University of York, UK
I'm here for the second annual conference on Randomised Controlled Trials in the Social Sciences. At this time of the year delegates outnumber students and many are here for a British Association for the Advancement of Science meeting, bringing science to the people. I presented at one of their sessions 20 years ago. Can't quite remember what on, but I do recall a co-presenter stripping off to reveal a T-shirt that said 'Stage not Age' (to remind listeners that stage of life was more important than chronological age). An early experiment in dissemination.
The RCT meeting is in two parts. Economists and educationalist today; more general discussion tomorrow. The first-day highlight is a paper by Paul Dolan, Professor of Economics at Tanaka Business School, Imperial College London. Dolan's work challenges economics orthdoxy.
In economics, preference satisfaction - should I buy tea or coffee – is used to understand behavior in public and private sectors. But what about the consumer's experience - what was the tea or coffee like? And what about their well-being - do they think the tea or coffee does them any good?
Much evidence used in health is based on assessments of preference. Researchers ask people what they would do if they got sick. But how we imagine future illness does not bear much resemblance to our perceptions if we actually are sick. We imagine physical ill-health to be much worse than it is. And we generally imagine mental ill-health to be less debilitating than it is.
Preferences do not take into account our ability to adapt. People imagine becoming paraplegic, not being paraplegic. The problem works both ways. Paraplegics imagine what life was like before losing the use of their limbs, not what it was actually like.
As Daniel Kahnemann puts it: nothing in life is as important as you think it is when you are thinking about it. And future preferences are about a moment in time. The subjective experience of those who are ill, changes over time.
There is no easy solution to this problem. One answer might be to stop asking people who are well about how they imagine they would behave if they were ill, and to start asking those who are ill about how happy they are, tak