If only lottery winnings were randomly assigned

doi:10.1136/bmj.324.7343.979

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Ian Walker (i.walker@warwick.ac.uk), professor

Department of Economics, University of Warwick, Coventry CV4 7AL

EDITOR—The causal effect of income on health has important policy implications, and yet its identification is dogged by the problem of income not being randomly assigned. Researchers continue to ignore this, including Rodgers in his editorial,1 but the idea that the problem can be overcome by exploiting lottery winnings as a “natural experiment”2 is superficial because winners are not randomly selected from the population since playing is not a random event.

Although playing is …