Speech and Survival

To the Editor: In the October 22 issue, Dr. McNeil and her colleagues presented an interesting methodologic construct for investigating the trade-off between the quality and the duration of life in patients with laryngeal cancer.¹ Their study, however, contains a serious methodologic flaw, which limits any generalization to persons who actually have laryngeal cancer: The subjects in the experiment did not have this disease. A person with such a dread disease will usually have dysphoric affects, e.g., anxiety or depression, which will clearly affect the decision-making' process. “State-dependent learning” is recognized as an important variable in cognitive processes.² The use.