BEACHNET==> ER visits for Diarrheal Illness Increased After Release of Undertreated Sewage

[dan dietrich <Daniel.Dietrich@vdh.virginia.gov>]

I think that it is important to keep in mind the limitations of the 
study before relying on it for policy decisions.  While the study shows 
an assocation between CSO events and illness, the authors acknowledge 
there are shortcomings to the study. First, the authors acknowledge that 
the association that they found does not demonstrate causation (though 
the do hint at a "dose-response" relationship, which is misleading).  
They further acknowledge that they do not have laboratory confirmations 
for the diagnoses that they included in their study, and they 
acknowledge the lack of exposure information.  They are assuming an 
exposure to pathogens from drinking water, which the study did not 
demonstrate.   Epidemiologically then, the study is weak in that it does 
not show a confirmed disease outcome as the result of a known exposure 
to a pathogen.
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