Dr Orr's observations are indeed pertinent. I agree that the accurate measurement of quality of life involves many difficult factors that might be "personal, subjective, and multidimensional."
Our study,1 however, is retrospective, and the fact that only 31% of our patients were alive at follow-up indicates that the subjective elements are indeed impossible to obtain. This is one of the known inherent difficulties with a retrospective study. I will allow the numbers to speak for themselves.
The irony in Dr Orr's approach is that quality of life cannot be accurately measured unless one does it from a truly subjective perspective. One would therefore conclude that to decide whether Sarajevo, Bosnia, would be a reasonable place to vacation, one would have to visit and experience the circumstance before deciding. Obviously, this is not the case.
The fact that a person can "subjectively" observe a clinical situation and decide whether or
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