Causal Machine Learning Is Not a Panacea: A Roadmap for Observational Causal Inference in Health
Authors: Donna Tjandra, Trenton Chang, Sonali Parbhoo, Rajesh Ranganath, Andre Kurepa Waschka, William Mitchell, Maggie Makar, Shalmali Joshi, +3 more
Organizations: Division of Computer Science and Engineering, University of Michigan, Ann Arbor, Michigan, United States · Department of Electrical and Electronic Engineering, Imperial College London, London, UK · Courant Institute of Mathematical Sciences, New York University, New York, New York, United States · Center for Data Science, New York University, New York, New York, United States · Department of Mathematics & Statistics, Elon University, Elon, North Carolina, United States · Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK · Department of Biomedical Informatics, Columbia University, New York, New York, United States · School of Engineering and Applied Science, Harvard University, Cambridge, Massachusetts, United States · Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States · Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States · Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
Abstract
Objective: The growing availability of large-scale observational clinical datasets and challenges in conducting randomized controlled trials have spurred enthusiasm in using causal machine learning (ML) for causal inference in observational data. We present a roadmap for applying causal ML to observational data. Materials and methods: We outline the importance of assessing validity assumptions within available data and applying causal ML responsibly for clinical experts using causal ML and ML practitioners with limited clinical expertise. Observations: Despite advances in causal ML, its limitations remain largely under-appreciated across disciplines. This gap in shared knowledge may impact the validity of findings. Discussion: Causal assumptions must be satisfied and modeling choices justified. Otherwise, these approaches risk producing biased or misleading results, with consequences for clinical research and patient care. Conclusion: Causal ML can be a powerful tool for generating causal hypotheses. We provide a template to strengthen the rigor and interpretability of causal analyses.
Predictive machine learning (ML) models are increasingly used to aid human decision-makers across various high-risk domains such as healthcare and criminal justice. There is a growing recognition of the need to evaluate the causal impact of deploying these systems on downstream outcomes, such as patient survival or crime recidivism. Randomized control trials (RCTs) can provide high-quality evidence on the impact of a deployed model, but they run into a challenge: it is often infeasible to run repeated trials when models are updated or retrained to improve predictive performance. In this work, we present a partial-identification approach to using prior RCT data to construct bounds on the causal effect of a new model. The core innovation in our approach is to leverage assumptions relating fine-grained predictive accuracy to downstream outcomes. We do so via two monotonicity assumptions: first, on individual-level `counterfactual correctness' (all else being equal, a correct prediction leads to non-inferior outcomes); and second, on the relation between subgroup predictive performance and outcomes, interpretable as an assumption regarding trust in model outputs. We demonstrate our method with a simulation study, illustrating how incorporating this information can lead to more informative bounds compared to prior work.
Causal inference is the practice of estimating the effect of a treatment or intervention from data. It traditionally requires a bespoke pipeline for every new problem: first proposing a causal mechanism, selecting a compatible estimator, and finally training it. Meanwhile, across diverse settings and modalities, much of machine learning has shifted to the paradigm of foundation models: networks pretrained once at scale and applied to new tasks without fine-tuning. Causal foundation models (CFMs) bring this paradigm to causal inference. CFMs are pretrained neural networks that estimate causal quantities, such as the average treatment effect, on entirely new datasets using in-context learning without requiring model updates. This work provides a practical introduction to this emerging area. We summarize the necessary background in causal inference and machine learning before discussing CFMs. Throughout, we include example code and Jupyter notebooks.
Christopher Stith, Hossein Rahmani, Jesse C. Cresswell
Scientific machine learning is limited less by model size than by the data it is trained on. Observational data records what happened but not why; template synthetic data has a known generating process but only for the simulator's template, not the case a user faces. We argue a third option is now operationally feasible: instrumented data, in which every datum carries the mechanistic model that produced it, an explicit uncertainty over that model, and an executable family of counterfactuals. Verification-and-validation (V&V) instrumented image-to-simulation pipelines are one realisation: a sensor observation becomes a fully specified, solver-backed simulation with explicit, editable parameters and a propagated aleatoric/epistemic uncertainty. The substrate is case-specific, mechanistically supervised, and supports causal interventions through Pearl's do-operator. Near-term consequences for validation, auditing, and surrogate training span computational biology, climate, materials, fluid mechanics, and medical imaging; a longer-term, falsifiable implication concerns foundation models for scientific reasoning.