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Martin GD Kelleher ‘McNamara’s’ and Other in Dentistry: Part 1

In 1984, Charles Handy, an Anglo-Irish philosopher, wrote a measured. That is fine as far as it goes. book entitled 'The Empty Raincoat.'1 In this elegantly written  The second step is to disregard that which cannot be easily book, he popularized the phrase 'The McNamara ' measured, or to ascribe to it an arbitrary quantitative value. although it had been described some years earlier by Daniel That is artificial and misleading. Yankelovich (1924–2017).  The third step is to presume that what cannot be measured In essence, a McNamara’s fallacy means that it is wrong 'to easily really is not important. This is blindness. make important something which one can measure – rather  The fourth step is to say that what cannot be measured easily than measuring the important things'. Anytime something really does not exist. This is suicide.' unimportant is measured, and is then claimed to be a valid surrogate for measuring something that really is important, but The origin of the term 'McNamara’s fallacy' when that arbitrary measurement does not do that accurately, it A McNamara’s fallacy is named after Robert McNamara (1916– is an example of McNamara’s fallacy. 2009). He was the US Secretary of State during the presidencies Unfortunately, McNamara’s fallacies abound in dentistry. of John F Kennedy (often referred to as 'JFK'), and also of Lyndon The wider context is that over the last 20 years, dentistry, as Baines Johnson (often abbreviated to 'LBJ'). well as medicine, have both become corrupted by this malign McNamara graduated from Berkeley and, having taken an MBA 'measurement at all costs' approach. The perverse result of this at Harvard, he became the youngest professor there at the age of fetish for measuring something/anything that can be measured 24. He specialized in statistical methodology. During World War II easily means that some important, but difficult-to-measure, he served in the US military’s Department of Statistical Control and things in dentistry get ignored. used his flair with statistics to achieve a remarkable improvement Since 2006, instead of measuring the seriously important in the efficiency of aerial bombing. He worked with General Curtis things, such as the long-term outcomes for patient’s health LeMay on the firebombing of Japanese cities, when approximately and their dentition, or ensuring that patients received 100,000 civilians died in a single night. After World War II finished, compassionate, effective, dental advice and/or treatment, NHS McNamara went to work for the Ford Motor Company, which was in dentistry in England and Wales fell victim to a McNamara’s deep financial trouble at that time. He used his skills with statistics fallacy when it became measured in facile, and corrupting, to help to return it to profitability, and he became the president of 'Units of Dental Activity' (UDAs). the Ford corporation at the age of 44 in 1960. In 2019, Professor Seamus Mahony, an Irish gastroenterologist However, just a few months later, he accepted USA President who spent much of his working life as a consultant in the English John F Kennedy’s offer to become the US Secretary of State for NHS, published a fascinating, but deeply troubling, book called Defence, just as the was really taking off. Once Can Medicine be Cured? The Corruption of a Profession.2 In it, there again, he used his quantitative approach to count the deaths of is a great chapter on the McNamara’s fallacy, which Professor the combatants on both sides in that war. His strong belief was O’Mahony described as follows: that, so long as the Viet Cong casualties exceeded those of the dead Americans, which McNamara insisted should be counted 'In essence, the McNamara Fallacy consists of various steps: s