Felicitometry: measuring the 'quality' in quality of life

Following Bernheim,(1) we examine aspects of 'felicitometrics,'(2) the measurement of the 'quality' term in Quality of Life (QOL). Bernheim argued that overall QOL is best captured as the Gestalt(3) of a global self-assessment and suggested that the Anamnestic Comparative Self Assessment (ACSA) approach, in which subjects' memories of the best and worst times of their lives are used to anchor a Visual Analog Scale (VAS), provided a serious answer to the serious question, 'How have you been?' Bernheim compares and contrasts the ACSA to multi-item questionnaire QOL instruments, such as the SF-36, concluding that the ACSA has a number of advantages. His discussion assumes that the use of QOL outcomes in clinical trials is both relevant and appropriate. In the present paper, we document the reasonableness of this latter assumption,(4) contribute to the characterization of the similarities and differences between multi-item and individualized QOL instruments, and point to some other individualized instruments that may be used in clinical trial contexts. These 'other individualized instruments' differ from the ACSA in fundamental ways; but they are individualized in that the subject defines those areas in his/her life that are most important, and these may vary from subject-to-subject.