On the Definition of the Concept of “Cause”

I. Yu. Stuks

Around the understanding of the terms “cause” and “condition” of disease, which has always been the subject of lively discussion, an especially sharp debate has been taking place in recent years. Disagreements on the question of causality in particular fields of knowledge are connected with disagreements among philosophers in the definition of the concepts “cause” and “condition.”

There is a tendency to designate by the term “cause” one of the factors necessary for the occurrence of an effect. Some authors indicate that this is matter or motion transmitted to the effect (I. V. Kuznetsov¹, M. Bunge²). The remaining factors necessary for the emergence of a causal connection are referred to as conditions. For example, the cause of the alternation of day and night is proposed to be considered solar energy, while the rotation of the Earth is considered the conditions of this alternation. Most authors do not indicate any criteria for isolating the cause from the totality of conditions, thereby opening the way for subjectivism. The impression is created that the above interpretation of the concept “cause” bears a considerable imprint of mechanical determinism.

But there is also another point of view, according to which the cause should be understood as the interaction of conditions that necessarily leads to the appearance of the effect. In this approach the cause is considered as the connection itself, and not as one of the elements of the connection.

As is known, monocausalism—the medical variety of mechanical determinism—did not take into account the significance of conditions. Monocausalism was overthrown by the development of medical science, and, in place of this metaphysical understanding of causality, conditionalism came as the other extreme. That very conditionalism, whose denial is almost a rule of good tone. It seems to us that such “criticism” of conditionalism, which is accepted in our literature, is to a significant degree based on a formal understanding of this conception.

Conditionalists are accused of denying determinism, of idealism. Does this correspond to reality? The concept of cause, wrote M. Verworn, is a mystical concept originating from the primordial phase of human thought. A strictly scientific method

exposition knows no “causes,” but only lawful dependencies... a lawful process or state is never wholly and precisely determined by “one exclusive cause,” but always by the sum of conditions, which are equivalent because they are equally necessary. Causal lawfulness is speculative mysticism; conditional lawfulness is experience”^3).

As is evident from the quotation cited, the author understood by the equivalence of conditions their equal necessity, which in no way contradicts the dialectical understanding of causal connection. This same statement by M. Verworn, who was one of the founders of conditionalism, testifies that the author did not deny causal connections and did not regard them as a product of our consciousness. However, not being versed in philosophical terminology, M. Verworn objected to the words “cause” and “causal lawfulness.” It was precisely for his inability to draw the line between dialectical and mechanical materialism that V. I. Lenin criticized M. Verworn. “Characteristic here is the naive expression of the view that ‘materialism’ is a hindrance! There is no conception whatever of dialectical materialism and a complete inability to distinguish materialism as a philosophy from the individual, ossified views of philistines calling themselves materialists of the given time”^4).

What, then, came to replace the rejected conditionalism? Cause came to be understood as the principal factor necessary for the occurrence of the effect. The cause of all diseases, with the exception of those whose hereditary nature is generally recognized, is proclaimed to be an external factor, most often a microbe (A. L. Ado^5), O. V. Kerbikov^6), G. I. Tsaregorodtsev^7), V. D. Zhirnov^8), S. S. Gurvich^9), N. A. Musabaeva^10) and others). The most vividly expressed point of view is that stated by O. V. Kerbikov. “The cause is the queen,” he writes, “whose exit is always accompanied by a retinue. The retinue is the conditions. They do not produce the effect, but are necessary for the action of the cause. The causal factor is always in interaction with the totality of conditions—external, inherent in the environment, and internal, inherent in the organism. Conditions may favor the action of the causal factor; they may make its action impossible... The specificity of the effect is determined not by the cause in itself, but by its combination, its interaction with definite conditions.”

Thus, the cause does not determine the phenomenon—conditions are needed. The cause does not determine the specificity of the phenomenon; specificity depends on the conditions with which the cause is combined. What, then, is the cause? Are criteria indicated by means of which one could single out any one of the conditions that evoke disease and define it as the cause? Criteria are indicated. Let us cite some of them and try to make use of them. 1. “By cause, modern pathology understands that without which a pathological process cannot arise, despite the presence of definite conditions.” 2. “If the cause is a necessary, irreplaceable factor for this or that

^3) M. Verworn. The Question of the Limits of Knowledge. St. Petersburg, 1909, p. 25.
^4) V. I. Lenin. Philosophical Notebooks. Moscow, 1965, p. 354.
^5) A. D. Ado. On the question of the essence of disease. Bulletin of the USSR Academy of Medical Sciences, 1965, No. 1, p. 3.
^6) O. V. Kerbikov. The Problem of Causality in Medicine. “Znanie,” Moscow, 1965.
^7) G. I. Tsaregorodtsev. Dialectical Materialism and Medicine. “Meditsina,” Moscow, 1966, p. 120.
^8) V. D. Zhirnov. The external and the internal in etiology and pathogenesis. Bulletin of the USSR Academy of Medical Sciences, 1965, No. 1, p. 31.
^9) S. S. Gurvich. Problems of Dialectical Materialism. Kiev, 1964.
^10) N. A. Musabaeva. The Problem of Causality in Philosophy and Biology. Alma-Ata, 1962.

of the pathological process, then the conditions constitute a series of mutually replacing factors” (G. I. Tsaregorodtsev).

As an example which, in G. I. Tsaregorodtsev’s opinion, confirms the concept set forth above, a simplified understanding of the etiology of pneumonia is often used (cause—the pneumococcus; condition—nervous and humoral shifts; occasion—chilling). This example is unsatisfactory, if one takes into account that the pneumococcus and many other “culprits” of pneumonias are “regular inhabitants” of the nasopharynx of healthy people; it does not stand comparison with the first definition, for it is clear that chilling and a number of other insufficiently studied conditions may also be defined as necessary, without which the pathological process cannot arise despite the presence of the pneumococcus. The criterion of the mutual replaceability of conditions (2), by means of which one allegedly can distinguish them from causes, also does not justify itself. The mutual replaceability of conditions and of so-called causes is explained by the fact that in various factors of the external environment there are “extremely general properties with respect to the living substratum”³ (V. D. Zhirnov). It is known that the most diverse microbes take part in the emergence of certain diseases. Yet microbes have been declared the cause, which supposedly, unlike conditions, cannot be replaced by “stand-ins.”

Thus, the definitions of G. I. Tsaregorodtsev cited above contradict facts that are common knowledge in medicine.

One cannot object to dividing the conditions participating in the emergence of some pathological process into principal and secondary ones, in the sense of their relative value in a given situation. Given sufficient objective criteria, this, apparently, can and must be done. Unfortunately, the resolving power of our methods for studying diseases still provides us with such a possibility far from always. But the arbitrary, subjective, unfounded singling out of one of the conditions as the principal one, and the identification of this “principal” condition with the cause—such operations come into contradiction with the basic propositions of dialectical materialism. Objecting to such ways of elucidating the “cause,” I. V. Davydovskii recalls the numerous examples of how, as our knowledge of diseases has developed, the “principal” has become etiologically negligible, and vice versa.

It is no accident that the understanding of causality in medicine set forth above encounters many objections (I. V. Davydovskii⁴, P. N. Veselkin⁵, V. N. Sagatovskii⁶). I. V. Davydovskii regards the cause as the interaction of internal and external conditions necessary for the development of a disease. “There are no isolated causes in real biological processes, just as there are no isolated causal series.” M. P. Konchalovskii⁷ held the same positions in understanding the causes of diseases. Here is what this outstanding clinician wrote about the causes of rheumatism: “...there is no single cause of rheumatism... we regard every morbid process as the result of the intersecting action of many factors.” The substitution of the concept of cause as a connection by “causal

I. V. Davydovsky regards the “factor” as a variety of monocausalism.

Genes or nutrients entering through the placenta are the “main” cause of the development of the embryo. Although it is written that only “methodological defenselessness often leads physicians in their practical activity to identify such factors as cause, condition, occasion,” nevertheless the weapon offered to us by some philosophers does not make the difficult task of determining the causes of biological processes any easier. To be convinced of this, it is enough to try, with the aid of the definitions proposed by G. I. Tsaregorodtsev⁸, to answer the two questions posed above. As for new factors, the matter is no better here. Thus, for example, the general adaptation syndrome in no way “fits” into the conception of the “conditioned cause”; moreover, there is a tendency to accuse of this... the author who discovered the syndrome. Only in this way can one understand S. Gurvich’s statement⁹ that H. Selye overestimates the standard forms of the organism’s reactions to environmental stimuli.

As G. I. Kositsky rightly notes¹⁰, “the established conception of the nature of causality does not withstand the onslaught of new facts.” True, not only new facts, but also quite old ones. What, for example, is the cause of an electric current when a conductor moves in a magnetic field: the motion, the magnetic field, or the internal state of the moving body (the fact that it is a conductor and not a cotton thread?).

Incidentally, the pragmatic approach used by many authors to support the modern variety of monocausalism has not justified itself. The thesis that only such an understanding of causality opens broad possibilities for prevention is untenable. It is perfectly clear that, in order to prevent the realization of a causal connection whose consequence is disease, one must eliminate not the condition that seems to someone to be the complete cause (its elimination may prove impossible), but those among the currently known conditions that are more readily removable. For example, if one is to be consistent, then, regarding microbes as the cause of pneumonia, one must recognize as the only means of preventing this disease the destruction of all microbes involved in the development of pneumonia. Taking into account the unreality of such a measure, all that remains is to abandon the idea that prevention of pneumonias is possible. Hence the conclusion suggests itself that the reproach directed at conditionalism, as allegedly disarming medical theory, can apparently to a much greater extent be applied to contemporary monocausalism.

In studying the etiology of diseases at various levels, in many branches of medicine and biology facts have been discovered that are in no way consistent with the assertion of the obligatory existence of “main” causes and conditions. It has been proved, for example, that there exists a hereditary predisposition to such a purely infectious disease as poliomyelitis (Sh. Auerbach¹¹, S. I. Ginzburg-Kalinina¹²). Apparently, there is a recessive gene with incomplete manifes—

and “permitting” the virus to penetrate into the nerve cell. “Thus,” writes S. Auerbach, “the virus, the genotype, and external factors (for example, physical exercise at an early stage of infection) interact in the process of poliomyelitis. A similar picture is observed in other diseases, in particular in tuberculosis.” Data are then cited which indicate that the existence of a hereditary predisposition to tuberculosis is beyond doubt.

The “specific weight” of conditions (external and internal) may, obviously, change in different situations; however, all of them remain equally necessary for the occurrence of the effect. A detailed classification of conditions according to their significance and their character in relation to the majority of diseases is still impossible, since we do not know the proximate causes of diseases.

In studying proximate causes, the intimate mechanisms of biological processes, the essence of causal connections is invariably disclosed. The question of the essence of causal connection was raised already by the ancient philosophers, in particular by Aristotle^21), who put forward four kinds of causes: material, formal, efficient, and final.

In contemporary literature there is a tendency to single out structurality as one of the aspects of causality^22, 23), and this echoes Aristotle’s formal cause. In biological systems it has been proposed to distinguish information of action and information of structure^24, 25).

In the book Philosophical Problems of Modern Physics a number of chapters are devoted to the study of the essence of causal connections in physics. One of the characteristic properties of causality, in the authors’ opinion, is the transfer of matter and motion along the chains of causation. The transfer of matter and motion also characterizes causality in biological processes. As is known, food taken in and assimilated is used by the organism either as plastic material or as a source of energy necessary for the countless reactions that maintain homeostasis. “If,” notes L. Webb^26), “it were possible to give a complete description of the process of energy transfer in the cell and of the pathways by which it is accomplished, then one could say that the nature of life had been unraveled.” But the study of the flows of energy and substances arising in chemical reactions in living systems is impossible apart from the enzymes which, together with inhibitors, control chemical reactions (S. E. Bresler^27), L. Webb). The general principles of enzymatic reactions amount to the following. Molecules of the reacting substrates, binding with special regions of the surface of enzymes called active centers, prove to be in immediate proximity to one another and in the spatial configuration required for the reaction. When the principle of catalysis is compared with the concept of information, which in a certain aspect is a measure of the organization of a system, the impression is created that the phenomena of catalysis may be regarded as an interaction of the information contained in the enzyme with the reacting substrates. If pri-

^21) Aristotle. Metaphysics, Moscow–Leningrad, 1934, p. 79.
^22) A. A. Furman. Materialist Dialectics and General Systems Theory. Tomsk, 1968.
^23) M. F. Vedenov, V. I. Kremyanskii. The Relation of Structure and Function in Living Nature. “Znanie,” Moscow, 1966.
^24) H. Raven. Pathogenesis. “Mir,” Moscow, 1964.
^25) V. P. Kaznacheev. Organoscleroses as a general pathological problem. In: Problems of the Pathogenesis and Therapy of Organoscleroses. Novosibirsk, 1967.
^26) L. Webb. Enzyme and Metabolic Inhibitors. “Mir,” Moscow, 1966, p. 21.
^27) S. E. Bresler. Introduction to Molecular Biology. “Nauka,” Moscow–Leningrad, 1966.

If one accepts the view of catalysis set forth above, it becomes obvious that the transfer of information, along with the transfer of substances and energy, is one of the necessary conditions in biological causality. The interaction of substances, some of which perform a structural function, others an energetic one, and still others an informational one, can be found in clarifying the causes of biological phenomena at the most diverse levels.

The cause of the growth and development of the fetus is the interaction of genetic information with substances arriving from the mother’s organism, some of which perform a plastic function and others an energetic function. Protein synthesis, as is shown by authors who summarize data obtained in recent years (J. Haggis and coauthors¹³), is reduced to the interaction of informational RNA with amino acids (plastic material) delivered by transport RNA. The energy necessary for the interaction is supplied by the breakdown of ATP, delivered together with the amino acids as part of aminoacyladenylate. Among the causes of the development of myocardial infarction, along with other factors, the influence of some stressor is often included, and such a stressor may also be alarming information. The damaging effect of a virus is reduced to the distortion by viral deoxyribonucleic acid of the genetic information of the cell, as a result of which the cell’s energetic resources and plastic material are used for the synthesis of the nucleic acids and proteins of the virus. Apparently, there is every reason to believe that informational phenomena also underlie the action of antigens and hormones. Convincing data in favor of the significance of information transfer in fundamental biological processes are presented in the works of M. F. Vedenov and V. I. Kremyansky¹⁴, and F. Grodins¹⁵.

Taking into account the examples and arguments cited above, it appears to us that if Aristotle’s material, formal, and efficient causes can be understood as the transfer of matter and motion, then the final cause should perhaps be understood as a program.

Thus, if the cause is interpreted as a relation, it is reduced to the interaction of substances with an exchange of structural elements, energy, and information. If by cause one understands the immediate conditions of the relation, then they apparently reduce to definite spatio-temporal relationships between substrates or systems and to a definite internal state of the systems. In this case, given the presence of the necessary conditions, the actualization of the causal relation is inevitable.

All that has been set forth above permits the following conclusion to be drawn. The identification of conditionalism with idealism cannot be considered justified; it is necessary to extract the rational kernel from conditionalism. The understanding of the causes of diseases as the conditions necessary for their occurrence appears to be the most correct, whereas the concept of the “principal cause” disorients medical theory. In studying the etiology of diseases, it is meaningful to distinguish the different aspects of cause-and-effect relations.

1. The Problem of Causality in Contemporary Physics. Publishing House of the Academy of Sciences of the USSR, Moscow, 1960, p. 53. ↩

2. M. Bunge. Causality. Foreign Literature Publishing House, Moscow, 1962. ↩

3. V. D. Zhirnov, “Some Questions of Reflection and Information in Biology and Medicine,” in: Philosophical and Social Problems of Medicine. Meditsina, Moscow, 1966. ↩

4. I. V. Davydovskii, The Problem of Causality in Medicine. Medgiz, Moscow, 1962. ↩

5. P. N. Veselkin, in: Philosophical and Social Problems of Medicine. Meditsina, Moscow, 1966. ↩

6. V. N. Sagatovskii, “Toward a Clarification of the Content of the Category ‘Cause,’” in: Some Questions of the Social Sciences in the Period of the Full-Scale Construction of Communism. Tomsk University Press, 1964. ↩

7. M. P. Konchalovskii, Selected Works. Medgiz, Moscow, 1961. ↩

8. G. I. Tsaregorodtsev. Dialectical Materialism and Medicine. “Meditsina,” Moscow, 1966, p. 126. ↩

9. S. Gurvich. Questions of Dialectical Materialism. Kiev, 1964, p. 259. ↩

10. G. I. Kositsky. In the collection: On the Problem of Causality in Medicine. Medgiz, Moscow, 1965. ↩

11. Sh. Auerbach. Genetics. Atomizdat, Moscow, 1966, pp. 156–157. ↩

12. S. I. Ginzburg-Kalinina. On the question of the influence of heredity on the development of immunobiological factors of the organism. Vestnik AMN SSSR, 1965, No. 3, p. 49. ↩

13. J. Haggis, D. Michie, A. Muir, K. Roberts, P. Walker. Introduction to Molecular Biology. “Mir,” Moscow, 1967. ↩

14. M. F. Vedenov, V. I. Kremyansky. The Relationship of Structure and Function in Living Nature. “Znanie,” Moscow, 1966. ↩

15. F. Grodins. Control Theory and Biological Systems. “Mir,” Moscow, 1966. ↩