This paper is written at the request of the IOM committee, which asked for an analysis of the lessons to be learned from the experience of two earlier commissions that are both generally cited as successes ¹--The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (the National Commission) and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (the President's Commission). The National Commission issued ten reports between 1975 and 1978; the President's Commission also issued ten reports (plus a summary report) between 1981 and 1983. (These reports are listed in Table 1.) This paper will explore the senses in which these two commissions were successful and the reasons behind their successes and failures.

The question of what makes a commission successful is far from straightforward. ² A report that helps to break a policy impasse may be viewed as successful by advocates of one policy option and as a disaster by