What Gets Measured...

Every institution obsesses over what’s measurable, be it circulation numbers or page views or profits or students’ marks or whatever. And almost all of us have complained that this mindset leads to the problem that V. F. Ridgway expressed so well:

“What gets measured gets managed - even when it's pointless to measure and manage it, and even if it harms the purpose of the organisation to do so.”

Of course, at the heart of this measurement mania lies the fear of the alternative: if it can’t be measured, does it become subjective? And once things are left to subjective assessments, will it become a free for all, where the lazy, the incompetent, the charlatans and the smooth talkers take over?

As Siddhartha Mukherjee wrote in The Emperor of All Maladies, objectivity lies at the heart of everything that calls itself a science (quantum mechanics may feel like an exception since it straddles both objective and subjective worlds, but then again, it is insanely accurate when comparing theory v/s measured values, often within 10 parts in a billion!):

“Science begins with counting. To understand a phenomenon, a scientist must first describe it; to describe it objectively, he must first measure it.”

So guess which type of cancer treatment became the first “rigorous science”? Leukemia, or blood cancer. Why? Unlike other forms of cancer which couldn’t be measured in any way in the pre-CT, pre-MRI era, leukemia could be measured. And as Lord Kelvin once said:

“If you can not measure it, you can not improve it.”

The cancer doctors agreed with Kelvin, as Mukherjee writes:

“If leukemia could be counted… then any intervention… could be evaluated for its potency in living patients.”

As medical tech advanced and it became possible to measure many things in the body, cancer treatment could track other numbers. So much so that Mukherjee describes this one doctor:

“To Li’s annoyance, (the hcg level) hadn’t gone all the way to normal… So despite every indication that the tumours had vanished, Li reasoned that his patients had not been fully cured. In the end, he seemed almost to be treating a number rather than a patient.”

Remember that saying about confusing the map for the terrain? Likewise, we often confuse what can be measured with what we wanted in the first place, but the alternative doesn’t seem very appealing and has its own downsides, so where does that leave us…