Quality Adjusted Life Years (QALYs) have become a household word among health economists. Their use as a means of comparing the value of health programmes and medical interventions has stirred up controversy in the medical profession and the academic community. In this paper, I argue that QALY analysis does not adequately take into account the differentiated nature of the health state values it measures. Specifically, it does not distinguish between needs and preferences with respect to its valuation of health states. (...) I defend the view that needs and preferences are clearly distinguishable, and that the concept of needs cannot be dispensed with, as many health economists suggest. It is argued that the scale along which health states are measured in QALY analysis is not a continuous interval scale, but one which concerns two distinctly different value dimensions. Measuring the values of health state intervals may reveal the weighting attached to the different value dimensions. (shrink)

“Everyone knows that language is variable.” This is the bald sentence with which Sapir (1921:147) begins his chapter on language as an historical product. He goes on to emphasize how two speakers’ usage is bound to differ “in choice of words, in sentence structure, in the relative frequency with which particular forms or combinations of words are used”. I should add that much sociolinguistic and historical linguistic research has shown that the same speaker’s usage is also variable (Labov 1966, Kroch (...) 2001:722). However, the tradition of most syntacticians has been to ignore this thing that everyone knows. (shrink)