[Moment of silence observed.]

          DR. GORDON:  Thank you.  Thank you all very much.

                    Opening Remarks

          DR. GORDON:  Just a couple of things to begin with.  One is it seems to me that our work, always important, takes on a whole new dimension in the light of the kinds of healing that we all, and all of us as part of a nation, need after the events of September 11th.

          What we would like to do is on Saturday morning, we will set aside a little bit of time, if there is specific thoughts that people have about the contribution that CAM might make to the general process of healing in our country, and we can focus on that on the 11th.

          I wanted also just to say how grateful I am to all of you for being here.  I think it is really important that we are here and that we are together, and that we are here in the Washington area at this time.  It is a very important statement about the importance of our work and about how healing and help is so necessary right now.

          The other thing I wanted to say before Steve goes into the order of how we are going to proceed is, as some of you know, I was out of the country.  I was actually in the middle of a war when this war began over here.  It was very strange being in Macedonia and then coming back here.

          One of things that I appreciate so much is all the work that everybody has done in preparing for this meeting, all the Commissioners and all the staff.  It is just an extraordinary document that we are going to be working with these next three days.  I am terribly grateful to everybody for all the work that everybody put into it.

          Steve is going to talk about how we are going to move through the next couple of days and then we are going to move through quickly, and Michele is going to be keeping us on time, all of us, very strictly on time as we move through.

          Steve.

          Since the Interim Progress Report, which as I mentioned in an e-mail to you was signed off by the Secretary last Friday afternoon, and we have copies of it at the desk and we will be putting it up on our Internet site to make it available for comments, and anything that anybody would like to respond to that, your friends or colleagues, just ask them to send us a note, and we will communicate that information to you, as well, so I do appreciate it.

          I just want to mention, two other people who are in the room, Mary Plummer and Mandy Stoneberger, a couple people from our Committee Management Office, if you want to stand up really briefly.

          They ask you to update your files as far as conflict of interest and everything else.  It is not a matter of them wanting to know everything that is going on, and this information is confidential, but we need to know where funds come from, where your support is coming from, so if anyone raises an issue we can say yes, we know about this and you are cleared as a member of the Commission.

          We don't take these things lightly.  We just never know where people will be asking us, when they will be asking us for information about the Commission.  We had this early on about the membership, so I would ask you just to please update the requests that are provided to you on a regular basis.  Usually, it is at each meeting.

          I think as we approach the meeting, especially as we have completed the Interim Progress Report, we were looking at how would we pull this meeting off, how would we begin to write the Final Report, and there were two possible approaches that we thought about and normally you would go through I guess.

          One is to write the report and then develop the recommendations.  The other way is to develop the recommendations and define the issues, and then write the report.  I think after the whole process of going through and preparing the Interim Progress Report, we thought that we needed the foundation on agreement with the issues and recommendations, and that is why I think we took the approach we did of trying to define issues and recommendations that we could discuss at this meeting, develop some of the background information for the Final Report, although the background information that you received and is in front of you really is the rationale for the recommendations.

          That may change, and probably will change, as we go through the next three days as we being to prepare the final report, at least the Draft Final Report, for the December meeting that we will be discussing at that point in time.

          So, we will be picking up maybe more appropriate examples, better ideas, better concepts, so this is fluid and it will remain fluid until we have final agreement on the part of the Commission either in December or perhaps at a later meeting depending on the progress that we make.

          We ask you not to focus so much on the language in the text of the background information, but we really want to focus on the issues and recommendations that are before you.

          The workgroups will continue to function as they have.  They will be responsible for developing that section of the Final Report that they are currently working on.  So, it is going to carry through until completion, so each of the workgroups will maintain their status and their activity level.

          People have said can we change, we prefer that you don't, but if someone wants to join another group, they are welcome.  I think you all realize how much work is involved with each individual group, especially the facilitators, so I don't know how many people want to take on an extra burden of an additional workgroup, because it has been a lot of work.

          Today, tomorrow, and Saturday morning, we tried to break out each of the sessions into two-hour periods.  We will open up with a 10-minute introduction by the facilitator or co-facilitators, talking about the process, how they got to where they are, some of the remaining issues that are problematic.  These are the types of things that will be brought out.

          We then will have five minutes to go around to the other workgroup members to see if they have anything additional to add to what the facilitators mention in the introductory comments.

          Following that, we will move into about a 75-minute discussion of the issues and recommendations that are before you.  We will just sort of run through and see if there are areas of agreement or disagreement, and then we will take it from there.

          I will be passing out a little bit of a cheat sheet here that has all of the issues, the time frames, and then the disposition of the issues and recommendations.

          After the discussion, we will have about 30 minutes that Jim will take to take care of the recommendations and the issues, and we will be asking you to make some decision whether to accept the issue or recommendation as presented, accept it with change, return the issue to the working group with all the discussion that we have, delete the issue of recommendation.

          There may be some of the recommendations that you want to knock out, and not include, or determine that it shouldn't be the status of a recommendation, they may not be worthy of that as far as emphasis.

          If there are new issues or recommendations, and we think there will be, we ask you to limit your discussion of that issue, that new issue, a very, very brief discussion.  We have time on Saturday morning to pick up and discuss in greater detail the new issues.

          We only want to get them on the table now.  Our concern with the very limited amount of time is if we spend a lot of time working on the new issues, we will never complete the recommendations that are presented.  So, I think what we would like to have is, raise the issue, your brief rationale for your concern, state it, and then get out.  You know, we are finished with it for now.  We will bring it back.  The workgroup, then, will address that as they prepare the draft of the report.  So, I think we have to rely upon the workgroups to do their work, and they will be in touch with the individual who raised the issue or the concern.

          So, I hope that is okay.  We just are reluctant to spend 10, 15 minutes out of 75 on a new issue, that the workgroup really needs to hear from you and then expand a little bit in their procedures.

          So, I ask you to be patient and let the workgroup do their thing after this meeting to bring this to completion for you.

          I think that is about it.  I apologize for some of the confusion, but we have to be out of here at 5:00 both days.  It is security, added security.  They are closing government facilities at 5:00 for meetings, so we will be bumped out of here.

          What happened, also, we tried to get the meeting at the Pooks Hill Marriott for Saturday morning.  They had no meeting room, so we are going to what is called the Marriott Suites Hotel over on Democracy Boulevard, not real far from here, and we will make arrangements again to get you out to the Marriott Suites Democracy Boulevard location, which is a breezeway walk over to our offices.

          Once we heard that we didn't have the Pooks Hill Marriott for meeting space, we ran over there, and they fortunately had a space for us to meet.  So, my apologies for the confusion on that Saturday.  Again, that is quite accessible to the interstates and to the airport, so it will be a little bit easier I think in the long run.

          On Saturday morning also, I will talk about how we are going to prepare the Final Report.  We have procedures in place to continue utilizing the workgroups, and all of that will be discussed on Saturday morning.  A couple of you I think have to leave, and we will make sure you get a copy of what we will be talking about at that point in time.

          DR. GORDON:  Thank you, Steve.

          Let me just make sure that everybody is on the same page with how we are going to proceed.  If there are any questions about that, we can deal with them now.

          The basic idea after the presentations by the workgroup facilitator and by any additional comments, and after any additional comments from workgroup members, is that the major discussion of all the recommendations will take place in that next 75 minutes.

          The final 30 minutes is -- and that will be led by the facilitators -- the final 30 minutes is to make sure that we are all on the same page as we move ahead, and that part I will facilitate.

          My job is just to make sure that we have heard each other correctly and that we agree about where we are, and that we put a recommendation into one of the categories that Steve mentioned, that Ken has listed up on that board, that either we accept it or we change it, there is a new issue, we decide we don't want to make that recommendation, et cetera.

          So, I am going to ask a question at that point, which will worded something like can we live with this recommendation, and if we can, then, we will put it up there in that category; if we can't, it will go back to that workgroup.

          So, this is a continuing process.  If we decide we can't live with the recommendation, then, it is up to the workgroup to keep on working with it, and working with whoever has issues or concerns.

          One of the things that Steve said that I think is important to emphasize is if you have concerns or issues about any recommendation, the workgroup will be available to you, but we really want each person who has those concerns to get in touch with the workgroup facilitator and to make those concerns clear.  Okay?

          So, if there is an issue, let whoever is in charge of that particular workgroup know about the issue, so they can grapple with it and if you have new information you want to bring to them.

          Once again, if there are new issues, new possible recommendations, we will just raise them and then come back to them on Saturday morning.

          Any questions about the way we are going to proceed for Steve, me, or Michele, or anybody?  Michele.

          MS. CHANG:  I just want to mention as we start each new topic, we are going to ask the facilitator or facilitators and the staff lead to move from where they are sitting now to that table there, so that everyone can see them clearly.  Take your name plate with you.

          DR. GORDON:  Just one thing about my role.  In the early discussion, I am a member of the Commission, the facilitator is in charge, and then I will step back and my job is to help make sure we have the recommendations as everybody wants it in the final 30 minutes.

          MS. CHANG:  I am going to start the clock at 90 minutes for the full discussion, which includes your 10-minute overview and member group around the table, and I will give you a 10-minute warning when you need to start summing up to get ready for the disposition.

          Thank you.

          MR. CHAPPELL:  Would you repeat the time sequence?

          MS. CHANG:  Yes.  I am going to set the timer at 90 minutes, which includes the 10-minutes overview and the 5-minute comment by other members of your workgroup before you move into the full discussion.  I will give you a 10-minute warning, so that you know that you need to start to summing up.

          MR. CHAPPELL:  Great.

             Session I: Definition of CAM

          I am going to help us through the section on the CAM description and definition, Dr. Jones will help us with the guiding principles, and Jim Swyers, the writer of the material, will contribute as he wishes.

          I want to thank particularly Jim Swyers for the great work that he has done for this group, this committee.  It has not been an easy topic, trying to get our hands wrapped around the definition of CAM has not been easy, and I just want to thank Jim for his good listening and good encouragement and good drafting for us.

          I also want to thank our committee for the time and attention, thought, and guidance that each has given on this process.

          With that as way of introductions, shall I proceed with my piece?  Fine.

          MR. CHAPPELL:  Great.  In looking at the definition of CAM, I will be referring us all to pages 1 through 6.  The structure of our dialogue will be built around basically describing CAM, speaking about the marginalization issue of CAM, talking about the differentiation of the different practices of CAM, some of the common characteristics of CAM, and then looking at a summary definition of CAM.  So, that is the structure of my portion for us.

          Why don't we begin then looking at pages 1 and 2 as we look at the while question of describing and defining.  We tried to say let's define CAM, and throughout our sessions over the last year and a half, this has been a provoking question, are we all talking about the same thing here, or do we really need to come up with a definition.

          So, my thanks to those of you that have been probing and forcing us to wrestle with this.  As you can see by our attempt to define CAM, it began with a description of CAM.  It is just too broad to wrestle to the ground that simply, so we have let ourselves cast the net here with being sure that we are touching down on all of the points that we need to in describing CAM, and that is what you have before you.

          It is a diverse set of both ancient and modern health care systems and practices.  These systems and practices, not always supported in the Western countries, focus on the support and stimulation of the healing processes and on the whole person care to prevent and treat illness.

          The health care system and practices are shown on the following table, and there you see the diversity in the chart and have gained increasing acceptance and recognition by mainstream health care.  This is our attempt to circumscribe the various modalities and practices.

          Before I move on to the marginalization section, could we have some discussion?

          DR. JONAS:  I just want to mention this definition.  Just to kind of reorient you, I think we have talked about this before, there have been multiple different definitions that have come down through the years and we had in our discussion and certainly in our subcommittee we saw many of these.

          Jim put together a very nice kind of summary list of definitions that have come over a number of years.  This one is one that has been pulled from, and modified slightly from, the Cochrane definition, which in turn was pulled from an OAM definition working committee on definitions back in 1995.  So, this is kind of the link to this particular one.

          This had input from a number of international groups, so it was felt that this was important that this be something that would have worldwide applicability or at least the potential to have worldwide applicability in those areas.  So, that is just a little bit about the history and the background of that.

          MR. CHAPPELL:  Great.  That is helpful, Wayne.

          Tieraona?

          DR. LOW DOG:  Just a couple thoughts.  Especially given the state in the United States and how we are going to talk about dietary supplements and that, complementary and alternative medicine is a diverse set of both ancient and modern health care systems practices and products.

          I do think that in many cases, people are using dietary supplements without the context of anything, and I think it is a multibillion dollar business in this country, and I think products may be appropriate there.

          The other thing is, these systems and practices which are not usually available or supported in most Western countries.  I am not sure I know what we are trying to say, but it is not really accurate when you consider that osteopathy, chiropractic, naturopathy, homeopathy, therapeutic touch, applied kinesiology, and relaxation therapy really developed in the West.  That is their origin.  That is where they came from.  Spiritual healing, nutritional therapy, aromatherapy, and herbal medicine are really worldwide.

          I think what we are trying to say there is that it is not supported often by the dominant systems within Western countries, but to say that they are not available, when that is where they came from and they still flourish, I think is somewhat misleading.

          Those were my only two comments.

          MR. CHAPPELL:  Thank you very much.

          Yes?

          DR. PIZZORNO:  Actually, I would just like to start with a general comment.  On the long cross-country flight, I had a chance to sit down and read this document in one sitting in its entirety.

          I actually would like to compliment the staff and the commissioners for an incredibly well-done job.  This document is very, very impressive.  If I had my druthers, I would say I move to accept and let's all go home.

          [Laughter.]

          It is still 5:00 in the morning for me.  I would also like, as a comment, to second Tieraona's insightful comments.  Indeed, many of these did arrive from the West and I think there needs to be some tweak in the language to recognize that.

          Thank you.

          DR. JONAS:  I just want to say there is no word originated from in this, Tieraona.  Maybe we want to change tweak the readily available or something like this, there is no statement in here about that they did not originate from.

          DR. LOW DOG:  My comment, though, is that I think it is somewhat misleading or not usually available.  I mean chiropractic and osteopathy are readily available, therapeutic touch is readily available, herbal medicine is across the board in the United States.  I mean you can buy it at any health food store or Wal Mart.

          Spiritual therapy goes on in churches every day all around this country, so I think it is a bit misleading.  This comes back to the problem again about when you are saying CAM, some of which are not supported by the dominant systems or medical systems of Western countries.

          I think that what we are really talking about is not so much availability as the acceptance of them, and that is what leads to marginalization.

          DR. JONAS:  I think availability is also part of it.  I mean access is a whole section that we are talking about, so it is certainly not one that we would take out.

          We had in the original definition from the OAM, and actually, Cochrane I think maintained it, the word "dominant" meaning the politically dominant, and I think it was stated "politically dominant," was part of the definition, which the committee decided we wanted to alter or remove.

          Is that reasonable?  I mean am I hearing that we should insert that back in?

          MR. CHAPPELL:  Dr. Gordon.

          DR. GORDON:  Wayne, one of the things that might help address some of your concerns, Tieraona, is to have more of the history and the background to give a sense of where the different perspectives and where the different practices are coming from.

          I agree that the definition needs to alter slightly to accommodate these concerns, but if we provide a sense of the development of some of these modalities and how they have entered into the world and the United States, not a huge treatise, but some background, I think that that will be helpful in helping us understand where we are in this issue.

          MR. SWYERS:  One of the main pieces here that we have talked about is doing a history like that, and I think that will help inform some of the language in this, but I think right now we need to focus on the major pieces, because this is kind of different than the other sections, we are actually reviewing text, but I think now we need to focus on the major chunks and then we will go back and we will wordsmith this.

          As we see those other pieces fall into place, it will help inform our definition and some of our descriptions.

          MR. CHAPPELL:  Go ahead.

          SISTER KERR:  I would like to request, Wayne, Tieraona started speaking, I think it might benefit us to read that definition that included the politically dominant and why we perhaps thought it might be a yellow flashing light to the listeners.

          The other thing is, is it appropriate to point out that we have another summary definition of CAM on page 6?

          MR. CHAPPELL:  We are coming to that.

          SISTER KERR:  Just because of where people strayed, thank you.

          MR. CHAPPELL:  Thank you.  I would like to take as a guideline to any edits to this work, that we simply ask ourselves whether a specific phrase or word choice, whether it needs to be there at all.

          I think if we are going to be building the case for the history and including that, that history section will speak for itself, but when we get to the actual description or definition of CAM, I think we have to ask whether or not that language needs to be there at all.

          In the case of the phrase "which are not usually available or supported in most Western countries," I just don't think that needs to be there at all.

          So, that is kind of the way we can comb without asking the Commissioners to wordsmith this from here, I am just giving us some guidelines of if there is going to be a history section, and there will be, perhaps some of this can drop right out and we just get the focus right to what it is we do, what is it we are all about.

          Go ahead, Joe.

          DR. FINS:  Thanks, Tom.  I want to just piggyback on what Charlotte was getting to because I think that her flashing forward to page 6 is I think relevant, because I think this definition is more of a historical conception, and what you have on page 6, which we will get to and I don't want to discuss now, is probably more reflective of what we all believe.

          So, I think that the reason why you have the dominant, and you were trying to do the history and go forward at the same time.  So I think if we simply said the prevailing views from Cochrane, and the earlier reports, viewed CAM as blah-blah-blah, because if we go to page 6, which we are not going to get to, it is a more integrative tone.  This is more dualistic and antagonistic and defensive.  So, I think we have evolved to page 6.

          This is a historical definition, and not necessarily a definition that we are currently embracing.  I think that might be my reading of how it played out.

          MR. CHAPPELL:  Thank you, Joe.

          Yes, Effie.

          DR. CHOW:  Just onto that statement, I think if we change the word from "usually," like someone suggested "readily," I think available means not only the fact that it is available on the shelves and acupuncture is available, homeopathy is available, and chiropractic is available, but it is available limited because of finances, as well.

          This is what I am interpreting into this.  It is not readily available and supported in most Western countries, is that it is not funded, we have to pay out of our own pocket usually for these CAM services or products.

          So, for me, I think that is important to keep that in, maybe not "usually," you know, that word.  Maybe "readily" is more suitable.  Maybe we need to say "financial" in there.

          MR. CHAPPELL:  I am not accepting edits to the language.  What I am accepting is what thought is missing for you, what thought is in the way, what thought is missing for you.

          DR. CHOW:  This is what I am presenting is that the financial aspect is not apparent in here.

          MR. CHAPPELL:  Okay, financial limitations is not apparent.

          DR. CHOW:  Yes.

          MR. CHAPPELL:  Thank you, Effie.

          Tieraona?

          DR. LOW DOG:  I think Charlotte's and Joe's comments, I would just like to echo that perhaps leading in, since this is really what you begin to read when you first read the report, I think a non-defensive, antagonistic opening is important, I think for the people that are reading it.

          When I read it, and I am a pro-CAM person, I felt I had a lot of disagreements with it, and I am pro.  I like the definition on page 6 quite well, and I just want to echo sort of what has been said, just for consideration when we are looking at it.

          MR. CHAPPELL:  I think we could actually open this section with the summary definition, and I am even asking whether we should be dealing with the guiding principles before we get to the definition, because the guiding principles really are the orientation of the whole report.

          My reflections on this are to flip the guiding principles to the very front and then move into the description and definition of CAM, and to everyone's concern here about the summary, in fact, I was going to open our discussion on the summary paragraph because I think that is where the real work becomes focused.

          We could open that section with the definition and then proceed from there.  I see some heads nodding.  Yes, Joe?

          DR. FINS:  The work that I didn't see anywhere in the whole chapter was "integrative."  In fact, the very last sentence of that paragraph, the summary definition, is saying that the lines are getting blurrier.  In fact, I think we want to encourage that blurriness a little bit.

          There may be a way of trying to say that patients, as we have said many times, patients don't define themselves as CAM or allopathic, they are just patients, and they are going back and forth and the lines are blurred, because they are going back and forth.

          So, I think we need to recognize that up front, and that is really the motivation for the entire commission, that people are utilizing it, so the inversion might be helpful.

          MR. CHAPPELL:  Thank you.

          DR. JONAS:  I think it is a double-edged sword.  Certainly, "integrative" and encouraging the blurriness of the definition is accurate.  On the other hand, it can come back to bite you and that suddenly there is no field called CAM.

          Yesterday, I was meeting with some folks at the NIH, and they were talking about all the CAM research they were doing, and I looked at it and I said, boy, this is the stuff that has been going on in the intramural program at NIH for years, but now all of a sudden it is redefined as CAM.

          So, I think we have to be careful about being too integrative.  We just have to be sensitive to that, because a powerful system, the politically dominant system can indeed swallow up and claim an area without really getting the fundamental issues of holism, of healing, et cetera, and end up kind of focusing on products.  This is a new way to look at the kind of products we haven't looked at before.  So we have to be a bit careful with keeping the boundaries blurry.

          There are some advantages to try to at least be clear about what the core issues are that we want to make sure are unique to complementary medicine, or at least what complementary medicine is providing.

          MR. CHAPPELL:  I would like to ask the group to go to page 6 to look at the summary definition of CAM, and then we will work backwards from there.

          Go ahead, Joe.

          DR. FINS:  I take Wayne's point seriously.  I think perhaps a diagram right here, Figure 1, might be a Ven diagram, which shows that there are polarities, there are elements of allopathic and CAM medicine which do not overlap, but there is an area in between that does.  Very simple; everybody would understand that.

          That would also show that we are trying to create in integration while maintaining the differences that are instrumental and valuable to our health care system.

          DR. JONAS:  I like the idea that one of our goals is to properly integrate, and that puts this kind of blurriness into a positive perspective, I think, a proactive perspective.  So I would like to have that term in there.

          MR. CHAPPELL:  Thank you.

          Let's look at the summary definition.  I will just ask whether there are any thoughts that are missing there for you or thoughts that are simply not stating it as you understand it.

          Dean?

          DR. ORNISH:  This may fall into your definition of wordsmithing language except that I think that this particular paragraph, of course, is crucial to the entire document because it is really defining what the rest of the document is about.

          When we say that it is other than those intrinsic to mainstream health care, I just want to emphasize that we start by marginalizing ourselves.  I think that what I would like to see as a common theme throughout the document is something that we really take the middle ground that says that it marginalizes people who are going to criticize the report.

          For example, in our report, what we talk about later, to say that CAM research should be held to the same standards as non-CAM research, no higher, no lower.  Well, that is kind of hard to argue with.  Then, you force people to say no, it should be held to a different standard, and that marginalizes their argument.

          Here, we are in effect, marginalizing ourselves literally by the definition of saying that is outside the mainstream, when I think one of the reasons that the Commission was formed in the first place was Eisenberg's, and other's, research, talking about how it really in many ways is mainstream.

          So, I think those words have such different connotations that we should choose them carefully, and if there is some way that we can say even in the definition that this is something, it is not a question of should people be using this marginalized stuff, but rather they already are in some way even more so than conventional medicine, and therefore, that is why these are worth looking at.  That, to me, is what is missing here.

          MR. CHAPPELL:  Thank you.

          Joe?

          DR. FINS:  Along those lines, it is really a means and ends kind of argument.  You know, allopathic medicine, primary care, general primary internal medicine, family practice might have the same ends, but a different means to the same ends.  So, that might be a way of overcoming this sort of dualistic or dichotomous language that sets up a false antagonism between the goals of the holistic CAM provider and the holistic allopathic provider or modality.

          This is an aspirational model that applies to different vehicles to achieve the same end.

          MR. CHAPPELL:  Yes, Dr. Gordon.

          DR. GORDON:  This is really just procedural.  I think that the more that the facilitators, as the discussion kind of comes to a natural end about a particular issue, the more you can sum up what you have heard and where you see things going, the easier it will make it for us to move along, so I am just giving that back to you.

          MR. CHAPPELL:  Thank you.

          Joe?

          DR. PIZZORNO:  I think one of the challenges we are facing here is a historic perspective where this clearly was way outside the mainstream, and now a more moderate perspective where there is definitely some overlap and some mutual appreciation.

          So, I think maybe if we put some historic language in here just for some of the separations, it will help clarify this, because clearly, this did come from outside the conventional academic institution, federally-funded system that has dominated health care in this country for so long.

          MR. CHAPPELL:  Great.  Thank you.

          Tieraona?

          DR. LOW DOG:  I am going to raise it now because it is going to come up again and again, but when we talk about the major CAM systems, we have never identified the major CAM systems.  We listed a whole bunch of systems, but we didn't say these are the major CAM systems, and when we refer in this document to major CAM systems, this is what we are referring to.

          DR. JONAS:  Do you want to list them?

          DR. LOW DOG:  Well, that is my problem.

          DR. JONAS:  It is our problem, too.

          DR. LOW DOG:  I think if we are going to use the phrase, though, my first question would be, if I didn't know much about this and I am somebody reading this in Congress, I would say, well, what are they; what are the major CAM systems; what are you talking about.

          DR. JONAS:  You can list some of them very easily, Ayurvedic, et cetera, et cetera.

          DR. LOW DOG:  Just put them down there then.

          DR. JONAS:  But the problem with listing them, as you know, is that some are not listed.

          DR. LOW DOG:  I think we are going to have to deal with it, though.  If you are going to use it as the major CAM systems, then you are going to build all these systems, have X, Y, and Z, and they do X, Y, and Z, and they are this, you have to define them.  Whether it is difficult or not, if we are going to use the phrase, it is going to have to be defin