Proceeding From Observed Correlation to Causal Inference: The Use of Natural Experiments.

This article notes five reasons why a correlation between a risk (or protective) factor and some specified outcome might not reflect environmental causation. In keeping with numerous other writers, it is noted that a causal effect is usually composed of a constellation of components acting in concert. The study of causation, therefore, will necessarily be informative on only one or more subsets of such components. There is no such thing as a single basic necessary and sufficient cause. Attention is drawn to the need (albeit unobservable) to consider the counterfactual (i.e., what would have happened if the individual had not had the supposed risk experience). Fifteen possible types of natural experiments that may be used to test causal inferences with respect to naturally occurring prior causes (rather than planned interventions) are described. These comprise five types of genetically sensitive designs intended to control for possible genetic mediation (as well as dealing with other issues), six uses of twin or adoptee strategies to deal with other issues such as selection bias or the contrasts between different environmental risks, two designs to deal with selection bias, regression discontinuity designs to take into account unmeasured confounders, and the study of contextual effects. It is concluded that, taken in conjunction, natural experiments can be very helpful in both strengthening and weakening causal inferences.