Counterfactual Randomization: Rescuing Experimental Studies from Obscured Confounding

Abstract

Randomized clinical trials (RCTs) like those conducted by the FDA provide medical practitioners with average effects of treatments, and are generally more desirable than observational studies due to their control of unobserved confounders (UCs), viz., latent factors that influence both treatment and recovery. However, recent results from causal inference have shown that randomization results in a subsequent loss of information about the UCs, which may impede treatment efficacy if left uncontrolled in practice (Bareinboim, Forney, and Pearl 2015). Our paper presents a novel experimental design that can be noninvasively layered atop past and future RCTs to not only expose the presence of UCs in a system, but also reveal patient- and practitioner-specific treatment effects in order to improve decision-making. Applications are given to personalized medicine, second opinions in diagnosis, and employing offline results in online recommender systems.