PREFACE 



Somewhat over twenty years ago, the Josiah Macy, Jr. Foundation 

 initiated a series of regularly scheduled conferences directed toward 

 challenging problems in medicine and health. With time, firm but not 

 immutable ground rules have been evolved for the conduct of these 

 sessions. Thus, each conference group is to meet annually for a period 

 of five or more years. Twenty-five persons, selected to represent a 

 multidiscipline approach, are to participate in a meeting. These indi- 

 viduals are termed conference members, if they have been selected 

 to participate in all of the meetings of a group, and guests, if they are 

 to participate in a single meeting. 



The purpose of each conference is the promotion of communication, 

 the exchange of ideas. To this end, an informal give-and-take among 

 the participants, members and guests, is encouraged. Structure and 

 continuity are given the discussion by a leader whose function is to 

 present some of the more interesting aspects of the problem under 

 discussion. The participants are enjoined to interrupt this presentation 

 with questions, criticisms, and comment. At their best, the interrup- 

 tions lay bare the birth and maturation of an idea, and form, therefore, 

 an essential part of the lessons to be gained from the conference 

 process. To share these lessons as widely as possible, an edited 

 transcript of the meeting is published. These transactions, which at- 

 tempt to retain the spontaneity of the discussion, have aroused con- 

 siderable interest and criticism. Comments range from an enthusiasm 

 for, to a total rejection of, the personalized approach. Criticism, in 

 the words of Frank Fremont-Smith, for many years the guardian of 

 these conferences, "has been directed primarily to editorial permis- 

 siveness which has allowed in the final text, in some instances, too 

 many questions, remarks, or comments which, although perhaps useful 

 during a heated discussion, seem out of context and interrupt the 

 sequence of thought." Clearly, not all critics recognize the narrowness 

 of the path twixt spontaneity, on the one hand, and editorial per- 

 missiveness, on the other, nor the challenges which confront the editor. 



