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∂AIL %2American Scientist%1↓345 Whitney Ave.↓New Haven, CT 06511∞
To the Editors:

	Doctors, psychologists and psychiatrists may be tempted to push
their moral and esthetic ideas about life style in the guise of medical
advice.  This is immoral, because it takes unfair advantage of the
patient's illness and the doctor's reputation as an expert, and it is
dishonest, because the therapist's moral and esthetic premisses are not
explicitly stated.

	David Glass in "Stress, Behavior Patterns, and Coronary Disease"
(%2Am. Sci%1. 65:177-187, March 1977) classifies behavior patterns as type
A or B and describes their relation to coronary disease.  Unfortunately,
the classification itself and his choice of scientific questions contain
unstated moralistic premisses that seem to underlie the whole trend in
medicine discussed by his 70 references.  Worse yet, since the premisses
are inexplicit and therefore undisclosed to the patients, the
pharmacological and behavioral treatments advocated violate the patients'
rights.

	Let us assume that all the studies reported were correctly
done and provide the reported answers to the questions that were
posed in them.  Nevertheless, the article and the research and therapy
by Glass and others reported in it are open to serious moral objection.

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	Here are the grounds for complaint:

	1. There is a lack of respect for the variability of human
behavior patterns, the right of a person to maintain his own except where
it infringes the rights of others, and the duty of a therapist to
help him reduce his disease risks, however he chooses his life style.
"It takes all kinds to make a world" is the old-fashioned way of putting it.
Can't there be a therapeutic ethic that recognizes a patient's right
to his life style and helps him avoid disease within it?

	2. Hard-driving personalities get short shrift from Glass.
Hostility is one of the characteristics included in the
type A cluster.  When they don't show it, it is because %2"they often
keep such affect under deep cover"%1.  They %2"believe that with sufficient
effort they can overcome any obstacle"%1.  Any obstacle?
They are %2"compulsively hard-driving"%1.  Could a person be uncompulsively
hard-driving?   They exhibit %2"excessive achievement
striving"%1.  No criterion is given for distinguishing this from normal or
subnormal achievement striving.
Any hard-driver who comes to the National Health Research Center, for example,
has reason to fear that there is more on the agenda than lessening
his risk of a coronary attack.

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	3. With the decline of explicit discussion of the "good life",
there is a tendency to incorporate ideas of the good life under the
notion of health.  Unfortunately, the reader can't tell
whether Glass thinks he has a duty to be less hard-driving and
what Glass thinks are legitimate social means to achieve this result.
Now I think hard-drivers have contributed much to the world,
and the type merits encouragement and help with its special medical
problems (if there are any), but the relevant arguments are surely
sociological, historical and moral - not medical.

	4. Glass's own studies show that type A's calm down and do
better when they have discriminated what they can change from what they
can't.  This might suggest helping people discriminate better, but
perhaps a bias in favor of reforming their personalities prevents Glass
from considering what might be done in this direction.  In the
days when preaching was explicit, we heard, "Lord help me change what
I can, endure what I can't, and know the difference".

	It seems to me that scientific authors owe the public
a duty to state explicitly their moral premisses when these substantially
affect the content of their work, and referees and editors are duty bound
to help them.
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John McCarthy
Computer Science Department
Stanford, University
Stanford, California 94305
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