Abstract: Establishing causal relationships in clinical medical research is not only a highly challenging scientific practice problem but also a core topic of concern in contemporary philosophy of medicine. The debate on this topic mainly focuses on what kind of evidence is sufficient to support the establishment of causal relationships. One side argues that association evidence obtained from randomized controlled trials is sufficient to establish causal relationships; the other side argues that association evidence alone (obtained from randomized controlled trials) is insufficient, as mechanistic evidence must also be provided as a supplement. The former believes that association evidence is sufficient, while the latter believes that both association and mechanistic evidence is necessary but not sufficient. This article, by demonstrating the untenability of the above two viewpoints, proposes a third approach: that the mechanism is both sufficient and necessary for establishing causal relationships.

Key Words: Causation; Clinical medicine; Mechanism; Evidence; Randomized controlled trials

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