3 ms·

> As they acknowledge, this factor is extremely difficult to isolate from demographics, geography, religion, etc. No? They used "a within-facility differences-

by verteu 3y ago

> As they acknowledge, this factor is extremely difficult to isolate from demographics, geography, religion, etc. No? They used "a within-facility differences-in-differences design to address nonrandom targeting of facilities" so they're measuring the change in outcomes at the same facility before & after takeover.

cscurmudgeon 3y ago
That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.
- wpietri 3y ago
  If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.
  - cscurmudgeon 3y ago
    > If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. My standard is authors (and random internet commenters) to have an inkling of the progress in causal analysis and related progress in the last two decades. Edit: Some resources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700403 https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700... https://www.hsph.harvard.edu/miguel-hernan/research/causal-inference-from-observational-data/ https://www.hsph.harvard.edu/miguel-hernan/research/causal-i... From 1999: https://liberalarts.tamu.edu/sociology/wp-content/uploads/sites/9/2021/07/winship_morgan_1999_causal_analysis.pdf https://liberalarts.tamu.edu/sociology/wp-content/uploads/si...
    - verteu 3y ago
      I'm quite familiar with causal analysis [1]. What are your qualifications in the field? The paper performs half a dozen standard robustness checks [2]. Which exactly do you believe are missing? Be specific, and include reasons why we should reasonably expect the opposite outcome. [1] Senior ML Researcher @ Google, top 3 PhD, etc. [2] Placebo analysis, instrumental variables, MTE analysis, breaking down the effect into plausible mechanisms such as reduction in front-line staffing, limiting results to nursing homes owned by the same chain, etc edit: Instead of linking random surveys on causal inference, please make a specific claim, such as "the authors should have used propensity scoring", or "causal inference studies should all be ignored." Otherwise, there's no way to have a debate.
      - starcraft2wol 3y ago
        That's nice of you to list where you work. On HN there are many qualified and intelligent people, so we generally prefer to talk about the issues directly. > half a dozen standard robustness checks My original comment isn't arguing they used tools improperly, it's an epistemology argument. It's about the limitations of what information could even be gathered from this kind of study.
        verteu 3y ago
        This was a reply to cscurmudgeon's objection, not yours. (You can tell because my comment is a reply to his comment.)
        wpietri 3y ago
        I think it's hilarious that somebody who has been here for all of 11 days wants to tell somebody who is coming up on their 10-year HNiversary what "we generally prefer".
        deleted 3y ago
        [deleted]
        starcraft2wol 3y ago
  - starcraft2wol 3y ago
    > study must fork the universe to compare the same business with different timeline Unfortunately, that might be what's necessary to know. I am not knocking the research quality, but there are limits on what we can conclude, and obviously other important factors have not been sufficiently isolated.
    - verteu 3y ago
      By this standard, should we not believe that smoking causes lung cancer? After all, a controlled experiment on humans has never been done.
      - starcraft2wol 3y ago
        Those studies aren't similar in methodology or subject at all. Can you acknowledge there are unmeasured social factors at play in this simple survey analysis, or not? If so, I'm happy to speculate about the epistemology of tobacco studies.
        verteu 3y ago
        > Those studies aren't similar in methodology or subject at all. They both used observational health data to create a causal conclusion on mortality. How is that not a similarity in methodology?
  - swsieber 3y ago
    I mean... people who go to cancer clinic have cancer at a higher rate than those who don't. Cancer clinics cause cancer. And therapists create mentally unstable people, etc. You wouldn't have to fork the universe. I think a randomly distributed trial would work, and could be reasonably made to work. Not sure though. FWIW, I think we should prevent private equity in lots of places, especially hospitals.
    - wpietri 3y ago
      I think doing a randomly distributed trial would be very challenging. How do you imagine funding it? How do you imagine getting PE to agree to buy random things rather than strategic things? Do you expect them to turn down 50% of almost-closed deals to keep it closer to random? How would you keep things being distorted by the money you'd be giving to PE to get them to change their behavior? And what additional knowledge do you hope to gain versus a study design like this one that would be justified by the much larger expense?
  - swsieber 3y ago
    I mean... people who go to cancer clinic have cancer at a higher rate than those who don't. Cancer clinics cause cancer. And therapists create mentally unstable people, etc. You wouldn't have to fork the universe. I think a randomly distributed trial would work, and could be reasonably made to work (woth Gov. help). Not sure though. FWIW, I think we should prevent private equity in lots of places, especially hospitals.
  - p0pcult 3y ago
    [dead]

by verteu 3y ago

cscurmudgeon 3y ago

That is not conclusive either. If PE had not acquired them, may be they would have been worse or better? This analysis doesn't answer that.

wpietri 3y ago
If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. Regardless, in this case, where the ongoing harm could be very large, we have to at some point go with the best evidence available.
- cscurmudgeon 3y ago
  > If your standard for "conclusive" is "study must fork the universe to compare the same business with different timeline" then you may be waiting a while. My standard is authors (and random internet commenters) to have an inkling of the progress in causal analysis and related progress in the last two decades. Edit: Some resources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300826/ https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700403 https://journals.sagepub.com/doi/pdf/10.1177/1536867X0800700... https://www.hsph.harvard.edu/miguel-hernan/research/causal-inference-from-observational-data/ https://www.hsph.harvard.edu/miguel-hernan/research/causal-i... From 1999: https://liberalarts.tamu.edu/sociology/wp-content/uploads/sites/9/2021/07/winship_morgan_1999_causal_analysis.pdf https://liberalarts.tamu.edu/sociology/wp-content/uploads/si...
  - verteu 3y ago
    I'm quite familiar with causal analysis [1]. What are your qualifications in the field? The paper performs half a dozen standard robustness checks [2]. Which exactly do you believe are missing? Be specific, and include reasons why we should reasonably expect the opposite outcome. [1] Senior ML Researcher @ Google, top 3 PhD, etc. [2] Placebo analysis, instrumental variables, MTE analysis, breaking down the effect into plausible mechanisms such as reduction in front-line staffing, limiting results to nursing homes owned by the same chain, etc edit: Instead of linking random surveys on causal inference, please make a specific claim, such as "the authors should have used propensity scoring", or "causal inference studies should all be ignored." Otherwise, there's no way to have a debate.
    - starcraft2wol 3y ago
      That's nice of you to list where you work. On HN there are many qualified and intelligent people, so we generally prefer to talk about the issues directly. > half a dozen standard robustness checks My original comment isn't arguing they used tools improperly, it's an epistemology argument. It's about the limitations of what information could even be gathered from this kind of study.
      - verteu 3y ago
        This was a reply to cscurmudgeon's objection, not yours. (You can tell because my comment is a reply to his comment.)
      - wpietri 3y ago
        I think it's hilarious that somebody who has been here for all of 11 days wants to tell somebody who is coming up on their 10-year HNiversary what "we generally prefer".
        deleted 3y ago
        [deleted]
        starcraft2wol 3y ago
- starcraft2wol 3y ago
  > study must fork the universe to compare the same business with different timeline Unfortunately, that might be what's necessary to know. I am not knocking the research quality, but there are limits on what we can conclude, and obviously other important factors have not been sufficiently isolated.
  - verteu 3y ago
    By this standard, should we not believe that smoking causes lung cancer? After all, a controlled experiment on humans has never been done.
    - starcraft2wol 3y ago
      Those studies aren't similar in methodology or subject at all. Can you acknowledge there are unmeasured social factors at play in this simple survey analysis, or not? If so, I'm happy to speculate about the epistemology of tobacco studies.
      - verteu 3y ago
        > Those studies aren't similar in methodology or subject at all. They both used observational health data to create a causal conclusion on mortality. How is that not a similarity in methodology?
- swsieber 3y ago
  I mean... people who go to cancer clinic have cancer at a higher rate than those who don't. Cancer clinics cause cancer. And therapists create mentally unstable people, etc. You wouldn't have to fork the universe. I think a randomly distributed trial would work, and could be reasonably made to work. Not sure though. FWIW, I think we should prevent private equity in lots of places, especially hospitals.
  - wpietri 3y ago
    I think doing a randomly distributed trial would be very challenging. How do you imagine funding it? How do you imagine getting PE to agree to buy random things rather than strategic things? Do you expect them to turn down 50% of almost-closed deals to keep it closer to random? How would you keep things being distorted by the money you'd be giving to PE to get them to change their behavior? And what additional knowledge do you hope to gain versus a study design like this one that would be justified by the much larger expense?
- swsieber 3y ago
  I mean... people who go to cancer clinic have cancer at a higher rate than those who don't. Cancer clinics cause cancer. And therapists create mentally unstable people, etc. You wouldn't have to fork the universe. I think a randomly distributed trial would work, and could be reasonably made to work (woth Gov. help). Not sure though. FWIW, I think we should prevent private equity in lots of places, especially hospitals.
- p0pcult 3y ago
  [dead]