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Some Issues to Consider in thinking about Causes and Explanations Issues in Causal Analysis • Limitations of traditional, single-causal models in dealing with non-communicable disease which have many, interconnected causes • There are many conceptions of causation itself • Statistics refers to probability and chance, but what do these actually mean? How do we deal with uncertainty? • Levels of explanation: the How vs. the Why? • Are we using the right mathematical basis? – Complexity & chaos theory; non-linear relations; fuzzy logic, etc. Epistemology • The theory of knowledge: what is knowledge and how is it acquired? • How do we know that we know what we think we know? Etc. • Bases of knowledge: – Metaphysics – Positivism – Post-positivism Metaphysics • Deals with knowledge that cannot be reached through studying material reality – Nature of the mind & ideas – Unverifiable • But science alone cannot explain reality – Scientific ideas are continually replaced by newer ones – “Truths” are not final – Human interpretation is variable Positivism • Rejects metaphysics – Focuses on observable & measurable – Thoughts are irrelevant because unmeasurable • Mechanical – Cause & effect – Seeks to predict & control the world Post-positivism • Rejects positivism • Knowledge is not based on solid foundations; it is conjectural – We may assert ideas but these can be modified in light of further investigations – We cannot take a fully objective point of view – Context is important – The closest we can come to proof is to try but fail to reject a hypothesis. Nomothetic & Idiographic • There is a spectrum of sciences from hard to soft; different approaches to causation in each • Especially: generalising vs. particularising traditions: – What is the purpose of science: to derive general laws, or to explain individual cases? (Nomothetic vs. idiographic sciences) – The approach to causal thinking is different in each, and medicine is in both camps Categories of explanation • Scientific explanations (theory is central) • Narrative (describes what happened) • Historical (explains specific events) • Teleological (the purpose or reason) • Everyday (usually the “why” questions) • Magical, religious (are these really explanations?) Two traditions Aristotelian • To make facts teleologically understandable • Applied to actions & intentional agency • “Why?” questions • Used in human & social sciences Galilean • To explain & predict • Commonly applied to events • Causal mechanisms • Generally “how?” questions • Used in natural sciences Both seem relevant to medicine… Holism, reductionism & complexity theory • Basic question of whether a complex whole (e.g., your mind) can be understood in terms of functioning of its parts • “Holism” argues that the whole cannot be understood by analyzing parts; “why?” & “how?” are distinct • “Reductionism” says that laws governing the whole can be deduced from laws governing the parts, plus laws concerning relations between the parts Sources of explanations for social epidemiology • Social sciences – sociology • Behavioral science • Psychology, personality, etc. • Combined psychological + biological (e.g., psycho-neuro-immunology) • What about history?