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As mortality rates from infectious diseases declined in the twentieth century, the medical profession increasingly focused on preventing chronic diseases (such as coronary heart disease). Unlike the insurance industry, medicine was more skeptical of the utility of statistics and probability in identifying the underlying causes of disease. Additionally, physicians were not adept at interpreting their results. Chronic diseases (such as heart disease) have been especially difficult for the medical profession, because it has been challenging to determine the biological mechanism that causes chronic heart disease. Medicine has not been able to identify the root biological causes of heart disease in the laboratory. Instead, physicians have been forced to diagnose heart disease primarly through large statistical studies.
Rothstein argues that a careful analysis of these studies do not necessarily support the conclusions of their authors. The data from the Framingham Heart Study has been used for years, but it focused on only three specific risk factors (smoking, blood cholesterol, and blood pressure). Rothstein posits that results of that study were flawed because its authors narrowed the concept of risk factors and ignored social characteristics (such as “education, income, occupation, living conditions, health care, marital status, place of birth and family structure”) even though they appeared to play an important role in who developed heart disease. (p. 285.)