Our brains are good at interpreting and detecting causal structures, but often, the real causal structures at play are more complicated than what we can easily see. A causal chain may include a mediator, such as citrus fruit providing vitamin C to prevent scurvy. A causal chain may have a complex mediator interaction, as in the example of my last post where a drug leads to the body creating an enzyme that then works with the drug to be effective. Additionally, causal chains can be long-term affairs.
In The Book of Why Judea Pearl discusses long-term causal chains writing, “how can you sort out the causal effect of treatment when it may occur in many stages and the intermediate variables (which you might want to use as controls) depend on earlier stages of treatment?”
This is an important question within medicine and occupational safety. Pearl writes about the fact that factory workers are often exposed to chemicals over a long period, not just in a single instance. If it was repeated exposure to chemicals that caused cancer or another disease, how do you pin that on the individual exposures themselves? Was the individual safe with 50 exposures but as soon as a 51st exposure occurred the individual developed a cancer? Long-term exposure to chemicals and an increased cancer risk seems pretty obvious to us, but the actual causal mechanism in this situation is a bit hazy.
The same can apply in the other direction within the field of medicine. Some cancer drugs or immune therapy treatments work for a long time, stop working, or require changes in combinations based on how disease has progressed or how other side effects have manifested. Additionally, as we have all learned over the past year with vaccines, some medical combinations work better with boosters or time delayed components. Thinking about causality in these kinds of situations is difficult because the differing time scopes and combinations make it hard to understand exactly what is affecting what and when. I don’t have any deep answers or insights into these questions, but simply highlight them to again demonstrate complex causation and how much work our minds must do to fully understand a causal chain.
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