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Epidemiology and causation

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Abstract

Epidemiologists’ discussions on causation are not always very enlightening with regard to the notion of ‘cause’ in epidemiology. Epidemiologists rightly work from a science-based approach to causation in epidemiology, but largely disagree about the matter. Disagreement may be partly due to confusion of the question of useful concepts for causal inference in epidemiological practice with the question of the metaphysical presuppositions of causal concepts used in epidemiology. In other words, epidemiologists seem to confuse the practical results of epidemiological research at the population level with the metaphysical views about the reality of disease causation at the individual level in their writings on causation.

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Notes

  1. In an earlier paper, I labeled such an approach an ‘epistemological-methodological approach’ to the notion of ‘cause’ (De Vreese 2006).

  2. It is not my aim to give a complete overview of causal concepts and related epidemiological methods for causal inference in this paper. Hence, I do not weigh all the pros and cons of these concepts and methods against each other in arguing for an average effect approach, neither will I focus on the Bradford Hill criteria (Bradford Hill 1965). Although elaborating a thorough comparison might be a worthwhile undertaking, it is not necessary in view of, and would lead me too far away from, the central aim of this paper. Hence, although I am convinced of the importance of the average effect approach for epidemiological practice, my defence should primarily be seen as illustrating the kind of ideas and problems one should tackle when answering the question for a useful concept of cause for epidemiological practice.

  3. Traditional philosophical approaches to causation are most often purely conceptual or purely metaphysical approaches. A conceptual analysis of causation tries to reveal the meaning of our everyday concept of causation, while a metaphysical approach is bound to shed light on what causation is in the world, i.e. apart from our (scientific) interpretation and description of it. Of course, nor our everyday notion of ‘cause’ and neither ‘causation as it is in the world’, is totally unrelated to the meaning accorded to ‘cause’ in the sciences. More about the differences and relations between different lines of approach to the notion of ‘cause’, and about the importance of science-based approaches next to purely conceptual and purely metaphysical ones, can be found in (De Vreese 2006).

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Acknowledgements

I would like to thank Erik Weber and two anonymous referees for their comments on earlier versions of this paper. The research for this paper was supported by the Fund for Scientific Research—Flanders through research project G.0651.07.

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Correspondence to Leen De Vreese.

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De Vreese, L. Epidemiology and causation. Med Health Care and Philos 12, 345–353 (2009). https://doi.org/10.1007/s11019-009-9184-0

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