The causation of disease - the practical and ethical consequences of competing explanations

Medicine, Health Care and Philosophy 9 (3):293-306 (2006)
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The prevention, treatment and management of disease are closely linked to how the causes of a particular disease are explained. For multi-factorial conditions, the causal explanations are inevitably complex and competing models may exist to explain the same condition. Selecting one particular causal explanation over another will carry practical and ethical consequences that are acutely relevant for health policy. In this paper our focus is two-fold; the different models of causal explanation that are put forward within current scientific literature for the high and rising prevalence of the common complex conditions of coronary artery disease and type 2 diabetes mellitus ; and how these explanations are taken up within national health policy guidelines. We examine the causal explanations for these two conditions through a systematic database search of current scientific literature. By identifying different causal explanations we propose a three-tier taxonomy of the most prominent models of explanations: evolutionary, lifecourse, and lifestyle and environment. We elaborate this taxonomy with a micro-level thematic analysis to illustrate how some explanations are semantically and rhetorically foregrounded over others. We then investigate the uptake of the scientific causal explanations in health policy documents with regard to the prevention and management recommendations of current National Service Frameworks for CAD and T2D. Our findings indicate a lack of congruence between the complexity and frequent overlap of causal explanations evident in the scientific literature and the predominant focus on lifestyle recommendations found in the mainstream health policy documents.



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Paula Boddington
University of Oxford

Citations of this work

A Cause without an Effect? Primary Prevention and Causation.H. S. Faust - 2013 - Journal of Medicine and Philosophy 38 (5):239-558.
Complex Causation and the Virtue of Pluralism.Ingemar Nordin - 2006 - Medicine, Health Care and Philosophy 9 (3):321-323.

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A System of Logic, Ratiocinative and Inductive.John Stuart Mill - 1843 - New York and London,: University of Toronto Press. Edited by J. Robson.
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The Cement of the Universe: A Study of Causation.J. L. Mackie - 1975 - British Journal for the Philosophy of Science 26 (4):353-355.

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