Contents  Summary  Chapter 1  Chapter 2  Chapter 3  Chapter 4  Chapter 5  References  Appendix A  Appendix B  Appendix C  Appendix D  IOM home page  NAP home page

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 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. 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 adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by funds from the National Institutes of Health (Contract No. N01-OD-4-2139). The views presented in this report are those of the Committee on the NIH Research Priority-Setting Process and are not necessarily those of the funding organization. International Standard Book No. 0-309-06130-X Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu. The full text of this report is available on-line at http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at http://www2.nas.edu/iom. Copyright 1998 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 Staatliche Museen in Berlin. COMMITTEE ON THE NIH RESEARCH PRIORITY-SETTING PROCESS LEON E. ROSENBERG*,† (Chair), Professor, Department of Molecular Biology, and Woodrow Wilson School of Public and International Affairs, Princeton University JOHN ALDERETE, Professor, Department of Microbiology, University of Texas Health Science Center at San Antonio KENNETH B. CHANCE, Dean and Professor of Endodontics, Meharry Medical College School of Dentistry CARON CHESS, Director, Center for Environmental Communication, Cook College, Rutgers University PURNELL CHOPPIN,*,† President, Howard Hughes Medical Institute JAMES W. CURRAN,* Dean and Professor of Epidemiology, The Rollins School of Public Health, Emory University DAVID CUTLER, Professor, Department of Economics, Littauer Center, Harvard University SUE DONALDSON,* Professor and Dean, School of Nursing and Professor of Physiology, School of Medicine, Johns Hopkins University BARUCH FISCHHOFF,* University Professor, Department of Engineering and Public Policy, Department of Social and Decision Sciences, Carnegie Mellon University SID GILMAN,* William J. Herdman Professor and Chair, Department of Neurology, University of Michigan ROBERT L. HILL,*,† James B. Duke Professor, Department of Biochemistry, Duke University Medical Center RALPH HORWITZ,* Chair and Professor, Department of Internal Medicine, Yale University School of Medicine THOMAS KELLY,† Boury Professor and Chairman, Department of Molecular Biology and Genetics, Johns Hopkins University ANNE PETERSEN, Senior Vice President, Programs, W.K. Kellogg Foundation SUSAN C. SCRIMSHAW,* Dean and Professor of Community Health Sciences, School of Public Health, University of Illinois at Chicago ROGER UNGER,† Professor of Internal Medicine, Center for Diabetes Research, University of Texas Southwestern Medical Center MYRL WEINBERG, President, National Health Council LINDA S. WILSON,* President, Radcliffe College ADAM YARMOLINSKY,* Regents Professor of Public Policy in the University of Maryland System Committee Liaisons HARVEY R. COLTEN,* Dean and Vice President for Medical Affairs, Northwestern University School of Medicine JOSEPH T. COYLE,* Eben S. Draper Professor of Psychiatry and Neuroscience Chair, Consolidated Department of Psychiatry, Harvard Medical School JOHN D. STOBO,* President, University of Texas Medical Branch Study Staff ANDREW POPE, Director, Health Sciences Policy Program GEOFFREY FRENCH, Research Associate Consultants KATHI HANNA MICHAEL McGEARY Copy Editor MICHAEL HAYES Section Staff CHARLES H. EVANS, JR., Head, Health Sciences Section ROBERT COOK-DEEGAN, Director, National Cancer Policy Board LINDA DEPUGH, Administrative Assistant JAMAINE TINKER, Financial Associate REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the Institute of Medicine in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the final report is the responsibility of the Institute of Medicine and the study committee and not the responsibility of the reviewers. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. The committee wishes to thank the following individuals, who are neither officials nor employees of the Institute of Medicine, for their participation in the review of this report: JOHN ABELSON,† California Institute of Technology DONALD D. BROWN,† Carnegie Institution of Washington MICHAEL S. BROWN,*,† University of Texas Southwestern Medical Center JAMES EBERT,*,† Marine Biological Laboratory, Woods Hole ROBIN ELLIOTT, Parkinson's Disease Foundation HARMON J. EYRE, American Cancer Society MARC W. KIRSCHNER,† Harvard Medical School S. ROBERT LEVINE, Juvenile Diabetes Foundation International ROBERT LEVY,* American Home Products Corp. MARSHALL LICHTMAN, Leukemia Society of America DOROTHY RICE,* University of California, San Francisco PAUL ROGERS,* Hogan & Hartson CHARLES SANDERS,* Glaxo, Inc. HOWARD K. SCHACHMAN,† University of California, Berkeley MORTON N. SWARTZ,* Massachusetts General Hospital SAMUEL THIER,* Partners Health Care System, Inc. LOWELL WEICKER, University of Virginia MYRON WEISFELDT,* Columbia University and past president, American Heart Association While the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the Institute of Medicine. *Member of the Institute of Medicine. †Member of the National Academy of Sciences.