Renton A
Academic Department of Public Health, St Mary's Hospital Medical School, London.
J Epidemiol Community Health. 1994 Feb;48(1):79-85. doi: 10.1136/jech.48.1.79.
In this paper the controversy over how to decide whether associations between factors and diseases are causal is placed within a description of the public health and scientific relevance of epidemiology. It is argued that the rise in popularity of the Popperian view of science, together with a perception of the aims of epidemiology as being to identify appropriate public health interventions, have focussed this debate on unresolved questions of inferential logic, leaving largely unanalysed the notions of causation and of disease at the ontological level. A realist ontology of causation of disease and pathogenesis is constructed within the framework of "scientific materialism", and is shown to provide a coherent basis from which to decide causes and to deal with problems of confounding and interaction in epidemiological research. It is argued that a realist analysis identifies a richer role for epidemiology as an integral part of an ontologically unified medical science. It is this unified medical science as a whole rather than epidemiological observation or experiment which decides causes and, in turn, provides a key element to the foundations of rational public health decision making.
本文中，关于如何判定因素与疾病之间的关联是否具有因果关系的争议，被置于对流行病学的公共卫生及科学相关性的描述之中。有人认为，波普尔科学观的日益流行，以及流行病学旨在确定适当公共卫生干预措施的目标观念，使这场辩论聚焦于推理逻辑中尚未解决的问题，而在本体论层面，因果关系和疾病概念在很大程度上未得到分析。在“科学唯物主义”框架内构建了疾病因果关系和发病机制的实在论本体论，并表明它为判定病因以及处理流行病学研究中的混杂和相互作用问题提供了一个连贯的基础。有人认为，实在论分析确定了流行病学作为本体论统一的医学科学不可或缺的一部分所具有的更丰富作用。是整个统一的医学科学而非流行病学观察或实验来判定病因，进而为合理的公共卫生决策奠定基础提供关键要素。
