National Academies Press: OpenBook

Biomedical Politics (1991)

Chapter: Front Matter

Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×

BIOMEDICAL POLITICS

Kathi E. Hanna, Editor

Division of Health Sciences Policy

Committee to Study Biomedical Decision Making

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1991

Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine.

Support for this activity was provided by the Howard Hughes Medical Institute. The opinions and conclusions expressed here are those of the authors and do not necessarily represent the views of the Howard Hughes Medical Institute, the National Academy of Sciences, or any of their constituent parts.

Library of Congress Cataloging-in-Publication Data

Biomedical politics / Kathi E. Hanna, editor ; Division of Health Sciences Policy, Committee to Study Biomedical Decision Making, Institute of Medicine.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-04486-3

1. Medical policy—Case studies. 2. Health planning—Case studies. I. Hanna, Kathi E. II. Institute of Medicine (U.S.).

Committee to Study Biomedical Decision Making.

[DNLM: 1. Decision Making. 2. Health Policy—United States.

3. Politics—United States. WA 540 AA1 B52]

RA393.B48 1991

362. 1—dc20

DNLM/DLC

for Library of Congress

91-18394

CIP

Copyright © 1991 by the National Academy of Sciences

No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purpose of official use by the United States Government.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×

COMMITTEE TO STUDY BIOMEDICAL DECISION MAKING

CARL W. GOTTSCHALK (Chair), Kenan Professor of Medicine and Physiology,

Department of Medicine, University of North Carolina, Chapel Hill, North Carolina

PAUL BERG, Director,

Beckman Center for Molecular and Genetic Medicine and Willson

Professor of Biochemistry,

Stanford University, Stanford, California

PETER F. CARPENTER, Visiting Scholar,

Center for Biomedical Ethics, Stanford University, Stanford, California

LEON EISENBERG, Presley Professor and Chairman,

Department of Social Medicine, Harvard Medical School, Boston, Massachusetts

WALTER HARRELSON, Distinguished Professor of Hebrew Bible, emeritus,

The Divinity School, Vanderbilt University, Nashville, Tennessee

WILLIAM HUBBARD, Jr., Retired President,

The Upjohn Company

WILLIAM R. KENNEDY, Professor of Neurology,

University of Minnesota Health Center, Minneapolis, Minnesota

PATRICIA A. KING, Professor of Law,

Georgetown University Law Center, Washington, D.C.

ERNEST R. MAY, Charles Warren Professor of History,

Kennedy School of Government, Harvard University, Cambridge, Massachusetts

DOROTHY NELKIN, Professor,

Department of Sociology and

Affiliated Professor,

School of Law, New York University, New York, New York

STANLEY JOEL REISER, Griff T. Ross Professor of Humanities and Technology in Health Care,

University of Texas Health Science Center, Houston, Texas

PAUL SLOVIC, President,

Decision Research and

Professor of Psychology,

University of Oregon, Eugene, Oregon

STAFF

RUTH ELLEN BULGER, Division Director,

Division of Health Sciences Policy

KATHI E. HANNA, Study Director

CATHARINE CHETNEY, Senior Secretary

LOUISE GILLIS, Senior Secretary

LEAH MAZADE, Staff Editor

SHELLEY MEYERS, Senior Secretary

APRIL POWERS, Senior Secretary

Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×

Preface

Scientists like to believe that they operate in a rational world, one in which interpretations and predictions are based on objective data and evaluated through a systematic process. While some question whether these suppositions hold true for science, they certainly fall apart when science becomes a public issue, as it so often does in biomedicine. Decisions about how to proceed with the funding, ordering, and use of biomedical research are made in the public arena. The interests of scientists, regulators, politicians, patients, practitioners, and interest groups converge and often clash. These clashes may slow the progression of science and medicine while simultaneously advancing moral, ethical, or democratic causes. Sometimes, the interests of all groups can be advanced. In other cases, rigid deadlock occurs with little movement in any direction. Is there a better way by which to deal with controversial biomedical issues confronting us today? Can we better anticipate the forces that will emerge on the various sides of an issue, or are we destined to muddle through and make policy incrementally and contentiously?

These were some of the questions posed in the summer of 1989 to our committee, a group of individuals with diverse backgrounds and experiences. We were given the task of using case studies as a first step toward answering some of these questions. This document is the result of our efforts. As we chose the topics for case study we were mindful of the fact that we were exploring possibilities, not necessarily testing hypotheses. We knew we needed to understand in great

Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×

detail how several decisions were made before we could attempt to postulate guidelines or prescriptions for better decision making. What we found was both illuminating and complex. The politics of decision making are easily described but difficult to predict. Each decision or set of decisions faces different paths, publics, and constraints, as the cases in this book so beautifully demonstrate.

In our deliberations, we stopped short of recommending a normative approach to decision making. Case study methodology militates against such an approach. What we chose to do was define areas of research to be examined that would move the study of decision making to a more analytical level. Our greatest contribution may well be providing six individuals the opportunity to tell compelling stories about how we arrive at public biomedical decisions.

ACKNOWLEDGMENTS

The committee thanks all who contributed to its work. We greatly appreciate the opportunity provided by the Howard Hughes Medical Institute to investigate the process of biomedical decision making. The committee is grateful to the six individuals who prepared and presented the case studies. These studies were the information base for the committee's deliberations.

We wish especially to thank and to acknowledge the contributions of Kathi E. Hanna, the study director and editor. With the able assistance and advice of Ruth E. Bulger, division director, she planned and organized the meetings, analyzed the data, edited drafts, and prepared the Introduction and Conclusions sections. The project was also assisted by the excellent support work of Catharine Chetney, Shelley Meyers, Louise Gillis, and April Powers, and the thorough copyediting of Leah Mazade.

Carl W. Gottschalk, Chair

Committee to Study Biomedical Decision Making

Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1991. Biomedical Politics. Washington, DC: The National Academies Press. doi: 10.17226/1793.
×
Page R8
Next: Introduction »
Biomedical Politics Get This Book
×
Buy Hardback | $65.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The abortifacient RU-486 was born in the laboratory, but its history has been shaped by legislators, corporate marketing executives, and protesters on both sides of the abortion debate.

This volume explores how society decides what to do when discoveries such as RU-486 raise complex and emotional policy issues. Six case studies with insightful commentary offer a revealing look at the interplay of scientists, interest groups, the U.S. Congress, federal agencies, and the public in determining biomedical public policy—and suggest how decision making might become more reasoned and productive in the future.

The studies are fascinating and highly readable accounts of the personal interactions behind the headlines. They cover dideoxyinosine (ddI), RU-486, Medicare coverage for victims of chronic kidney failure, the human genome project, fetal tissue transplantation, and the 1975 Asilomar conference on recombinant DNA.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!