Medicine, Health Care and Philosophy

, Volume 3, Issue 1, pp 59–67

Causation: The elusive grail of epidemiology

  • L.R. Karhausen


The paper discusses the evolving concept of causationin epidemiology and its potential interaction with logic and scientific philosophy. Causes arecontingent but the necessity which binds them totheir effects relies on contrary-to-fact conditionals,i.e. conditional statements whose antecedent is false.Chance instead of determinism plays a growing role inscience and, although rarely acknowledged yet, inepidemiology: causes are multiple and chancy; a priorevent causes a subsequent event if the probabilitydistribution of the subsequent event changesconditionally upon the probability of the prior event.

There are no known sufficient causes in epidemiology.We merely observe tendencies toward sufficiency ortendencies toward necessity: cohort studies evaluatethe first tendencies, and case-control studies thelatter.

In applied sciences, such as medicine andepidemiology, causes are intrinsically connected withgoals and effective strategies: they are recipewhich have a potential harmful or sucessful use; theyare contrastive since they make a differencebetween circumstances in which they are present andthose in which they are absent: causes do notexplain Event E but event E rather thaneven F. Causation is intrinsically linked with thenotion of ``what is pathological''.

Any definition of causation will inevitably collapseinto the use made of epidemiologic methods. Theprogressive methodological sophistication of the lastforty years is in perfect alignment with a gradualimplicit overhaul of our concept of causation.

cause causality epidemiologic methods probability 


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  1. Brennan, T.A.: 1987, ‘Untangling causation in law and medicine: hazardous substance litigation’, Annals of Internal Medicine 107(5), pp. 741-747.PubMedGoogle Scholar
  2. Charlton, B.G.: 1995, ‘Mega-trials: methodological issues and clinical implications’, Journal of the Royal College of Physicians 29(2), pp. 96-100.Google Scholar
  3. Charlton, B.G.: 1996, ‘Attribution of causation in epidemiology: chain or mosaic?’, Journal of Clinical Epidemiology 49(1), pp. 105-107.CrossRefPubMedGoogle Scholar
  4. Collingwood, R.G.: 1940, ‘Causation in practical natural science’, In: R.G. Collingwood (ed.), An Essay in Metaphysics. Oxford: The Clarendon Press.Google Scholar
  5. Cook, T. and D. Campbell: 1979, Quasi-Experimentation. Boston: Houghton Miffin Company.Google Scholar
  6. Evans, A.S.: 1976, ‘Causation and disease: the Henle-Koch postulates revisited’, Yale Journal of Biology and Medicine 49(2), pp. 175-195.PubMedGoogle Scholar
  7. Fagot-Largeault, A.: 1989, Les causes de la mort. Histoire naturelle et facteurs de risque. Paris: Vrin.Google Scholar
  8. Garfinkel, A.: 1981, Forms of Explanation. Rethinking the Questions of Social Theory. New Haven: Yale University Press.Google Scholar
  9. Gasking, D.:1955, ‘Causation as recipes’, Mind 64, pp. 79-487.Google Scholar
  10. Giere, R.N.: 1988, Explaining Science. A Cognitive Approach. Chicago: University of Chicago Press.Google Scholar
  11. Greenland; S.: 1988, ‘Probability versus popper. An elaboration of the insufficiency of current Popperian approaches for epidemiologic analysis’, In: K. Rothman (ed.), Causal Inferences. Chestnut Hill, MS: Epidemiologic Resources, pp. 95-104.Google Scholar
  12. Hart, H.L.A. and T. Honoré: 1959, Causation in the Law. Oxford: Clarendon Press.Google Scholar
  13. Hill, A.B.: 1965, ‘The environment and disease: association or causation?’, Proceedings of the Royal Society of Medicine 58(May), pp. 295-300.Google Scholar
  14. Holland, P.W.: 1986, ‘Statistics and causal inference’, Journal of the American Statistical Association 81(396), pp. 945-960.Google Scholar
  15. Howson, C. and P. Urbach: 1993, Scientific Reasoning. The Bayesian Approach. Chicago: Open Court.Google Scholar
  16. Jeffrey, R.: 1992, Probability and the Art of Judgment. Cambridge: Cambridge University Press.Google Scholar
  17. Karhausen, L.: 1995, ‘The poverty of popperian epidemiology’, International Journal of Epidemiology 24(5), pp. 869-874.PubMedGoogle Scholar
  18. Karhausen, L.: 1996, ‘The logic of causation in epidemiology’, Scandinavian Journal of Social Medicine 24(1), pp. 8-13.PubMedGoogle Scholar
  19. Lanes, S.F.: 1988, ‘The logic of causal inferences in medicine’, In: K. Rothman (ed.), Causal inferences. Chestnut Hill, MS: Epidemiologic Resources, pp. 59-75.Google Scholar
  20. Lilienfeld, A.M. and D.E. Lilienfeld: 1980, Foundations of Epidemiology. Oxford: Oxford University Press.Google Scholar
  21. MacMahon, B., T.F. Pugh and J. Ipsen: 1960, Epidemiologic Methods. Boston: Little, Brown and Company.Google Scholar
  22. MacMahon, B. and D. Trichopoulos: 1996, Epidemiology Principles & Methods. Boston: Little Brown and Company.Google Scholar
  23. McCormick, J.:1992, ‘The abuse of language and logic in epidemiology’, Perspectives in Biology and Medicine 35(2), pp. 186-188.PubMedGoogle Scholar
  24. Mill, J.S.: 1941, A System of Logic. (1874) 8th edition. New York: Harper and Row.Google Scholar
  25. Morabia A.: 1991, ‘On the origin of Hill's criteria’, Epidemiology 2(5), pp. 367-369.PubMedGoogle Scholar
  26. Olsen, J.: 1993, ‘Some consequences of adopting a conditional deterministic model in epidemiology’, European Journal of Public Health 3(3), pp. 204-209.Google Scholar
  27. Olsen, O.: 1994, ‘Probabilistic causality in epidemiology’, In: U. Scheffler and M. Urchs, (eds.), Logic and Causal Reasoning, Jan Faye. Berlin: Akademie Verlag, pp. 255-276.Google Scholar
  28. Petitti, D.B.: 1991, ‘Associations are not effects’, American Journal of Epidemiology 133(2), pp. 101-102.PubMedGoogle Scholar
  29. Peto, R.: 1984, ‘The need for ignorance in cancer research’, In: R. Duncan and M. Weston Smith (eds.), The Encyclopædia of Medical Ignorance. Oxford: Pergamon Press, pp. 129-133.Google Scholar
  30. Plato.:1995, Phædrus. Indianapolis: Hackett Publishing Company (265E).Google Scholar
  31. Poole, C.: 1988, ‘Induction does not exist in epidemiology either’, In: K. Rothman (ed.), Causal inferences. Chestnut Hill, MS: Epidemiologic Resources, pp. 153-161.Google Scholar
  32. Putnam, H.: 1978, Meaning and the Moral Sciences. London: Routledge & Kegan Paul, pp. 41-44.Google Scholar
  33. Renton, A.: 1994 ‘Epidemiology and causation: a realist view’, Journal of Epidemiology and Community Health 48(1), pp. 79-85.PubMedGoogle Scholar
  34. Rothman, K.J.: 1976 ‘Causes’, American Journal of Epidemiology 104(6), pp. 587-592.PubMedGoogle Scholar
  35. Rothmann, K.: 1986, Modern Epidemiology. Boston: Little Brown and Company.Google Scholar
  36. Rothmann, K.J.: 1988, ‘Inferring causal connections-Habit, faith or logic?’, In: Rothmann (ed.), Causal Inferences. Chestnut Hill, MJ: Epidemiological Resources, pp. 3-12.Google Scholar
  37. Rothmann, K. J. (ed.): 1988, Causal Inferences. Chestnut Hill, MS: Epidemiologic Resources.Google Scholar
  38. Rothmann, K.J. and S. Greenland: 1998, ‘Causation and causal inference’, In: K.J. Rothmann and S. Greenland (eds.) Modern Epidemiology, 2d edition. Philadelphia: Lippincott-Raven, pp. 7-28.Google Scholar
  39. Ruben, D.-H.: 1990, Explaining Explanation. London: Routledge.Google Scholar
  40. Savitz, D.A.: 1994, ‘In defense of black box epidemiology’, Epidemiology 5(5), pp. 550-552.PubMedGoogle Scholar
  41. Schlesselman, J.J.: 1987,’ “Proof” of cause and effect in epidemiologic studies: criteria of judgment’, Preventive Medicine 16, pp. 195-210.CrossRefPubMedGoogle Scholar
  42. Schmaus,W.: 1996, ‘The empirical character of methodological rules’, Philosophy of Science 63 (Supplement), S98-S106.Google Scholar
  43. Segall, E.L.: 1970, ‘Medical vs legal meanings of causation’, Medical Counterpoint 2: 9-18.Google Scholar
  44. Skrabanek, P.: 1992, ‘The poverty of epidemiology’, Perspectives in Biology and Medicine 35(2), pp. 182-185.PubMedGoogle Scholar
  45. Skrabanek, P.: 1994, ‘The emptiness of the black box’, Epidemiology 5(5), pp. 553-555.PubMedGoogle Scholar
  46. Stehbens, W.E.: 1985, ‘The concept of cause in disease’, Journal of Chronic Diseases 38(11), pp. 947-950.CrossRefPubMedGoogle Scholar
  47. Stehbens, W.E.: 1992, ‘Causality in medical science with particular reference to heart disease and atherosclerosis’, Perspectives in Biology and Medicine 36(1), pp. 97-117.PubMedGoogle Scholar
  48. Susser, M.: 1986, ‘The logic of Sir Karl Popper and the practice of epidemiology’, American Journal of Epidemiology 124, pp. 711-718.PubMedGoogle Scholar
  49. Vandenbroucke, J.P.: 1988, ‘Is ‘The Causes of Cancer’ a miasma theory for the end of the twentieth century?’, International Journal of Epidemiology 17, pp. 708-709.PubMedGoogle Scholar
  50. Van Fraassen, B.: 1980, The Scientific Image. Oxford: Clarendon Press.Google Scholar
  51. Weed, D.L.: 1986, ‘On the logic of causal inference’, American Journal of Epidemiology 123(6), pp. 15-32.PubMedGoogle Scholar
  52. Whitbeck, C.: 1977, ‘Causation in medicine: the disease entity model’, Philosophy of Science 44(4), pp. 619-637.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • L.R. Karhausen
    • 1
  1. 1.ParisFrance

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