{'fraction_non_alphanumeric': 0.025809716599190284, 'fraction_numerical': 0.0, 'mean_word_length': 4.763848396501458, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Death by Questionnaire: Quality of Life Measurement Could Seriously Damage your Health

One might think, reasonably enough, that any venture which ostensibly claimed to measure patient well-being and quality of life was, by its very nature, a 'good thing' and bound to benefit patients regardless of their gender, race, creed or disease. Sadly, such a view is naively optimistic. Any form of measurement has the inherent ability to place the phenomena it is measuring in some form of order. Sometimes the order seems innocuous enough and ranks that which it is measuring from biggest to smallest, or from highest to lowest. However, some forms of ordering are more evaluative in tone and, for example, attempt to place phenomena on a scale from best to worst. Thus, quality of life data can place people in hierarchies from the least to the most unwell. The concern is, what can be done with such information? In many instances such data can be used benignly enough: to aid diagnosis, to assess competing treatment regimes in a trial, or to assess the burden of disease. However, such data can also be used to prioritise, which, of course, is a modem day euphemism for rationing. The danger is that such a use threatens the outcomes movement, firstly in the eyes of patients and then in the eyes of clinicians and policy-makers. If patients believe that health status measures are being used in this way then it is likely to affect their responses. The primary suspect for the dangerous use of quality of life data in the invidious manner of 'prioritisation' must be the quality adjusted life year (the QALY) and the various technicalities on which it depends: the time trade-off technique, the standard gamble, magnitude estimation and utility measures of health status such as the EuroQol. In addition to technical concerns about the derivation and application of QALYs, there are also psychological limitations to this form of assessment. First, though, the technicalities.