The Theory of the Patient: Toward an Integration of Clinical Reasoning, Causal Inference, and Mechanistic Biology

Rationale

Clinical medicine, epidemiology, and mechanistic biology each have partial purchase on disease, but none treats the patient (the individual biological system constituted by genetics, biography, environment, and time) as a unifying object of inquiry. Population-level causal inference cannot explain why a specific intervention failed in a specific patient. Cause is the language of populations; mechanism is the language of the individual. Aims and objectives: To propose a theory of the patient: a scientifically grounded account of how biological, biographical, and environmental processes interacted over time in this person to produce their disease and shape their response to treatment; and to show that it meets the criteria of a scientific theory.