p then q then p again: effects as causes and the case of vicious circles in medicine Kent-UCL Causality Workshop UCL, 11 th August 2011 Brendan Clarke Department of Science and Technology Studies UCL

McArdle, 1951

Schmid and Mahler, 1959a

Mommaerts et al, 1959

Larner and Villar-Palasi, 1959

Schmid, Robbins and Traut, 1959

Schmid and Mahler, 1959b

Schmid and Hammaker, 1961

Pearson, Rimer and Mommaerts, 1961

Discriminating cause and effect is supposed to be easy The mind can never possibly find the effect in the supposed cause, by the most accurate scrutiny and examination. For the effect is totally different from the cause, and consequently can never be discovered in it. Hume 1975 (1748): 4.9

J.B Hurry The term ‘vicious circle’ (circulus vitiosus) denotes a morbid condition in which cause and effect are so correlated that cause becomes effect, and effect becomes cause. Hurry 1907: 1104

Hurry’s classification of vicious circles By system Single or concurrent? Specific or non-specific? (i.e. ns lowers resistance) By aetiology –Organic, mechanical, infective, chemical, neurotic Natural or unnatural? Number of components?

Medical examples Metabolic cycles Life cycles Homeostatic mechanisms Disease mechanisms

Metabolic cycles

Life cycles

Homeostatic mechanisms

Disease mechanisms

Philosophical causal examples Billiard balls Poisoned and punctured water bottles Nixon and the nuclear apocalypse …

Not a conclusion

Bibliography Boon et al Davidson’s Principles and Practice of Medicine 20th ed., Edinburgh: Elsevier Churchill Livingstone. Hume, D An Enquiry Concerning Human Understanding 3rd ed. L. A. Selby-Bigge, ed., Oxford: Clarendon Press. Hurry, J.B Vicious Circles in Disease. Third Edition. Blakiston’s: Philadelphia, PA. Kumar et al Robbins and Cotran Pathologic Basis of Disease 7th ed., Philadelphia: Elsevier Saunders. Solomon, L Apley’s System of Orthopaedics and Fractures 8th ed., London: Arnold.

McArdle bibliography Chen, Y., Glycogen Storage Disease. In Scriver CR, et al., eds The Metabolic and Molecular Basis of Inherited Disease. New York: McGraw- Hill, pp. 1521—51. Larner, J. and Villar-Palasi, C “Enzymes in a Glycogen Storage Myopathy,” PNAS. 45(8): 1234—5. McArdle, B “Myopathy Due to a Defect in Muscle Glycogen Breakdown,” Clinical Science. 10: 13—33. Mommaerts, W.F. et al “A Functional Disorder of Muscle Associated with the Absence of Phosphorylase,” PNAS. 45(6): 791—7. Pearson, C., Rimer, D. and Mommaerts, W “A Metabolic Myopathy Due to Absence of Muscle Phosphorylase,” The American Journal of Medicine. 30: 502— 17. Schmid, R. and Hammaker, L “Hereditary Absence of Muscle Phosphorylase (McArdle's Syndrome),” NEJM. 264: 223—5. Schmid, R. and Mahler, R. 1959a. “Syndrome of Muscular Dystrophy with Myoglobinuria: Demonstration of a Glycogenolytic Defect in Muscle,” The Journal of Clinical Investigation. 38(6): Schmid, R. and Mahler, R. 1959b. “Chronic Progressive Myopathy with Myoglobinuria: Demonstration of a Glycogenolytic Defect in the Muscle,” The Journal of Clinical Investigation. 38(11): 2044—58. Schmid, R., Robbins, P. and Traut, R “Glycogen Synthesis in Muscle Lacking Phosphorylase,” PNAS. 45(8): 1236—40.