Scientists were paid as consultants and expert witnesses in litigation to defend and promote smoking, and to give the impression of “a chorus of seemingly authoritative voices from respected institutions around the world spreading damaging arguments designed to benefit the tobacco companies and damage health.” 16 (p979) The industry also commissioned wide-ranging research to challenge scientific evidence of the harmful health effects of tobacco use and offer alternative explanations. It is now well documented that the industry has sought over many decades to undermine the scientific evidence on smoking and health. We examined the extent to which the enduring popularity of the TABP concept can be explained, in part, by its interest to the tobacco industry.
9,13,14 It is also possible to assess type A personality type on a popular Web site “to see if your heart health is at stake by taking this test.” 15 10ĭespite the lack of evidence that it really is a risk factor for CHD, the concept of type A behavior has continued to enjoy public appeal, fostered through popular books by Friedman and Rosenman that describe “how to recognize the deadly Type A pattern in your own personality.” 1,11 TABP has also remained the subject of contemporary health research, including epidemiological investigations of CHD 8,9,12 and the featuring of TABP in discussions on the psychosocial causes of health inequalities. Subsequent studies also have shown no association with mortality: for example, the PRIME study, which examined psychosocial risk factors for cardiovascular disease in France and Northern Ireland 8 the GAZEL study, which found no association between type A behavior and mortality in French men, and actually found it to be protective of all-cause mortality in women 9 and the JHPC study, which found type A not to be predictive of CHD in a Japanese population. 6,7 For example, a 2002 systematic review, which summarized the findings of 18 etiologic and 15 prognostic studies, showed that studies reporting a significant association were in the minority in both groups. 5 However, these positive findings proved the exception, and many subsequent reviews have not found strong or consistent evidence that TABP is causally associated with CHD onset or outcome.
1 This theory appeared to be supported by findings from the Western Collaborative Group Study in 1970, 2 1974,, 4 and the Framingham Study in 1980. The concept was developed in the late 1950s by American cardiologists Meyer Friedman and Ray Rosenman, who argued that TABP was a risk factor for coronary heart disease (CHD), notably among White middle-class men. THE TYPE A BEHAVIOR pattern (TABP)-typically characterized by individuals who are highly competitive, ambitious, work-driven, time-conscious, and aggressive-has been the subject of research for more than 50 years.
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