Similarly, with regard to review of requests to access records for which consent has not been provided, the most critical question is, which of the two mechanisms being offered works best? Along with Dr. Simon et al., I suggested reliance on institutional review boards for that purpose. Dr. Goldman correctly notes that institutional review boards are already overwhelmed and expresses the belief that an independent body dedicated to this role alone might do a better job. There are a number of unanswered questions about this proposal, including whether the issue arises frequently enough at any site to warrant creation of a separate body, where the resources (human and financial) will come from to support this group, and whether it will do a better job than institutional review boards in protecting privacy while permitting important research to proceed. But we will not know the answer to these questions until we have had an opportunity to inspect such a system in operation.