PREFACESomewhat 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 individuals 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 interruptions 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 attempt to retain the spontaneity of the discussion, have aroused considerable 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 permissiveness 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 permissiveness, on the other, nor the challenges which confront the editor.