|Mervyn Susser and his wife Dr. Zena Stein|
Mervyn Susser has died. The physician, epidemiologist, and philosopher of science was 92 when he passed at home in Hastings on Hudson. The former editor of the American Journal of Public Health, he was a South African-born progressive, who collaborated with his wife Zena Stein. I had just began to seriously look at the problem of how to prove causation of disease in occupational illness cases where no exact mechanism of injury could be identified. Susser gave me direction as I represented the Trial Lawyers Association in the asbestos-related disease case Landrigan v. Celotex, a landmark guide in the use of scientific evidence.
When I was in graduate school at B.U. Howard Zinn’s syllabus on method included Karl Popper, the positivist philosopher of science and anti-communist polemicist. Popper was a skeptic who asserted that propositions could not be proven, only falsified. On that foundation he built a vision of science that ironically saw it as the brick by brick construction of certainty. In the culture of science that view was embraced as a strong attachment to the null hypothesis and an extreme attachment to calculations of probabilities.
Mervyn Susser, like the great progressive epidemiologists Irving Selikoff and Sir Austin Bradford Hill, was motivated by the fight against disease and the need to identify causal relationships. The epidemics of heart and lung disease associated with tobacco and asbestos motivated Selikoff and Hill. Susser, a pioneer of community medicine, worked in a clinic treating Black citizens in Johannesburg. In the progressives view causal inference was to be achieved neither by idolatry of formal tests of statistical significance nor by anecdotal snapshots. Rather the public health called for a socially aware observational perspective informed by clinical methods, pathology, and biostatistics. No single factor was decisive. The health of patients called for effective strategies, not skepticism.
Susser's was always the approach of a physician concerned for his patients. He wanted to help and that required rejection of skepticism, magic, and authoritarianism:
"The philosophy of causal inference reaches deep into abstractions. Applied in clinical (practice), however, it yields some practical benefits. For clinicians, inference is a constant and every day activity. In going about their business of diagnosis and treatment, clinicians are constantly making logical inferences, that is to say, drawing conclusions from a set of facts and premises...This logic (of causal inference) enables the contemporary clinician, in dealings with patients, to shift from charismatic priest-like authority to the authority of tried knowledge and of rational predictions founded on explicit models of causal relationships."This approach offered guidance for judges and lawyers who seek to achieve a just result for those who suffer from illness, and for those who would act to prevent illness. Dr. Susser explained that scientific skepticism is to be doubted. “We have to practice believing”. He wrote:
In the end, a quality which lawyers should understand better than any- judiciousness- matters more than any. Scientists use both deductive and inductive inference to sustain the momentum of a continuing process of research. The courts of law, and the courts of application, use inference to reach decisions about what action to take. Those decisions often cannot rest on certitudes, most especially when population risks are converted into individual risks. It is my firm belief, nonetheless, that practical decisions that draw sustenance from scientific inference will be better decisions than those that do not.
George W. Conk
Against the Odds: Proving Causation of Disease with Epidemiological Evidence, 3 Shepard's Expert and Sci. Evidence Q. 103 (1995)
Causal thinking in the health sciences: concepts and strategies of epidemiology (1973)
`Causal Thinking in Practice: Strengths and Weaknesses of the Clinical Vantage Point', Pediatrics 74:842-849 (1984)
`The Logic of Sir Karl Popper and the Practice of Epidemiology', American Journal of Epidemiology 124:711-718 (1986)
`Rules of Inference in Epidemiology', Regulatory Toxicology and Pharmacology 6:116-128, 116 (1986)
Susser, Epidemiology, Health and Society, Selected Papers, Oxford University Press, New York, 1987.
`What is a Cause and How Do We Know One? A Grammar for Pragmatic Epidemiology', American Journal of Epidemiology 133:635-648 (1991)