by Dr. Marcel Behr and Dr. William Chamberlin

In these first two videos, Dr. Behr and Dr. Chamberlin introduce the conference, frame the issue of MAP and address the issue of causality.

Transcript

Marcel Behr:

Good morning. Marcel Behr from McGill University in Montreal. First thing I would like to do is thank Todd who for being very organized and thorough, getting us here, getting a room, and getting his chair to pay us a lunch, and all that type of stuff, and I think we are quite impressed with all the work you’ve done, and I think we should just applaud you right now, so we don’t forget.

One of the instigating ideas of what we wanted to cover today is summarized in Todd’s excellent plan for the meeting is to follow up on a 2007 meeting that was held, sponsored by the American Academy of Microbiology, so, the funny thing is that some of the people in the room were at that 2007 meeting, none of us has aged, it’s already ten years later. And one of the questions is whether we have gone forward or like that Hollywood film about the wine drinker in California, whether the field has sort of moved sideways. It is unclear to me that anything has presented in the last decade that has stopped the hypothesis, or eliminated the hypothesis or said, ‘don’t do what you’re doing’, but it’s a chance for a lot of us to do some soul searching and say ‘so what have we done constructively in the last decade, so that we can start to build and say so what can we do from 2017 to 2027, because we probably don’t want to have the same agenda 20 years from now. We’d like to move this forward somehow.

So, how do we move it forward? I think what we want to do is we wanted to be scientifically thoughtful, constructive, insightful and if necessary, critical while maintaining at a human level a common sense of decency and respect so that we can have ten minutes of question and answer after every talk, and we can respect the differences of opinion and try to work our way forward. And not, in the words of Kapur who with me co-wrote a summation he said, “sometimes the discussions bring more heat than light”. And I think we really want more light than heat. So, I think that’s the goal of the next two days and let’s see if we can see that forward. Thank you all for attending and we look forward to more discussion.

William Chamberlin:

What I am going to talk about now. Here are a few thoughts and what we want as I see as the goal is to get a consensus statement at the end whether you think that Mycobacterium avium paratuberculosis causes symptoms in people. Does it infect people and cause symptoms? How sure are you of your statements? You can say, you don’t think it at all, but we have already selected out a group, but how sure are you? Give probabilities.

Now I am going to promise, what I am, my talks are going to be very quick and pithy and move on because I don’t think that what I have to say is all that important. What we are going to be doing now, is we’re going to be having to address certain concepts, and the first is causality. Now I am going to ask you to spend five minutes on your cell phones at night, just google ‘causality’ and look at the different philosophical traditions that defines what the cause is, and you can see that it covers a spectrum, and you can see how hard it is, if not impossible to actually prove causality.

And I am going to refer you to the Davids right now. The first is David Hume which was a mid-1700s British philosopher and paraphrasing what he said was that you can never prove cause, the best you can do is identify predictable associations of ‘A’ with ‘B’. You can always come up with some theoretical explanation why it’s not causal, but it is based on the probability today, ‘A’ is associated with ‘B’ that we can start discussing causality. And the other David, is David Graham, who says at the end of this conference all we are going to have is associations, we are not going to prove causality, so, I am going to be asking you at some point in time there is going to be a threshold, that we’ve got to act upon and we are just going to have to define it, and that can be all individual, at what point are you going to say, that ‘A’ is the cause of ‘B’?

The other thing that we are going to address, is epistemology, which is a subset of philosophy that deals with knowledge. How do we know what we know? And this Venn diagram here says it best. We’ve got our beliefs, some of which is true, some of which isn’t true. And then there is this theoretical construct that we call truth that’s out there. And where it overlaps, we are right, those are our true beliefs. Knowledge is something different. Knowledge is what we can justify, our justifiable beliefs and you got to decide where you think we are in this whole process right now. Have we moved into knowledge or are we very close to it? That’s all part of it.

As Marcel was saying, let’s not back track, the 2007 meeting, we’ve got proof that MAP is associated with Crohn’s disease. MAP is an infection. Okay, let’s not backtrack, and I’ve just lifted this slide from something, a talk that Tim Bull gave long ago, and MAP is seven times more prevalent in Crohn’s according to this, a lot of the work done by these people. And it is also present in normal controls, in normal people that are considered to be healthy.

Now if we can go on and on and on about is MAP a causal agent or not, and by putting a finer point on it, we can grind it down to pencil dust. We can never prove anything for certain, we can only increase the probability of it being so and at some threshold we’ve got to act. So that is a consensus group, is really what I am asking you to do now and think about what threshold you will need. Now this is just a statement, and it is not so much directed against you, but we are being recorded and this is going to go out on the Internet, and this is to explain to the people out there that may be looking at this a month, two months, a year from now. What are we actually doing?

So, I am going to paraphrase an anonymous author, ‘I cannot know anything for sure, but I must act’, therefore I act on probabilities, I can observe and see associations, I can form hypothesis and create explanations. I can further observe and call my explanations theories, and create greater stories to explain what I see. And these stories influence how I think and become paradigms. And through them, I interpret and give meaning to what I see. And if enough other people also believe these stories, then these associations are called facts and our stories are considered truth until they change. And thus. I do not know anything for sure, but I must act and I do so on probabilities. Passing thought, there you go…