continue to participate in the committee process, and help address the issues raised in her paper, Dr. Stone attended no other committee or working group meetings. In an effort to accommodate her schedule and focus on her concerns (primarily the abortion issue), the committee even set up a special working group meeting, but at the last minute Dr. Stone was unable to attend.

The committee process Dr. Stone criticizes so strongly is a slow, often arduous consensus-building exercise in which a group of experts study an issue as outlined in the statement of task, or charge, provided to them by the Institute of Medicine. Their findings, conclusions, and recommendations are then gathered together and presented in a report, which is subject to independent critical review by an anonymous group of authorities in the field at issue, appointed by the Institute of Medicine and the National Research Council. Such scrutiny is required before a report is approved for release to ensure that the committee has addressed its charge appropriately and substantiated its conclusions and recommendations.

The committee process is notable for the extent of its discussions, debates, and even arguments about available evidence and the conclusions to be drawn from it. Committee members are selected to bring varying points of view and so contribute to a broad perspective on the problem at hand. But in the consensus-building process, these views are often shaped, and—in the best sense—"influenced," not by sponsors, who take no part in the often heated give-and-take of committee deliberations, but by the ideas and opinions of other experts who bring their combined knowledge and understanding to bear. Dr. Stone's lack of participation in this process appears to have led to her misconception of the role played by study sponsors and her view of their ability to constrain the committee's conclusions and eventual recommendations. In the case of our committee, although sponsor representatives attended some meetings, they participated only as resources; when appropriate, they were excused from meetings so that the committee could discuss issues in their absence. Moreover, sponsor representatives did not attend working group meetings, during which most of the recommendation formulation work was carried out. The character, organization, and substance of the report clearly reflect the work of committee members alone; in addressing the committee's Statement of Task (see box) we made decisions about the content and organization of the report and how each point should be presented. The process was fair, and members' participation was broad and vigorous. No other committee member besides Dr. Stone, whose experiential basis for judgment must be considered extremely narrow, experienced feelings of constraint or pressure from the sponsors.

Much of Dr. Stone's critique of the process stems from her displeasure with the committee's handling of the abortion issue and the revisions that were made to the paper she submitted. She implies that the Centers for



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