Evaluation and Medicine

Abstract

Numbers are the stuff of science. They are necessary but are rarely sufficient for many personal and political decisions about the credibility of both medical and economic claims, findings, recommendations, and generalizations. Numbers apart, however, there is little in any scientific endeavor that is value free. Indeed, the values of scientists are major determinants of the problems they choose to examine or the questions they choose to ask. In turn, these choices initiate the application of the scientific process. Values also influence the assumptions underlying the investigators’ analytical or experimental designs and the conclusions they draw. In these respects, medicine and economics are alike in that both aspire to become more scientific by applying the laws of logic, the rules of evidence, and, to an increasing extent, the power of numbers to evaluate critically their hypotheses and improve their predictive powers. And it is predictability with respect to individual benefits and personal well-being as well as public policies and collective choices that we seek. As means to these ends, we use numbers to measure outcomes and attach relative values to the many complex issues that surround notions of health, disease, illness, and medicine.