One of the vital intriguing information tales of the brand new 12 months claimed that the Epstein-Barr virus (EBV) is the “trigger” of A number of Sclerosis (MS), and prompt that antiviral drugs or vaccinations for Epstein-Barr might remove MS.

I’m not an MD or an epidemiologist. However I do suppose this text forces us to consider the that means of “trigger.” Though Epstein-Barr isn’t a well-recognized title, it’s extraordinarily frequent; a superb estimate is that 95% of the inhabitants is contaminated with it. It’s a variant of Herpes; for those who’ve ever had mononucleosis, you’ve had it; most infections are asymptomatic. We hear far more about MS; I’ve had associates who’ve died from it. However MS is way much less frequent: about 0.036% of the inhabitants has it (35.9 per 100,000).


Study sooner. Dig deeper. See farther.

We all know that causation isn’t a one-size-fits-all factor: if X occurs, then Y all the time occurs. Plenty of individuals smoke; we all know that smoking causes lung most cancers; however many individuals who smoke don’t get lung most cancers. We’re positive with that; the causal connection has been painstakingly documented in nice element, partly as a result of the tobacco business went to such nice lengths to unfold misinformation.

However what does it imply to say {that a} virus that infects nearly everybody causes a illness that impacts only a few individuals? The researchers seem to have executed their job nicely. They studied 10 million individuals within the US navy. 5 % of these had been unfavorable for Epstein-Barr at first of their service. 955 of that group had been finally recognized with MS, and had been contaminated with EBV previous to their MS prognosis, indicating a danger issue 32 occasions increased than for these with out EBV.

It’s definitely honest to say that Epstein-Barr is implicated in MS, or that it contributes to MS, or another phrase (that would not unreasonably be referred to as “weasel phrases”). Is there one other set off that solely has an impact when EBV is already current? Or is EBV the only real reason for MS, a trigger that simply doesn’t take impact within the overwhelming majority of individuals?

That is the place we’ve to suppose very rigorously about causality, as a result of as vital as this analysis is, it looks like one thing is lacking. An omitted variable, maybe a genetic predisposition? Another triggering situation, maybe environmental? Cigarettes had been clearly a “smoking gun”:  10 to twenty % of people who smoke develop lung most cancers (to say nothing of different illnesses). EBV might also be a smoking gun, however one which solely goes off hardly ever.

If there aren’t any different elements, we’re justified in utilizing the phrase “causes.” But it surely’s hardly satisfying—and that’s the place the extra exact language of causal inference runs afoul of human language. Mathematical language is extra helpful: Maybe EBV is “vital” for MS (i.e., EBV is required; you possibly can’t get MS with out it), however clearly not “ample” (EBV doesn’t essentially result in MS). Though as soon as once more, the precision of arithmetic could also be an excessive amount of.

Organic programs aren’t essentially mathematical, and it’s attainable that there is no such thing as a “ample” situation; EBV simply results in MS in a very small variety of cases. In flip, we’ve to take this under consideration in decision-making. Does it make sense to develop a vaccine towards a uncommon (albeit tragic, disabling, and inevitably deadly) illness? If EBV is implicated in different illnesses, probably. Nevertheless, vaccines aren’t with out danger (or expense), and despite the fact that the danger may be very small (as it’s for all of the vaccines we use right this moment), it’s not clear that it is smart to take that danger for a illness that only a few individuals get. How do you commerce off a small danger towards a really small reward? Given the anti-vax hysteria round COVID, requiring kids to be vaccinated for a uncommon illness may not be poor public well being coverage; it may be the tip of public well being coverage.

Extra typically: how do you construct software program programs that predict uncommon occasions? That is one other model of the identical downside—and sadly, the coverage resolution we’re least more likely to make is to not create such software program. The abuse of such programs is a transparent and current hazard: for instance, AI programs that faux to foretell “prison habits” on the premise of the whole lot from crime knowledge to facial photos, are already being developed. Many are already in use, and in excessive demand from legislation enforcement companies. They’ll definitely generate much more false positives than true positives, stigmatizing 1000’s (if not tens of millions) of individuals within the course of. Even with rigorously collected, unbiased knowledge (which doesn’t exist), and assuming some form of causal connection between previous historical past, bodily look, and future prison habits (as within the discredited nineteenth century pseudoscience of physiognomy), it is vitally troublesome, if not inconceivable, to motive from a comparatively frequent trigger to a really uncommon impact. Most individuals don’t change into criminals, no matter their bodily look. Deciding a priori who will can solely change into an train in utilized racism and bias.

Virology apart, the Epstein-Barr virus has one factor to show us. How will we take into consideration a trigger that hardly ever causes something? That may be a query we have to reply.



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