem like that much, but remember that the reason covid-19 is so dangerous is not its mortality rate, but its unusual contagiousness that leads to case counts exponentially increasing. Just like a small drag on economic growth can result in huge differences in standards of living, a small impact on case growth can result in numerous lives saved. Indeed, as the same lead researcher of the Bangladesh observed in an earlier study, “If masks reduce the transmission rate of the virus by only 10%, epidemiological models suggest that hundreds of thousands of deaths could be prevented globally.”

And if you think the number of cases and deaths are being inflated, I suggest you examine the research on excess deaths (and also here) which compares how many deaths we’ve experienced these past two years against more typical years to find that it is very likely that we are undercounting deaths due to covid-19, partly because test kits are mainly reserved for the living, and partly because deaths caused by the strain of covid-19 upon healthcare resources aren’t being included in the official count.

Natural Experiments, Naturally

Beyond the Bangladesh RCT, there are also a number of observational studies, akin to natural experiments (an approach for which Card, Angrist, and Imbens won a Nobel prize in economics). These involve finding real-world groups which are similar in most respects except one, allowing researchers to focus upon the impact that results from that one change by comparing the groups. The key issue here is to make sure the groups are similar enough to have confidence that the differences are due to the change you are examining. It doesn’t usually make sense to compare people in different countries or even states within the same country due to differences in weather, demographics, socioeconomic status, or culture. But counties within the same state is a different story.

Indeed, researchers in Kansas found a natural experiment when they noticed that a July 3rd mask mandate was implemented by some counties but not others until November 25. Their results show that the masked counties controlled the spread better than the unmasked counties, despite having started off with more cases per day. When they employed econometric techniques to control for other variables such as social distancing and mobility, they were able to confirm that the difference was due to masks (also see their earlier slideshow of their results aimed at the public).

This was in-line with other results elsewhere, including a study that looked at data across fifteen states plus Washington D.C. Remember, I oppose mask mandates and am focusing upon the efficacy of masks themselves so that you can be better informed about your personal choices.

For those concerned about safety, particularly regarding masks upon children, the American Academy of Pediatrics has an informative FAQ to reassure parents that masks are safe for children (also see a similar article from the Mayo Clinic Children’s Center). Masks do not cause cancer, can be worn during exercise (I’m a 50-year-old asthmatic and was able to wear one during pickup basketball), and a study shared by mask opponents regarding impacts on surgeons actually found that the reduction in oxygen saturation of hemoglobin was also observed in the control group without masks, and thus could not rule out the possibility that the reduction was actually due to the stress of performing an operation. If you are concerned about chemicals in some N95s that have been found to cause skin irritation, simply consider surgical or cloth masks.⁴ And if you are still concerned, talk to your family doctor!

So, I think the case is clear. Masks are an extremely low-cost and low-risk method to help contain the spread of covid-19. For further reading, please see my links and summaries of mask research (link should provide permission to comment). Indeed, wearing a mask can also help further the spread of liberty! Too many people have this misconception about libertarians being selfish and uncaring about others. What better way to dispel this inaccurate notion than to wear a mask with a message like this or one of these?

YOU ARE REQUIRED TO IGNORE WHAT I WRITE ABOUT VACCINES!!!

As for vaccines, they do carry slightly more risk of an adverse reaction, but remember that you should not be comparing this risk against absolute safety, but against the higher risk an unvaccinated person would face of contracting covid-19, along with all the health risks that would entail, some of which are long-term. And unlike masks, the primary benefit of vaccines is to the person who gets the shot (with reduced transmission a secondary benefit), and so it is far more straightforward for researchers to use RCTs for the clinical trials (results for Pfizer, Moderna, and J&J), and as you can see to the left, the results were about as straightforward as they get.⁵

The vaccine debate is, I believe, considerably more complex as well as more politically contentious, so I will defer further discussion to a future post. In the meantime, I’ll refer you to this article from Kaiser Permanente (my health provider), this FAQ from Dr. Panthagani, and this post discussing concerns about long-term side effects from a group with the great name of Those Nerdy Girls, who are “an interdisciplinary all-woman team of researchers and clinicians with expertise including nursing, mental health, demography, health policy/economics, and epidemiology.”

But of course, the person you really should consult is… okay, you know the drill by now.

Originally published at the LPOC blog.

Footnotes

[1] The theory of psychological reactance was first proposed by Jack Brehm in a 1966 book, and he and Marsha Weintraub performed the barrier experiment with two-year-olds. For a review of the academic literature on psychological reactance, there’s Rosenberg & Siegel’s aptly titled, “A 50-year review of psychological reactance theory: Do not read this article.” Return.

[2] To deal with the problem of rampant misinformation on social media, I prefer the market-friendly “middleware” proposal by Francis Fukuyama and others in Foreign Affairs that calls to separate the moderation function to a separate set of competing companies. Their only requirement would be to make their algorithms transparent so that users can pick the policy that best suits them (whether it be fact-based or partisan or filtering out body-shaming images or whatnot). Return.

[3] Indeed, this is a rather crude way of expressing the Non Aggression Principle that underpins the philosophy of many libertarians, some of whom go so far as to believe that the only crimes are violations of this principle (apparently ignoring crimes like fraud and embezzlement). My belief is underpinned by Lord Acton’s view that power corrupts, but I must admit I have yet to look into its empirical backing. Return.

[4] One objection I heard was regarding the presence of formaldehyde, a known carcinogen, in some N95 masks. I was not able to find any studies that link masks to cancer, whether via formaldehyde or some other means, and a few reputable popular press sources that reported no cancer link: Reuters, USA Today, and Logically, as well as the Moffitt Cancer Center (but none of which mention formaldehyde). Reuters notes that, “Healthcare professionals have been wearing face masks for years. If this claim [that masks cause cancer] were somewhat true, cancer rates would be noticeably high among this population.”

But please note that, even if there is a link, this would be a case where you need to balance risks. Much like with a seat belt that could either keep you from being hurled to your death or break your neck, a key factor to consider is likelihoods. And there are probably a number of other ways you can reduce your cancer risk without compromising your covid-19 risk, such as quitting smoking, reducing red meat intake, getting enough exercise and sleep, getting vaccinated for Hep. B and HPV, using exhaust fans when you use a gas stove, refraining from cooking on nonstick pans, being careful about what containers you microwave, and wearing a good mask when around traffic (it’s not just the car fumes, it’s also the brake dust). Return.

[5] For those of you not familiar with the XKCD comic strip by Randall Munroe, he has a degree in physics and worked as a programmer and roboticist for NASA before becoming a cartoonist and author. While some of his graphs are obvious jokes, his more scientific ones are dead-on accurate, and also usually much more readable and easier-to-interpret than the originals. Just compare his rendition with the graphs in the original RCT studies: Pfizer, Moderna, and J&J. Return.