The debate between public bodies and the pharmaceutical industry is restricted by fundamental differences in the arguments put forward. The former highlight differences between the increasing curve in medical expenditure and progress judged by increased life expectancy, whereas the latter stress that the aims of contemporary medicine should now be to limit the results of disease and improve quality of life. The failure of health care to demonstrate beneficial effects originates from the fact that the measurement parameters used are inappropriate; new ones are required. In order to make judgments on subjective health and disease outcome, nonphysiological parameters must be used. The first part of this discussion will describe the concepts involved, the second will examine mechanisms currently available. Finally, the qualities such instruments must possess shall be assessed.
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