Miscarriage, economic downturns and causality

There is a really interesting piece and ensuing discussion in recent American Journal of Epidemiology:

“Spontaneous Pregnancy Loss in Denmark Following Economic Downturns” http://aje.oxfordjournals.org/content/183/8/701.full?etoc

I find this interesting for a lot of reasons, including that it suggests another respect in which health and economic well-being are linked. But I am particularly curious how potential outcomes enthusiasts would respond to this sort of study, given that an economic downturn is neither a well-defined intervention nor susceptible to one.

Potential Outcomes at the LSHTM

Along with my co-authors Jan Vandenbroucke and Neil Pearce, I engaged in a stimulating debate at the London School of Hygiene and Tropical Medicine today, on this paper:

http://ije.oxfordjournals.org/content/early/2016/01/21/ije.dyv341.full.pdf

Here is a link to the slides from my presentation:

https://www.dropbox.com/s/n0xe0zz86gyfxo4/2016-03-07%20Causal%20Inference%20in%20Epidemiology.pptx?dl=0

The debate was impassioned yet civilized. For me the most striking thing was how much seemed to come down to who said what, and who thought what. Are we attacking a straw man? If so, does that mean we’re right in substance, and wrong to think anyone would disagree? That itself would be remarkable, because it really seems to me, both from reading and talking, including feedback from other audiences, that some people do espouse the views we criticize. Or if we are not attacking a straw man, then is our position correct, or a sort of methodolical Ludditism, a reactionary preference for existing views?

I hope that more epidemiologists, and hopefully philosophers too, will weigh in.

March talks in UK and Norway

I’m giving several talks over the next two weeks in the UK, and one in Bergen, Norway. I’m also having a book launch and giving a career advice session. Schedule as follows and abstracts below.

2 March, 1-2.30pm. Cambridge Philosophy of Science Forum: ‘Prediction and Medicine’ (abstract below).

4 March, 1.30-3pm. Masterclass/Reading Group for MSc/PhD students, UCL, on two recent papers: ‘Causation and Prediction in Epidemiology: A Guide to the Methodological Revolution’ (Studies in History and Philosophy of Biological and Biomedical Sciences 2015) and ‘Causality and causal inference in epidemiology: the need for a pluralistic approach’ (with Jan Vandenbroucke and Neil Pearce, International Journal of Epidemiology 2016)

4 March, 3-5pm. UCL STS Seminar: ‘Prediction and Medicine.’

4 March, 5.30-8pm. Book launch of “Philosophy for Graduate Students: Metaphysics and Epistemology’ (Routledge 2016) and career advice session (abstract below).

7 March, 12.30-2pm. London School of Hygiene and Tropical Medicine seminar, with Jan Vandenbroucke and Neil Pearce. ‘Causal Inference in Epidemiology: What Was It, What Is It, and What Will It Become?’ (Abstract below.)

8 March, 3-5pm. Bergen philosophy seminar: ‘Prediction and Medicine.’ (Abstract below.)

9 March, 4-5.30pm. Oxford philosophy of medicine seminar: ‘Prediction and Medicine.’ (Abstract below.)
Abstract: Prediction and Medicine

Historian of medicine Roy Porter maintains that the position of medicine in society has had, and still has, little to do with its ability to make people better. There is a line of thinking in both history and philosophy of medicine that we might call medical nihilism (following Jacob Stegenga). This view holds that medicine is not what it is cracked up to be. But this view assumes (unlike Porter) that the purpose of medicine is indeed to cure people. In this paper I argue that the core medical competence is not to cure, nor to prevent, but to predict disease. The predictions expected of doctors are both actual and counterfactual: both “When will I get better?” and “What would have happened if I had not taken my medicine?”. This “predictive thesis” does a better job than the “curative thesis” at explaining why not all medicine is concerned with curative efforts, and it enjoys considerable historical support from the ancient entanglement of prophesy and medicine and from the fact that medicine thrived for centuries with almost no effective cures, and continues to thrive today in various non-Western and complimentary forms that are mostly without curative efficacy. I also argue that it relieves medicine of the pretences of potency that generate the anger implicit in the arguments for medical nihilism. This view also affects expectations of epidemiology, which is sometimes criticised for cataloguing predictive risk factors whose causal relation to the outcome is unclear, instead of identifying decisive interventions. Finally I ask whether this descriptive thesis about the nature of medicine offers any normative lessons for the development of medicine.


Abstract: Career Advice Session at UCL on 4 March

Gloom and doom dominate current discussions about the state of higher education, and humanities in particular. In this climate, why would anyone wanting to be able to feed themselves and their family embark on an academic career, and in particular a career in philosophy, which is especially arduous and especially abstract? More practically, if you find yourself in this track, are there things you can do to improve your chances of success? The answer to the latter is a definite “yes”, but because the shape of the academic profession is changing, some of the philosophical standard career advice that would have worked even a few years ago is no longer applicable. Alex Broadbent is a young philosopher of science and also Dean of Humanities at the University of Johannesburg. He is committed to the view that philosophy can be useful without compromising rigour, and also to the view that academics – especially young ones – need to be more proactive about running their universities. He is author of “Philosophy of Graduate Students: Metaphysics and Epistemology” recently published by Routledge. In this session he offers some ideas about managing an early career in the contemporary academic world.
Abstract: Causal Inference in Epidemiology: What Was It, What Is It, and What Will It Become?

Epidemiology is centrally concerned with identifying causes of health and disease, so as to inform the search for effective interventions, either in public health policy or in the clinic. The epidemiology of the second half of the twentieth century saw the connection between a cause of disease and an effective intervention as a very loose one, with the intervention to be uncovered later after further biomedical research. By contrast, the first part of this century has witnessed a strong push to connect the notions of cause and intervention. This movement, often going under the misleadingly broad label “causal inference”, sees a very tight connection between interventions and causes, such that a causal question is not even well defined for the purposes of epidemiological research unless there is a well-specified intervention on that cause, against which the causal effect is measured. This movement is inspired in part by a pragmatic concern with achieving effective interventions and in part by the appeal of the powerful mathematical tools that can be used if causal questions are restricted in this way. It is the development and deployment of these tools that various recent workshops books on “causality” (Pearl 2009) and “causal inference” (Hernán and Robins 2015) focus upon. This technical focus hides the revolutionary nature of this new way of thinking about causality and causal inference. This workshop seeks to understand the conceptual framework of this movement, to place it in context against traditional epidemiological thinking, and to establish both the advantages and the risks of accompanying this “methodological revolution”.

This event has been organised as part of the Design and Analysis theme of the Centre for Evaluation. The event is intended for staff and students interested in evaluation, casual inference, and epidemiology.

Paper: Causality and Causal Inference in Epidemiology: the Need for a Pluralistic Approach

Delighted to announce the online publication of this paper in International Journal of Epidemiology, with Jan Vandenbroucke and Neil Pearce: ‘Causality and Causal Inference in Epidemiology: the Need for a Pluralistic Approach

This paper has already generated some controversy and I’m really looking forward to talking about it with my co-authors at the London School of Hygiene and Tropical Medicine on 7 March. (I’ll also be giving some solo talks while in the UK, at Cambridge, UCL, and Oxford, as well as one in Bergen, Norway.)

The paper is on the same topic as a single-authored paper of mine published late 2015, ‘Causation and Prediction in Epidemiology: a Guide to the Methodological Revolution.‘ But it is much shorter, and nonetheless manages to add a lot that was not present in my sole-authored paper – notably a methodological dimension that, as a philosopher by training, I was ignorant. The co-authoring process was thus really rich and interesting for me.

It also makes me think that philosophy papers should be shorter… Do we really need the first 2500 words summarising the current debate etc? I wonder if a more compressed style might actually stimulate more thinking, even if the resulting papers are less argumentatively airtight. One might wonder how often the airtight ideal is achieved even with traditional length paper… Who was it who said that in philosophy, it’s all over by the end of the first page?

Paper – Tobacco in Korea

Alex Broadbent and Seung-sik Hwang, 2016. ‘Tobacco and epidemiology in Korea: old tricks, new answers?’ Journal of Epidemiology and Community Health doi:10.1136/jech-2015-206567.

Now available online first, open access.

http://jech.bmj.com/content/early/2016/01/14/jech-2015-206567.full

For those at the recent CauseHealth workshop N=1, this relates to the same key topic (viz. the application of population evidence to an individual), but in the legal rather than clinical context.

 

Book: B Smart, “Concepts and Causes in the Philosophy of Disease”

Recently published with Palgrave Macmillan: Concepts and Causes in the Philosophy of Disease, by Benjamin Smart. A very interesting short book that aims to summarise and progress some of the central recent work in the philosophy of medicine, concerning the nature of health and disease, causality in medicine, the classification of diseases and the relation between medicine and public health.

On Amazon: http://www.amazon.co.uk/gp/search?index=books&linkCode=qs&keywords=9781137552938

On the Palgrave site: http://www.palgrave.com/page/detail/?k=9781137552914