Medicine, Health Care and Philosophy

, Volume 12, Issue 1, pp 77–90 | Cite as

Causality in complex interventions

  • Dean RicklesEmail author
Scientific Contribution


In this paper I look at causality in the context of intervention research, and discuss some problems faced in the evaluation of causal hypotheses via interventions. I draw attention to a simple problem for evaluations that employ randomized controlled trials. The common alternative to randomized trials, the observational study, is shown to face problems of a similar nature. I then argue that these problems become especially acute in cases where the intervention is complex (i.e. that involves intervening in a complex system). Finally, I consider and reject a possible resolution of the problem involving the simulation of complex interventions. The conclusion I draw from this is that we need to radically reframe the way we think about causal inference in complex intervention research.


Causality Intervention research Complexity Randomized controlled trials Observational studies 



I wish to thank Alan Shiell, for his perceptive comments on an earlier version of this paper, and the two anonymous referees for this journal for their helpful comments and suggestions. This work was completed while a postdoctoral fellow at the University of Calgary, as part of The International Collaboration for Complex Interventions [ICCI]: the ideas are not necessarily representative of that group, and, of course, any errors are my own responsibility.


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Unit for History & Philosophy of ScienceUniversity of SydneySydneyAustralia

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