Medical Causation

As previously reported (Fibromyalgia 1995-6, Medical Litigation News Volume 2, Issue 3), criteria that were summarised by Canada's McMaster University Hospital Clinical Epidemiology Department from the 1965 work of Sir Austin Bradford Hill[1] are widely accepted:

1 Is there evidence from true experiments in humans?
2 Is the association strong and consistent from study to study?
3 Is the temporal relationship correct?
4 Is there a dose-response gradient?
5 Does the association make epidemiologic sense?
6 Does the association make biologic sense?
7 Is the association specific?
8 Is the association analogous to a previously proven causal relationship?
 

Many established, traditional diseases will fail one or more of these exacting tests. Nevertheless, diseases thus recognised as nosological entities are given individual recognition in the International Classification of Diseases (ICD)[2].

 

 
PRACTICE POINT

The status of "diagnoses", particularly those which are unfamiliar, should be checked for vulnerability


In addition to Diseases, Western medicine recognises Syndromes, which are collections of symptoms and signs that are found clustered together in different patients, even though the causes of the condition are not known with any degree of certainty, or are entirely speculative.

Counsel should be aware that certain concepts which masquerade as "diagnosis" are the creation of 1 author and have not even been validated as recognised Syndromes by other researchers. Post Traumatic Hyperirritability Syndrome is an example of a terminology which has no common medical usage or generally accepted meaning[3].

 

Copyright 2008 Electronic Handbook of Legal Medicine