  Kandel’s genetic reductionism is a metaphysical position aimed at identifying a privileged level in nature and a general explanatory strategy that unifies the phenomena and offers lawlike explanations. However, in medicine the goal of causal explanation is instrumental. We seek the factors that make a difference in a given case, not a metaphysically privileged level or a general unifying account. There is little reason so far to believe that the reductionistic approach Kandel urges has been more fruitful.