Rejoinder to "'Harm' in personalized medicine-an alternative perspective".

Abstract

In our original article, we examine twin definitions of "harm" in personalized medicine: a first based on predictions of individuals' unmeasurable response types (counterfactual harm), and a second based solely on the observations of experiments (interventionist harm). In their commentary, Mueller and Pearl read our review as an argument that "counterfactual logic should…be purged from consideration of harm and benefit" and "strongly object…that a rational decision maker may well apply the interventional perspective to the exclusion of counterfactual considerations." Here, we show that this objection is misguided. We analyze the examples in Mueller and Pearl's commentary and derive a general result showing that determinations of harm through interventionist and counterfactual analyses concur. Therefore, individuals who embrace counterfactual formulations and those who object to their use will make equivalent decisions in uncontroversial settings.