To the Editor.-Reply

—Drs Berzoff and Cohen point out that in our recent paper¹ we compared disparate populations of patients with chronic illnesses who were older and better educated than our study patients. The purpose in referring to these other groups was only to point out the marked difference between the presentations of these two groups rather than making any discrete statistical comparisons. Furthermore, they correctly point out that the management of these patients is confounded by coexistent physical and/or psychiatric illnesses, an issue which we and other authors have mentioned.^2-4 Finally, we too are concerned that patients with somatization disorder or other "high cost" disorders may be discriminated against. This concern, however, should not discourage clinical research. Rather, we as physicians should advocate the best care for our patients.

We appreciate Dr Stewart's letter. Patients such as the one described by Dr Stewart are true management problems. The most difficult