Therefore
When improvement becomes policy, what else becomes inevitable?
After the cell-therapy program’s success, a simple method for finding unnecessary waits begins to spread. A shared sheet becomes a formal process. The process becomes guidance. The guidance becomes a national framework. Every step is defensible, every number traceable, and most of the results are genuinely better.
Roscoe’s concern is not that anyone is lying. It is that context gets thinner as careful local judgments are compressed into fields, stages, benefits, and decisions. A qualified estimate becomes a worked example. A worked example becomes a template. Soon institutions far beyond the original program are removing delays by the same logic, with people still present at every decision but increasingly asked only to approve what the system already does well.
Therefore is a novel about the distance between evidence and decision, and about what happens when a method that works begins to change the systems it was meant to improve. Roscoe can find no villain and no clear intention, only better solutions accepted one at a time for good reasons, and a question that stronger evidence has not managed to settle.