First of all, it concerns itself only with quantities of specific things, not quality. So nutrient-poor industrialized, toxin-compromised foods are given the same score as organic and nutrient-rich foods free from toxins.
Second, Mediterranean Diet research assumes that only diet, or only diet and exercise are factors in the superior health and longer lifespans of Mediterranean people, but as other research is showing, sunshine is another factor. This is a problem because Mediterranean diet research does not include advice to get more sun.
Third, with the exception of alcohol and saturated fats, the Mediterranean Diet Scale doesn't concern itself with consumption or over consumption of unhealthy foods. So it's possible to get a perfect 9 on the Mediterranean diet scale, and still consume huge amounts of cotton candy and Red Bull and every day.
Fourth, subjects get an alcohol point for consuming from one to three glasses of alcohol for men and slightly less for women. That means drinking zero alcohol -- the healthiest option, assuming the rest of your diet is healthy -- is treated the same as drinking a bottle of scotch every day. The upper end of this scale -- three glasses per day -- is enough to develop chronic alcoholism.
Also: The research presents Mediterranean food as a drug that "reduces the risk" of diabetes. In fact, the Mediterranean diet is simply closer to what people have eaten for millennia, and that our science-fiction industrialized modern diet *causes* diabetes and other diseases.
When scientists discovered that children were suffering from growth retardation and nervous system damage from eating lead paint, they didn't say that "switching to paint that contains lower amounts of lead can help reduce nervous system damage by 83 percent." No, they reported that lead causes the damage.
The same is true for industrialized diets: They *cause* diabetes, heart disease, obesity, cancer and other maladies.