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Confusing correlation with causation: the most common error in science

The universe can be a very confusing place.

Quite often, things will happen together or one-after-another that will cause even learned people to connect two events as causative when they are not. These misattributions are not just of academic concern. They can have real-world consequences.

In 1347, a plague began to sweep through Europe. At the time, no one knew what caused plagues, and the germ theory of disease was centuries away. A millennium before, the Romans had believed that “bad air” was the culprit. Often referred to as a “miasma,” brilliant physicians like the fabled Galen believed and taught this concept. Miasma was associated with decaying organic matter like corpses, sewage, garbage, and stagnant water (all very reasonable).

Miasma was also associated with moral or religious transgressions (less reasonable and susceptible to a multitude of competing interpretations). To fight this miasma, the Romans maintained good hygiene (an excellent course of action), quarantined the infected (superb), and forbade the burying of corpses within the city walls and the dumping of waste — all excellent actions to take. They also burned incense and herbs indoors and pitched outdoors in large cauldrons. The latter two measures were a little less brilliant, especially during Justinian’s Plague from 541 to 543 AD when pneumonia was a major component of the disease, and inhaling heavy fumes and tar was probably not the best therapy. But the old Romans were doing their best — as did the Europeans in 1347.

The Black Death, as it was called, swept across Europe and Asia, killing between 75 and 200 million people. If we go with 100 million, that would be 21% of the world’s population at that time. The survivors would have laughed at our panic over the recent pandemic, deadly though COVID was. However, the Europeans made a fatal error in assuming correlation vs causation, which compounded their death rate. Searching for a cause for the disease, religious figures began to blame it on divine judgment for humanity’s toleration of its own failings… and witchcraft, of course. No good demagogue misses the opportunity to blame a nation’s misfortunes on those whose numbers will never threaten them or influence a vote.

The Europeans fell victim to what is called observational bias. Looking for something to connect to the illness, they noticed there were a lot of cats around. These cats were often spotted near dead rats, which is not uncommon when millions of people are dying, leaving corpses and unprotected food around. The cats were proliferating and “known” to be the familiars of witches. Lots of death and lots of cats gave the simple equation that cats equal death; therefore, fewer cats would equal less death. And the game was on.

Lacking empathy for the targets of their suffering and ire, the populace quickly began tracking down any poor plague survivor who could be labeled a witch; just about any woman someone held a grudge against would do. And, of course, there were the witch’s guilty familiars, those pesky cats.

The problem, as we know it today, is that the disease is caused by a bacterium, yersinia pestis, which is carried by fleas– fleas living on rats, specifically. The rats had proliferated first, moving on ships and trade routes, rapidly spreading plague. The cats had proliferated in response to the rats and were doing their part, unknowingly, of course, to limit the plague. Then, humans started wiping the cats out, and that’s why all surviving cats dislike humans to this day. Or at least that’s my theory.

I bring all of this up in response to a recent article by Matt McCord and Brian Klepper. These men quoted Benjamin Franklin, my favorite founding father after Thomas Paine, and remarked on how preventing opiate addiction was much better than treating it — an argument with which I agree entirely. They then went on to say that “nearly 75% of heroin users report having been introduced to opioids through prescription medications. For them and for most Americans, a doctor provides the pill that can trigger opioid addiction.” Here is where we part ways.

The fact that someone has experienced an opioid medication and later goes on to develop an addiction is correlative but not causative. The fact is that five million young people have their wisdom teeth removed every year in the U.S., and another fifteen million Americans have root canals performed. Then we have fractures; about 40% of boys and 25% of girls experience a fracture before adulthood. Almost everyone has experienced an opiate of some type by the time they become a young adult. That in no way proves a causative link between this prescription and the development of addiction. How many of these young adults went on to experiment with early alcohol use and other drugs? 46.6%, according to a study in 2023. Yet almost 100% will have experienced severe pain. Why are these factors ignored? It is as reasonable to say that the illicit use “caused” addiction, or even that the inadequately treated pain predisposed them to addiction, as to say the prescribed medication, “pulled the trigger.”

Addiction is a multifactorial disease, with genetic, epigenetic, environmental, and behavioral contributions. It would be just as easy to find an experience of severe pain in their childhood that was not adequately treated and argue that deprivation of proper pain care causes addiction. I know it is popular these days to pretend that NSAIDs, Tylenol, and perhaps a good massage will alleviate this pain. If you hold that belief, I invite you to undergo an elective root canal and report back afterward.

Physicians and dentists did not create the opiate crisis. The federal government’s restricting the availability of relatively safe opiate medications and the targeting of physicians treating pain and addiction were the real causes. These actions left patients with no good options.

The DEA started restricting the availability of medications in 2015, and that is exactly when we see a dramatic spike in overdose deaths. The DEA seems to think that simply making medications unavailable cures a medical problem. This seems to me comparable to the Russian province of Chechnya declaring, “We have no homosexuals.” This is nonsensical. The pain is still there, and human beings do not tolerate pain well. Denial of pain relief sends them searching for other ways to acquire treatment, and that inevitably sends them to the street, where they find fake tablets laced with fentanyl. And lots of them die. If these were pharmaceutical tablets, they would not die.

It is here that we find the crux of the matter. The DEA is trying to eradicate all diversion at any cost. And just like the European cat killers, they are making things far worse in the process. Americans are the most overworked and undertreated population of any advanced nation. Europeans are horrified at the lack of work-life balance here, and rightfully so. While our economy as a whole prospers, it is at the expense of the average working man or woman. A single injury can leave someone on a disability income far below any reasonable living standard. Leaving hundreds of thousands of Americans in a desperate situation. With chronic pain, financial stress, and even hunger their constant companion. Who would not want to escape such a world?

The authors, I fear, are toeing the party line at exactly the time it is critical to do the opposite. According to the same CDC whose evidence-free “guidelines” allowed the government to target innocent doctors with flawed algorithms, among 34 States reporting to the SUDORS Dashboard, in 2020, illegally manufactured fentanyl was present in 69.8% of all overdose deaths. Legitimately prescribed opioids were present in 18.6% of reported overdose deaths. In 2022, fentanyl deaths continued to accelerate, with 74.6% involvement in overdose, compared to legitimately prescribed opioids in 12.5% of overdose deaths. Many other factors also contributed to overlapping cohorts, but the evidence is clear. Fentanyl flooding across border checkpoints is killing American citizens who are seeking an escape from terrible pain, citizens whose doctors are now afraid to treat them.

L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues. 

He can be reached on LinkedIn and YouTube.

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