NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W., Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are draw from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of member of the National Academy of Sciences, the National Academy of Engineeing, and the Institute of Medicine.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate profession in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Science by its congressional charter to be an adviser to the federal government and, upon its own initiative to identify issues of medical care, research, and education Dr. Kenneth I.Shine is president of the Institute of Medicine.
Support of this activity was provided by the Howard Hughes Medical Institute. The opinions and conclusions expressed here are those of the author and do not necessarily represent the views of the Howard Hughes Medical Institute, the National Academy of Sciences, or any of their constituent parts.
Additional copies of this report are available in limited quantities from the Board on Health Sciences Policy, 2101 Constitution Avenue, N.W., Washington, DC 20418.
Copyright 1993 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.
BOARD ON HEALTH SCIENCES POLICY*
J.CLAUDE BENNETT, Chair, Professor and Chairman,
Department of Medicine, The University of Alabama School of Medicine, Birmingham
EMILIO DADDARIO,
Washington D.C.
WILLIAM N.HUBBARD, Jr., President (retired),
The Upjohn Company, Hickory Corners, Michigan
THOMAS INUI, Professor and Chairman,
Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Community Health Plan
RICHARD J.JOHNS, Distinguished Service Professor,
Department of Biomedical Engineering, The Johns Hopkins University School of Medicine
ERIC R.KANDEL, University Professor and Senior Investigator,
Center for Neurobiology and Behavior, Columbia College of Physicians and Surgeons
PATRICIA KING, Professor of Law,
Georgetown University Law Center
SHELDON S.KING, President and CEO,
Cedars-Sinai Medical Center, Los Angeles, California
ELAINE L.LARSON, Dean,
School of Nursing, Georgetown University
JOSHUA LEDERBERG, Ph.D., University Professor,
The Rockefeller University
ROBERT I.LEVY, President,
Wyeth-Ayerst Research, Philadelphia
MARY LAKE POLAN, Chairperson,
Department of Obstetrics and Gynecology Stanford University
JOHN D.STOBO, Director,
Department of Medicine and Physician-in-Chief, The Johns Hopkins Hospital, Baltimore, Maryland
PAUL D.STOLLEY, Professor and Chairman,
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore
JOHN E.WENNBERG, Director,
The Center for the Evaluative Clinical Sciences, Dartmouth Medical School
JEAN DONALD WILSON,
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
Staff
Jessica Townsend, Study Director
Janet Wittes, Consultant
Ruth Ellen Bulger, Director
Philomina Mammen, Administrative Assistant
