Causal Pluralism in Medicine and its Implications for Clinical Practice

Area of Science:

• Philosophy of Medicine
• Causal Inference
• Medical Research Methodology

Background:

• Philosophical perspectives on causality in medicine are diverse and often conflicting.
• A unified concept of causality may not adequately capture the complexities of medical research and practice.

Purpose of the Study:

• To argue for causal pluralism in medicine, supporting multiple concepts of causality.
• To demonstrate how different research designs and clinical practices align with distinct causal frameworks.

Main Methods:

• Analysis of three primary research designs: randomized-controlled trials, observational epidemiology, and laboratory research.
• Examination of clinical practice and the role of causal claims in therapeutic decision-making.
• Distinction between prediction, interference, and intervention based on causal manipulation.

Main Results:

• Randomized-controlled trials support manipulationist causality.
• Observational epidemiology aligns with probabilistic causality.
• Laboratory research is best understood through mechanistic causality.
• Different causal concepts provide evidence for distinct therapeutic decisions.

Conclusions:

• A pluralistic approach to causality is essential for understanding medical research and practice.
• Diverse causal claims, derived from various methodologies, offer unique evidence for therapeutic interventions.
• Recognizing different types of causality enhances the foundation for medical decision-making.