Establishing Causal Claims in Medicine

ABSTRACT Russo and Williamson [2007. “Interpreting Causality in the Health Sciences.” International Studies in the Philosophy of Science 21: 157–170] put forward the following thesis: in order to establish a causal claim in medicine, one normally needs to establish both that the putative cause and putative effect are appropriately correlated and that there is some underlying mechanism that can account for this correlation. I argue that, although the Russo–Williamson thesis conflicts with the tenets of present-day evidence-based medicine (EBM), it offers a better causal epistemology than that provided by present-day EBM because it better explains two key aspects of causal discovery. First, the thesis better explains the role of clinical studies in establishing causal claims. Second, it yields a better account of extrapolation.