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disease, or sarcoidosis must also be taken into consideration as poten-
tially causal or contributing agents.
2. In medicine, multiple causes as sets of causes are often at the origin
of a health problem. Multiple consequences as sets of consequences
may follow the action of the same beneficial factor. We will call them
“sets” rather than “webs” as originally illustrated. 39 The real webs are
explained in approach 4 below. (N.B. Sets and webs require different
biostatistical and other methods and techniques of analysis like path
analysis 51 and various multivariate independent variables and multivari-
able dependent variables techniques and analyses.) 52 Friedman offers a
good introduction to them in the context of epidemiology. 53 Figure 2.8
illustrates this concept and paradigm applied to a set of causes of medi-
cal error and harm and a set of consequences of alcohol abuse.
There are numerous possible sets of causes of medical error and
harm including combinations and even interactions, varying case by
Liver cirrhosis
Chronic hepatitis
Drinking
Korsako psychosis
Fatigue
Wernicke encephalopathy
Stress
Peripheral neuritis
Violent behavior
Drug abuse
Alcohol
abuse
Breakdown of family
relationships
relationships
Breakdown of professional
life
life
Inadequate diet
Injury
Poorly controlled
morbidity (e.g., diabetes)
Experience
Road and work injuries
Road, workplace, or
living conditions
Suicide
Other factors
Homicide
Health care needs
and delivery
and delivery
Other eects
Possible causes
Eect
(consequence)
Cause
Possible eects
(consequences)
Figure 2.8 Sets of causes and consequences in epidemiology. (Redrawn with modifications
from Jenicek, M., Epidemiology. The Logic of Modern Medicine , EPIMED International,
Montréal, 1995; Jenicek, M., Foundations of Evidence-Based Medicine , The Parthenon
Publishing Group/CRC Press, Boca Raton/London/New York/Washington, 2003.)
 
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