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Writer's pictureLaura Rathbone

When a cause cannot be found: embracing medical pluralism

By Laura Rathbone


In the field of medicine, understanding causality is a complex task that requires the use of multiple methodologies. The traditional approach of relying solely on randomised controlled trials (RCTs) may not always be sufficient to uncover the full complexity of causal relationships. In this blog post, we will explore the importance of methodological pluralism and the role of patient narratives in advancing our understanding of causality in healthcare.


The Limitations of RCTs


RCTs have long been considered the gold standard for establishing causality in medical research. However, they have their limitations. RCTs are best suited for studying specific interventions and outcomes, often overlooking rare conditions or dispositions that may not be captured by statistical methods. For instance, retrospective case-control studies are better suited for studying outlier cases or very rare conditions.


It is important to recognise that no single method can perfectly capture all aspects of causality. Each scientific method is designed to test specific symptoms of causality, while other symptoms may fall outside its scope. Operationalising causality by identifying it with the method used to test it may be acceptable for strict empiricists, but it fails to account for the complexities inherent in causality.


The Epistemological Importance of Patient Narratives


To overcome the limitations of traditional approaches, we argue for the inclusion of patient narratives as a valuable source of causal information. Patient narratives provide qualitatively rich data that can uncover relevant dispositions unique to individual patients. By understanding the patient's perspective and context, we can gain insights into their condition and treatment that may otherwise be overlooked.


The clinical encounter plays a pivotal role in advancing our understanding of the causal story behind illness and suffering. It goes beyond the mere clinical examination, delving into the patient's biography, context, and lived experiences. Patient narratives offer a holistic view of the individual, shedding light on the meaning and interpretation of symptoms and their impact on the patient's life.


The Power of Methodological Pluralism


Embracing methodological pluralism allows us to harness the strengths of different approaches to causality assessment. Patient narratives, for example, serve as a tool for understanding the complex web of causality that contributes to illness. They can be used to assess causality, understand the causal story, and even collaborate with patients in constructing a shared narrative of their condition.


In addition to patient narratives, methods such as pharmacovigilance, which collects patient stories about medication side effects, provide crucial evidence for causality assessment. By taking into account a patient's subjective experience and the context in which it occurs, we can gain a more comprehensive understanding of the causal factors at play.


Understanding causality in medicine requires a multifaceted approach. By embracing methodological pluralism and incorporating patient narratives into our research and clinical practices, we can enhance our understanding of the complex causal relationships underlying health and illness. Let us move away from the notion of a single perfect test for causality and instead embrace the richness of diverse methodologies to uncover the intricacies of causality in medicine.


References:

  • Anjum, R.L., & Mumford, S. (2018). Causation in Science and the Methods of Scientific Discovery. Oxford University Press.

  • Chandler, R. (2017). The Importance of Patient Stories in Pharmacovigilance. Drug Safety, 40(1), 23-27.

  • Kirkengen, A.L. (2017). What if…. CauseHealth blog. https://causehealthblog.wordpress.com/

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