The causation of disease – The practical and ethical consequences of competing explanations

Abstract

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; (i) 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 (CAD) and type 2 diabetes mellitus (T2D); and (ii) how these explanations are taken up (or not) 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: (i) evolutionary, (ii) lifecourse, and (iii) 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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Acknowledgements

Research for this paper was conducted as part of a Wellcome Trust funded research project called ‘Explanations in Genetics – Causality and Accountability in Complex Disorders’ and an early draft of the paper was presented at the Elsagen/ESPMH conference ‘Genetics and Health Care’ in Reykjavik, Iceland, 25–28 August 2004.

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Correspondence to Angus Clarke.

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Räisänen, U., Bekkers, MJ., Boddington, P. et al. The causation of disease – The practical and ethical consequences of competing explanations. Med Health Care Philos 9, 293 (2006). https://doi.org/10.1007/s11019-006-9007-5

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Keywords

  • causal explanations
  • common complex disorders
  • coronary artery disease
  • ethics
  • health policy
  • thematic and textual analysis
  • type 2 diabetes