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Stud Hist Philos Biol Biomed Sci. 2018 Feb;67:8-15. doi: 10.1016/j.shpsc.2017.11.002. Epub 2017 Dec 6.

Universal etiology, multifactorial diseases and the constitutive model of disease classification.

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Faculty of Medicine, University of Toronto, Canada; Research Associate, African Centre for Epistemology and Philosophy of Science, University of Johannesburg, South Africa. Electronic address:


Infectious diseases are often said to have a universal etiology, while chronic and noncommunicable diseases are said to be multifactorial in their etiology. It has been argued that the universal etiology of an infectious disease results from its classification using a monocausal disease model. In this article, I will reconstruct the monocausal model and argue that modern 'multifactorial diseases' are not monocausal by definition. 'Multifactorial diseases' are instead defined according to a constitutive disease model. On closer analysis, infectious diseases are also defined using the constitutive model rather than the monocausal model. As a result, our classification models alone cannot explain why infectious diseases have a universal etiology while chronic and noncommunicable diseases lack one. The explanation is instead provided by the Nineteenth Century germ theorists.


Disease classification; Etiology; Monocausal model; Multifactorial; Philosophy of medicine

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