RichardKennaway comments on Smoking lesion as a counterexample to CDT - Less Wrong Discussion
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Best of luck getting that one to fly in practice.
That's the general problem with instrumental variables. But sometimes that's all you have to work with.
That is the fundamental problem of statistical experiments.
Well, it's just as easy as varying smoking directly, which would also work to identify a smoking->cancer effect.
Without experimentation, there is no way to distinguish between the world of smoker's lesion and the world of carcinogenic cigarettes.