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To the Editor.—Drs Leplége and Hunt ¹ assert that variability across cultures, between patients, and in the same patient over time makes efforts to define the term quality of life impossible. It is an "idiosyncratic mystery." They conclude that physicians and health economists should avoid quality of life assessment. At the same time, the authors assert that quality of life is paramount to patients and is, indeed, the only concern of the patient who seeks medical care. The unwelcome conclusion is that outcomes—whether patients feel better and are able to do more, whether they are spared subsequent treatments, and whether they are glad they sought medical care—are not a part of medicine.

This argument, however, rests on a faulty assumption. Variability among patient appraisal of quality of life is limited. No one thinks severe abdominal pain is better than a runny nose, as Fanshel and Bush² long ago pointed out . . . [Full Text of this Article]

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JAMA. 1997;278(1):47-50.
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