sis for the Centers of Disease Control and Prevention. He worked for the National Institute for Occupational Safety and Health from 1980 to 1987, where he directed its main workplace consultation program. From 1987 to 1994, he worked for the New York State Department of Health where he directed environmental and occupational health programs including the development of a network of occupational health clinics.

STEPHEN G.PAUKER, M.D., is Vice Chairman for Clinical Affairs, Department of Medicine, and Associate Physician-in-Chief, New England Medical Center, and Sara Murray Jordan Professor of Medicine, Tufts University. Dr. Pauker is a member of the Institute of Medicine (IOM). Prior committee memberships have included IOM’s Guidelines on Thyroid Cancer Screening, and the Committee to Evaluate the Artificial Heart Program of the National Heart, Lung, and Blood Institute, as well as Workshops on the National Institutes of Health Consensus Development Process and the Use of Drugs in the Elderly, both within IOM. His publications and research have focused on screening for cancer and other conditions, applications of clinical decision theory and medical informatics to health policy, technology assessment and the individualization of patient care, cost-effectiveness analysis, clinical cardiology, telemedicine, ethics of various reimbursement models, and efficiency of care delivery.

ROBERT C.SPEAR, Ph.D., is a Professor of Environmental Health Sciences at the University of California, Berkeley. He received an M.S. in mechanical engineering in 1963 from the University of California, Berkeley, and a Ph.D. in control engineering from Cambridge University in Cambridge, England, 5 years later. Dr. Spear’s research interests relate principally to the assessment and control of exposures to hazardous agents in both the occupational and community environments. He has an extensive publication record in this field which spans farmworkers’ exposures to pesticides to strategies for the characterization and control of the exposure of rural populations to parasites in the developing world. He was appointed Founding Director of the University of California’s Center for Occupational and Environmental Health in 1979 and continues to serve in that capacity. He has served on numerous committees advisory to governmental agencies including the National Advisory Committee on Occupational Safety and Health and, currently, the National Institute for Occupational Safety and Health Board of Scientific Counselors.

LESTER N.WRIGHT, M.D., M.P.H., is Deputy Commissioner/Chief Medical Officer responsible for provision of health care to 72,000 in-



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