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Causal Machine Learning Is Not a Panacea: A Roadmap for Observational Causal Inference in Health

Donna Tjandra (Division of Computer Science and Engineering·University of Michigan·Ann Arbor·Michigan·United States)·Trenton Chang (Division of Computer Science and Engineering·University of Michigan·Ann Arbor·Michigan·United States)·Sonali Parbhoo (Department of Electrical and Electronic Engineering·Imperial College London·London·UK)·Rajesh Ranganath (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)·Andre Kurepa Waschka (Department of Mathematics & Statistics·Elon University·Elon·North Carolina·United States)·William Mitchell (Department of Ophthalmology·Cambridge University Hospitals·Cambridge·UK)·Maggie Makar (Division of Computer Science and Engineering·University of Michigan·Ann Arbor·Michigan·United States)·Shalmali Joshi (Department of Biomedical Informatics·Columbia University·New York·New York·United States)·Finale Doshi-Velez (School of Engineering and Applied Science·Harvard University·Cambridge·Massachusetts·United States)·Leo Anthony Celi (Laboratory for Computational Physiology·Institute for Medical Engineering and Science·Massachusetts Institute of Technology·Cambridge·Massachusetts·United States·Department of Biostatistics·Harvard T.H. Chan School of Public Health·Boston·Massachusetts·United States)·Jenna Wiens (Division of Computer Science and Engineering·University of Michigan·Ann Arbor·Michigan·United States)·2026

Abstract

arXiv:2605.20782v1 Announce Type: new 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.

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