Causal criteria: time has come for a revision

Abstract

Epidemiologists study associations but they are usually interested in causation that could lead to disease prevention. Experience show, however, that many of the associations we identify are not the causes we take an interest in (correlation is not causation). In order to proper translate association into causes, a set of causal criteria was developed 50–60 years ago and they became important tools guiding this translational process (sometimes correlation is causation). Best known of these are the Bradford Hill 'criteria'. In these last 50 years, epidemiologic theory and infrastructure have advanced rapidly without changes in these causal criteria. We think time has come to revisit the 'old' criteria to see which ones we should keep and which ones should be taken out or be replaced by new measures of association. Robustness of these criteria in attempts to make the association go away should have high priority. A group of renowned internationally recognized researchers should have this task. Since classifying associations as causes is often done in order to reduce or eliminate the exposures of concern results from conditional outcome research should also be used. We therefore suggest to add a 'consequence' criterion. We argue that a consequence criterion that provides a framework for assessing or prescribing action worthy or right in social contexts is needed. A consequence criterion will also influence how strict our causal criteria need to be before leading to action and will help in separating the 'causal discussion' and the discussion on what to do about it. A consequence criterion will be a tool in handling dilemmas over values (as social solidarity, fairness, autonomy). It will have implications for the interpretation and use of the procedural criteria of causality. Establishing interconnected procedural and consequence criteria should be a task for institutions representing and being recognized by experts, civil society and the state.

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