The Arts, Sciences and Medicine: THE WOLVES OF MIS-MEASURE

Measurement…

01001101 01100101 01100001 01110011 01110101 01110010 01100101 01101101 01100101 01101110 01110100

The mismeasure of life falls on shoulders that bear no burden. Now that is quite provocative a statement as any, don't you think? It is true! Here goes…

The Yesteryears:
In the world today Charles Dickens’ Thomas Gradgrind(s); he of the ready with “a pocket’s rule and a pair of scales,” excel in their merchandising, selling whatever it is they do not or need not understand, except in return, they must receive a fair amount of monetary advantage. They talk of measuring the essence of all things material. Indeed nothing can pass without a metric that cannot be reality-weighed in pounds, kilograms, tonnes or if not then by virtual means. Such recursive abstractions using manufactured evidence is the bane of true understanding. The days when Johannes Kepler stood on Tyco Brahe's shoulders and figured out the ellipses of the solar system and Sir Issac Newton's claim of the equatorial bulge of our earthly planet (26.58 miles) from the spin, are long gone. Gone also are the days of polymaths like Eratosthenes who calculated the earth's circumference in stadia and also created a sieve to determine the Prime numbers. Today it is "publish" nonsense or "perish," into academic oblivion.

Society has flourished with measurement. From the clay tablets of the 4000 BC to the modern day smart phones where abacus is but a long past antiquity. Today everything is being measured form body mass index to the Higgs Boson. And each measurement reflects a differing set of metrics. Some in weight (Archimedes and his “Eureka”), others in volume and even the tiny bosons in electromagnetic voltage (Higgs = 125 GeV). You see even Plato's Socrates had a detection meter called the “Elenchus,” which through questioning ultimately elicited the truth. Alas today, "sincerity and purpose" displace true rigor as the touchstone. We have fallen into the trap of shielding ourselves against questions to protect our vulnerable and unverifiable results. And to boot, those false prophets of measures are being associated/correlated/linked with other measures creating a a population of mis-measured "Roaches" that make it difficult to defy the inherent Augury.

The Yesterdays:
Erroneous numbers can cause economic damage when the metric of measurement is different. A $125 million Mars orbiter was lost in 1999 due to a serious mismeasure between the NASA and Lockheed Martin. One side used the English metric system and the the other used the conventional one. The net result was a spectacular news splash. Only after such a catastrophe and a quiet contest of the wills, did the rules of mental engagement change.

The Todays:
Today quantification is akin to reality and real science. "Economists" and "Scientists" revel in this measurement sort of thing. They measure a nation’s output in various different ways as GDP or GNP and Liabilities in the form of debt and deficit. All are material to a nation’s well being. Quite simply if you produce 2 of anything and consume 1 of the same then you will be 1 richer over time. The reverse is equally true making a nation poorer. Solutions from these gifted snake-oil people in a stagnating economy is "don't worry about the debt, print the money, spend with abandon and everyone will be happier," (I often wonder and worry about the "everyone") forgetting the value of the paper money will go down as there will be more of that paper around (inflation). The touchy feely state of affairs is cloaking the sense of foreboding temporarily, expertly employing, kicking the can down the road philosophy.

In medicine one wonders if Lord Kelvin’s, he of the absolute temperature fame, statement was taken to heart by the expert physicians, “when you can measure what you are speaking about and express it in numbers you know something about it, but when you cannot measure it numbers, your knowledge is of a meagre and unsatisfactory kind.” So every form of medical study to date about newer treatment has graphs and numbers that deal with benefits over something else as a means to convince others about the validity of the new treatment vs. the old. The manipulations of the numbers is a whole different story (Read: p-Hacking). As a consequence of this riddled thought 54% of all medical landmark studies cannot be validated in re-experiemtnation (Read: John Ionnadis).

Today we have gone into a “Measurement” overdrive. Using the computing power and a set of simple mathematical formulae with assumed variables quantified through axiomatic weighting we arrive at results that give us implied “Values” and “Benefits.” We determine statistically the Quality of Life using arbitrary numerical values laced with, again, assumptions that may or may not invoke Thomas Bayes’ name. Going far into the realm of this “Science” where everything has a weighted measure of value-that we pull out of a hat, we then ascribe a monetary reward for that achievement. It isn't anything like 1-lb of this equals 10 Shekels and therefore 2-lbs equals 20 Shekels. It is more like this ethereal “value” is worth 10 Shekels and failing the arbitrary metric of that value equals 0 Shekel or even -5 Shekels. And of course lack of value is a simple complaint away from the worker receiving any Shekels. The perpetual engine of revolution has ceased. No oil, no grease just a jammed up thought of yesterday’s todays.

The Mis-measure of Emotions:
Lets look at Satisfaction Scores as a measure of value. I leased a car from a car dealer and the salesman said, “You will receive an email asking if you are satisfied with our dealership. If you are not going to give us 5 stars then please call me before you submit that form.” Curious as to what the was about, I called him and lo and behold he said he would be willing to forgo the expense of the next car service charge. Some would consider that a bribe others would say “take it, what do you have to lose?” The problem is the awards emanating from the "award bestowing agencies" are fraught with hidden moral hazard. But you knew that already!

Taking that a step further, look at the “Pain” issue among patients. The Joint Commission for Hospitals and all "expert" endowed policy determiners recommended that “Pain” be considered a “5th Vital Sign.” In other words every doctor must assess the pain of his of her patient. And there were many formats to measure pain also devised by other well-meaning people. In one measure emoticons were used as means to determine intensity (Wong-Baker FACES). Patients needing pain medications used it to their advantage and a physician not wishing to get his “Satisfaction Score” in the gutter complied. Soon the opioid epidemic became a newsworthy item with “Breaking News” and “Alerts.” And a few doctors, worried about "Satisfaction Scores," on which depended their income got themselves into legal and regulatory muddle writing prescriptions with abandon. The husk of this ceaseless proliferating misinformation grows as the core of real knowledge atrophies and dies in the hearts and minds of those "grunting and sweating under the weary life.".

The Tomorrows:
The desire to measure is fed by our own hubris and grows and grows to overwhelm us with its unintended consequences. Today the elite speak only with the experts and the experts communicate only within themselves, thus propagating the myth of their "far-reaching knowledge and intellect." Thus the only piece of information is a rehashed version of manufactured evidence processed as knowledge and distributed via ventriloquists posing as teachers across the campuses.

"For who would bear the whips and scorns of time,
Th' oppressor’s wrong, the proud man’s contumely,
The pangs of despised love, the law’s delay,
The insolence of office, and the spurns
That patient merit of th' unworthy takes..."Indeed, who would?
But the people with a conscience and the fear and dread of the potential ill that might befall them from the "slings and arrows," hurled at them via "The insolence of office."

So measurement used in things that remain unmeasurable creates a false sense of illusion of expertise and intellect.

The Warning:
Remember whenever numbers are thrown out and percentages are flickered on and off in conversations or written on paper, know to cast a weary eye on them. There is a deeper, darker and more sinister mechanism at play; Self Advantage under the guise of intellect. And if you should hear the words, “Public Good” be equally afraid. The real boogey man is nearby.