Disease Entities, Negative Causes, Multifactoriality, and the Naturalness of Disease Classifications. Remarks on Some Philosophical Misperceptions of Medical Pathology

Abstract

In twentieth and twenty-first century medicine, the concept of disease entity has proven to be of key importance for pathology and the theory of diseases. Disease entities are kinds of complex clinical and etiopathogenetic processes that are triggered by specific primary causes and develop on anatomical, physiological, clinical and subjectively experienced levels. They are distinguished from healthy states of life by definite criteria of pathologicity. This paper sketches the prehistory as well as the central features of the current paradigm of disease entities. Since the 1970s, philosophical theories of disease tend to ignore or, at best, reject this concept. By examining the well-respected theories of H. Tristram Engelhardt, Jr. (The concepts of health and disease. In: Engelhardt HT, Spicker SF (eds) Evaluation and explanation in the biomedical sciences. Reidel, Dordrecht, pp 125–141, 1975 ff.), and Caroline Whitbeck (Philos Sci 44:619–637, 1977), it is shown that this defensive attitude results from a philosophical misconception of the concept. Engelhardt criticizes the concept of disease entity on account of historically obsolete, substantialistic or quasi-platonistic (essentialistic) interpretations of the concept. He erroneously assumes that explanations using this concept are inconsistent with explanations by laws of physiology. Caroline Whitbeck correctly refers to the modern, scientific version of the concept. But in her opinion, the concept “cause of disease” is defined according to certain “instrumental interests” that may differ between subjects and is, thus, neither objective nor unique and unequivocal. Hence, the concept of disease entity is ambiguous and not suited for establishing a unique, unambiguous, and unequivocal natural classification of diseases. It is shown that Whitbeck’s objections rest upon misconceptions concerning the concept of “primary cause” resp. “etiological factor” and of the so-called “multi-factorial” causation. By reference to a careful, medically and philosophically correct reconstruction of these concepts, it is shown that her objections do not apply.