I know people dealing with Long COVID. The root cause, the COVID virus, is easily identifiable and outside their body. The only way this helps with treatment is knowing they're not dying from cancer. What does help? Figuring out all the inside-the-body issues, like post-nasal drip, vagus nerve dysfunction, gut issues, vitamin imbalance, blood clotting, immune suppression, and then going and treating those.
Lots of people break arms. Sometimes it's a lifestyle issue. Maybe they should go mountain biking less often. Even if they threw away their bike, it wouldn't fix the currently-broken arm.
Many times—probably most times—damage is closer to random than recurring, and looking for causes outside the body has marginal gain compared to just fixing the body.
Medicine doesn't have cures for every disease, so of course finding the root cause isn't always going to be able to help you. Failing to find the real root cause is a trap when that failure causes you to miss out on a cure.
Many times—probably most times—damage is closer to random than recurring, and looking for causes outside the body has marginal gain compared to just fixing the body.
I mentioned GERD in my post. That's 20% of the population walking around with a curable, externally-caused disease, almost all of whom have no idea. GERD exploded in prevalence over last few decades, so of course it's not some randomly caused genetic disorder. 20% is a big number. There are many other diseases that follow a similar pattern. I don't see how it could be true most of the time that disease is just random.
I am a bit skeptical that it is always (or more than 90% of the time) true that there is a root cause outside the body that is useful to identify. For example, maybe someone goes through a stressful life period, and this, combined with some kind of genetic susceptibility, triggers an autoimmune condition. It might be more useful to trace back to that autoimmune condition and then consider that "the cause" without tracing back further, because the external causes might be very arbitrary and uninformative in the context of your current state.
I think your framing makes sense under the assumption that the body is very functional and very self-correcting by default, such that any malady can be traced back to some intervening genetic situation or external circumstance, which then becomes super informative about which interventions would be best. I think this is like not a bad assumption. I am not sure how much I agree with it. Probably I think it's at least a little underrated as an assumption.
I think the human body is super complex, and it's good to keep an open mind about how to think about any given health issue and how to frame health in general, so I would worry about someone getting too attached to this frame. But I still think this is an interesting and useful perspective.
If my doctor told me my autoimmune condition was caused by stress triggering a genetic susceptibility, I would be very suspicious and spend a long time ruling out every other possibility. But I accept that you're right that sometimes the outside-the-body root cause is basically too hard to figure out, or not helpful to figure out. I'd have a hard time assigning a useful probability to how often that's the case.
Sometimes cancer occurs without any carcinogen exposure, some tiny percentage of cells simply experience random mutations while transcribing DNA, and some tiny percentage of those mutations manifest as cancer. I don't see how this can be attributed to anything but the system itself, it doesn't even need your parents to pass you cancer risk genes.
The body is full of stochastic processes which, in their natural state, almost always work. Sometimes you just get unlucky. This post seems much too quick to overlook that type of health issue.
I agree that the system can break by itself without specific external cause, but I also think from my own observations that current medical practice is extremely often accepting too shallow explanations and applying far suboptimal treatments because of it. I like the look-until-the-cause-is-external heuristic, though it may be unachievable in many cases (e.g. polygenic diseases are poorly understood) and occasionally wrong when the cause is actually a random degradation inside the body.
I agree with you that such diseases exist. I think the rest of society is already doing a too-good job taking that kind of health issue into account, so I want to present the alternative view. And by the way, I think even with cancer, people are too quick to accept a random-chance explanation, when a round a third of cancer cases come down to lifestyle factors.
How is this any more plausible than saying "the root cause of your car issues is always outside of the car"?
I think the plausibility might differ between different kinds of systems. For example: What if you replace car with computer operating system, and add that it has been hardened for a billion years by an optimization process and as one result is full of error-correcting/self-repair mechanisms? Does that change how plausible it is that observed issues mostly have external causes rather than the system breaking under its own normal operation?
Obviously the human body has a bunch of self-repair and homeostasis mechanisms a car does not, but even given that, I suspect the root cause of your car issues is probably usually outside the car. Do you change your oil on time? How do you use the brakes? What climate are you driving in? How low do you let the fuel tank get before refueling? I would guess the majority of car issues come down to user behavior and environment.
You can never stop the inevitable decline from wear and tear over the years. Not so different from a human being. But during the expected useful life of the machine, I think the root causes will be mostly outside the car, and you'll be making the exact same mistake as I pointed out in my post if you behave otherwise.
Often the best way to understand why other people do things we view as "irrational" is to notice why we do the same things. Or at least, what the closest thing is that we do, and why we do that.
In this case, you stopped at "I had a desk job", and labeled that the root cause. You came up with "it's outside the body!", and rested on that to justify the halt.
But does "I had a desk job!" not have a cause? Might not the cause dip back into the system with something like "I wanted money, and that was the best paying job available"? Maybe the root cause is greed?
Why do you count "My internal decision making used my internal muscles to orient my neck in a certain way for hours per day" as "external", but "lack of a high fiber prebiotic diet, the way my body evolved to expect" isn't an external root cause? Lack of vitamin C is pretty clearly the "root cause" of scurvy, so this seems like a valid type of explanation. And once you notice that "lack of input" counts, even "lack of exogenous opioids" fits your criterion for a root cause of the pain — which it clearly isn't.
The tree of causality has many branches, and it's possible to intervene at any of them. The fire was caused by the fuel! No, by the oxygen! No, by the ignition source! Maybe a prebiotic diet would have fixed your stomach issue and things would have been fine. Maybe it would have been insufficient because you'd still have to fix your neck issues, but this criterion couldn't tell you.
A "root cause" is a cause from which all other symptoms stem. Technically, there is no root as we can always keep going, but we can make pragmatic decisions about where to prune our representations of this tree of causality. Your "external to the body" heuristic, when applied intuitively as you do, is a heuristic. It is not the thing itself, and the "root cause" for a lot of rationality failures has to do with a failure to track this distinction, and giving in to the temptation to stamp our pragmatic decisions with the rational seal of approval.
Or at least, noticing that node does a lot for ya. The tree keeps going.
It's a heuristic that works because it usually stops the mistake where you think you've identified the thing that's wrong, but actually there's another thing that you would like to know is wrong, but you don't know it, in that if you found out about it, you'd be glad you found out about it.
The reason this works is that the human body is very complicated and unknown, and finding a cause outside the body means finding a cause that's easier to reason about, like desk sitting or a toxic molecule that entered your body.
But it's just a heuristic to help people avoid a common and dangerous mistake. Of course, the tree of causality can be traced back as far as you want, until you end up invoking the Big Bang.
Many people make costly mistakes when reasoning about their health. Even most doctors make this mistake, because it's not a mistake that's caused by a lack of medical knowledge. Rather, it's caused by a lack of clear thinking.
I doubt this is caused by lack of clear thinking on the doctors' part.
The process of identifying root causes you advocate is resource and time intensive. Sure, a determined patient, such as yourself, could go on the journey of finding some root cause, but this is not scaleable.
Consider, a man with insomnia goes to the doctor and hears:
"Instead of doing the foolish thing of stopping at diagnosing you with insomnia, I'll to the wise thing. Could you tell me in detail about your lifestyle and family history? This interview could take several hours, we wouldn't like to miss the root cause outside your body, after all. If this fails, I'll order a vast array of medical tests, it will be expensive and take a while, no guarantees it'll work. But we MIGHT identify some cause outside the body, wouldn't that be grand."
Physicians do this to a much smaller extent, when the expected value is especially positive. But giving the full treatment above for every patient, and for every not-fully explained health problem, would overwhelm the healthcare system and the benefits seem doubtful.
Additionally, the median patient is a constraint as well. You may want to have a doctor such as the one I described above, but I'd expect the median patient to not go along with this arduous and expensive process which may or may not lead to a solution at the end. Even if you identify some root problem in the patient's lifestyle, this is unlikely to solve much. My understanding is that convincing patients to make even minor lifestyle changes is extremely hard, while convincing them to take pills is easier.
Doing a full root cause analysis may be costly, but simply not pretending we already found the root cause is not costly and misleads the patient into not finding the root cause on their own. The reason they don't avoid such pretending is that they're not pretending: they actually think GERD is the root cause of acid reflux, or depression is a lack of seratonin. This is a lack of clear thinking.
This seems actionable, and is unaccompanied by any action -> effect pairs. You don't directly assert that your stomach pain is gone, or what you changed about your desk job, let alone how sure you are that your change to your change to your desk job fixed your stomach pain. Details!
Stomach pain is gone because I treated the symptom with slippery elm powder. I definitely believe in treating symptoms also, just not treating symptoms only.
As for my overall health issues, I only got to the last part of the chain a few days ago, so I can't report on how a change to my desk job will change my other health issues yet. Though I now know when my neck is strained after too many hours of sitting at my desk, or by doing neck exercises, my health issues all get worse for a few hours/days, so I'm at least not uncertain about the cause now.
I'll write a follow-up months from now.
The idea of evidence-based medicine is to find symptom clusters and then test which interventions improve those without focusing on root causes. The idea that psychiatrists are just believing in the straw theory of neurotransmitter imbalance when they give drugs to treat depression isn't really matching of that profession operates. It rather focuses on giving out drugs because of their effect in clinical studies.
Evidence-based medicine rests on the idea that you don't just give patients drugs because of theoretical reasoning about root causes. I do think that it's worthwhile to question dogma from time to time including that of evidence-based medicine, but I don't think that this post really engages with the status quo's reasons for doing medicine the way it's currently done.
I call publication bias on your (as of itself interesting) chain example.
The root cause of a health issue is always something outside the body. (In the case of genetic disorders, the root cause is your parents giving you bad genes, and your parents are outside your body.) Our universe is material, and operates on cause and effect.
If you really want, root cause of everything is Big Bang (or whatever modern physics suggests).
But your own example defeats the implicit claim that this root is what matters. You know most gene annoyances cannot be removed by (i) post-natally prevent your parents to give you the genes you got nor even by (ii) simply changing your genes - with current SOTA medicine.
So it's all a bit overselling the argument in your article even if the bare thought that one shouldn't overlook 2nd and 3rd and so underlying chain elements may of course often be a good idea and too often overlooked. The way you present it here seems more suitable for a superficial esotherism book than a soberly argued for rationalist case imho.
I can't make a soberly argued for rationalist case for medical analysis because I'm not a doctor or even someone that interested in medicine. I just wanted to share my experience and a heuristic I find useful, and which seems to be missing from many people's thinking about medicine.
I agree that sometimes finding the external root cause won't be helpful, as in the case of genetic disorders (aside from stopping you from pursuing other avenues of treatment that won't help you). But you won't know whether finding an external root cause will help you until you do it, so in that sense it's worth doing.
The idea about digging for the root cause and treating it is useful. But the idea that the root cause is always outside the body is stupid.
Replace always with in the majority of cases and the idea seems fine. A complication is also that genetic problems we currently understand are mostly monogenic ones, while in the territoty we should expect a lot of polygenic issues that we can't put on the map yet.
Many people make costly mistakes when reasoning about their health. Even most doctors make this mistake, because it's not a mistake that's caused by a lack of medical knowledge. Rather, it's caused by a lack of clear thinking.
People experience symptoms, and then they look for the root cause of their symptoms. For example, somone with heartburn or pain in their stomach might decide the root cause of their issues is excess stomach acid/GERD (GastroEsophageal Reflux Disease -- a disease affecting around 20% of the population!!). They then treat this root cause with antacids, often for many years. These people sometimes die of esophageal cancer, because the identified root cause was not the true root cause, and the treatment was imperfect.
The mistake was identifying a root cause inside the body. The root cause of a health issue is always something outside the body. (In the case of genetic disorders, the root cause is your parents giving you bad genes, and your parents are outside your body.) Our universe is material, and operates on cause and effect. You can always, in theory, trace the causes back far enough to find one that's outside your body. This is important, because if you identify a cause within your body, you can't be sure there's not another cause inside your body, causing that cause.
My story, briefly: I initially started having stomach pain. Later, I developed lower GI issues, like bloating. I initially attributed these issues to bad gut bacteria, which I did in fact have.
If I had decided that bad gut bacteria were the root cause of my health issues, I would have taken antibiotics and probiotics to correct that issue, but it would have kept coming back, and I would have been chronically ill for life, having to go through cycles of antibiotics repeatedly, which I did for a while.
The bad gut bacteria were most likely caused by stomach acid and bile flow issues. Took me a while to figure that out.
If I had decided that excess stomach acid or low bile flow were the root cause, I would have taken an antacid or a bile supplement, and I would have been chronically ill for life.
The stomach acid and bile flow issues were most likely caused by vagus nerve dysfunction. Took me a while to figure that out too. I won't go into all the details, because they're not important, but one thing that helped was developing new symptoms (heart palpitations) that were clearly not related to acid/bile.
If I had decided that vagus nerve dysfunction was the root cause, I would have done vagus nerve calming methods like ice packs, deep breathing, and vagus nerve massages, and I would have been chronically ill for life.
The vagus nerve issues were most likely caused by muscle tension in the neck. I figured this out when a physiotherapist released muscle tension at the back of my neck, and the episode of heart palpitations I was having stopped quickly afterward.
If I had decided muscle tension in my neck was the root cause, I would have done regular physiotherapy to release the muscles and gotten regular massages, and I would have been chronically ill for life.
Fortunately, it was easy for me to see that the tense muscles were themselves caused by my desk job. This is the real root cause, which you can tell, because it's outside my body. This is the only thing I can fix or work around that will fully fix my health issues. Everything else is only treating symptoms.
There are no shortage of doctors, naturopaths, etc. who would only treat the bad gut bacteria, or only treat the stomach acid issues, never finding the root cause of what's wrong. I met several of these people. The utter disinterest health care practitioners have when it comes to identifying root causes -- even good, kind, caring practitioners -- was shocking to me. But medical school doesn't teach you to think, it teaches you about medicine. The sheer number of non-root-cause diagnoses in medicine is a sign of how irrational the whole field is when it comes to this. "IBS" doesn't even pretend to identify a root cause. Mental health issues are often blamed on chemical imbalances in the brain (which is inside the body). Insomnia is treated with sleeping pills. And so on.
Just today I saw a woman on TikTok describing how she was sick of doctors not finding the root cause of her POTS (a condition giving elevated heart rate when changing body position), which she'd had for five years. Doctors would treat the heart rate itself, prescribing her beta blockers to stabilize her heart rate. She eventually decided on an admirable, high-agency strategy: she called neurology clinic after neurology clinic, asking them if the testing they perform would be able to show her exactly what's wrong with her, without any guesswork. If they equivocated, she'd hang up and call the next clinic. She eventually came across a functional neurology clinic that satisfied her requirements, and did a tilt table test. What that test showed was that her brain's blood flow was dropping first (by 70%!), before the elevated heart rate kicked in. So the root cause of her POTS, she concluded, was cerebral hypoperfusion (low blood flow to the brain), caused by broken reflexes that control blood flow and heart rate in the brain. Her TikTok video ended on a note of hope, describing how now she's found the root cause of her health issues.
Notice, however, that the brain reflexes that control blood flow and heart rate are inside the body. That means some exterior cause exists, but has not been identified. By random chance, I think I know what it might be. In one comment, the woman admitted to having EDS (Ehlers-Danlos syndrome, a hypermobility disorder). Again, I'm not a doctor, but from my own health investigations I discovered that people with EDS often have blood flow issues to the brain because of a neck issue called cervical instability. The neck ligaments become stretched out, and the upper spine bones move around too much, putting pressure on nerves and blood vessels, especially during position changes. I suspect this woman will eventually discover her neck is the cause of her blood flow issues, and that the EDS is the cause of the neck issues. EDS is an inherited disorder, caused by your genes, and your genes come from your parents, which are outside the body, so that could complete the root cause analysis. If this is the case, then this woman is going to spend who knows how long messing around with trying to retrain her brain's broken reflexes, treating a "neurotransmitter failure", when her brain is fine, and her neck is the issue. I could be wrong! The root cause could turn out to be something totally different! But what it cannot be, is broken reflexes in the brain, because the brain is inside the body.
Sometimes, there can be more than one external cause. Sometimes, you won't be able to figure out the root cause at all. The human body is not fully understood. But then, if you're adhering to the outside-the-body standard, at least you know you don't know the answer! At least you know to keep looking, unlike the millions of people currently taking antacids who explain their stomach acid issues by saying "I have GERD" and don't even realize there's an unanswered question lurking in the background, or all the people who attribute their depression or anxiety to neurotransmitters! I often wonder just how many millions of people currently suffer from chronic health conditions simply because they don't even realize the root cause of their health issues has not been found. I also wonder if medicine itself would benefit from adopting an outside-the-body standard to make it clear what diagnoses are root causes and which are only intermediate explanations.
Being very intelligent doesn't make you rational. Being very educated doesn't make you rational. A doctor knows a lot about the body. A rationalist knows how to think. They know that the universe is made of tiny balls bumping into each other, and that everything can be explained in these terms. Only the rationalist has heard Richard Feynman ask why recursively, and read Eliezer Yudkowsky explain why some explanations aren't actually explanations. I've tried to identify the exact rationalist principle that would lead to the outside-the-body test, but I can't think of what it would be. Still, it's clearly a rationalist maneuver, to say that no, this intermediate explanation cannot be good enough. No, changes to this system cannot be caused by the system itself. Trace it back far enough, and you'll find a cause outside the system, or the system couldn't have changed at all.