THE ARTICLE by Oldham et al¹ effectively discusses several of the most important criticisms of the National Bioethics Advisory Commission (NBAC) report,² namely, that the focus on mental disorders stigmatizes patients with mental illness and that the reliance on only 2 levels of risk in determining the degree of protections required may markedly impede psychiatric research. After having reviewed the NBAC report, I still fail to understand why the NBAC believes that a 3-tier level of risk category system such as that described by the New York Advisory Work Group³ is unworkable and unacceptable. In their report, the NBAC writes that they "did not find these concerns convincing" in reference to their proposed 2-tier level of risk. They believed that the