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We live among a myriad of causes. Every cause has an effect, every effect has a cause. Cause and effect are inseparable. When investigating this problem it is important not to confuse cause with correlation. Establishing a correlation between events and occurrences does not show a causal connection.

As Hygienists, causality is important to us and some understanding of the inherent difficulties is desirable.

Historically it has been stated that, “toxaemia is the universal basic cause of disease” (Tilden 1851-1940). For those of us with a solid background in hygienic philosophy, we can appreciate what this means but it is logically and empirically suspect. Not only is it a gross oversimplification but also it necessitates the subsuming of myriads of causes and effects under the heading of cause.

The cause of any phenomena is the sum of all the antecedent conditions and circumstances necessary to bring about the effect, result, condition or state. An antecedent condition is a contributory factor. When we try to analyse cause in this connection it becomes an infinite regress. So whilst it superficially appears to explain, it is ephemeral; it is no explanation at all. The principle of cause and effect implies determinism. If it were possible to discover all the cause and effect relationships accurate predictions could be made, all would be determined. Everything is the cause of everything. This is not useful to us. Cause, to be meaningful, must be something within our control. We must be able to do something about it.

It is known that there are systems of “causeless effects” and “effectless causes”, that is, random events. Only thus can we escape determinism. This is inherent in quantum theory and led the physicist, Werner Heisenberg; to enunciate the “uncertainty principle” There is an ambiguity between causation and determinism. The concept of self-generated action by the living organism embodies this principle.

The philosopher David Hume (1711-1776), who is one of the most important philosophers ever to have written in English, influenced developments in psychology, philosophy of mind, ethics, philosophy of science, political and economic theory, political and social history and literally an aesthetic theory. His earliest work, “A Treatise on Human Nature”, written when he was only in his early 20’s is a remarkable work. However, the major contribution he made to the philosophy of science centres around the concept of cause . Hume defined causation at least twice in his treatise. He concluded that causation consists of three conditions:

Spatial, temporal contiguity: “there is no action at a distance”
Temporal priority of the cause: there is no future or retro causation or no simultaneous causation among distinct events, and
The instantiation of general regularities by particular causal sequences.

Causation in one sequence of events requires constant conjunction of other events of the same types. To quote Hume, “it is commonly supposed that there is a necessary connection betwixt the cause and the effect and that the cause possesses something, which we call a power, or force, or energy.” Hume says, “we may define a cause to be an object followed by another and where all the objects, similar to the first, are followed by objects similar to the second.” Conversely, “where if the first object had not been, the second never had existed.” As we can see, Hume’s view was mechanics, the relationship between actions and actions. Action presupposes an entity, which “acts”. Therefore the hygienist would argue that causes reveal relationships between entities and actions.

Causation is central to the scientific enterprise. Science, as it is generally understood, aims to explain more than statistical correlations. It attempts to uncover the underlying causes that are responsible for the observed phenomena. For example, when we talk of the Law of Gravity, we mean much more than that objects have been observed behaving in a certain way. We often hold the belief that some power or force makes a stone move towards the centre of the Earth when dropped. Indeed here we see the very thing that Hume denied, ‘action at a distance’. This fact of gravity, “action at a distance”, certainly worried Newton.

We believe that events that scientists study are much more than a series of random occurrences. We believe they are connected together, so that a given cause produces, no, even necessitates, the resulting effect. Hume argued that when we see one billiard ball hitting another all we observe is the movement of ball A followed by the movement of ball B. Any further attempt to explain some parallel force or some link between the first event and the second is outside anything we can detect through the senses. This is the endorsement of the Action/Reaction concept. The premise that every action is only a reaction to prior action rules out, arbitrarily and against the evidence, the existence of self-generated, goal directed action of which the living organism is capable.

One of the appealing characteristics in the enervation toxaemic theory is its enormous explanatory power. Of course, this is its Achilles heel. Those who admire Marx, Freud and Adler may be impressed with the explanatory power of their psychoanalytic theories. They are not scientific. The Hygienic Theory of Enervation and Toxaemia appears to be able to explain practically everything that happens in health, disease and healing. There is just one small problem. It is unverifiable. The theory cannot be tested; it cannot be refuted; therefore it is unscientific.

The theories of Freud may be appealing; they may be plausible; but they cannot be tested. If a theory cannot be challenged and an attempt made to refute it, it falls outside the scope of science. The enervation toxaemia theory may be true, on the other hand it may not. At the present stage of our knowledge, it is not possible to tell because we have no means of testing it. We may argue that it is easy to find confirmations or verifications of our theory. Certainly, if we look for confirmations, but this is not a true verification. The toxaemia theory is irrefutable but this is the flaw; that is not its virtue but its vice.

A similar theory in medicine, which may be aligned with enervation toxaemia, is stress. Many problems are said to be caused by stress. Similarly this is not a scientific theory. Certainly we know what toxaemia is, we know what stress is, both have been scientifically demonstrated, both have been objectively demonstrated, but to establish cause and effect relationships is not possible, certainly not at the present state of our knowledge. We have no means of measuring stress anymore than we have a means of measuring enervation.

For the professional hygienist, the notion of cause must relate to factors that are related to the individual’s choices. Causes must be something we can do something about. When we read, in pathology texts, that a cause of diabetes is “Jewish race”, it is pointless, there is nothing that can be done about it. There are myriads of causes and effects in homeostasis (maintaining constancy of the internal environment) , the organism as a self regulating mechanism, is dependent upon the invariability of cause and effect, but it is little value to us to attempt to enumerate all of these causes of homeostasis and say that these are the causes of health. Similarly it is equally fatuous to argue that the causes of health are food, air, water, sunlight etc. Certainly these are necessary conditions. On the other hand it is positively advantageous to highlight causes of disease as they relate to:

A : factors which are within our own control, and
B : known materials, agents and influences which bring about a positive disturbance of homeostasis, even though, again, myriads of causes and effects may be involved in understanding the detail.

For example, if we suggest that smoking causes lung cancer, but we are aware, and it is a fact, that many who smoke do not develop lung cancer. To make this claim is to argue that smoking is a cause of lung cancer and acknowledge that other causes are necessary. Dr. Shelton used to argue that a cause that needs an ally is not a cause. I do not believe this is true, but what is true is the cause that needs an ally is not the cause.

There is an urgent need for us, as professionals, to examine the concept of causality so that we may be clearer in our educational attempts and make our philosophy more cohesive and intelligible.

References:

Hume, David, Treatise on Human Nature, 1739

Mackie, J.L. The Cement of the Universe, A Study of Causation
Oxford University Press,1974

Lewis, David, Philosophical Papers Volume 11, Causation,
Oxford University Press 1986

Sosa, E and Tooley, M., Ed. Causation Oxford Readings in Philosophy: Oxford University Press, 1993