not yet been played out, and the primary documents available to the author were those provided to the press by the actors involved and media accounts of the events as they unfolded. Because the case study approach is inherently a subjective process, the writers were urged to use all available sources of reference for their work and describe the process by which they investigated the case study. Endnotes and references can be found at the conclusion of each case.

Also following each case are two commentaries, written and signed by individual members of the IOM committee, all of whom have their own rich experiences on which to draw. They present different aspects and viewpoints on the decisions—their unique perspectives as opposed to the conclusions of the full committee. The last chapter summarizes the committee conclusions and suggests areas for continued research. In Appendix A, committee member Stanley Reiser provides a historical perspective on the public and the expert in biomedical policy controversies.

These cases illustrate the complexity and evolution of decision making related to the diffusion and adoption of advances in biomedicine. The committee did not judge whether the cases were resolved adequately; in fact, in many of these cases the debate is still in process. What makes this collection different from other “technology transfer” reports is the deliberate intent to include the impact of values and the role of the public in the discussion. The cases do not merely present a historical, descriptive documentation of the diffusion process. Integral to the final analyses is a discussion of the myriad moral, religious, political, legal, psychological, and economic forces that influence how and when certain decisions are made.


Banta, H. D. 1984. Embracing or rejecting innovations: Clinical diffusion of health care technology. In The Machine at the Bedside, S. T. Reiser and M. Anbar, eds. Cambridge: Cambridge University Press.

Jonsen, A. R., and S. Toulmin. 1988. The Abuse of Casuistry: A History of Moral Reasoning. Berkeley, California: University of California Press.

Neustadt, R. E., and E. R. May. 1986. Thinking in Time: The Uses of History for Decision Makers. New York: The Free Press.

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