Reasoning in Measurement by Mößner Nicola; Nordmann Alfred;

Author:Mößner, Nicola; Nordmann, Alfred;
Language: eng
Format: epub
Publisher: Routledge

Part III

Measuring the Immeasurable

10 Measurement in Medicine and Beyond: Quality of Life, Blood Pressure, and Time

Leah McClimans

Quality of life measures are popular with health policymakers in large part because of their ability to function as quantitative measuring instruments, while also providing the patients’ point of view (see Darzi 2008). From a development perspective this attraction requires that these measures are epistemically and ethically sound. This double burden has proven difficult to achieve and these instruments have received significant criticism, mostly from those who develop and work with them. For instance, in 1995 the Lancet ran an editorial cautioning the use of these measures as end points in clinical trials and in 1997 Sonia Hunt’s editorial in Quality of Life Research argued that they are misleading and probably unethical; more recently in 2007 Jeremy Hobart and colleagues argued in Lancet Neurology that almost all current measures are invalid (see ibid.). In my own work I have argued that they are invalid and difficult to interpret, at least in part because they do not accurately represent the patients’ point of view (see McClimans 2010a; 2010b; 2011).

In this contribution I ask why quality of life measures face these challenges. One explanation that researchers commonly invoke is that quality of life measures lack a “gold standard” and are thus more difficult to measure than physical properties such as blood pressure. In what follows I examine and reject this explanation and offer a different one: the problems that quality of life measures encounter arise because quality of life lacks a theory that provides a representation of the measurement interaction, i.e. the relationship between the quality of life construct and its instruments.

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