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 Principal Investigators
responsible for the report were chosen for their special competences and with regard for appropriate
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.
This study was supported under contract No. DC7C02 from the Executive Office of the President,
Office of the National Drug Control Policy.