SCHOOL OF MEDICINE
STANFORD UNIVERSITY. STANFORD. GALIFORNIA 94305

June 16, 1978

JOSHUA LEDERBERG
JosePH D. GRANT PROFESSOR
OF GENETICS

Prof. Jules Hirsch
Hospital

The Rockefeller University
1230 York Avenue

New York, NY 10021

Dear Jules:

I have enjoyed the opportunity to read the essay on
"Reflections on medical science-1977 and beyond" that you were kind
enough to send me. I am sorry this has not appeared in print as
it is an eloquent exposition of one pole of an extremely important
and necessary debate. I find myself resonating affirmatively with
a great deal of what you said (and perhaps will over persuade you
about that by pressing on you a number of my own writings that
deal with some of the same issues.) I have been particularly
interested in questions akin to the somatopsychic and reverse-
psychodynamic phenomena that you wrote about. At one time I had
to take a look at the status of etiological explanation in infantile
autism and was very much impressed by the burden that was placed
on parents’ attitudes; to me it was virtually self evident that
these were derivative of the child's disease and that the psychiatrists
were quite wicked in conpounding the imputed guilt.

I am certainly in wholehearted agreement with you that medical
research ,and particularly medical education,need to be leavened and
informed by insights about the adaptive behavior of the whole organism.
How to translate that into effective research programs for an insti-
tution like ours poses additional problems of obvious complexity:

We, of course, must pay heed to those areas of investigation that
are amenable to attack by the methods available to us and we must
also build on the existing strengths of the scientific collegium
in order to have an efficient plan. But I can well understand how
you may be reacting to a tradition that may well have been far too
rigid and narrow on the other side.

This kind of reaction is also notable, and self-admitted,in your
characterization of hard-core reductionism. The trouble is:that kind
of caricature may be co-opted by people like Koestler and Weitzenbaum
in ways that can end up being quite discouraging to the pursuit of
the most important and achievable aims both in basic biology and
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Hirsch
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in medical applications. Without some degree of reductionist fervor

we would still believe that the replication of the gene was beyond
human comprehension and we might well lack access to the most important
psychotropic medications now available for the treatment of severe
psychiatric illness. I guess I have met a few people who would conform
to the stereotype of the hard-core reductionist ;but they are rare and
rarer still is their insistence on that position in the face of
sympathetic criticism. But I suspect you are much closer to my own
position than you would be to a Koestler.

I am certainly looking forward to many opportunities to delve
further into these issues,and to making practical use of the insights
that we can develop collegially for the further planning of programs
for the hospital and of the university.

Thank you again for a provocative and challenging essay.
Yours sincerely,

Jgshua Lederberg,
Professor and Chairman
Department of Genetics

JL/gel