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Med Health Care Philos. 2009 Mar;12(1):77-90. doi: 10.1007/s11019-008-9140-4. Epub 2008 May 9.

Causality in complex interventions.

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  • 1Unit for History & Philosophy of Science, University of Sydney, Sydney, NSW, 2006, Australia.


In this paper I look at causality in the context of intervention research, and discuss some problems faced in the evaluation of causal hypotheses via interventions. I draw attention to a simple problem for evaluations that employ randomized controlled trials. The common alternative to randomized trials, the observational study, is shown to face problems of a similar nature. I then argue that these problems become especially acute in cases where the intervention is complex (i.e. that involves intervening in a complex system). Finally, I consider and reject a possible resolution of the problem involving the simulation of complex interventions. The conclusion I draw from this is that we need to radically reframe the way we think about causal inference in complex intervention research.

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