In my recent wandering of the net, I came across a thought piece entitled, A Theory of Reality as More than the sum of its parts. The article discusses the mathematical work of a theoretical neuroscientist (who knew of such a field?), Erik Hoel, in trying to unite the reductionist belief that “all behavior arises from mechanistic interactions between particles,” with the belief in agency, that our behavior is goal oriented and intentional. He is attempting to reconcile these two ancient adversaries, determinism where actions are fore-ordained and predictable; and free will where we have choice or agency.  And why should you be interested? Because these beliefs anchor the philosophic poles underlying our search for cause in the phrase ‘cause and effect;' and because if cause is deterministic it allows for predictability, while free will as a cause, introduces increasing uncertainty.
Science seeks to explain the effects we see all around us. In more ancient times, effects were manifest to everyone, for example, solar eclipses. For a long period of time, eclipses were ascribed to agency, the intentional acts of the gods. They were unpredictable. But with the application of the power of reductionism (as deductive reasoning), the underlying cause was found to be the orbits of the planets and moons about the sun – movement governed by fundamental rules. Based on those fundamental laws, we predict, with great accuracy, when solar eclipses will occur.
Today, not all effects are easily visible; some are uncovered by the reductionist tools of averages or statistics, for example, the increasing body mass index (BMI), a measure of obesity in the American population. Similarly, causes are often identified through mathematics and confirmed by science’s objective measurement, for example, the Higgs Boson. Effects and underlying causes are often trumpeted in the news, it is science’s public face, and the frequent variable even contradictory nature, particularly for cause, reflect the poles of determinism and agency. Is the underlying cause of increasing BMI genetic and therefore pre-determined or is it a lack of will and motivation and therefore a result of choice and agency? Consider, the following:
“In a fatal drunk driving accident, what’s the cause of death? Doctors name a ruptured organ, while a psychologist blames impaired decision-making abilities and a sociologist points to permissive attitudes toward alcohol. Biologists, chemists and physicists, in turn, see ever more elemental causes.”
For the biologists, chemist and physicists there are fundamental laws governing microscopic or even smaller, atomic processes. There is no intentionality to the behavior of sodium bonding with chloride; it is a more stable lower energy compound. From this vantage point, cause and effect are predictable, and our failure to predict the accident is due only to a lack of computational ability to track all the variables. The microscopic or atomic scale we are using to view causality is too small for us to make meaningful predictions from our observations, so we group those small, highly predictable events into larger ‘chunks’ to facilitate our recognition of a cause. Our vantage point becomes less ‘granular’ we take in ‘the bigger picture” – a higher scale.
Doctors, psychologists, and sociologists work in fields, with few discernable fundamental laws, we are big picture people. As a physician, I understand electron transport, metabolic energy requirements, and nutritional needs but when I am asked to provide a cause of the obesity of the patient in front of me, I use the higher scale, informational chunks - the platitudes of eating less, eat better, exercise more. And while we might believe that some genomic difference is at play, many of those recommendations, in fact most health recommendations, are based on a belief in intentional behavior. Why else would we recommend choosing different foods or exercise?
This paradox, that fundamental, predictable, microscopic events, in turn, lead to macroscopic effects we believe are grounded by intention underlie much of what we measure and report in health studies. The contradictory results we discover may well have to do with the scales we have chosen. Surely a study that finds just one glass of wine increases your risk of breast cancer is too coarse a scale. And equally true, BRCA mutations, which result in 45 to 65% of women developing breast cancer, are too granular. I say this because the remaining 35 to 55% of those women do not develop breast cancer; a strongly suggestion that a BRCA explanation is incomplete.  It is a bit like Goldilocks, too big and too small, what is just right?
Hoel’s mathematics seeks to identify how far up the scale we need go to determine cause effectively. He believes that as you scale up from ‘hard’ sciences’ fundamental laws to ‘soft’ sciences’ chunkier explanations, you find a point at which identifying cause is optimal – “predicting future states in the most reliable, effective manner.” Hoel’s mathematical work tries to unite how the fundamental components ruled by determinism may give way to agency – at what point do the simple rules become complex volitional behavior. For me, Hoel’s work suggests that the contradictory and paradoxical causes identified in the soft science of healthcare are due to views that are not appropriately scaled. Some are grounded in determinism, too granular; and others rooted in agency and too sweeping.
Humans are pattern seekers; it is what we do. Difficulties arise because of our new abilities to look simultaneously so close and far. We haven’t found the right scales, the right way to chunk the fundamentals to explain the macroscopic. Science’s power to explain and predict is, in part, about finding the right scales to measure and describe, that sweet spot as determinism gives way, possibly, to the choices of free will. Unfortunately, that work is just not as attention grabbing as “Just one alcoholic drink a day increases risk of breast cancer, study says.”
 For a fascinating discussion of emotion as determinism or free will listen to the first two episodes of this year’s Invisibilia. Perhaps emotion is more pre-determined than we realize.
 This is not to say the BRCA mutations are not a major causal agent, just that they are insufficient explanations of cause.