Adopting orphan drugs--two dozen years of treating rare diseases.

445 ing or evaluating the work of so many volunteers. Some organizations conduct internal evaluations, and they tend to agree with experienced volunteers on some guidelines for effective overseas missions. It is best, they say, to send an advance team so that requirements such as lodging, an adequate electrical supply, clinic space, and surgical facilities can be anticipated. Many stress the importance of developing strong relationships with local physicians on the basis of respect for their skills, knowledge, and traditions and, whenever possible, using locally available medications. Surgeons recommend a conservative approach to choosing patients and operations to perform. Finally, says Migliori, “don’t operate the day before you leave.” An interview with Dr. Mark Migliori can be heard at www.nejm.org.