Spark, trigger, cause

There's a sloppy tendency to use a bunch of words to mean the same thing: "cause."

Spark, trigger, precipitate, risk, fall, contribute, lead to...

Here's how to tell: if the word is being used to explain or justify a treatment approach then it usually is meant as "cause."

I spoke at the recent Renfrew Foundation conference on the topic of agnosticism in treatment. This made more of an impression than anything else I said. The idea of being agnostic in what causes the illness pulled the rug out from so much that we are used to saying and thinking and arguing about eating disorders. Go ahead, try to discuss treatment without using causes. It's difficult. In the process, let's see if all the euphemisms for "cause" have to be set aside as well. Let's ask ourselves if there are other illnesses in which those words are used in the same way.


  1. I can think of many illnesses, both mental and physical, in which those words are used in the same way, but I'll just take one to start off with: osteoporosis.

    Osteoporosis results from a bone remodelling imbalance. The latter means that bone resorption exceeds bone formation, or bone is broken down faster than it is re-formed. The net result is bone loss, which can lead to osteopenia or even osteoporosis and fracture.

    The fractures and the osteoporosis need to be treated, starting with the fracture, which will require rest of the damaged body part. But there are different treatments for osteoporosis which depend upon the cause. And there are many different causes of osteoporosis; yet all are caused by a bone remodelling imbalance. Causes may include menopause, premature ovarian failure, ageing, glucocorticoid excess, corticosteroid use, anorexia nervosa, thyrotoxicosis, ideopathic osteoporosis, vitamin D deficiency, other vitamin or mineral deficiences, bedrest or travel into space.

    The treatment often depends upon the cause, even though the objective is the same: to balance bone remodelling or to alter it in such a way that bone formation exceeds bone resorption to hopefully increase bone density. Some treatments which are very effective for postmenopausal osteoporosis (HRT, bisphosphonates) don't work for osteoporosis induced by AN. Therefore, the treatment depends upon the cause.


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