And the article notes some of the strengths of epidemiological research: “No one questions the value of these epidemiologic studies when they’re used to identify the unexpected side effects of prescription drugs or to study the progression of diseases or their distribution between and within populations.” And thus it is no mean achievement that researchers have discovered that in the case of breast cancer, for instance, “we know…a carcinogenic factor of diet or lifestyle exists, waiting to be identified.” Why? Well, “Breast cancer is not the scourge among Japanese women that it is among American women, but it takes only two generations in the United States before Japanese-Americans have the same breast cancer rates as any other ethnic group. This tells us that something about the American lifestyle or diet is a cause of breast cancer.”

The media reporting of epidemiological research, perhaps skewed in part owing to researchers seeking the requisite publicity necessary to generate more research funding, often fails to appreciate the modest scope of specific epidemiological studies, not unlike research in genetics, in which case only now are we beginning to appreciate the manner in which the claims made on its behalf were chock full of so many false or misleading promises (of course some, like Richard Lewontin, long ago warned us of the oversell and hyperbole on behalf of genetic research) .

As Daniel makes clear, there is nothing in the article that in any way undermines the approach or conclusions of Frank’s recent posts on health care, as his arguments were not relying in the main on this or that epidemiological study for their plausibility, soundness, or persuasiveness.

The idea that many epidemiological studies are suspect, of course, hardly implicates Frank’s views alone. If correct, it means that the evidence-base for a number of public health policies based on epidemiological findings is shaky at best. This is also hardly a new development, as public health policies in general in the U.S. and beyond have typically rested on questionable evidentiary foundations, which is partly why many scholars maintain that cultural and social attitudes animate many of our public health policies in general.

Indeed, some of my own work argues that most scientific literature and public health policy is based on a patently dubious model of disease causality, on a fundamental misunderstanding of the largest causal factors of illness and health (and I am not alone in arguing this, either).

My point is that the potentially weak evidence base for public health policies hardly affects Frank’s views alone. In fact, being somewhat familiar with his views in general, I’d go so far as to suggest such a premise is far more troubling for those who support the kinds of policies he typically opposes.

from

http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?_r=1&oref=slogin&pagewanted=print

I have critiqued health care “rankings” because I believe the “objective data” they are based on can result from a gaming of the system. For example, a heart hospital may have a low mortality rate because it only takes healthy patients.

If the private-investor-backed nursing homes discussed in the NYT story take a disproportionate share of the sickest and most vulnerable patients, then the study is flawed. But I did not see evidence of that in the Duhigg article. Do you have evidence that the private investor-backed homes take a disproportionate share of the sickest and most vulnerable patients?