One of the main problems in establishing causality in medicine is going from a correlation to a causal claim. For example, heavy smoking is strongly correlated with lung cancer, but so is heavy drinking. There is normally held to be a causal link in the former case, but not in the latter. The Russo-Williamson thesis suggests that to est;J.blish that A causes B, one needs, in addition to statistical evidence, evidence for the existence of a mechanism connecting A and B. This thesis is examined in the case of the claim that smoking causes heart disease. It is shown that the correlation between smoking and heart disease was established by 1976 before any plausible linking mechanism was known. At that stage, there were doubts about whether a genuine causal connection existed here. Details of the history of research in atherosclerosis from 1979 to the late 1990s are then given, and it is shown that there is now a plausible mechanism connecting smoldng and heart disease, and th'\t, correspondingly,,most experts now accept that smoldng causes heart disease. This historical case study therefore provides support for at least one version of the Russo-Williamson thesis.
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