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The diagnosis of causation 

The diagnosis of causation
Chapter:
The diagnosis of causation
Author(s):

Mark Elwood

DOI:
10.1093/med/9780199682898.003.0010
Page of

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date: 18 October 2019

This chapter brings the book together, showing the overall scheme of assessment of causation for one study or in many studies, based on 20 questions in five sections. The scheme includes describing the key features of the study; then assessing observation bias, confounding, and chance variation. The chapter presents the consideration of the positive features of causation: the Bradford Hill guidelines of time relationship, strength, dose-response, consistency, and specificity, leading to an assessment of internal validity. External validity (generalisability) relates to the eligible, source, and target populations. Comparisons with other studies assess consistency and specificity further, but also plausibility and coherence, including analogy and experimental evidence. The chapter shows the overall decision process. Applications to non-causal associations, other types of study, and in designing a study are discussed. In part two, the chapter shows applications of causal reasoning to clinical care and health policy, including hierarchies of evidence, methods used by important groups, and the GRADE system.

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