If there is any value in the idea that disease is something other than the mere absence of health then that value must lie in the way that diseases are defined. Elsewhere I have identified and criticised two distinct trends in thinking about disease definition: “monocausal” and “multifactorial” models of disease. Instead I have endorsed a “contrastive” model of disease, which is intended to retain the benefits of the monocausal model without the implausible commitment to classification in terms of just one cause (Broadbent 2009; Broadbent 2013, Ch 10).

An obvious difficulty for the contrastive account is that some kinds of ill health, such as instances of particular cancers, seem to be fruitfully treated as belonging together. Yet on the contrastive account they cannot be called instances of a disease unless a classificatory constellation of causes is known or at least suspected. (Of course one might prefer to mark the distinction with a word other than “disease”; but my hope is to get at an important distinction without getting tangled in semantic disputes.) This raises an objection of irrelevance: the objection would be that the contrastive account of disease lays down distinctions between disease and non-disease that are irrelevant both to clinical practice and to scientific understanding.

In this paper I get to grips with the irrelevance objection to the contrastive model, using the cancer-virus link as a focus point.

References

Broadbent, Alex. 2009. ‘Causation and Models of Disease in Epidemiology'. Studies in History and Philosophy of Biological and Biomedical Sciences 40: 302–311.

———. 2013. Philosophy of Epidemiology. New Directions in the Philosophy of Science. London and New York: Palgrave Macmillan.

Carter, K. Codell. 2003. The Rise of Causal Concepts of Disease. Aldershot: Ashgate.