Rani Lill Anjum

Causation in Medicine

Scientific methods are supposed to guarantee the quality of our research. But they do more than this. They define what counts as evidence, what counts as a cause, and what counts as a result. Any science that looks for causes must therefore do so with a pre-understanding of what causation is. This understanding if often tacit and unexamined, yet it forms the basis of our scientific practice. An orthodoxy has developed from Hume which has affected the way causation is understood within the medical model: 1) robust correlations, 2) difference-making, 3) probability raising, 4) same cause, same effect. This paradigm is tacitly accepted in many scientific methodologies, especially in the health sciences. Evidence based medicine is premised on the idea that what is true of a given population should be directly applicable in individual clinical decisions. What works for most people should also work for the patient. Such external validity only holds if we assume that individual propensities can be derived directly from statistical frequencies. Dispositionalism about causation represents a better alternative, emphasising complexity, context-sensitivity, tendency, singularism and holism. While these features are problematic for the orthodox view, they are central to a number of complex diseases, many of which are still unexplained.

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