I think I have a good idea for a simple test of value for subjective outcomes, and it's a simple question: would you do it again, or would you rather take $10 home? The $10 value is arbitrary, it's an amount that isn't significant but still counts as able to buy a cheap meal or something that has little value but is helpful, even if at around 1/10. Hey, at least it isn't 0, basically. Could be $5. Whatever, it has to be significant but not worth doing or giving up much for it. In my case, if I look at effective treatments that helped me and someone asked to either get $10 or never use it when needed, there are some where I would say thanks but I'll keep the medication/treatment, it's definitely worth more than $10. That includes stuff like stretching. I do a lot of stretching during the day. No one is going to lose $10 to me by giving me the choice of either never stretching to soothe the muscle pain everywhere or enough money to just about buy a cheap meal. Same with ginger for nausea and Pepcid for GI issues. When it works it works. For CBT and GET, I assume that over 90% would choose the money every time, and that's probably a massive undercount. It could be a standard in a trial, at the end participants can choose to keep trying the treatment or get the $10. Ironically it would be dismissed as biasing, but an amount of money is objective, it buys a number of things and no more, no less. It's also familiar to everyone, and far more objective than any subjective questionnaire. No treatment worth less than $10 to a patient is worth pursuing. In the case of CBT and GET it could be booster sessions. In the case of medication it could be a longer course with a follow-up for those who value the treatment, a useful comparison point for responders. Along with reasons both for drop-outs and responders, available in the paper. Risk aversion is a known phenomenon, we value losing a small amount more than winning a larger one. Being presented with the option of that $10 means it feels acquired, and giving it up means hitting against that risk aversion. It's a no-brainer when the treatment is worth it. Also when it isn't.
Perhaps the amount could be determined by the cost of the treatment. So if it's a medication that needs to keep being taken, you could be offered the price of a month's worth of the pills and asked to decide whether to have the pills or the cash. If it's a therapy, you get either the price of a month's worth of therapy sessions or the sessions. I suspect if it's CBT most would take the cash after trying a couple of sessions. Similarly for GET.
Just for badness, I'm going to suggest bringing in a third alternative! Continue the treatment; Be given $10; Receive nothing (but you don't have to leave the house either).
It suprises me how much people will continue to attend session after session of a course of CBT/GET/APT etc with the hope that maybe in the next session all will be revealed and there will actually be something suggested that helps. I've done it myself - knowing after one session that it's not going to be useful, but still keeping attending.
Yes, it surprises me too. I haven't done CBT, but I've cut out of other treatments that weren't making any difference because staying at home did me much more good. (I've now corrected the typo on the original post, too, so it makes a bit more sense!)
Humans aren't rational about such things. Religions and superstitions abound, despite no supporting evidence. Humans want to believe in magic solutions for their problems, sometimes desperately so, and will aggressively fight any rational arguments against the magic. I expect there's an estimate of how many people have died or suffered serious harm by trusting quackery to fix what the doctors couldn't help with, and I expect it's a shockingly large number.
As for the $10 test, there have been 4 treatments that I'd definitely have paid $10 to be able to continue, and a sadly large number that I wouldn't. There was another--Fisetin--that gave slight reductions in my brainfog; enough that I bought more at I think under $10/bottle, but I wouldn't have paid over $10. As tests for ME treatments go, it's better than the typical tests that psychologists design in the hope that it will improve their professional profile (fancy fashionable terminology, yet meaningless).
I don't find the $10 test useful. Plenty of people will pay for a treatment they thinks helps a little, but is just a placebo.
The amount is irrelevant, it's a psychological anchor to ascribe value to something, something people do every day. Most people will take free stuff if it's handed out to them, then look at whether it has any use or value and throw it away, wouldn't have paid $1 for it, but it's free so whatever take it. If they passed the useless items again, they wouldn't take any. It's easy to do an experiment for this: set up a table where you hand out free stuff, clearly marked. This happens a lot around festivals and the like. Most people will accept something handed out for free, but if you look at the trash cans around they'll soon be filled with them if what's handed out isn't useful or valuable. A lot of people comment that about trials, it was essentially a waste of time but they went through it anyway because it's free. Wouldn't have paid money out of their own pockets, not even $1, but it was free so just nod and smile, then throw the tchotchke away. Sometimes there's an independent enjoyment factor, more often than not socialization, but that can be taken into account through testimony. Frankly I can't understand why it's not standard to have patient evaluations giving their reasons why it was helpful or not. Everyone, good or bad. There is no determination of actual value in research. There are BS takes on efficacy, then the usual useless criteria of feasibility and acceptability, but the only determinant of value is cost-effectiveness, and it's based on the value (direct expenses only) to the healthcare system, not the patient. An effective treatment is almost priceless, if there were some out there that cost $100K, lots of people would go ahead with it. Looking back at my experiences with healthcare, it's filled with worthless interactions, in fact the vast majority of them were. In any other context than healthcare I would just leave without paying since nothing worth paying for happened. But patient outcomes are never used, never even asked in most cases. In almost all cases if I'd been asked if it made a difference, if it was valuable or even simply to rate it 1-10, I would have said 0 every time. They are everywhere, because when it comes to chronic illness, the value is entirely in the mind of the healthcare systems, almost all of it fake, it does not exist for the patients in most cases, and when it does it's usually simply chance, same reason why some people end up drinking their own urine. I don't think healthcare should be a free market, but the lack of market forces, of matching supply and demand, is massive and obvious in medicine. Most useless treatments could be ended this way, if their value was actually properly determined. Some people will pay for useless things, even again and again, but most people won't. But that can be taken into account if it's done smartly, in the right conditions. Mostly it's that right now there is no useful assessment for pragmatic trials. Being feasible and acceptable is laughable. Most claims of efficacy are complete BS and unreliable. Value, though, it something we already use and do in every day life. That's what makes it different from the BS questionnaires with ambiguous questions and interpreted in odd ways, whatever you can buy with it, $1 is worth $1. And it's really about determining whether it has any value at all, to account for the fact that people will say please and thank you about worthless stuff just because it was handed out for free, a massive bias in all EBM that is exploited on purpose.
There is not necessarily a linear relationship between cash and perceived value. Not exactly the same scenario, but there is the classical cognitive dissonance experiment, where one group of subjects participated in a boring, tedious and deliberately pointless experiment and were paid a pitiful fee, whilst the other group were over paid for participating in the same experiment. The under paid group said how much they enjoyed pushing back the frontiers of science while the over paid accurately assessed it as a pointless waste of time. Also how wide spread is the idea of ‘no pain no gain’ or ‘it tastes awful so it must be doing me good’. Often immediately following an intervention people so want to believe it will help, and often are willing to defer to experts. That is why people may rate an intervention very highly during and after, but only realise months later what a waste of time it was.
I keep forgetting stuff... The reason I thought of this is because I keep seeing the standard for psychosocial treatment is that it "can be helpful". That's it, just the most possibly generic: "hey, it's probably not entirely useless". Even though the claims and beliefs within the medical profession is that they are 100% safe and effective treatments, it's just that we're too stupid to accept it. Even though in most cases, if patients had the option between that treatment and $10, most would take the $10. It may be "helpful", but not as much as just giving someone a small amount of money, or something of minimal value. There are so many things that can be helpful and useless at the same time. Giving $10, or even $50, to someone struggling financially because they are ill is helpful. It doesn't treat the illness at all, leaves the patient in the same state, their illness is unchanged, but is definitely helpful in ways that most psychosocial stuff simply isn't. I'm trying to separate the generic concept of helpful, which in almost any case simply handing out even just $10 would qualify to most people, with specifically helpful, in that it actually addressed the problem, and not some other preferred but irrelevant factor. It's true that money has different value to different people, but for the vast majority it's basically equivalent. Unless someone is in the top 1% of income, or has a trust fund, if they're struggling to work and face no income for the foreseeable future because of illness, $10 is definitely helpful, or whatever amount. And that can be accounted for easily. Personally I don't think this generic "helpfulness" is of any value, it's scandalous that it's a standard. In fact it's worse than nothing because of how turbocharged the asymmetry of bullshit is in medicine, once bad evidence becomes popular, it becomes impossible to do any better. But it is a standard, and I don't know that it's possible to convince medicine that it's wrong anymore than it seems possible to get them to care about the dismal quality of EBM, where pragmatic trials with overlapping thresholds are not only accepted, it's even OK to assert this means it's a psychological condition, even though it's not valid.
Well put - I remember trying to pose a similar idea maybe a year ago (but it was along the ‘how much would you pay for it’ lines) and caused confusion because of the nhs thing over here. But there is a reason the world runs on markets and as it does everyone us trained into using those terms of quantity better than other ‘measures’ even height or numbers etc nevermind scales in a questionnaire. Heck retailers can tell how effective and important a carpet cleaner or dishwasher tablet is to each individual based on flexing price point. Using the set amount perhaps works well in removing the affordability issue whilst cutting to the works/doesn’t work enough to be worth it without the noise of very good, very very good and so on
Agree that the same issues arise with regards influence and ability to programme in bias from other sources. Including ‘packaging’. Although theoretically by bringing in the price out you’d open the door to marketing/consumer behaviour literature that makes denial of these being nudges and manipulations less possible.
I think the test would only be valid for treatments already personally tried for a suitable period. Judgements about untried treatments are pretty much worthless for this test, since it would be judgements about beliefs based on unproven data.
