Although it’s a common word, when we look closer, the verb “to cause” is often misused. The Oxford dictionary defines it this way: “Make (something, especially something bad) happen.” The dictionary uses “this disease can cause blindness” as a sentence example. Notice how the example uses the word “can” to mark a possibility. Let use a real-world example and change the “this disease” for “diabetes.” Diabetes can lead to blood leaks in the retina that could result in permanent vision loss. So, it’s true that “diabetes can cause blindness.” However, we can’t say “diabetes cause blindness,” because it is not all diabetes cases that will result in blood leaking in the retina, and it’s not all blood leaks that will result in blindness. It’s a possibility, not a certainty.
When we’re using the word “cause” as a noun instead of a verb, we often lose the possibility aspect. One typical example is the link between tobacco and lung cancer. We know that smoking increases your chance to develop lung cancer, but smoking doesn’t inevitably give a smoker lung cancer. Indeed, some lucky ones will never develop any cancer. Still, a person that smoke has a more significant chance to develop one than a non-smoker. Thus, the right thing to say is that smoking is a risk-factor to lung cancer.
However, in everyday language, we often say “smoking is a cause of cancer.” When we hear something like this, no one usually corrects the affirmation. Since the association between tobacco and lung cancer is so strong, we’ve accepted this risk factor as a cause. The criteria for which a risk factor can be considered a cause are still up to debates. Several epidemiologists proposed different benchmark. One of the most used is the Bradford Hill Criteria.
What is a Cause?
Let’s take an example. We have three hypothetical guys named Bob, Steve, and Sam.
Bob has a bad diet. By bad, we mean he’s always eating chocolate, fried chicken, and other sugary/fat foods. He eats too many calories per day, and he’s overweight.
Steve has the same diet, but he isn’t overweight. Because of his active life and his metabolic rate, Steve compensates for his caloric intake and burns all his everyday calories.
Sam has a healthy diet. Although his calories intake is typical for someone of his age and sex, he’s still overweight. Sam suffers from hypothyroidism which results in a slower metabolism that burns fewer calories. Added to the fact that he’s not doing a lot of physical activities, he’s overweight even if he eat fewer calories than Steve.
As you can see, a bad diet isn’t always synonym of a weight problem. Also, it’s possible to be overweight by eating healthy food. Still, the bad diet is responsible for Bob’s weight problem. So, does a bad diet is a cause of obesity?
It depends on your definition of cause. Kenneth Rothman, a famous American epidemiologist, define a cause as “an event, condition, or characteristic without which the disease would not have occurred.” As you can see, to be considered a cause, we have to be sure that the condition wouldn’t have happened without this specific factor. So, in a specific example, like Bob’s case, we can say that his bad diet caused his obesity. If Bob were eating less calorific food (healthier diet), he wouldn’t be overweight.
However, when we’re talking about the general condition, it isn’t so clear. Of course, if you have a bad diet, you increase your chance of suffering from obesity. In everyday language, it’s accepted that a bad diet is a “cause” of obesity since it’s the cause of a lot of individual weight problem. However, what’s causing the weight gain is the difference between the calories intake and the calories burned. Since a “bad diet” increase your calories intake, it increases your chances of gaining too much weight. That’s why the term we should use is “risk factor.” Although a risk factor can also be a cause, as we will see, it’s not all risk factors that are causes.
So what is a risk factor? A risk factor is anything that increases your chance of having a condition. A risk factor is based on the correlation principle.
The best way to explain what is a correlation is to use an example. Let’s say we take a group of person and we measure their weight and their calories intake. We draw a graph with the x-axis representing the average number of calories they eat per day and the y-axis representing their weight. For each person, we put a dot on the graph where the person stands in term of diet/weight ratio. If it looks like all the points are around a line, you have a correlation. In the example above, we have a positive correlation because the line goes upwards. If the bar were going downward, we would have a negative correlation.
However, if the points look scattered in random order, you do not have a correlation.
In simple terms, a correlation happens when a factor (like a diet rich in calories) can help us predict the occurrence of something (like the weight of a person).
However, you may have heard that correlation doesn’t imply causation. It’s not because a factor correlates with the condition that it causes it. There are several ways a risk factor could be linked to a condition.
The Types of Correlations
We have on this website a section called Causes of Premature Ejaculation. This section doesn’t list the premature ejaculation causes, but the risk factors. Although it can look misleading, it’s because nobody knows the exact causes of premature ejaculation. In scientific vocabulary, the term cause involves a level of certainty more important than in everyday language. Our list of premature ejaculation causes is, in fact, a list of factors that can potentially cause, or contribute, to premature ejaculation.
For example, anxiety is one of premature ejaculation risk factor. As you can read on the premature ejaculation and anxiety page, some studies show a correlation between some anxiety disorders and PE. However, it’s not clear that an anxiety disorder alone could cause the early ejaculation problem. In fact, there are several different relation types that could explain the correlation.
Some risk factor could worsen an already present condition. For example, if we take our anxiety and PE example, it’s possible that anxiety aggravates the situation without causing it. It would mean that without other factors, anxiety itself wouldn’t trigger the premature ejaculations. However, when combined with other factors, it makes the premature ejaculation worse.
If this is the case, treating the anxiety disorder would help the PE problem, although it wouldn’t address it completely.
Cyclic Causations (Vicious/Virtuous Cycle)
Sometimes, the aggravating factor could also be aggravated by the condition. It’s what we call a vicious cycle. For example, the anxiety could contribute to the PE, but the PE can also add to the anxiety.
If this is the case, treating the anxiety disorder would help the PE problem, although it’s not clear if it could address it completely.
Shared Cause (consequence of a common cause)
Another possible explanation for the correlation is that anxiety and premature ejaculation share a common cause. For example, if the premature ejaculation is caused by an imbalance in the nervous system, like a diminished level of serotonin, and that imbalance also causes some anxiety disorders, you will have a correlation.
However, in this case, treating the anxiety won’t help the ejaculation problem. To treat the PE, we would need to resolve the nervous system imbalance.
Reverse causation (consequence)
Another explanation for the anxiety/premature ejaculation correlation would be that early ejaculations cause anxiety disorders. In this case, anxiety doesn’t impact ejaculation. It’s the other way around. So, anxiety would still be a risk factor to PE even if it never causes premature ejaculation.
In this scenario, treating the PE would cure the anxiety problem, but addressing the anxiety won’t help the PE problem.
Direct causation (root cause)
The last explanation for the anxiety/premature ejaculation correlation would be that anxiety itself cause the PE problem. It’s what we call a direct causation.
In this case, treating the anxiety would treat the PE, but not the other way around.
When it comes to premature ejaculation, the link between each risk factors and the condition is never clear. For most risk factors listed on this site, scientists can’t clarify what is the correlation type. However, we know that most PE risk factors have multiple and complicated links. We can’t explain early ejaculations with simple, direct causations. PE’s risk factors probably look more like a web of indirect causation, aggravating factors and cyclic causation all linked together.