UNITED STATES PHARMACY COLLEGES AND SCHOOLS
| Alabama | Alaska | Arizona | Arkansas | California |
| Colorado | Connecticut | Delaware | Florida | Georgia |
| Hawaii | Idaho | Illinois | Indiana | Iowa |
| Kansas | Kentucky | Louisiana | Maine | Maryland |
| Massachusetts | Michigan | Minnesota | Mississippi | Missouri |
| Montana | Nebraska | Nevada | New Hampshire | New Jersey |
| New Mexico | New York | North Carolina | North Dakota | Ohio |
| Oklahoma | Oregon | Pennsylvania | Rhode Island | South Carolina |
| South Dakota | Tennessee | Texas | Utah | Vermont |
| Virginia | Washington | West Virginia | Wisconsin | Wyoming |
Health technology assessment (HTA), as it is currently represented within PharmD programs, presents itself as a quantitative framework for evaluating therapies, guiding pricing, and informing resource allocation. Across pharmacoeconomics and outcomes teaching, students are introduced to models, ratios, thresholds, and simulations that claim precision and objectivity. These constructs, most notably utilities, QALYs, and reference case cost-effectiveness models are treated as if they provide a valid numerical basis for decision-making. Yet interrogation of HTA-related knowledge bases associated with U.S. colleges and schools of pharmacy demonstrates a consistent and reproducible pattern: the foundational requirements of measurement are not recognized or applied. Arithmetic operations are performed, comparative claims are made, and thresholds are invoked, but the quantities involved are not demonstrated to possess the properties required for measurement. This is not a marginal concern. It represents a structural condition in which numerical outputs are interpreted as measures without satisfying the axioms that define measurement.
The consequence is a systematic pattern of measurement inversion. Constructs that do not meet the requirements of unidimensionality, dimensional homogeneity, and ratio scaling are nonetheless treated as if they support multiplication, aggregation, and comparison. This inversion is embedded within pharmacoeconomics teaching, reinforced through research outputs, and institutionalized through reference case frameworks that prioritize simulation over measurement. Over more than four decades, this approach has been replicated across academic programs, journals, and national agencies, creating what appears to be a stable and coherent analytical system. However, its persistence reflects not the validity of its constructs, but the successful transmission and reinforcement of a framework that operates outside the constraints of scientific measurement.
This section presents the results of an ongoing structured interrogations of HTA knowledge bases across U.S. colleges and schools of pharmacy. The findings to date point consistently to the same conclusion: the current framework does not support credible, evaluable, and replicable value claims. A transition is required. This is not a call for wholesale curriculum redesign, but for a return to the standards that define quantitative science. Within this framework, only two types of value claim are admissible: those based on manifest attributes measured on linear ratio scales, and those based on latent constructs transformed to interval-level measurement through Rasch measurement theory. The objective is to align PharmD education with the requirements of measurement, ensuring that future pharmacists are equipped to evaluate therapies on a scientifically defensible basis rather than through numerical representations that lack measurement validity.