Objective Despite well‐described biologic causes, the public views unhealthy lifestyle choices as the primary cause of gout. This study investigated how causal beliefs about gout influence the public's views about its management. Methods In a randomized study, 201 members of the public viewed one of two 2‐minute videos about gout. The videos were identical except for a 45‐second section describing the causes of gout using either a biologic explanation (including genetics, kidney disease, age, sex, and diuretic therapy) or a lifestyle explanation (including diet, alcohol, sugary drinks, and weight). Participants completed a questionnaire about gout and its management. Primary outcome was rating of “How likely is it that long‐term medications would help gout?” on an 11‐point Likert scale. Results Participants who viewed the biologic explanation rated hereditary factors and aging as more important causes of gout than those who viewed the lifestyle explanation, and they rated poor diet, alcohol use, and the person's own behavior less highly ( P < 0.001 for all). In the biologic group, 13 of 99 (13.1%) gave diet or a specific dietary factor as the most important cause compared with 62 of 102 (60.8%) in the lifestyle group. Those in the biologic group were more likely to believe that long‐term medication would help gout (mean score 7.6 vs 6.5, P = 0.001). Conclusion Explaining gout as caused by biologic rather than lifestyle factors affects beliefs about the benefits of long‐term medication. Accurate communication about causes of gout could affect the public's beliefs about treatment strategies and may improve long‐term medication uptake.