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

["Joan Rose" <rosejo@msu.edu>]

I think this is a problem with most Epi studies in water unless they are 
prospective.  We are working on a paper using dose-response and actual 
concentrations of pathogens measured in sewage.  It will be interesting to 
compare these.

joan
Joan B. Rose, PhD
Homer Nowlin Chair in Water Research
Michigan State University
13 Natural Resources
E. Lansing MI 48824
517-432-4412 (ph)
517-432-1699 (fax)
rosejo@msu.edu

----- Original Message ----- 
From: "dan dietrich" <Daniel.Dietrich@vdh.virginia.gov>
To: <beachnet@great-lakes.net>
Sent: Tuesday, January 15, 2008 9:59 AM
Subject: BEACHNET==> ER visits for Diarrheal Illness Increased After Release 
of Undertreated Sewage


> 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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