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Tag: causality

  • Causality, the Philosophy, Evaluation, and the Tawhidic View

    Understanding causality is essential in everyday life because it shapes how people make decisions, assign responsibility, and anticipate outcomes. From simple actions such as taking medicine to relieve pain, to complex choices like implementing public health policies, people rely on assumptions about cause and effect. When these assumptions are unclear or mistaken, decisions may be ineffective or harmful. Reflecting on causality is therefore not merely philosophical, it directly affects daily routines, professional judgement, and ethical responsibility.

    The classical philosophical discussion of causality begins with Aristotle in the 4th century BCE. Aristotle proposed that a complete explanation of anything requires four causes. The material cause explains what something is made of, the formal cause explains what makes it the kind of thing it is, the efficient cause explains what brings it about or produces change, and the final cause explains its purpose. These causes work together rather than separately. Aristotle assumed that causes have real power in nature. Under similar conditions, similar causes will tend to produce similar effects. Nature, in this view, is orderly, purposeful, and intelligible, and human reason can understand how it operates.

    This understanding was critically examined within Islamic thought, most notably by Al-Ghazali in the 11th century CE, particularly in Tahafut al-Falasifah written around 1095. Al-Ghazali challenged the idea that natural objects possess intrinsic causal power. His critique focused on efficient causation and the notion of natural necessity. He argued that observing events occurring regularly together does not prove that one causes the other by itself. Fire does not burn by its own power, and medicine does not heal by itself. Rather, Allah creates both the apparent cause and the effect at each moment. The regularity observed in nature reflects divine custom, not independent natural necessity. Al-Ghazali did not deny purpose, but he rejected the idea that purpose is built into nature itself. Final causation, in his view, belongs to divine wisdom rather than autonomous natural processes.

    Modern discussions of causality emerged strongly in the 18th century CE through the work of David Hume, especially his writings published around 1748. Hume argued that humans never observe necessary connections between events. What we observe are repeated patterns, from which we form expectations through habit. Causality therefore becomes an inference rather than a certainty. This view influenced modern science, where causation is treated as probabilistic and open to revision. Rather than claiming absolute certainty, science evaluates causal claims based on evidence, consistency, and explanatory value.

    In applied sciences, particularly epidemiology, causality is evaluated using structured reasoning rather than philosophical proof. Austin Bradford Hill articulated this approach in 1965 by proposing considerations to assess whether an observed association is likely to be causal. These considerations accept uncertainty as unavoidable and focus on judgement rather than necessity. Causality in modern science is therefore practical, evidence-based, and aimed at guiding decisions rather than establishing metaphysical truths.

    From a tawhidic perspective, Muslims engage with all these levels of causality while maintaining a clear theological position. Islam affirms that Allah is the ultimate cause of all events. Natural causes, regularities, and scientific laws are real at the level of human experience and reasoning, but they operate only by divine permission. This allows Muslims to accept empirical causality for evaluation and action, while rejecting the idea that nature possesses independent or self-sustaining power. Causality therefore operates at two levels, an observable level that supports scientific inquiry and decision-making, and an ultimate level grounded in tawhid, where all power, purpose, and outcome return to Allah.

    In this way, causality is not rejected but properly ordered. Philosophy explains its structure, science evaluates it through evidence, and the tawhidic worldview places it within a coherent and meaningful understanding of reality and daily life.

  • The Evolution of Causality in Understanding Disease

    Understanding causality has always been central to the quest for knowledge about health and disease. From the philosophical inquiries of Aristotle to the precision of modern causal inference frameworks, our ideas about what causes disease and how to intervene have evolved through centuries of intellectual effort. This article traces that journey, highlighting key contributions from Aristotle, Al-Farabi, Robert Koch, Austin Bradford Hill, Ken Rothman, and Judea Pearl, and connects their ideas to modern medical practice.

    Aristotle and the origins of causal thinking

    Aristotle (384–322 BCE) introduced what is arguably the first formal framework for understanding causation. He proposed that to fully explain why something exists or happens, one must consider four types of causes: material, formal, efficient, and final causes.

    The material cause is what something is made of. In medicine, this could refer to the tissues, cells, or substances involved in disease. The formal cause is the design or pattern that gives a thing its structure, comparable to the organisation of cells or the genetic blueprint of the body. The efficient cause is the agent or force that produces change. In health, this might be an infectious agent, injury, or environmental exposure. The final cause represents the purpose or goal. For Aristotle, everything in nature had an end or purpose, and in medical terms, this could be metaphorically linked to the goal of health or survival.

    Aristotle’s framework laid the foundation for causal reasoning not only in natural science but also in ethics, politics, and medicine. His approach encouraged generations of thinkers to seek deep, structured explanations for the phenomena they observed.

    Al-Farabi and the integration of causality into Islamic philosophy

    Al-Farabi (872–950 CE), often called the Second Teacher after Aristotle, engaged deeply with Aristotle’s ideas and reinterpreted them through the lens of Islamic philosophy. Al-Farabi did not discard the Four Causes, but he gave them new meaning within a framework that aligned with tawhid, the concept of divine unity.

    Al-Farabi argued that all efficient causes ultimately trace back to the First Cause, God. He extended Aristotle’s final cause beyond natural purposes to include divine wisdom and the moral purpose of human life. In Al-Farabi’s philosophy, causality was not simply a mechanical chain of events but a reflection of divine order and purpose.

    His famous idea that human beings are madani bi al-tab‘i (social by nature) linked causality to the collective pursuit of well-being. In his vision of the Virtuous City (al-Madinah al-Fadilah), knowledge of causes guided not just individual health, but the health of the community and the moral responsibility to promote the common good.

    Robert Koch and the birth of scientific causality in medicine

    The modern scientific study of disease causation began with the work of Robert Koch (1843–1910). Koch introduced formal criteria, known as Koch’s postulates, for identifying the causal relationship between a microorganism and a disease.

    Koch’s postulates required that the microorganism be found in every case of the disease, be isolatable in pure culture, cause the disease when introduced into a healthy host, and be re-isolated from the experimentally infected host. This approach transformed causality in medicine, especially in infectious diseases, from speculative reasoning to testable science.

    Koch’s work exemplified the search for necessary causes in disease. His criteria worked well for infections like tuberculosis but less so for complex diseases that result from multiple interacting factors.

    Austin Bradford Hill and the rise of multifactorial causality

    By the mid-20th century, it had become clear that many diseases did not have single necessary causes. Chronic diseases like cancer, heart disease, and diabetes involved numerous risk factors. Austin Bradford Hill (1897–1991) addressed this complexity by proposing a set of considerations, now known as the Bradford Hill criteria, to help scientists judge whether an observed association is likely to be causal.

    The criteria include strength of association, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence, and analogy. These considerations reflect the complexity of disease causation and guide researchers in interpreting epidemiological data.

    Hill’s approach helped move the focus from single necessary causes to component causes that contribute to sufficient causal mechanisms. This shift set the stage for modern causal models.

    Ken Rothman and the component cause model

    Ken Rothman (born 1945) further refined the understanding of disease causation by introducing the component cause model, often visualised as the causal pie model. This model describes how a disease can result from different combinations of factors, where each combination forms a sufficient cause.

    In Rothman’s model, component causes represent individual factors (such as smoking, genetic susceptibility, or environmental exposure) that combine to complete a causal mechanism. No single component cause needs to be necessary or sufficient on its own. The model illustrates why many diseases cannot be attributed to a single factor and why prevention strategies must target multiple risk factors.

    Rothman’s work has influenced generations of epidemiologists and public health professionals, providing a practical and visual tool to understand and teach multifactorial causation.

    Judea Pearl and the ladder of causation

    The most recent revolution in causality comes from Judea Pearl (born 1936), whose work has transformed causal inference into a formal, mathematical science. Pearl introduced causal diagrams, known as directed acyclic graphs (DAGs), and structural causal models to make causal relationships explicit and testable in data.

    One of Pearl’s key contributions is the concept of the Ladder of Causation. The ladder describes three levels of causal reasoning. The first level is association, where one observes patterns in data. The second level is intervention, where one reasons about what happens if something is changed or manipulated. The third level is counterfactuals, where one asks what would have happened under different circumstances.

    Pearl’s framework allows researchers to distinguish between mere correlation and true causation and to address complex issues such as confounding, mediation, and effect modification. His work is now central to fields ranging from epidemiology to artificial intelligence.

    Causality in modern medicine

    Understanding causality has practical implications in modern medicine. Few diseases today are thought to have single necessary and sufficient causes. Instead, most conditions arise from combinations of component causes that form sufficient causal mechanisms.

    Take lung cancer as an example. Smoking is neither a necessary cause (because lung cancer can occur in non-smokers) nor a sufficient cause (because not all smokers develop lung cancer). However, smoking is a major component cause that contributes to sufficient causal mechanisms. Interventions that reduce smoking prevalence can prevent many cases of lung cancer, even if they do not eliminate the disease entirely.

    Similarly, understanding that hypertension, high cholesterol, and physical inactivity are component causes of cardiovascular disease guides interventions that target these factors. The insights from causal reasoning help shape prevention strategies, clinical decisions, and public health policies.

    From philosophy to practice

    Tracing the journey of causality thinking from Aristotle to Pearl shows the progression from philosophical reflection to scientific precision. Aristotle’s Four Causes encouraged us to look for deeper reasons behind events. Al-Farabi integrated these ideas with a moral and social vision, reminding us that understanding causes should serve the common good. Koch’s postulates gave us tools to prove necessary causes in infectious diseases. Bradford Hill’s criteria helped navigate the complexity of chronic disease causation. Rothman’s component cause model illustrated the multifactorial nature of disease. Pearl’s ladder of causation and causal models now give us the tools to analyse and act on causal relationships in complex systems.

    Together, these frameworks have helped medicine move beyond treating symptoms to addressing root causes. They also remind us that understanding causality is not only about explaining disease but also about guiding interventions that promote health and well-being.

    References

    Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58(5), 295–300.

    Koch, R. (1884). Die aetiologie der tuberkulose. Berliner Klinische Wochenschrift, 21, 221–230.

    Pearl, J. (2018). The book of why: The new science of cause and effect. Basic Books.

    Rothman, K. J., Greenland, S., & Lash, T. L. (2008). Modern epidemiology (3rd ed.). Lippincott Williams & Wilkins.

    VanderWeele, T. J. (2015). Explanation in causal inference: Methods for mediation and interaction. Oxford University Press.