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Monday, July 6, 2009

The legacy of Robert McNamara

Robert McNamara died today at the age of 93. His accomplishments were many and on the whole his legacy should be viewed in a positive light. However, his focus on quantitative methods as tools to gauge success in the Vietnam war was quickly recognized as a perverse application of quantitative tools with limited relevance to critical decision making. When we think of McNamara, we think of the body counts.

McNamara's quantitative bent and use of numerical tools subsequently permeated science, finance, and policy making, not always with optimal outcomes. While data and measurements are essential elements of understanding our world and decision making, we need to be sure that we do not become blind to the point that we find ourselves focusing on the equivalent of body counts in various endeavors. Just because we can measure and model does not mean we can understand and control.

New and powerful quantitative tools were unleased in the financial markets over the past two decades, tapping into unrealized sources of wealth and capital. These tools ultimately created the impression of control and prediction beyond actual reality and drove the development and subsequent collapse of a financial bubble. (see Demons of our own Design - We thought as long as we could count what we thought what counted, we were in control. It was not the case.

In one realm of medicine, one of the original quants, Alain Einthoven, has become a luminary within the realm of health care economics and policy. A little known fact is Dr. Einthoven was Deputy Assistant Undersecretaries secretaries of defense under Robert McNamara. He has been instrumental in using quantitative tools to look at health outcomes. I will not disagree that outcomes are important in health care, much as they are in military campaigns. The problem is that what gets measured is what is measurable and what is measurable may or may not be important.

We are entering into tricky waters when it comes to measuring outcomes in healthcare, a world which consumes an ever increasing amount of resources and is coming under greater and greater stgate control. When payment becomes linked to outcomes and relevant outcomes are difficult to impossible to measure, it will be easy for us to begin to count the bodies to see if we are winning.

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