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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education.

This project was supported in part by funds from the National Institutes of Health, National Institute of Child Health and Human Development, Contract Number NO1-HD-0-2905. The Johnson and Johnson Foundation, the Burroughs Wellcome Fund, Syntex (U.S.A.), Inc., the Institute of Medicine, the Andrew W. Mellon Foundation, and the Richard King Mellon Foundation also supported this project.

Library of Congress Catalog Card No. 92-70987

International Standard Book Number 0-309-04697-1

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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 at the Staatlichemuseen in Berlin.

First Printing, April 1992

Second Printing, June 1992

Third Printing, December 1992



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