Massachusetts Department of Public Health Listeria food testing prompts expanded national recall of Enoki mushrooms

In 2020, a total of 36 people infected with the outbreak strain of Listeria monocytogenes were reported from 17 states linked to Enoki mushrooms.

Testing conducted by disease investigators at the Massachusetts Department of Public Health (DPH) has led to the expansion of a national recall today of Enoki mushrooms, after two packages the investigators purchased in the Commonwealth tested positive for Listeria monocytogenes.

Guan’s Mushroom Co. of Commerce, CA said today it was recalling all packages of its Enoki mushrooms and suspending national distribution after tests conducted at the Massachusetts State Public Health Laboratory by staff from DPH’s Food Laboratory came back positive for Listeria monocytogenes, an organism that can cause serious and sometimes fatal infections in young children, pregnant women, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

The State Public Health Laboratory’s findings highlighted the presence of this organism in the company’s mushroom product found on store shelves in Massachusetts.

“This outcome of our food surveillance testing demonstrates how public health in Massachusetts works to protect the food supply and enable consumers to purchase products and dine out with confidence,” said Public Health Commissioner Monica Bharel, MD, MPH.

The company said the recalled products were distributed to retail stores nationwide from produce distributors in California, New York, and Pennsylvania. The company said no illnesses have been reported to date and credited DPH as well as routine testing by the Michigan Department of Agriculture and Rural Development for prompting the recall.

The Enoki mushrooms come in a clear plastic package with the description “Enoki Mushroom” in English, Korean, and French, with Guan’s logo in the front. On the back, there is a UPC code. For the 100g/3.5-ounce, the code is 859267007020 and code 810023170303 is for the 200g/7-ounce.

Listeria:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria and other foodborne illness outbreaks and have recovered over $800 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as lettuce, polony, deli meat, cantaloupe, cheese, celery and milk.

If you or a family member became ill with a Listeria infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Listeria attorneys for a free case evaluation.

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Healthy Recipe: Smoked Salmon Unda Wrap


This breakfast is an ode to the Indian street food, the egg kati roll, aka “unda style”, which means egg style. Traditionally, this dish has a flavorful filling in an egg omelette or crepe, with the whole thing wrapped in naan bread. 

Roll up this winning combination in tortilla bread instead (not unlike a homemade breakfast burrito), and you have a simple and delicious way to boost the protein in your morning routine. 

This recipe is a lower-carb and protein-rich spin on the lox and bagel concept. And once you get the hang of your “unda wrap”, you can experiment with many more tasty flavors. 


1 tablespoon low fat, plain Greek yogurt 

¼ teaspoon lemon zest 

½ teaspoon lemon juice, freshly squeezed


1 teaspoon extra-virgin olive oil

1 large egg, beaten and seasoned with salt and pepper

1 sprouted whole-wheat tortilla 

3 slices (about 2 oz/60 g) lox smoked salmon

⅓ small red onion, thinly sliced

½ teaspoon capers 

4 cherry tomatoes, sliced in quarters 

1 handful arugula


In a bowl combine yogurt, lemon zest, lemon juice, and a pinch of salt. Set aside.

Heat the olive oil in a small non-stick pan. Add the egg and swirl it around to create an even crepe-like base that covers the size and shape of your pan, similar to how you’d cook an omelette. Let the egg crepe set for approximately 1 minute. 

Next, lay your tortilla directly on top of the egg and press it down lightly with a spatula and give it about 30 seconds to bind. Gently flip the egg-tortilla combo over, tortilla side down, careful to avoid breaking or folding, and let it set for another 10 to 30 seconds. 

Once the egg has cooked through and your tortilla is warm, slide it onto a plate, egg side up. 

Smear the lemon yogurt across the middle of your “unda wrap”. Layer with smoked salmon, onion, capers, tomatoes, and arugula. Finally, roll like a burrito, slice in half and enjoy.

Makes 1 serving.


Calories 320

Protein 23 g

Total fat 15 g

Saturated fat 5 g 

Cholesterol 200 mg

Carbs 22 g

Fiber 4 g

Total sugars 5 g

Added sugars 1 g

Sodium 740 mg

Powered by ESHA Nutrient Data, © 2021 ESHA Research, Inc. 

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Vegan Tofu “Prawn” Patia | Holy Cow! Vegan Recipes

Prawn Patia is a classic dish made with shellfish and it comes from India’s small but prominent Parsi community. Its incredible explosion of flavors–sweet, spicy, salty, tangy and savory–works just as well with tofu in this vegan version.

Closeup photo of tofu patia in a black bowl with a spoon.

In my memory, a Prawn Patia will forever be the dish that made me sick as a dog the first time I ate it, yet it was so good I fell in love with it.

The sickness I chalked down to the prawns, a shellfish very similar in appearance to shrimp, and the possibility that hygiene at the hole-in-the-wall restaurant we had eaten at, known for its Patia, may have been short of stellar.

And the love? Well, it was impossible not to adore a coconut curry that’s a tango of salty, sweet, tangy and spicy.

I learned how to make a prawn patia just as delicious, and after becoming vegan, I morphed it, effortlessly I think, into a Tofu Patia, where chewy chunks of tofu stand in for the shrimp.

My Tofu Patia recipe has lived on this blog for 12 years now, and so many of you have made it and loved it, so I wanted to bring it back to the top for anyone who’s new to the blog, with new photos.

The Parsis– who migrated to India from Persia more than a thousand years ago because of religious persecution– are also some of its most interesting and, to some extent, inscrutable residents. The story goes that when they landed in Gujarat, a state in western India, the king there accepted them on the condition that they would not seek converts. They assured the king that they would assimilate into the local culture as a spoonful of sugar in a glass of milk–a promise they lived up to.

Parsis are often described in cliches like tight-knit, wealthy, insular and eccentric, and there’s some truth in all of that. But to my mind no one describes the community better than my friend Lyla, a willowy, green-eyed woman with a quick wit and a ready laugh.

At the Bombay newspaper where we worked, Lyla would often regale us with stories of her adventures about the city which, one time, included taking her aging mom and aunt to a strip joint in South Bombay because, she said, she had never been in one but didn’t dare to go alone. The next day she related, deadpan, a colorful account of the goings-on, including what the dancers did and her mom’s and aunt’s reactions.

Parsi cuisine is just as delightful. The settlers borrowed from the flavors of western India, where they settled in, as well as from the flavors of their native Iranian cuisine to come up with unique dishes like koimino patio (prawn patia), dhansaak, a combination of mutton and dal, and akoori, a spicy, scrambled egg preparation.

Prawn Patia sparkles with vibrant flavors. Instead of the prawns I used tofu air-fried with turmeric, cayenne and a touch of Old Bay seasoning for the seafood flavor.

Overhead photo of tofu patia in a black bowl with a silver spoon.

What you’ll love about this vegan Tofu Prawn Patia

  • It is vibrant with so many flavors–sweet, tangy, salty, spicy and savory. There’s something here to tickle every tastebud. The tangy note is added by tomatoes and lemon, the sweetness comes from coconut and jaggery (an unrefined Indian sugar), and the spice is added by cayenne and a touch of garam masala.
  • It is creamy. I use coconut milk for the curry base which makes it really creamy and smooth. The non-vegan recipe I first learned to cook used coconut shreds which were ground up into a paste, but I so much prefer the version with the coconut milk because it’s easier and tastier. There are versions of patia that don’t use coconut at all but I really like it in here.
  • It is easy. You can air-fry or bake the tofu, which adds a bit of time, but if you’d like to save on that just used storebought baked tofu. The rest of the curry takes barely any time to make.


  • Extra firm or super firm tofu. This adds some protein muscle and stands in nicely for the shrimp. If using extra firm be sure to press out any water.
  • Red chili peppers. I used Kashmiri red chilies, which add really nice color to the curry and are mildly spicy. But any mildly hot dry chili pepper would work or, alternatively, use red pepper flakes.
  • Coconut milk. Use the full-fat version in the can, not the one in a carton.
  • Turmeric, ground cumin, ground coriander and garam masala. For the spice base.
  • Ginger. For more spiciness and depth.
  • Onions. These add amazing flavor but they also help thicken the sauce.
  • Tomatoes. The tomatoes should go in toward the end of cooking, rather than toward the beginning. That way they will not break down fully but will rather melt into the curry, which is exactly what you want.
  • Jaggery. Jaggery, or gur, is an unrefined sugar sold in blocks that you shave bits off and use. In appearance, and in flavor, it is not unlike piloncillo, the Mexican sugar you can easily find at supermarkets here, and piloncillo is a fine substitute in this dish. If you can’t find either, use coconut sugar or just plain sugar.
  • Old Bay seasoning (optional). Old Bay adds a nice seafood-y flavor to the tofu, but it is entirely optional and you don’t have to use it. If you do use it, use no more than a teaspoon before air-frying or baking the tofu.
  • Lemon: Lemon finishes off the dish nicely and adds a nice tang along with the tomatoes.
  • Cilantro or mint. Either of these herbs adds a nice, complementary finish to the dish.

What to serve with the tofu patia

Jeera Rice or Cumin Rice is really nice with this patia. But plain boiled white or brown rice will do too.

Serve with a fresh salad or a Cucumber Raita on the side.

More Indian style tofu curry recipes

Photo of tofu patia in a black bowl.
Photo of vegan tofu prawn patia in a black bowl with spoon and cilantro

Vegan Tofu “Prawn” Patia

Prawn Patia is a classic dish made with shellfish and it comes from India’s small but prominent Parsi community. Its incredible explosion of flavors–sweet, spicy, salty, tangy and savory–works just as well with tofu in this vegan version.

Print Recipe
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Review Recipe

Course: Main Course/Curry

Cuisine: Parsi (Indian)

Diet: Vegan, Vegetarian

Keyword: Tofu Patia

Prep Time: 10 minutes

Cook Time: 30 minutes

Total Time: 40 minutes

Servings: 6 servings

Calories: 218kcal


  • 16 oz super firm tofu (or extra firm tofu with water pressed out, cut into ½-inch cubes)
  • 2 tsp vegetable oil
  • ½ tsp turmeric (divided)
  • ¼ tsp cayenne
  • 1 tsp Old Bay seasoning (optional)
  • Salt to taste.
  • 14 oz coconut milk
  • 1 tsp cumin seeds
  • 1 tbsp grated ginger
  • 2 dry red chillies
  • 1 large onion (finely diced)
  • 1 tbsp ground coriander
  • 1 tsp ground cumin
  • 2 large tomatoes (finely diced)
  • 1 tbsp jaggery (can substitute with coconut sugar or regular sugar)
  • ½ tsp garam masala
  • Juice of 1 lemon
  • 2 tbsp cilantro or mint (for garnish)


  • Mix the tofu with ¼ tsp turmeric, cayenne, Old Bay, if using, and 1 tsp vegetable oil. Place in an air fryer basket and air fry at 375 degrees for 12 minutes or bake in 400-degree oven for 30-40 minutes or until firm and chewy.

  • Blend the coconut milk, cumin seeds, ginger and red chili peppers into a smooth paste. Set aside.

  • Add the coriander powder, cumin powder, and remaining turmeric.

  • Stir for a minute and then add the coconut milk mixture. Cook on a slow flame about five minutes or until you see tiny pools of the fat from the coconut milk on top.

  • Stir in the tofu and ½ cup water. Mix well.

  • Add the tomatoes, jaggery and garam masala and stir in.

  • Bring to a boil and let the curry simmer for another couple of minutes. You can add a bit more water, around ½ cup, if the sauce is too thick for your liking. Check salt and add more if needed.

  • Serve hot.


Calories: 218kcal | Carbohydrates: 11g | Protein: 8g | Fat: 17g | Saturated Fat: 14g | Potassium: 463mg | Fiber: 2g | Sugar: 5g | Vitamin A: 558IU | Vitamin C: 11mg | Calcium: 62mg | Iron: 4mg

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FMF Launches Campaign to Oppose Alabama “Personhood” Amendment – Feminist Majority Foundation

The Feminist Majority Foundation (FMF) has launched a campaign to educate and mobilize students against a thinly-veiled “personhood” amendment to the Alabama state constitution on the ballot this November. Amendment 2 would grant full legal rights to fertilized eggs, embryos, and fetuses, declare that there is no constitutional right to abortion in Alabama, and pave the way to banning abortion and some forms of birth control in the state.

The campaign, “Alabama Students Voting No on Amendment 2,” is working throughout the state to inform students about the potential impact of Amendment 2 and encourage students to get to the polls on Election Day.

“When we talk to young people about what’s at stake with Amendment 2, they are outraged that the government is trying to control what they can and cannot do with their bodies,” said Sherill Dingle, chairperson of Alabama Students Voting No on Amendment 2. “Students deserve to be looking towards the future, not worrying about whether or not they’re going to get dragged back to the 1960s.”

If Roe v. Wade is overturned, a very real threat following the confirmation of Brett Kavanaugh to the Supreme Court, abortion would immediately become illegal in Alabama with no exception for rape or incest, and Amendment 2 would allow the government to outlaw abortion even if the life of the pregnant woman is at risk. Amendment 2 would also make it constitutionally impossible for a woman to receive Medicaid funding for abortion care, as is available in 17 states.

Beyond outlawing abortion, Amendment 2 would give rights to fertilized eggs, embryos, and fetuses, threatening the legality of some forms of birth control, including IUDs and emergency contraception. Procedures that enable pregnancy like in vitro fertilization (IVF) could also be outlawed. IVF requires doctors to have access to many fertilized eggs, some of which will not be implanted. Under Amendment 2, disposing of fertilized eggs and embryos could violate criminal homicide, abuse and assault laws.

Amendment 2 also poses an immediate threat, even without the reversal of Roe. If passed, Amendment 2 would mean that police, prosecutors, judges, doctors, and nurses have a legal obligation to “ensure the protection of the rights of the unborn child,” opening the door for women who experience miscarriage or stillbirth—the result of 15 to 20 percent of pregnancies—to be criminally investigated, prosecuted, and jailed.

According to National Advocates for Pregnant Women, Amendment 2 would allow the state to prosecute pregnant women for assault, criminal endangering the welfare of a child, or child abuse if she engages in actions that are disapproved of by law enforcement. Women could be arrested for smoking cigarettes, drinking alcohol, failing to attend prenatal care appointments, or continuing to work despite a doctor’s recommendation. Pregnant women who are in car accidents or unable to leave abusive partners could also be prosecuted for engaging in risky conduct. Even women who intentionally or unintentionally give birth outside of a hospital could be arrested.

In fact, even without Amendment 2, Alabama has arrested over 500 pregnant women under a law prohibiting the chemical endangerment of a child, which is intended to punish adults who bring children to places like methamphetamine laboratories. Even pregnant women who were taking prescribed medications as directed by doctors have been arrested under this law, and Amendment 2 would only further bolster its authority.

Because Amendment 2 gives fertilized eggs, embryos, and fetuses all the same legal rights as children, a pregnant woman could be prosecuted with kidnapping if she leaves the state of Alabama, whether it be to obtain an abortion in another state or to flee an abusive partner. Men could be permitted to seek court orders to force their partners to remain in the state if such travel is suspected.

Personhood ballot measures similar to Amendment 2 have failed in recent years in Mississippi, North Dakota, and Colorado. FMF was active in all of those opposition campaigns.

You can donate to support FMF’s get out the vote efforts here.

Media Resources: Ballotpedia 2018; Slate 7/17/18; National Advocates for Pregnant Women

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You Don’t Have To Suffer to Benefit From COVID Vaccination


By Arthur Allen

If you think vaccination is an ordeal now, consider the 18th-century version. After having pus from a smallpox boil scratched into your arm, you would be subject to three weeks of fever, sweats, chills, bleeding and purging with dangerous medicines, accompanied by hymns, prayers and hell-fire sermons by dour preachers.

That was smallpox vaccination, back then. The process generally worked and was preferred to enduring “natural” smallpox, which killed around a third of those who got it. Patients were often grateful for trial-by-immunization — once it was over, anyway.

“Thus through the Mercy of God, I have been preserved through the Distemper of the Small Pox,” wrote one Peter Thatcher in 1764, after undergoing the process in a Boston inoculation hospital. “Many and heinous have been my sins, but I hope they will be washed away.”

Today, Americans are once again surprisingly willing, even eager, to suffer a little for the reward of immunity from a virus that has turned the world upside down.

Roughly half of those vaccinated with the Moderna or Pfizer-BioNTech vaccines, and in particular women, experience unpleasantness, from hot, sore arms to chills, headache, fever and exhaustion. Sometimes they boast about the symptoms. They often welcome them.

Suspicion about what was in the shots grew in the mind of Patricia Mandatori, an Argentine immigrant in Los Angeles, when she hardly felt the needle going in after her first dose of the Moderna vaccine at a March appointment.

A day later, though, with satisfaction, she “felt like a truck hit me,” Mandatori said. “When I started to feel rotten I said, ‘Yay, I got the vaccination.’ I was happy. I felt relieved.”

While the symptoms show your immune system is responding to the vaccine in a way that will protect against disease, evidence from clinical trials showed that people with few or no symptoms were also protected. Don’t feel bad if you don’t feel bad, the experts say.

“This is the first vaccine in history where anyone has ever complained about not having symptoms,” said immunologist Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

To be sure, there is some evidence of stronger immune response in younger people — and in those who get sick when vaccinated. A small study at the University of Pennsylvania showed that people who reported systemic side effects such as fever, chills and headache may have had somewhat higher levels of antibodies. The large trial for Pfizer’s vaccine showed the same trend in younger patients.

But that doesn’t mean people who don’t react to the vaccine severely are less protected, said Dr. Joanna Schaenman, an expert on infectious diseases and the immunology of aging at the David Geffen School of Medicine at UCLA. While the symptoms of illness are undoubtedly part of the immune response, the immune response that counts is protection, she said. “That is preserved across age groups and likely to be independent of whether you had local or systemic side effects or not.”

The immune system responses that produce post-vaccination symptoms are thought to be triggered by proteins called toll-like receptors, which reside on certain immune cells. These receptors are less functional in older people, who are also likely to have chronic, low-grade activation of their immune systems that paradoxically mutes the more rapid response to a vaccine.

But other parts of their immune systems are responding more gradually to the vaccine by creating the specific types of cells needed to protect against the coronavirus. These are the so-called memory B cells, which make antibodies to attack the virus, and “killer T cells” that track and destroy virus-infected cells.

Many other vaccines, including those that prevent hepatitis B and bacterial pneumonia, are highly effective while having relatively mild side effect profiles, Schaenman noted.

Whether you have a strong reaction to the vaccine “is an interesting but, in a sense, not vital question,” said Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center. The bottom line, he said: “Don’t worry about it.”

There was a time when doctors prescribed cod-liver oil and people thought medicine had to taste bad to be effective. People who get sick after covid vaccination “feel like we’ve had a tiny bit of suffering, we’ve girded our loins against the real thing,” said Schaenman (who had a slight fever). “When people don’t have the side effects, they feel they’ve been robbed” of the experience.

Still, side effects can be a hopeful sign, especially when they end, says McCarty Memorial Christian Church leader Eddie Anderson, who has led efforts to vaccinate Black churchgoers in Los Angeles. He helps them through the rocky period by reminding them of the joyful reunions with children and grandchildren that will be possible post-vaccination.

“I’m a Christian pastor,’’ he said. “I tell them, ‘If you make it through the pain and discomfort, healing is on the other side. You can be fully human again.’”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Previously Published on khn


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Waterbirth supplies | Where are the birth pools and how did they get here? — buoyant birth

I mention my husband Steve a fair amount, and I’d like to tell you a little more about his role around here.  Steve went to undergrad at Kings Point, the United States Merchant Marine Academy, and has a degree in Marine Transportation along with a commission in the Navy Reserves.  He spent about ten years working as a deck officer on board merchant ships around the world.  Steve sailed on container ships, car carriers, oil tankers, supply boats.  He generally worked as second or third mate, meaning that he was responsible for ship’s navigation or for cargo safety.   On one trip, a documentary photographer sailed with him to Bangladesh and published a book about the voyage – Shipbreak, by Claudio Cambon.

After sailing, he got an MBA in Supply Chain Management from Michigan State University.  After a few years of working as a supply chain manager in Dallas, the Navy called and he answered, spending a year in Afghanistan as the supply chain officer for US and Afghan Special Forces.    

Now, he works for Dr Pepper Snapple Group and ensures your favorite beverages make it to store shelves.  Steve runs a supply chain team all day, then comes home and works for Buoyant Birth at night.  He’s my technical advisor – he knows all about pumps and hoses, and helps me find the best products for our kits – and supply chain manager.  When we agreed to take on the sales business, he leapt into action and did all of the work to actually get the pools to our warehouse in Dallas.  Many of you have seen him at pickups, because he’s often running around town for me, too!

He is also an incredible ballroom dancer, knows a zillion dad jokes, and is insanely handy around the house.  He works with our Congressman’s office to help high school students get into the federal military academies and is a tireless advocate for the Safe Families for Children program.  In short, Steve’s absolutely my better half and I couldn’t do this without him.

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The Splintered Mind: Three Faces of Validity: Internal, Construct, and External

Consider a simple causal claim: “α causes β in γ”.  One type of event (say, caffeine after dinner) tends to cause another type of event (disrupted sleep) in a certain range of conditions (among typical North American college students).

Now consider a formal study you could run to test this.  You design an intervention: 20 ounces of Peet’s Dark Roast in a white cup, served at 7 p.m.  You design a control condition: 20 ounces of Peet’s decaf, served at the same time.  You recruit a population: 400 willing undergrads from Bigfoot Dorm, delighted to have free coffee.  Finally, you design a measure of disrupted sleep: wearable motion sensors that normally go quiet when a person is sleeping soundly.

You do everything right.  Assignment is random and double blind, everyone drinks all and only what’s in their cup, etc., and you find a big, statistically significant treatment effect: The motion sensors are 20% more active between 2 and 4 a.m. for the coffee drinkers than the decaf drinkers.  You have what social scientists call internal validity.  The randomness, excellent execution, and large sample size ensure that there are no systematic differences between the treatment and control groups other than the contents of their cups (well…), so you know that your intervention had a causal effect on sleep patterns as measured by the motion sensors.  Yay!

You write it up for the campus newspaper: “Caffeine After Dinner Interferes with Sleep among College Students”.

But do you know that?

Of course it’s plausible.  And you have excellent internal validity.  But to get to a general claim of that sort, from your observation of 400 undergrads, requires further assumptions that we ought to be careful about.  What we know, based on considerations of internal validity alone, is that this particular intervention (20 oz. of Peet’s Dark Roast) caused this particular outcome (more motion from 2 to 4 a.m.) the day and place the experiment was performed (Bigfoot Dorm, February 16, 2021).  In fact, even calling the intervention “20 oz. of Peet’s Dark Roast” hides some assumptions — for of course, the roast was from a particular batch, brewed in a particular way by a particular person, etc.  All you really know based on the methodology, if you’re going to be super conservative, is this: Whatever it is that you did that differed between treatment and control had an effect on whatever it was you measured.

Call whatever it was you did in the treatment condition “A” and whatever it was you did differently in the control condition “-A”.  Call whatever it was you measured “B”.  And call the conditions, including both the environment and everything that was the same or balanced between treatment and control, “C” (that it was among Bigfoot Dorm students, using white cups, brewed an average temperature of 195°F, etc.).

What we know then is that the probability, p, of B (whatever outcome you measured), was greater given A (whatever you did in the treatment condition) than in -A (whatever you did in the control condition), in C (the exact conditions in which the experiment was performed).  In other words:

p(B|A&C) > p(B|-A&C).  [Read this as “The probability of B given A and C is greater than the probability of B given not-A and C.”]

But remember, what you claimed was both more specific and more general than that.  You claimed “caffeine after dinner interferes with sleep among college students”.  To put it in the Greek-letter format with which we began, you claimed that α (caffeine after dinner) causes β (poor sleep) in γ (among college students, presumably in normal college dining and sleeping contexts in North America, though this was not clearly specified).

In other words, what you think is true is not merely the vague whatever-whatever sentence

p(B|A&C) > p(B|-A&C)

but rather the more ambitious and specific sentence

p(β|α&γ) > p(β|-α&γ).[1]

In order to get from one to the other, you need to do what Esterling, Brady, and I call causal specification.

You need to establish, or at least show plausible, that α is what mattered about A.  You need to establish that it was the caffeine that had the observed effect on B, rather than something else that differed between treatment and control, like tannin levels (which differed slightly between the dark roast and decaf).  The internally valid study tells you that the intervention had causal power, but nothing inside the study could possibly tell you what aspect of the intervention had the causal power.  It may seem likely, based on your prior knowledge, that it would be the caffeine rather than the tannins or any of the potentially infinite number of other things that differ between treatment and control (if you’re creative, the list could be endless).

One way to represent this is to say that alongside α (the caffeine) are some presumably inert elements, θ (the tannins, etc.), that also differ between treatment and control.  The intervention A is really a bundle of α and θ: A = α&θ.  Now substituting α&θ for A, what the internally valid experiment established was

p(B|(α&θ)&C) > p(B|-(α&θ)&C).

If θ is causally inert, with no influence on the measured outcome B, you can can drop the θ, thus inferring from the sentence above to 

p(B|α&C) > p(B|-α&C).

In this case, you have what Esterling, Brady, and I call construct validity of the cause.  You have correctly specified the element that is doing the causal work.  It’s not just A as a whole, but α in particular, the caffeine.  Of course, you can’t just assert this.  You ought to establish it somehow.  That’s the process of establishing construct validity of the cause.

Analogous reasoning applies to the relationship between B (measured motion-sensor outputs) and β (disrupted sleep).  If you can establish the right kind of relationship between B and β you can move from a claim about B to a conclusion about β, thus moving from 

p(B|α&C) > p(B|-α&C)


p(β|α&C) > p(β|-α&C).

If this can be established, you have correctly specified the outcome and have achieved construct validity of the outcome.  You’re really measuring disrupted sleep, as you claim to be, rather than something else (like non-disruptive limb movement during sleep).

And finally, if you can establish that the right kind of relationship holds between the actual testing conditions and the conditions to which you generalize (college students in typical North American eating and sleeping environments) — then you can move from C to γ.  This will be so if your actual population is representative and the situation isn’t strange.  More specifically, since what is “representative” and “strange” depends on what causes what, the specification of γ requires knowing what background conditions are required for α to have its effect on β.  If you know that, you can generalize to populations beyond your sample where the relevant conditions γ are present (and refrain from generalizing to cases where the relevant conditions are absent).  You can thus substitute γ for C, generating the causal generalization that you had been hoping for from the beginning:

p(β|α&γ) > p(β|-α&γ).

In this way, internal, construct, and external validity fit together.  Moving from finite, historically particular data to a general causal claim requires all three.  It requires establishing not only internal validity but also establishing construct validity of the cause and outcome and external validity.  Otherwise, you don’t have the well-supported generalization you think you have.

Although internal validity is often privileged in social scientists’ discussions of causal inference, with internal validity alone, you know only that the particular intervention you made (whatever it was) had the specific effect you measured (whatever that effect amounts to) among the specific population you sampled at the time you ran the study.  You know only that something caused something.  You don’t know what causes what.


Here’s another way to think about it.  If you claim that “α causes β in γ”, there are four ways you could go wrong:

(1.) Something might cause β in γ, but that something might not be α.  (The tannin rather than the caffeine might disrupt sleep.)

(2.) α might cause something in γ, but it might not cause β.  (The caffeine might cause more movement at night without actually disrupting sleep.)

(3.) α might cause β in some set of conditions, but not γ.  (Caffeine might disrupt sleep only in unusual circumstances particular to your school.  Maybe students are excitable because of a recent earthquake and wouldn’t normally be bothered.)

(4.) α might have some relationship to β in γ, but it might not be a causal relationship of the sort claimed.  (Maybe, though an error in assignment procedures, only students on the noisy floors got the caffeine.)

Practices that ensure internal validity protect only against errors of Type 4.  To protect against errors of Type 1-3, you need proper causal specification, with both construct and external validity.


Note 1: Throughout the post, I assume that causes monotonically increase the probability of their effects, including the presence of other causes.



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