Thinking about Causation: A Thought Experiment with Dominos

We argue that population attributable fractions, probabilities of causation, burdens of disease, and similar association-based measures often do not provide valid estimates or surrogates for the fraction or number of disease cases that would be prevented by eliminating or reducing an exposure because their calculations do not include crucial mechanistic information. We use a thought experiment with a cascade of dominos to illustrate the need for mechanistic information when answering questions about how changing exposures changes risk. We suggest that modern methods of causal artificial intelligence (CAI) can fill this gap: they can complement and extend traditional epidemiological attribution calculations to provide information useful for risk management decisions.