Where is the evidence?

So I ask people for evidence supporting their argument. And sometimes they come back to me with a study showing that what they are saying is true. And I say to them, "I'm sorry, but one study is not science. Science is repeat studies showing the same thing." So I insist that, to support their argument, that they show me a second study showing the same thing. 

Sometimes the argument ends their, as it should. Although, too often the argument continues, as the person I am debating insists that the one study supports their claim. Sadly, this is how it has become in medicine -- where a pharmaceutical or some other company or the government does one study. And whatever that one study shows is what is considered as "The Fact." 

But, one study does not make a fact. Science uses evidence to prove what is or is not. By its nature, science is argument. It's debate. It’s controversy. It is attempting to disprove or prove a theory, not blindly adhering to one.

So, allow me to postulate some theories that have flooded the respiratory therapy community. 

1. Prior to COVID breathing treatments DO spread COVID. (No study. Hospital policy was that we had to switch any breathing treatment orders to inhalers which do not spread germs. Doctors not happy because breathing treatments solve all lung ailments. 
2. After COVID, breathing treatments DO NOT spread COVID. (based on one study. Hospital policy was changed to we can give them breathing treatmentes as needed or wanted). 
3. BiPAP, high flow nasal cannula, intubation, bronchoscopy, extubation are all procedures that spread aerosols. (No study. Anyone in the room must don NRB and other PPE. 
4. Hypertonic saline helps COPD patients cough up secretions. (One study showed the experimental group had a 2% more likelihood of coughing up secretions compared with the control. This is compared with another study showing hypertonic saline significantly helped bronchiectasis patients expecgtorate secretions.  Regardless, we now order them on anyone regardless of indication)
5. Many studies show breathing treatments work just as well as inhalers when proper technique is done. (Doesn't matter, everyone gets breathing treatments because.... because... because...). 
6. Pulmicort added to systemic steroids helps open up lungs (No study has ever showed that patients receiving systemic steroids will benefit from the added BID pulmicort breathing treatments. To the contrary, patients not in the hospital setting usually wisely stop taking inhaled steroids when on systemic steroids. But in the hospital setting reduntant therapy is indicated). 
7. 20 mg of albuterol will lower potassium (some studies show it may lower it a little bit, but not nearly as much as other medicines. Plus, if this were true, I would have never survived the 80's, where I'd sometimes use one inhaler in a day). 

It seems as though, when there is no study, the people making the rules do whatever they want. Actually, they do whatever sounds good. Or, in the case of breathing treatments for COVID, doctors were complaining that they coudn't  order them. So, when one study came out showing breathing treatments did not spread germs, they went with that study. No point doing a second study to confirm the first). 

Personally, there is no evidence that breathing treatments do spread germs and no evidence that they don't. If a patient has COPD or asthma, breathing treatments should be given as needed regardless of whether the patient has COVID or flu. If you're worried about spreading germs, wear an N-95 mask. Done. 

When it comes to pulmicort and hypertonic saline, I'm still looking for studies to verify they help with anything other than a select few patients. Yet, because it sounds good, we'll probably keep doing them, even though that's not sound science.