American Podiatry Association

Norman 	Kl k b e r s , 	DPM
E x e c u t i v e D i r e c t o r
h e r i ecan Podi a8 r y Associ a t I on
2 0 Chevp C h a s e Ci scl e
Was h i n g l o n , 	D,C, 	2 0 0 3 5
J o h n G r a d , 	E s q ,
G e n e r a l 	Counsel
P o d i e t r y 	S s e i e t y 	of 	I q r g i r a i a
P o s t 	O f f i c e 	Box 	1 2 2 6
A f e x a n d r i a , 	VA 	22313
Dear 	Dr, Klmbers 	a n d M r , 	GFIsCJ:
T h i s 	l e t t e r 	r e s p o n d s 	t o 	t i l e 	request 	of 	t h e m e r i e l a n 	P o d i a t r y
AssscS a t i o n 	(eABAw) a n d 	t h e 	Podi & t r y Soei e t y 	of 	Vf r g i n l a 	("PSV"),
a n 	APA 	e o ~ o n e w t s n e i e t p , 	f o r 	B 	C 	i s s i o n 	a d v i s o r y 	o p i n i o n
e o n c e r n f ng 	a 	p r o p o s e d 	psogr8m 	f o r 	peer 	r e v i e w 	of 	g o d i a t r l s t s 8
f e e s , 	uiilizstionI 	a n d 	q u a 1 i l y 	of 	c a r e , 	by APA 	a n d 	Its' component
podistric 	s o e i e t i e r . 	l e t t e r 	of 	Mereh 	2 2 , 	1983, 	APA 	a s k e d
w h e t h e r 	t h e 	r e i s s u a n c e 	of 	i t s 	P e e r 	R e v i e w 	G u i d e l i n e s 	and
n o c e d u r e s 	M a n u a l 	( " G u i de1 i n e s R ) 	and 	t h e 	adoption 	&;PIC
implementetian 	of 	%!wee 	G u i d e 3 i n e 	y 	A 	esmpsnenl 	socletles
w o u l d 	vf c l l a t e 	t h e 	F e d e r a l 	T r a d e 	i s s i o n 	A c t , 	By 	l e t t e r 	of
J u n e 	2 1 , 	3 9 8 3 , 	PSV 	j o i n e d 	i n 	t h i s 	r e q u e s t , 	a n d 	e x p r e s s e d 	i t s
d e s i r e 	$ 0 	a d o p t 	a n d 	i m p l m e n l 	t h e 	p r o p o s e d 	Guieelines. 	M A 	arid
PSV 	h a v 	b o t h 	a d v i s e d 	me 	t h a t , 	l o 	e x p e d i t e 	a 	r e s p o n s e 	t o 	t h e i r
r e q u e s t , 	they 	w o u l d 	t e 	s a t i s f i e d 	w i t h 	an 	advisory 	o p i n i o n 	l e t t e r
f r o m 	t h e 	B u r e a u 	of 	C m p e t i t i o n 	(mBureau"), p u r s u a n t 	t o 	Sect isrr
I , l ( b ) 	sf t h e C o m i s s i a n 3 R u l e s 	of 	Praelice.
1 	I n 	t h e 	p a s t , 	Al.>A 	hrsls 	i s s u e d 	guidklLirres 	f o r 	u s c s ' b y 	i t s
eompanent 	s o e i e t ! PS, 	Foll l o w i n g 	t h e 	Supreme Court's 	d e e i s i o n
i n U n i o n 	Labor 	L i f e 	I n s . 	G o , 	V , 	Birena, 	-U I S . 	102 	S ,
C t , 	3002 	(1982), 	:{*kicR h e l d 	t h a t 	t h e 	p r o f e s s i o n a l 	peer 	r e v i e w
aetivltles 	i n 	I O I L ~ ~	e ~ s ewere 	n o t 	e x m p t 	f r m 	t h e 	a n t i t r u s t
laws 	a s 	p e r t 	of 	t h e 	" b u s i n e s s 	of 	i n s u r r s n e e , " " ABA 	r e c o r n e n d e d
l o 	I t s 	emponent 	jtocietf 	es 	t h e % t h e y 	I n d e f i n i t e l y 	s u s p e n d 	6 ; ;
peer 	review 	8eIivIties. 	APA 	now 	p r o p o s e s 	t o 	r e e o m e ; ~ d t o
component 	s o c i i e t ~ e s t h a t 	t h e y 	a g a i n 	eonduel 	p e e r 	review
a c t i v i l i e s 	i n 	a e e o r d a n e e w i t k APA8s Gui d e l i ncs.

~ o a m a hK l m b e r s , 	DPM a n d
J o h n G r a d , 	E s q *
Page 	2
Adcording 	t o 	t h e 	f nfosmation 	you 	h a v e 	p r o v i d e d , 	M A 	i s 	a
r o l l t . c~kporation existing 	as 	a 	confedera$6on 	o f 	fifty-two
esmponenl 	sseielfes, 	w i f R 	cr 	t o t a l 	m m b e r s h i ? 	0 3 .
s l p p ~ o x l m a t c l y 	8,2063 	doctors 	of 	podilnlrf c 	medIeDrre 	l o c a t e d
throughout 	% h e 	U ~ i l e d S l a t e s , 	PSV 	h a s 	approximately 	1 2 5
m m b e n s , 	A l t h o u g h 	M A 	prepanred 	i t s 	Guidelines 	f o r 	use 	by 	t h e
eomponenl 	s o c i e t y 	p e e r 	r e v i e w 	conmitlees, 	t h e y 	w i l l 	n o t 	be
b I w d 3 n g 	ow 	c m p o n e n t 	b s c i e I : I e s 	a n d 	may 	be 	adopted 	w i t h
modifieatiows. 	Tkf s 	advisory 	o p i n i o n , 	of 	c o u r s e r 	% B l i m f t e d 	t o
t h e 	p r o p o s e d 	p r o g r m 	d e s c r i b e d 	i n M A 9 	sad 	B P S V " ss u b i s s i o n ,
1 	understand 	t h a t 	APA's 	p u r p o s e 	i n 	re-eslab1Ishing 	i t s 	peer
r e v i e w 	p r o g r m 	is 	t a 	p r o v i d e 	er 	mechanism 	l o r 	d 	e 	V o B u n t e r y
r e s o l u t i o n 	of 	disputer 	r e g a r d i n g 	podi a t r i e 	s e r v i c e s ? 	A c c o r d i n g
t o 	t h e 	p r o p o s e d G u i delines, 	patients, 	t h i k Q - p a r t y 	p a y e r s 	( s u c h 	as
i n s u r e r s ) , 	or 	p ~ d i ~ t r i s f s	may 	r e q u e s t 	e?smpone~,ts s e i e t l e s t 	peer
i t t e e s 	(10 	r e v i e w 	t h e i r 	p a r t i e l a l a s 	disputes, 	The?
m a t t e r s 	rev3 ewed. wii 1 1 	i n c l u d e 	d i s p u k e s 	over 	padialaie 	f e e 	l e v e l s
or 	over 	t h e 	q u a l i t y 	or 	n e c e s s i t y 	of 	c a r c e 3 	The 	p a r t i e s 	t o 	a
8 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - - ~ - - - - - - - - ~ - - - ~ - ~e
a: 	sstlsted 	p u r p o s e 	of 	mC31scharg[ilrlgl 	a 	p a r t 	O E 	t h e
g r ~ f e s s i o n ~ s	r&pohsiibI11ly 	lo 	t h e 	5 u b l I c 	lay 	a s s u r i n g 	t h a t
Pees 	& r e i n 	a c c o r d 	wf l h 	t h e 	r a n g e 	o f 	u s u a l , 	e u s t m a r y , 	and
r e a s o n a b l e 	c h a r g e s 	i n 	t h e 	p a r t icu18r 	eonmunf t y w 	c o u l d 	be
i n t e r p r e t e d 	as 	e x p r e s s i n g 	an 	intention 	t h a t 	c m p o n e n b 	s o c i e t y
peer 	r e v i e w 	comit"lees 	~ 	c 	t on 	t h e i r 	own 	Ica 	p r e v e n t
p o d i r a t r j s t s 	I r a , 	c h a r g i n g 	f e e s 	t h a t 	a r e 	n o t 	" i n 	r a e e ~ r d * ~	w i t h
t h e 	eomunf t y a s 	u s u a l , 	customary, 	and 	r e a s o n a b l e 	c h a r g e s .
S u c M j o i n t 	golieing 	of 	f e e s 	might 	m o u n t 	t o 	price-fixing.
M A , 	however, 	h a s 	i n d i c a t e d 	t o 	u s 	t h a t 	t h e 	p s o g r m 	i s 	meant
6 0 	s e r v e 	an 	i n f o r n a t i o n a l 	a n d 	m e d i e t a r y 	f u n ~ t i o n a n d 	t o
ogeraste 	s o l e l y 	w h e n 	t h e 	p a r t i e s 	lo 	a 	d i s p u t e 	v c o B u n l a r I l y
request 	a 	R e a r i n g ; 	f u r t h e r , 	I h e 	Association 	does 	n o t 	i n t e n d
i t s 	s t a l e d 	p u r p o s e 	t o 	be 	r e a d 	or 	interpreted 	as 	i n v i t i n g 	o r
c o n d o n i n g p r i c e - f i x i n g 	by 	members, 	The 	d e s i g n 	of 	t h e 	p r o g r m
i s 	esnsistent 	w i t h 	t h i s 	representation.
3 	A s 	I 	u n d e r s t a n d 	y o u r 	p r o p o s a l , 	t h e 	peer 	r e v i e w 	c
wlI1 	normally 	d ~ t e r n r i i n e whether 	a 	d f s p u t t d 	f e e 	is 	P"usraa19@o
m e u s f m a ~ y , m	O P 	m r e a ~ ~ ~ a b l e w	by 	a p p l y i n g 	t h e 	definitions 	sf
t h o s e 	terms 	t h a t 	a p p e a r 	i n 	t h e 	G u i d e l i n e s , 	P a r %i e u l a r
t h i r d - p a r t y 	p a y e r s 	m a y 	d e f i n e 	t h o s e 	terms 	differently 	I n
d e l i n e e l i n g 	t h e 	s c o p e 	sf 	t h e i r 	c o v e r a g e . 	Y o u 	have 	e x p l a i n e d ,
8 however, 	t h a t 	a l l 	p e r t i c i p e t i n g 	p a y e r s 	w i l l 	be made 	awere 	s f
t h e 	d e f i n i t i o n s 	t h e 	r e v i e w 	cornnitlees 	a p p l y . 	11 a 	p a r t i c u l a r
p a y e r 	p r e f e r s 	lo 	h a v e 	i t s 	own 	definition 	applied 	in 	t"n 	p e e r
(Conl i n u e d )

Norman 	K l m b e r s , 	DBM e n d	- -
J o h n G r a d , 	E s q ,
Page 	3
d i s p u t e 	m u s t 	volunta?ily 	a g r e e 	t o 	partleipate 	i n 	t h e 	peer 	r e v i e w
proeegs, 	I n 	addition, 	peer 	r e v i e w 	determinatlsns 	wf 11 	be
rdvisory 	I n 	n a t u r e , 	unless 	t h e 	prca'rtfes 	Rave 	f r e e l y 	agreed 	m o n g 	,
t h e r r r s t l v c s 	t o 	be 	bound, 	Y o u 	h v c 	f u r t h e r 	e x p l a i n e d , t h a t 	M A ' s 	.
ecrqsnent 	s o e i e t i c s 	or 	t h e i r 	p e e r 	r e v i e w 	e o m i t t e e s 	w i l l 	n o t 	be
I n v o l v e d 	I n 	t h e 	decfsicsn 	by 	t h e 	p a r t i t s 	w h e t h e r 	t o 	choose 	t o 	be
bound 	by 	t h e 	r e s u l t s 	sf 	t h e 	p e e r 	review 	p r o c e s s ,
The 	p r o g r m 	described 	ir; 	t h e 	Guidelines 	copntrins 	o t h e r
no"BbB e 	aspects, 	For 	e x m p l e, 	dc'd I b e r a t f sws 	anf 	d e e l s i sns 	try a n y
f t t e e 	a r e 	C O D P S ~	d e b e d 	eomlidentf 11 	c 	uniealiows, 	t c
be 	r e l e a s e d 	o n l y 	t o 	t h e 	t h i r d - p a r t y 	p a y e r , 	t h e 	podiatrist 	b e i n g
reviewed, 	a n d , 	when 	appropriate, 	l o 	t h e 	p a t i e n t , 	u n l e s s 	t h e 	law
otherwise requires, 	Moreover, 	r e v i e w 	cornittee d e l i b e r a t i o n s 	a n d
d e c i s i o n s 	a r e 	limited 	4 0 	%Re p a r t i c u l a r 	l e e 	o r 	u s e s f 	s e r v i c e s 	i n
question* 	Parties 	dIssatisIIed 	w 	t h e 	decisions 	sf 	a 	p e e r
r e v $ew 	c o m i t t e e 	a p p e a l 	t h e 	i t t e e 9 	ddeeision 	I s 	the
Regi onal 	Appeal s' 	i t t e e , 	w h i e k 	a11 	t h e 	powers 	of 	r e v i e w
t h e 	s t a t e 	c o m i 	possesses, 	P a r t i e s 	d i s s a t l s l i e d 	w i t h
Reg'l o n a l 	A p p e a l s 	Connli t t e e 	d c e i s ji o n s 	rnay 	a p p e a l 	t o 	the 	1 nsusance
8 Cornittee 	of 	" 2 e 	M A 	B o a r d 	of 	T r u s t e e s , 	but 	t h e 	Insurance
i t t e e 	.crhalI 	gteeept 	Fee 	d i s p u t e s 	f o r 	a g p e e l 	o n l y 	w h e n 	t h e
i s s u e 	i s 	u n u s u a l l l y 	important,
As 	q s u 	k n o w , 	t h e 	a n t i t r u s t 	laws 	I r e a t 	p e e r 	r e v i e w 	sponsored
by 	a 	professional 	assseiatisn 	as 	c o n c e r t e d 	a c t i v i t y 	of 	t h e
members 	of 	t h e 	a s s o c i ~ t t i o n . 	S u c h 	j o i n t 	a c t i o n 	v i o l a t e s 	t h e
F e d e r a l 	T r a d e 	C 	i s s i o n 	A e t 	a n d 	I h e 	o t h e r 	a n t i t r u s t 	news 	i f 	i t
* u n r e a s o n a b l y 	r e s t r a i n s 	e o m p e t i l i o n , 	The 	m a j o r 	esmpetilive
concern 	peer 	r e v i e w 	001 	f e e s 	e r e a l e s 	is 	t h a t 	i t 	may 	t h r e a t e n
i n d e p e n a n t 	p r i c i n g 	by 	t h e 	a s s a e i a l i o n Q 	s a b e r s 	and 	dampen 	t h e
e o s t - e o n t r o k g l l o r t s 	of 	t h i r d - p a r t y 	p a y e r s , 	r c s u l l i n g 	i n 	h i g h e r
bees, 	Similarly, 	p e e r 	review 	i n v o l v i n g 	t h e 	n e c e s s i t y , 	o r
q u a l i t y , 	of 	c a r e 	c a n 	i n j u r e 	e m p e l i t i o n 	i f 	u s e d 	t o 	diseourege 	o r
PI i n d c r 	i n n o v a t i v e - p r a e l i ee 	t e c h n i q u e s 	O P 	c o s t - c o n t r o l
a r r a n g m e n l s , 	T h e s e 	a n l i e m p e l i t i v e 	r e s u l t s 	wou:d, 	of 	c o u r s e , 	be
most 	l i k e l y 	l a 	a e e u r 	i f 	t h e 	sponsoring 	organization 	h a s 	m a r k e t
power 	or 	i n t e n d s 	s u c h 	resu11s, 	a n d 	f b 	p a t i e n t s , 	p a y e r s , 	o r
g r a e t l t i o n e r s 	a r c 	coereed 	i n t o 	u s i n g 	t h e 	p e e r 	r e v i e w 	process 	a n d
a b i d i n g 	by 	i t s 	deeisicns,
.......................................
review 	p r o c e s s , 	i t 	m a y 	s o 	r e q u e s t , 	1 1 	t h a t 	request 	i s 	not
8 h o n o r e d , 	t h e 	p a y e r 	rnay, 	o f 	e o u r s e , 	choose 	e i t h e r 	n o t 	t o
s o l h i t 	i t s 	elaitr? 	l o 	t h e 	peer 	r e v i e w 	cornitlee 	o r 	not 	l o
follow 	t h e 	r e c o r n e n d e l i o n 	t h e 	c o r n i t l e e nnede,

Norman 'Klm b e r s , 	BPM r ~ n d
J o h n G r a d , 	E s q ,
Page 	I
On 	considering 	t h e 	request 	sumi t t e d 	by 	APA 	and 	PSY, 	t h e
Bureau 	has 	reviewed 	b o t h 	t h e C 	" s s i o n 8 s a d v i s o r y 	opinion 	on 	f e e
review 	issued April 	8, 	1982, 	h e 	Iowa 	D e n t a l 	Association, 	a n d .
% s s l o n B s a d v i s o r y 	o p i n i o n 	ran 	utilization 	a n d , q u a l i t y 	(sf 	.
lew 	issued May 	9 , 	8983, 	t o 	t h e 	RRode 	I s l 	nd Professional
S t a n d a r d s 	R e v i e w Organizetion 	(eopi er 	The 	Bureau 	i s
of 	t h e 	o p i n i o n 	t h a t 	operation 	sf 	t h e 	p r o p o s e d 	pees 	r e v i e w
p r o g r m , 	as 	described, 	w o u l d 	not 	v i o l a t e 	S e c t i o n 	S 	of 	t h e F e d e r a l
i s s i o n A c t , 	$ 5 U-S,C, 	S 4 5 ,
T h i s 	conclusion 	i s 	based 	on 	s e v e r a l 	elmewts, 	Pibast, 	M A u s
i n t e n t 	i n 	designing 	t h e 	proposed 	program 	or 	f n 	recornending 	t h a t
c m p o n e n t 	soei e t i ts 	r e c o m e n e e 	peer 	r e v i ew 	a e l i v i t i es 	does 	n o t
a p p e a r 	t o 	be 	antieompetitive, 	Moreover, 	t h e 	v o l u n t a r y 	and
a d v i s o r y $ 	n a t u r e 	of 	t h e 	p r o g r m 	m a k e s 	i t 	unlikely 	t h a t 	t h e 	p e e r
r e v i e w 	p r o c e s s , 	i f 	o p e . r a t e d 	as 	proposed, 	c o u l d 	be 	used 	e i t h e r 	( a )
l o 	c o e r c e 	t h e 	p a r t i e s 	i n t o 	cirdoptirrg 	t h e 	policies 	of 	M A 	o r 	i i s
component 	societies 	o r 	( b ) 	t o 	f e e i l i l a t e 	p r l e e - - f i x i n g , 	boycotts,
or 	o t h e r 	a n t i e m p e t i t i ve 	eonspi r a c i e s . 	F u r t h e r , 	t h e 	p r o c e d u r a l
8 saf e g u a h d s 	d e s c r i b e d 	above 	s k o u l cJ 	1 i m i I 	t h e 	d i s s m i n a l i on 	of
i n f o m a t i a n 	eoneerning 	t h e 	matters 	u n d e r 	r e v i e w 	a n d 	t k e i r
results, 	lms 	o b v i a t i n g 	a n y 	f e a r s 	t h a t 	t h e 	p r o c e s s 	m i g h t
i n f l u e n c e 	p r a e l f e e s 	i n 	a 	whole 	c 	u n i t y 	or 	s t a l e , 	I t 	t h e r e f o r e
a p p e a r s 	u n l i k e l y 	lhrnl 	t h e 	proposed 	progrclrn w i l l 	c a u s e 	s i g n i i f i c a n l
antiempctibive e f f e c t s 	i n m a r k e t s 	f o r 	t h e 	f i n a n c i n g 	or 	p r o v i s i o n
of 	podi a t r i c 	s e r v i e e s .
me----w----*------------------------------
8
W e 	h a v e 	a l s o 	reviewed 	t h e 	S u p r e m e 	C o u r t ' s 	d e c i s i o n 	i n 	O n i o n
~ a b d r~ 	i 	f 	e	~ n s u r a r i e eC O , 	v , 	~ i r e s a o , 	U ~ S - 	1 0 2 S. 	er,
3 0 0 2 	( 1 9 8 2 1 , 	The P i r e n o 	d e c i s i o n 	d i d 	not 	d e c i d e 	w h e t h e r 	p e e r
revi*ew p r o g r m s 	v i o l a t e 	t h e 	a n t i t r u s t 	laws, 	h e a d 	o n l y
t h a t 	peer 	review 	does 	not 	c o n s t i t u t e 	t h e 	""business 	s f
i n s u r a n c e m 	a n d 	t l l e r e f u r c : 	is 	s u b j e c t 	t o 	a n t i t r u s t 	s e r u l i n y ,
and 	no 	o t h e r 	c a s e 	has 	a d d r e s s e d 	t h e 	lcgelity 	u n d e r 	t h e
a n t i t r u s t 	laws 	of 	p e p ? 	r e v i e w 	p r o g s m s ,
' 	As 	discussed 	a b o v e , 	t h e 	p r o g r a m 	APA 	p r o p o s e s 	i s 	a d v i r o r v
unless 	t h e 	p e r t i c?s 	l o 	a 	d i s p u t e 	i n d e p e n d e n t l y 	clgyee 	l o 	b e
bound 	by 	t h e 	r e s u I t s 	f 	t h e 	p e e r 	r e v i e w 	p r o e e s s , 	Beecluse
n e i t h e r 	MA 	nor 	I t s 	l o c a l 	components 	will 	p a r t l e i p a l e 	i n 	t h e
p a a r l I e s 9 	independent 	a g r e e m e n t 	l a 	a b i d e 	by 	Ifre 	decisicsrr 	of
t h e 	p e e r 	r e v i e w 	process, 	nor 	a t t e m p t 	l o 	a s s u r e 	s u c i 8
eompl i a n c e , 	t h e 	s p o n s o r i n g 	s o e i e t y 	e a n n o l 	coerce 	o r 	put 	u n d u e
p r e s s u r e 	o n 	t h e 	p s r l i e i p e i n t r c 	n..3o 	ehoose 	l o 	be 	bound.

Norman 	X l m b e s s , 	DBM &!PC
J o h n G r a d , 	Esq.
Page 	5
I n 	f a e l , 	imp"aemew~ation of 	t h e 	proposed 	p a s g r m may 	benefit
empc"l 	hit isn, t h e r e b y 	benefi t i n g 	e o n s m e ~ s . 	As 	I k e 	$:
s l a t e d 	l n 	I t s 	a d v i s o r y 	o p i n i o n 	t o 	t h e 	RRode 	I s l a a d 	Professionel 	.
S t a n d a r d s 	Revf e w 	Organization, 	p e e r 	r e v %aw 	p r s g r m s 	p r a v i d e
esntr81eting 	i n s u r e r s , 	emp1sytrs, 	and 	e s n s m e r s 	wi t h 	@ e x p e r t w
o 	m 	i n 	d e c i d i n g 	w h e t h e r 	t o 	pay 	f o r 	m e d i c a l 	@ a r e 	i n
p a r t i c u l a r 	i n s t a n c e s . 	Beeause 	p e e r 	r e v i e w 	can h e l p 	p a r t i c i p a t i n g
h e a l t h 	c a r e 	p l a n s 	redtree 	c o s t s , 	i t 	may 	I n c r e a s e 	t h e 	c m p e a i t i v e
incentives 	f o r 	o t h e r 	Bhi sd-pbr t y 	p a y e r s 	t o 	part i c i g a t e 	i n
e f f e c t i v e 	cost-con%&$ ranera6 	p r o g r m s . 	P e e r 	r e v $cw 	p s o g b m s 	may
a l s o 	c a u s e 	market-wide 	p r e s s u r e 	on 	prov"rde:rs 	t o 	preetice 	i n 	a
c o s t - c o n s c i o u s 	m a n n e r , 	a n d 	g i v e 	t h m 	greater 	Incentives 	to do 	s o -
I n 	Implementing 	t h e 	p r o p o s e d 	p r o g s m , 	c a n " l n n 4 	d a r e 	a n d
vigilance 	s h o u l d 	be 	exercised 	6s 	i n s u r e 	t h a t 	t h e 	p r o g r ~ r n "
p u r p o s e 	remains 	legitimate 	a n d 	t h a t 	i t 	does 	n o t 	p r o d u c e
significant 	a n t i e m p e t i t i v e 	e f f e c t s 	and 	t h e r e b y 	v i o l a t e 	t h e
antitrust 	laws. 	T h e 	B u r e a u 	r e t a i n s 	t h e 	r i g h t 	t o 	r e c o n s i d e r 	t h e
questions 	i n v o l v e d 	a n d , 	w i t h 	n o t i c e 	t o 	t h e 	r e q u e s t i n g 	p a r t y , 	t o
8 r e s c i n d 	or 	revoke 	i t s 	o p i n i o n 	i f 	implementdntican 	of 	libre 	p r o p o s e d
peer 	r e v i e w 	p r o g r a n : 	r e s u l l s 	i n 	s u b s t a n t i a l 	a n t i e m p e l i t i v e
c f l e e t s , 	i f 	t h e 	p r o g r . m 	is 	u s e d 	f o r 	improper 	p u r p o s e s , 	o r 	I f 	i t
w o u l d 	be 	i n 	t h e 	p u b l i e 	i n t e r e s t 	I o 	do 	s o ,
F i n a l l y , 	as my 	s t a f f 	h a s 	s d v i s e d 	y o u , 	t h e 	above 	l e g a l 	a d v i c e
is; 	t h a t 	of 	t h e 	B u r e a u 	of 	C m p e t i t i o n 	o n l y . 	U n d e r 	I h e
issisn" 	R u l e s 	sf 	P r c a e t i e e 	SI.3(e), 	t h e 	G 	i s s i o n 	i s 	Isor
bound 	by 	t h i s 	a d v i c e 	a n d 	r e s e r v e s 	t h e 	r i g h t 	t o 	r e s c i n d . 	i t 	a t 	as
l a t e a 	"ime.
~i 	rectbr /B u r e a u 	of 	C m p e t i l i o n