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Creating the Institute of Medicine

In the summer of 1964, Dr. Irvine Page, who edited a journal that was widely distributed to members of the medical profession, wrote an editorial on the need for a National Academy of Medicine. With the appearance of this editorial, Irvine Page began a concerted campaign to create the National Academy of Medicine (NAM). Although he was ultimately unsuccessful in creating an entity with this name, he set in motion the forces that would lead to the creation of the Institute of Medicine (IOM) in 1970.

Between 1964 and 1970, key government officials and leaders of academic medicine agreed on the need for an organization concerned with health policy but disagreed over what form that organization should take. Irvine Page had the idea of an advocacy group that would represent the best collective wisdom of the medical profession. In his mind, such a group should be composed primarily of physicians. James Shannon, director of the National Institutes of Health (NIH), thought that the organization's primary mission should be to support scientific research in medicine. Walsh McDermott, a prominent practitioner of academic medicine with a deep interest in public health, believed that the organization should serve as a forum where physicians and other professionals concerned with health policy could work toward the solution of health-related social problems.

Although profound differences divided these three men, they concurred in the belief that the organization should do more than bestow an honor on its members. Each favored an entity composed of working members. Each also realized that the primary reason for forming a new organization lay in the changed relationship between the federal government and medicine. They understood that the federal government, the nation's primary source of funds for the conduct of medical research and the payment of medical care, could not be ignored as a factor in health policy.

The discussions in which Page, Shannon, and McDermott engaged took place in two main settings. Beginning in 1967, Irvine Page organized a series of meetings in Cleveland to discuss the formation of



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To Improve Human Health: A History of the Institute of Medicine 1 Creating the Institute of Medicine In the summer of 1964, Dr. Irvine Page, who edited a journal that was widely distributed to members of the medical profession, wrote an editorial on the need for a National Academy of Medicine. With the appearance of this editorial, Irvine Page began a concerted campaign to create the National Academy of Medicine (NAM). Although he was ultimately unsuccessful in creating an entity with this name, he set in motion the forces that would lead to the creation of the Institute of Medicine (IOM) in 1970. Between 1964 and 1970, key government officials and leaders of academic medicine agreed on the need for an organization concerned with health policy but disagreed over what form that organization should take. Irvine Page had the idea of an advocacy group that would represent the best collective wisdom of the medical profession. In his mind, such a group should be composed primarily of physicians. James Shannon, director of the National Institutes of Health (NIH), thought that the organization's primary mission should be to support scientific research in medicine. Walsh McDermott, a prominent practitioner of academic medicine with a deep interest in public health, believed that the organization should serve as a forum where physicians and other professionals concerned with health policy could work toward the solution of health-related social problems. Although profound differences divided these three men, they concurred in the belief that the organization should do more than bestow an honor on its members. Each favored an entity composed of working members. Each also realized that the primary reason for forming a new organization lay in the changed relationship between the federal government and medicine. They understood that the federal government, the nation's primary source of funds for the conduct of medical research and the payment of medical care, could not be ignored as a factor in health policy. The discussions in which Page, Shannon, and McDermott engaged took place in two main settings. Beginning in 1967, Irvine Page organized a series of meetings in Cleveland to discuss the formation of

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To Improve Human Health: A History of the Institute of Medicine a National Academy of Medicine. These gave way in November 1967 to the activities of the Board on Medicine, a group convened in Washington by the National Academy of Sciences. What emerged in 1970 was the Institute of Medicine. An institute not an academy, the new organization nonetheless reflected the ideas of all three men. The Page Discussion Group Between 1964 and 1967, Irvine Page had the field pretty much to himself, although he was not alone in proposing a National Academy of Medicine. In the fall of 1960, a six-person task force, which contained no fewer than four future members of the Institute of Medicine, advised President-elect Kennedy of the need to establish a National Academy of Medicine ''comparable to the National Academy of Sciences.'' President Kennedy showed little interest in this recommendation, preferring to concentrate instead on the creation of Medicare, as the expansion of Social Security to pay the hospital bills of Social Security recipients became known. When Irvine Page wrote his editorial on the need for a National Academy of Medicine in 1964, Medicare was a hotly contested issue. On September 2, 1964, within weeks of the appearance of Page's editorial, the Senate approved a version of the measure. It was no wonder, then, that Page led his editorial by calling attention to the "important trend linking medicine to government." A group from the medical profession was needed to provide the government with the impartial yet expert advice necessary to make "decisions of wisdom" on questions of medical policy. The American Medical Association, according to Page, approached the federal government with a "grumbling hostility" that limited its effectiveness. The Association of American Medical Colleges, a similarly venerable organization that was in the process of transforming itself from a "congenial 'deans' club' into a powerful lobby for academic medicine," represented the interests of academic health centers, not the medical profession. Few other organizations were large or influential enough to speak for the profession. Page believed that the solution was a National Academy of Medicine, located in Washington, D.C., that would be "truly representative of excellence in all branches of medicine."1 Irvine Page was the logical leader of a campaign to create a National Academy of Medicine. Like nearly everyone who helped found the Institute of Medicine, he came from the fields of academic medicine and scientific research. He combined a high academic

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To Improve Human Health: A History of the Institute of Medicine pedigree (degrees from Cornell and the Cornell Medical School) and scientific prowess with a talent for organization that enabled him to publicize his causes effectively. Born in 1901, he was older than most of the Institute of Medicine's other founding mothers and fathers, more than 65 years of age by the time serious discussions began. His career reflected many of the major developments in American academic medicine. He began by studying the chemistry of the brain and in 1928 received an invitation from the prestigious Kaiser Wilhelm Institute in Munich to begin a department in brain chemistry. After the rise of Hitler made working in Germany uncomfortable, he secured a position at the Rockefeller Institute for Medical Research in New York. These aspects of Page's career illustrated the influence of German models on American science and demonstrated that in the prewar era, support for medical research came as much from private philanthropy as from government grants. Working at the Rockefeller Institute between 1931 and 1937, Page became interested in the phenomenon of high blood pressure. He both demonstrated the harmful effects of hypertension and showed that the disease could be treated effectively. In 1937, moving to the Lilly Laboratory for Clinical Research, he continued his efforts to "identify and isolate the compounds that affected blood pressure." After the Second World War, he started a research division at the Cleveland Clinic that attracted many topflight doctors and scientists. Not content to limit his work to the laboratory, Page also made rounds at the clinic and became a public health advocate, stressing the importance of exercise and diet in the prevention of heart disease. To further his goals, he helped create such organizations as the American Foundation for High Blood Pressure and the American Society for the Study of Arteriosclerosis.2 Irvine Page, then, was far from a typical physician engaged in the full-time practice of clinical medicine; rather, he was a representative of a branch of the profession that enjoyed close relations with academia. Not surprisingly, Page communicated the results of his research by publishing, writing textbooks on the chemistry of the brain, editing books on treatment techniques for stroke and high blood pressure, and producing scientific papers and laboratory reports. Because of his academic prominence and ability to communicate his ideas, he received opportunities to serve in advisory capacities for influential organizations, such as NIH. If he obtained support from the Rockefellers at the beginning of his career, he, in common with many of his colleagues, switched to the National Institutes of Health, whose budget grew from $3 million to $400 million between 1941 and 1960, in the postwar era. Over the course of

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To Improve Human Health: A History of the Institute of Medicine a long career, therefore, Page had observed the changing relationship between government and medicine at close hand.3 At the end of the summer of 1964, Page wrote a letter to his many contacts in the medical profession and in the world of science and asked for their reactions to his proposal to create a National Academy of Medicine. In the letter, he noted that the National Academy of Sciences (NAS) did a good job in representing the interests of science and that engineers appeared well on their way to establishing a National Academy of Engineering within the larger NAS. He wanted to know if a National Academy of Medicine would serve a similarly useful purpose. Page's correspondents presented him with a bewildering variety of views. Some wanted to wait to see how the National Academy of Engineering turned out. Others expressed skepticism about finding an exact purpose for the organization. Some advocated a close alliance with the National Academy of Sciences, but others felt just as strongly that the new organization should have nothing to do with the NAS. They criticized the NAS as a "self-perpetuating" body. It was a great honor to join, and the "main function ... is to decide who deserves the honor." "Let us proceed slowly and thoughtfully, but let us proceed," Page concluded.4 In private, he told a colleague that no one needed to be pushed ''but if the thinking about it is open and moves along, the whole thing will gel."5 In public, he wrote another editorial for Modern Medicine that appeared in March 1965. In this piece, Page again cited the gap between the American Medical Association, which at the moment was leading a last-gasp effort to prevent the passage of Medicare, and the various federal agencies concerned with medicine. Something had to be done to close this gap, because "no serious-minded person denies the role that medicine must play if we plan to have a 'Great Society'." Summarizing the letters that he had received, he wrote that they demonstrated a need for a National Academy of Medicine and indicated that the material was "certainly there to form it." In July 1965, Page refined his ideas about the proper membership for a National Academy of Medicine and once again solicited the views of his colleagues. He had no doubt that unlike the democratic and relatively ineffectual American Medical Association, the new organization should draw "from the upper, relatively thin layer of the best medical and scientific and lay talent." There should, however, be no limit on the number of members because the subject of medicine was "constantly growing." Further, membership should depend on a person's capabilities, without regard to degrees or titles. These

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To Improve Human Health: A History of the Institute of Medicine capable members would be expected to work, not just to participate in "an honorary society for the greater glory of the individual." For the most part, his correspondents agreed, Dr. Julius H. Comroe, Jr., director of the Cardiovascular Research Institute of the San Francisco Medical Center and later an influential figure in the creation of the Institute of Medicine, argued for the importance of "real working committees picked from individuals best able to give advice on specific problems." Fred Robbins, a Nobel laureate in medicine who worked up the road from Page at Case Western Reserve University and would later be president of the Institute of Medicine, emphasized the need to choose people who commanded respect at the national level and suggested that practitioners of the biological, behavioral, and social sciences be represented. Each of these ideas would influence the subsequent development of the Institute of Medicine.6 External events motivated Page to go from ideas to action. Signing Medicare into law on July 30, 1965, President Lyndon Johnson set in motion forces that would lead to a rise in medical expenditures—from 6.2 to 7.6 percent of gross national product between 1965 and 1970—and a fall in the percentage of these expenditures paid by the private sector—from 75 to 63.5 percent in the same five years. Although these trends created opportunities for collaboration between the medical profession and the federal government, they also produced tensions. Similarly, federal support of medical research, although lavish, bred its share of problems among members of Congress, the executive branch, and representatives of medical schools. In June 1966, President Johnson convened a meeting of his top health policy officials and asked them whether "too much energy was being spent on basic research and not enough on translating laboratory findings into tangible benefits for the American people." The mere fact that the President posed the question, according to Stephen Strickland, "fell like a bombshell" on NIH officials and created a ripple of panic among the scientists in medical schools.7 Not long after this meeting, Science printed an item in which it attributed a desire to create a National Academy of Medicine to "reform-minded top officials of the Department of Health, Education, and Welfare." The new organization "would supply the profession with another set of spokesmen and provide the government with a more congenial source of authoritative advice.''8 Only a short time after President Johnson's meeting with his science advisers, Page used his local connections to secure a grant of $6,000 from the Cleveland Foundation that enabled a group of leading physicians to travel to Cleveland, Ohio and discuss strategy. The

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To Improve Human Health: A History of the Institute of Medicine meeting took place on January 17, 1967. In addition to Page, 15 physicians, nearly all of whom were on the faculties of medical schools or attached in some capacity to the National Institutes of Health, attended the meeting.9 It was Page's show. He set the agenda, hosted the meeting, chaired the sessions, and gave an opening talk, to which he devoted substantial preparation, on the need for a National Academy of Medicine. The new organization, Page said, should be the "voice of moderation, wisdom, and integrity," and it should be "free and beholden to no one" as it ''provided advice ... to any who want to listen." Above all, Page stressed the fact that advice on medical questions could no longer be left to amateurs: medicine's growing scientific base and its increasingly complicated relationship with the government necessitated the creation of a group that could mobilize the best professional opinion in the country.10 Although Page dominated the meeting, James Shannon also made his presence felt. Only three years younger than Page, James Augustine Shannon was something of a Washington legend because of his extraordinary success at running the National Institutes of Health. Like Page, Shannon combined interests in science and medicine. He received a medical degree from New York University (NYU) and a Ph.D. in physiology. During the war, he became the director of an NYU research service at Goldwater Memorial Hospital and did work on malaria that led to a Presidential Medal of Merit. After flirting with private industry after the war, Shannon arrived at the National Institutes of Health in 1949 as associate director for intramural research of the National Heart Institute. On August 1, 1955, he became the director of the National Institutes of Health. In this position, he held what Donald S. Fredrickson, himself an NIH director and an IOM president, described as an "uncomplicated philosophy of science" that consisted of "unfettered support of good science and rejection of the bad." Good science tended to mean basic research, rather than research targeted on finding a cure for a particular disease. He blended this uncomplicated philosophy with a sophisticated understanding of congressional relations and of the policy process.11 Shannon, whose career bore so many similarities to Page's, was just the sort of person whom Page hoped to interest in a National Academy of Medicine. Addressing the group in Cleveland, Shannon said that a National Academy of Medicine should be able to speak to government and to conduct sound studies. It should be highly professional and not be formed unless it could isolate four or five broad areas of inquiry, because its initial studies would determine its reputation. An

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To Improve Human Health: A History of the Institute of Medicine overarching purpose of the organization, according to Shannon, would be to "define, enunciate, and promote the health sciences." As a practical matter, Shannon advised that representatives of the group should sit down with Fred Seitz, the physicist who served as president of the National Academy of Sciences, and with Harvey Brooks, a Harvard academic who chaired the Academy's influential Committee on Science and Public Policy, and gauge the NAS's level of interest in a National Academy of Medicine.12 A second meeting, held on March 7, 1967, satisfied Page that the need existed for a National Academy of Medicine. Still, he wondered, as had James Shannon, whether the group should proceed on its own or whether it should "come under the umbrella of a chartered organization such as the NAS." In fact, the Cleveland group was already in contact with the NAS. After the first meeting, Shannon and Ivan Bennett had arranged a Washington conference with Frederick Seitz, president of the NAS. They had no trouble getting an appointment. An NAS member, Shannon was one of the federal government's most influential bureaucrats concerned with science. Although a generation younger than Shannon or Page, Ivan Bennett was an academic physician with impressive Washington connections, who had worked at Yale and as the Baxley Professor of Pathology at Johns Hopkins before accepting an appointment as deputy director of the Office of Science and Technology in the Johnson White House. Talking with Shannon and Bennett, Seitz had offered the possibility of establishing a "board" within the Academy that could begin to do the sorts of studies the Cleveland group wanted and, according to Shannon, "give us a base from which we could begin to operate and to study what sort of organization should emerge." Shannon believed that Page's group should take advantage of the NAS's generosity, even though he thought that there ultimately should be a National Academy of Medicine that was independent of the National Academy of Sciences. Bennett pointed to the advantages of working with a group as prestigious as the Academy. If things turned out badly, the doctors could always back out gracefully and form their own group. Colin MacLeod, who played a key role in discussions at the second meeting of Page's group, agreed with this assessment, and like the others in attendance, he spoke with considerable authority on the subject of medical policy. He came from an academic and scientific background that was far removed from the daily practice of clinical medicine. A doctor with a strong interest in science, MacLeod had worked at the Rockefeller Institute during the 1930s, just as Page had. From there he had gone on to chair the Microbiology

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To Improve Human Health: A History of the Institute of Medicine Departments at New York University and the University of Pennsylvania. In 1963, he took a job in the White House at the Office of Science and Technology, which he later yielded to Ivan Bennett. In 1967, he served as the vice president of medical affairs at the Commonwealth Fund, an important dispenser of funds for medical research and public health. Highly regarded as a scientist, MacLeod, like James Shannon, was a member of the National Academy of Sciences.13 Walsh McDermott and the Board on Medicine As Ivan Bennett noted, the prestige of the National Academy of Sciences, with its federal charter and its proud history that stretched back to the presidency of Abraham Lincoln, was beyond dispute. In 1967, it consisted of about 800 members, each of whom had undergone rigorous nomination and election procedures. Almost all of the members owed their selection to the quality of their published research in the "hard sciences." Upon election to the Academy, a member voluntarily joined one of 18 discipline-specific sections. Physics and chemistry formed the two largest sections. Attempts to increase the number of physicians in the Academy had met with repeated failure. In 1941, for example, Ross Harrison of the Yale Medical School called attention to the "urgent need for the Academy to have in its membership a larger proportion of the distinguished clinicians of the country than at present." He was told that creating a section of medical scientists would result in attracting people who were "merely clinicians,'' and the idea was dropped for the next 27 years.14 In the interim, the few medical doctors elected to the Academy were found in the microbiology, physiology, and biochemistry sections. It was not a young crowd; the median age of the microbiologists was 66.5. Very few social scientists belonged to the Academy, and those who did were concentrated in the anthropology and applied mathematics sections. Beyond the prestige that came from joining the Academy, members also enjoyed the benefit of two yearly meetings at which they discussed NAS governance, awarded medals to one another, and listened to scientific papers. The Academy also contained what observers called an "operational arm" in the form of the National Research Council (NRC). Established in 1916 during the period of mobilization before the country's entry into the First World War, it responded to requests for studies or advice from Congress, the executive branch, and a variety of other

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To Improve Human Health: A History of the Institute of Medicine private and public sources. The periods of greatest activity for the NRC came during the two world wars. In the Second World War, for example, the NRC's Division of Medical Sciences had advised the surgeons general of the Army and Navy on medical research and other matters related to wartime care. Between 1940 and 1946, the division's advisory committees on war services held more than 700 meetings and 243 conferences and played an important role in shaping the nation's wartime medical policy.15 In 1946, however, the National Research Council contemplated an end to these emergency activities. The advent of the cold war once again increased the demand for the NRC's services, yet the Division of Medical Sciences initiated little work of its own. As a result of the policy to respond to requests from others, the division contained a bewildering variety of committees, offices, research boards, and panels such as an Office of Tropical Health, an advisory committee to the Federal Radiation Council, the Atomic Bomb Casualty Commission, and the Committee on Radiology. To do its work, the National Research Council drew on the resources of large numbers of scientists in academia and private industry; its reach extended well beyond that of the Academy itself.16 Beyond the formal Academy and the National Research Council, the National Academy of Sciences also housed the National Academy of Engineering (NAE). Established in 1963, it marked an outgrowth of the engineering section within the NAS. Engineers felt that the scientists in the Academy failed to accord the engineering profession the respect it deserved. After the engineers received a grant from the Sloan Foundation, the NAS agreed to form what Fred Seitz called "a sister academy under the original NAS Charter." The possibility remained that the National Academy of Engineering would eventually split away from the NAS. By the end of the decade, however, the NAE remained entrenched within the Academy, and the exact relationship between the National Academy of Engineering and other parts of the NAS was a matter of constant negotiation. Engineers continued to feel that they were not first-class citizens of the NAS. Officers of the NAS believed that the engineers elected people to their Academy who were better known as executives of large private firms than as scientists. 17 Although NAS leaders who served on the Academy's governing council regarded the National Academy of Engineering as less than a hopeful precedent, they nonetheless listened to Colin MacLeod, who reported to them in April 1967 on the events in Cleveland, with considerable sympathy. Seitz told the Executive Committee of the NAS Council that he had already talked with Bennett and Shannon and suggested the creation of an advisory board on medicine. Such a

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To Improve Human Health: A History of the Institute of Medicine board, Seitz felt, could provide advice on policy questions related to medicine and health and consider the question of whether to form a National Academy of Medicine. For the NAS, it was a way of bringing discussion about a National Academy of Medicine in-house. Furthermore, an ad hoc advisory board of the sort Seitz proposed would involve a minimum of bureaucratic disruption and avoid the time-consuming and often contentious matter of a vote by the membership. Council members agreed with Seitz. If nothing else, creation of an advisory board on medicine would prevent the Carnegie Corporation and the Commonwealth Fund from taking independent action on the matter, as they threatened to do. Seitz felt confident enough about the matter to inform NAS members at their 1967 spring meeting that it appeared "fairly clear" that an advisory board on medicine would be created. 18 Early in June, the NAS Council approved a motion to establish this advisory Board on Medicine and Public Health. The new Board, charged with the responsibility to "formulate recommendations on matters of policy related to medicine and public health," would report directly to the Council. Seitz told the division heads of the National Research Council that the Board could "possibly lead to the formation of a National Academy of Medicine somewhat analogous to the NAE."19 The Page group hoped this would be the case and made plans to hold a third meeting. These plans received a serious setback on June 12, 1967, when Irvine Page suffered what his secretary described as a "mild coronary." Page, the expert on heart disease, now found himself looking at the condition "from inside out." After his heart attack, Page, despite his relative vigor, occupied a less prominent place in the movement to create a National Academy of Medicine. His role changed from that of primary advocate to chief critic of the Board on Medicine.20 Seitz realized that the chairman of the Board on Medicine and Public Health would have to be a physician who was also a member of the National Academy of Sciences. His choice was Walsh McDermott, a 56-year-old professor of medicine and public health at Cornell Medical School who recently had been elected to the Academy. McDermott belonged to Page's discussion group, although he had missed both meetings and told Page of his ambivalence toward a National Academy of Medicine. 21 The appeal of his selection lay not only in his familiarity with the movement to create a National Academy of Medicine but also in his unquestioned prominence as a doctor and a public health official.

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To Improve Human Health: A History of the Institute of Medicine McDermott was an American aristocrat—"white shoe," in the words of one of his colleagues. The son of a New Haven physician, he attended Andover, Princeton, and Columbia Medical School. During his residency at New York Hospital in 1935, he developed tuberculosis and had to go to the tuberculosis sanitarium in Saranac Lake, New York. Over the course of the next few years he eased his way back into work until he accepted an appointment in 1942 as the head of the Division of Infectious Diseases at New York Hospital. In this post, he performed important clinical trials on penicillin, streptomycin, and other so-called wonder drugs. He also engaged in laboratory work on the effects of antimicrobial therapy on animals, despite the fact that he had never had formal training in either microbiology or experimental pathology. In the 1950s, he shifted directions and became interested in bringing medical treatment to underserved populations, earning substantial fame for organizing a successful tuberculosis treatment program for the Navajos living in Arizona and New Mexico. This experience sparked a continuing interest in public health and led him to become involved in other public health projects both in the inner-city neighborhoods of New York and the developing nations of the world. In the course of these activities, McDermott acquired a plethora of contacts and honors. He served, for example, as a member of the NIH's National Advisory Health Council between 1955 and 1959 and of New York City's Board of Health.22 McDermott accepted the appointment as head of the NAS Board on Medicine and Public Health at the end of June. Both he and Seitz hoped that the Board would develop into "a widely respected voice of American medicine." He proceeded to negotiate with Seitz over other members of the Board. They agreed that Ivan Bennett, Colin MacLeod, James Shannon, and Irvine Page, the prime movers behind Page's efforts to launch a National Academy of Medicine, should all be members. Seitz suggested other names, making it a point not to limit membership to physicians. For example, he mentioned Rashi Fein, an economist at Brookings, who had served as a staff member on the President's Council of Economic Advisors and, according to Seitz, "has a deep interest in the social problems connected with medicine," as a potential member of the Board.23 Despite Page's illness and the preemptive action of the NAS, the Page group held a third and final meeting on June 28. Colin MacLeod chaired the meeting in Page's absence. Some of the nine physicians present wondered if the Board on Medicine and Public Health would really be able to do anything constructive, because it started from the narrow base of doctors within the NAS. The participants conveyed a sense of regret that Page's group no longer controlled the action on a

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To Improve Human Health: A History of the Institute of Medicine "qualitatively similar to the Board but sufficiently expanded ... to meet the great needs revealed by 2.5 years of Board experience." The Institute would conduct its own studies, provided they were less than a year in duration. Longer studies would be conducted jointly by the NRC and the Institute. As in the previous proposals for an academy, the Institute would have fixed terms of membership and be able to select its own members, most of whom would not be NAS members. At least 25 percent of the members would have degrees in fields other than medicine or biomedical sciences. All members would be selected for their personal attributes, not because they represented a particular constituency. Soon after the Institute started, it would have about 100 members, and ultimately it might grow to 250 members.103 Walsh McDermott and a delegation from the Board on Medicine presented this "draft charter" to the NAS Council on June 5, 1970. Yarmolinsky, the principal writer, hastened to reassure Council members that the Charter marked a revision of, but not a departure from, the Board on Medicine. It would not establish a propaganda body, as some Council members feared. On the contrary, it represented the culmination of long years of discussion and established a workable relationship with the NAS. If the Academy rejected this approach, McDermott warned, it would lose "the medical constituency." The following day, the Council voted to authorize the president of the National Academy of Sciences "to take the necessary steps to create an Institute of Medicine." The Council specified that it would have final authority over the Institute, including the right to review publications and the right to add or delete names of those nominated for membership. It also asked to see a "specific detailed plan describing the organization and operation of the Institute." It regarded this plan as little more than a formality, however, because it authorized Handler to announce the Council decision to the public.104 On June 10, 1970, the National Academy of Sciences made a formal announcement that it would create an Institute of Medicine "to address the larger problems of medicine and health care." In a letter to McDermott, Handler cited the design of the health care delivery systems, the role of university medical schools, the mechanisms for funding medical care, and the support and nature of biomedical research as the types of problems the Institute might address. He also requested McDermott to prepare a document containing the bylaws of the organization in time for the NAS Council meeting in August.105 Appearing before the Board on Medicine in June, Handler assured the group that the NAS Council had given the Board on Medicine the

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To Improve Human Health: A History of the Institute of Medicine "broadest kind of hunting license" to establish the new Institute. The head of the Institute would be "someone of stature who would command a commensurate salary." The Board envisioned such a person to be about 45 years old. ''If you find the best man for it, we are just going to be delighted," Handler said, using the conventional sexist language of the era. He added that he did not foresee any problems with NAS Council approval.106 A draft of the constitution and bylaws received the Board's approval on July 22. The next step was for Irving London, Adam Yarmolinsky, Walsh McDermott, and James Shannon to present these documents to the NAS Council on August 24. In the meantime, Handler offered his suggestions. Among other things, he changed the title of the president of the IOM to the director, and the name "executive council" to "executive committee." In making these suggestions, Handler hoped to avoid confusion between the IOM and the NAS itself. The August 24 meeting of the NAS Council went smoothly. On nearly all matters of dispute between the Board and the NAS, the Council yielded. The Council wanted to restrict the total number of members, but McDermott assured them that the Institute's work required more than 200 people. The Council agreed that the IOM should have a president, not a director. Both sides concurred in the provision that all members of the Medical Sciences Section of the National Academy of Sciences would receive an invitation to join the Institute. On September 9, 1970, Walsh McDermott wrote that he, Adam Yarmolinsky, and Irving London were all quite pleased with the final version of the Institute of Medicine's Charter and Bylaws. The Charter contained a ringing statement that reflected McDermott's point of view: "The problems posed in provision of health services are so large, complex and important as to require, for their solution, the concern and competences not only of medicine but also of other disciplines and professions."107 In the terms of the earlier debate with Irvine Page, the Institute would speak about, not for, medicine. Irvine Page retreated as gracefully as he could. In an editorial that appeared in October, he stated that he had once believed that only a freestanding National Academy of Medicine would do. Recently, however, he had been persuaded that the "N.A.S sincerely wishes to fulfill those needs through an Institute of Medicine. The immediate plans have taken more than two years to evolve, and the institute deserves a fair trial." Robert J. Glaser called Page's statement "excellent.... I believe we are now well on our way to creating the kind of organization you and others envisioned from the start."

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To Improve Human Health: A History of the Institute of Medicine Although Glaser warned that much would depend on securing financial backing, the initial signals from the foundation community were encouraging. Independently of Glaser, Page learned that foundation money for the sort of national academy he had wanted to form was no longer obtainable. As Page put it, the Carnegie Foundation and Commonwealth Fund planned to let the Institute "have a try and fail before big money will be available for NAM."108 Conclusion Between 1967 and 1970, the Board on Medicine spent most of its time trying to reconcile the conflicting points of view of its members and negotiating with the National Academy of Sciences. As a consequence, it completed few studies and gained fame only for a short statement that it issued on heart transplants. An initial round of enthusiasm for the venture went largely unexploited, because the members of the Board could never quite agree on its final form. An almost superhuman form of patience was required on Walsh McDermott's part to bring the process to conclusion. In the end, however, the Institute of Medicine reflected McDermott's vision as much as anyone else's. When Irvine Page wrote the 1964 editorial launching the process that ultimately led to the Institute of Medicine, he did not envision that the result would be an organization in which a quarter of the membership would be composed of people from outside the health sciences. Nor did he foresee an entity concerned not only with the problems of medical research but also with the larger social problems surrounding health. The Institute of Medicine was created at a time when health policy experts and even some of those in the realm of heath sciences research, such as McDermott, emphasized the social aspects of medical problems and people thought these problems were amenable to solution. The optimism of the era was stamped on the Institute of Medicine's Charter and Bylaws and on its initial agenda. So were the organizational tensions that had developed in the National Academy of Sciences. These tensions created ambiguities that would continue to plague the Institute. Exactly how much autonomy did the Institute have? How did the Institute relate to the rest of the Academy structure? Few people wished to probe these questions too deeply for fear of upsetting the delicate set of understandings on which the IOM rested.

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To Improve Human Health: A History of the Institute of Medicine On December 17, 1970, Philip Handler appeared before the Board on Medicine, functioning as the Executive Committee of the Institute of Medicine, and announced that Dr. Robert J. Glaser would serve as acting president of the Institute. He would volunteer his time and keep his regular job. Until recently the dean of Stanford's School of Medicine, Dr. Glaser currently worked as a vice president of the Commonwealth Fund in New York, a position previously held by Board member Colin MacLeod. Four days later, the NAS issued a press release announcing the "formal activation of the Institute of Medicine."109 The Institute of Medicine was launched. Notes 1.   Irvine H. Page, "Needed—A National Academy of Medicine," Modern Medicine, July 20, 1964, pp. 77–79; Wilbur Cohen, "Health and Security for the American People," reprinted in U.S. Senate, Committee on Finance, Nomination of Wilbur J. Cohen, March 22 and 23, 1961. The description of the Association of American Medical Colleges comes from Robert Ebert, "The Changing Role of the Physician," in Carl J. Schramm, ed., Health Care and Its Costs (New York: W.W. Norton and Company, 1987), p. 163. For a historical overview of the many organizations concerned with health policy, see Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982). 2.   Lawrence K. Altman, "Dr. Irvine H. Page Is Dead at 90: Pioneered Hypertension Research," New York Times, June 12, 1991; Curriculum Vitae of Irvine H. Page, M.D., Box 8, Irvine Page Papers, National Library of Medicine, Bethesda, Md. 3.   Paul Starr, The Social Transformation of American Medicine, p. 347; Stephen P. Strickland, Politics, Science, and Dread Disease: A Short History of United States Medical Research Policy (Cambridge, Mass.: Harvard University Press, 1972); Daniel M. Fox, Health Policies, Health Politics: The British and American Experience, 1911–1965 (Princeton, N.J.: Princeton University Press, 1986). 4.   Irvine H. Page, "More on a National Academy of Medicine," Modern Medicine, March 15, 1965, pp. 89–90; materials in File IOM: 1965, Box 1, Page Papers. 5.   Irvine Page to Dr. Karl Folkner, President, Stanford Research Institute, April 6, 1964, File IOM: 1965, Page Papers. 6.   Irvine Page, "Membership in a National Academy of Medicine," and "Replies to July 1965 Query re: Membership in a N.A.M.," both in Container 1, File IOM: 1965, Page Papers. 7.   Edward D. Berkowitz, America's Welfare State: From Roosevelt to Reagan (Baltimore, Md.: Johns Hopkins University Press, 1991), p. 178; Stephen P. Strickland, Politics, Science, and Dread Disease, p. 207. 8.   "News in Brief," Science, September 23, 1966, p. 1508.

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To Improve Human Health: A History of the Institute of Medicine 9.   Irvine Page to Robert Aldrich, September 6, 1966, and "Agenda of First Organizational Meeting," January 17, 1966, both in Page Papers. 10.   Irvine Page, "Is There a Need?" Notes for first organizational meeting, Page Papers. 11.   Donald S. Fredrickson, "James Augustine Shannon," Proceedings of the American Philosophical Society, 140 (March 1966), pp. 107–114; Stephen P. Strickland, Politics, Science, and Dread Disease, pp. 100–101. 12.   "Minutes of Organizational Meeting of National Academy of Medicine," January 7, 1967, Board on Medicine Files, National Academy of Sciences (NAS) Archives. 13.   "Minutes of Second Organizational Meeting for a National Academy of Medicine," March 7, 1967, Board on Medicine Files, NAS Archives. 14.   Ross Harrison to George H. Whipple, September 6, 1941, and E. B. Wilson to Harrison, September 12, 1941, Box 80, Ross Harrison Papers, Yale University. 15.   Report of the National Academy of Sciences, National Research Council, Fiscal Year 1945–46 (Washington, D.C.: U.S. Government Printing Office, 1947), p. 52. 16.   See, for example, National Academy of Sciences, National Academy of Engineering, National Research Council, Annual Report Fiscal Year 1967–68 (Washington, D.C.: U.S. Government Printing Office, 1970). 17.   Frederick K. Seitz Memoir, p. 289; J. F. A. McManus, M.D., "Why a National Academy of Medicine?" Medical Science, April 1967, in Agenda Book, Background Materials on Further Institutional Forms for the Board on Medicine, Board on Medicine Files. 18.   Council Meeting, Executive Session, April 22–23, 1967, and Business Session, April 25, 1967, both in Board on Medicine: General 1967 file, NAS Records. 19.   Council Meeting, June 3 and 4, 1967, and Governing Board Meeting, June 4, 1967, both in Board on Medicine: General 1967 file, NAS Records. 20.   Betty Libby to Robert Aldrich, June 15, 1967, and Irvine Page to Philip Lee, June 23, 1967, both in Page Papers. 21.   Walsh McDermott to Irvine Page, October 5, 1966, File IOM: 1966, Page Papers. 22.   Paul B. Beeson, "Walsh McDermott, October 24, 1909–October 17, 1981," NAS Biographical Memoirs, pp. 283–299, enclosed in Beeson to Samuel Thier, May 10, 1990, Wallace Waterfall Materials, National Academy of Sciences. 23.   Frederick Seitz to Dr. Walsh McDermott, June 28, 1967, and McDermott to Seitz, July 22, 1967, NAS, Committee and Boards, Board on Medicine, General, NAS Records, NAS Archives. 24.   Minutes of Meeting, June 28, 1967, Board on Medicine Meetings, Minutes, 1967–1968, Board on Medicine Files, NAS Records, NAS Archives. 25.   Irvine H. Page to Dr. Robert Aldrich et al., September 13, 1967, Container I, File IOM: August–December 1967, Page Papers; Diary Note, September 14, 1967, Meeting of Organizing Group, September 12, 1967, NAS Records.

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To Improve Human Health: A History of the Institute of Medicine 26.   Minutes of Council Meeting, September 30, 1967, NAS Records; Walsh McDermott to Frederick Seitz, September 18, 1967, NAS Records; Daniel Bell to Seitz, October 3, 1967; Kermit Gordon to Seitz, October 26, 1967; Milton Friedman to Seitz, October 13, 1967; and James Tobin to Seitz, October 5, 1967, all in Board on Medicine: Membership, NAS Records; Seitz to Rashi Fein, October 31, 1967, and Fein to Seitz, November 6, 1967, both in Rashi Fein Papers (privately held); Interview with Rashi Fein, August 2, 1997, Lake George, New York. 27.   Evert Clark, "Medical Board Set Up to Speed Benefits of Research to Public," New York Times, November 14, 1967, p. 1. Other media coverage included articles in the Journal of the American Medical Association, December 4, 1967; Medical World News, November 24, 1967; U.S. Medicine, December 15, 1967, Medical Tribune, November 27, 1967; and Science, 158 (1967), p. 891. Each of these stories is carefully collected in the Page Papers. 28.   Irvine Page to Colin MacLeod, July 2, 1967; Page to Fred Seitz, October 3, 1967; Page to Stuart M. Sessoms, December 4, 1967; Page to James A. Shannon, December 8, 1967; Page to Julius Comroe, January 2, 1968; and Page to MacLeod, January 2, 1968, all in Page Papers. 29.   "First Meeting of the Board on Medicine, National Academy of Sciences, November 15, 1967: Summary of Discussion" (prepared by Joseph Murtaugh), Board on Medicine Meetings, Minutes, 1967–1968, Board on Medicine Files. 30.   "Summary Minutes of the Second Meeting of the Board on Medicine, Washington, D.C.," December 14 and 15, 1967, File Board on Medicine Meetings: Minutes 1967–1968, Board on Medicine Files, NAS Records, NAS Archives. 31.   Walsh McDermott to Dr. Julius H. Comroe, Jr., January 16, 1968, File Functional Statement: Proposed, Board on Medicine Files. 32.   Irvine H. Page to Drs. R. A. Aldrich et al., December 18, 1967, File Board on Medicine: Meeting: December 14–15, 1967, Board on Medicine Files. 33.   Irvine H. Page to Drs. R. A. Aldrich et al., February 6, 1968, Container 1, Page Papers. 34.   Minutes of Board on Medicine Meeting, February 2, 1968, Board on Medicine Files. 35.   Walsh McDermott to Board on Medicine, February 20, 1968, Board on Medicine Files. 36.   "Board on Medicine Recommends Criteria for Heart Transplants," press statement for release on February 28, 1968, File Draft Annual Report, August 1969, Board on Medicine Files. 37.   Evert Clark, "Guidelines Urged for Transplants," New York Times , February 27, 1968. 38.   Rudy Abramson, "Don't Try Heart Transplants too Soon, Scientists Warn," Atlanta Journal, February 29, 1968. 39.   "Appraising Heart Transplants," Saturday Review, April 6, 1968, pp. 59 ff. 40.   Alberto Z. Romualdez, M.D., Secretary General, World Medical Association, to Walsh McDermott, February 2, 1968, Heart Transplant

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To Improve Human Health: A History of the Institute of Medicine     Material, Board on Medicine Records; Congressional Record, March 5, 1968, pp. S 22212–22213; Joseph A. Califano, Jr., to McDermott, March 5, 1968; Wilbur Cohen to McDermott, March 11, 1968; and Joseph Murtaugh to McDermott, April 21, 1968, all in File Transplant Statement: Correspondence, Board on Medicine Records. 41.   Dr. Francis Moore to Walsh McDermott, March 14, 1968, File Transplant Statement: Correspondence, Board on Medicine Records. 42.   Walsh McDermott to Dr. Francis D. Moore, April 3, 1968, File Transplant Statement: Correspondence, Board on Medicine Records. 43.   Walsh McDermott to Dr. Henry K. Beecher, Department of Anaesthesia, Harvard Medical School, April 27, 1965, File Transplant Statement: Correspondence, Board on Medicine Records. 44.   Irvine Page to Walsh McDermott, March 18, 1969, File Transplant Statement: Correspondence, Board on Medicine Records. 45.   Quigg Newton, Commonwealth Fund, to Fred Seitz, May 9, 1968, Board on Medicine Records. 46.   James Shannon to Fred Seitz, May 23, 1968, Committee and Boards: Board on Medicine, General, 1968, NAS Records. 47.   Joseph Murtaugh to the record, Meeting at the Commonwealth Fund, June 10, 1968, Committees and Boards, 1968, Board on Medicine, Panels, Further Institutional Forms Ad Hoc, NAS Records. 48.   See ''Source of Funds, Board on Medicine, 1968–1969," Board on Medicine Records. 49.   "Summary Report of Meetings April 10 and 11, at Stone House, Bethesda, Maryland," April 15, 1968, and Joseph Murtaugh to John S. Coleman, April 22, 1968, File Meeting April 10–11, 1968, Agenda, Attendance, Draft Minutes, both in Board on Medicine Files; 50.   Task Order 49, Medical Education for the Future, Board on Medicine Records. 51.   "Health and the Poor" (Proposal for a Study), June 10, 1968, Study of Health and the Disadvantaged File, Board on Medicine Files. 52.   "Summary Report of the Meeting of the Panel on Health and the Disadvantaged," September 11, 1968, Study of Health and the Disadvantaged File, Board on Medicine Records. 53.   Thomas Francis, Jr., M.D., Professor and Chairman, Department of Epidemiology, University of Michigan, to Fred Seitz, January 5, 1968, Committee and Boards: Board on Medicine: General, 1968, NAS Records, 54.   Internal Health, Education, and Welfare memorandum from Jane E. Fullerton to the Record, March 25, 1968, included in Joseph Murtaugh to Members, Board on Medicine, April 4, 1968, Drawer 1, Board on Medicine Files; Julius Comroe to McDermott, April 8, 1968, File Board on Medicine Functional Statement: Proposal, Board on Medicine Files. 55.   Julius Comroe to Joseph Murtaugh, March 14, 1968, and Irvine Page to Comroe, March 19, 1968, File NAS-Board on Medicine Correspondence, March 1968, Page Papers. 56.   Irvine Page, "Needed—A National Academy of Medicine," July 3, 1968, in Joseph Murtaugh to Members, Board on Medicine, July 16, 1968,

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To Improve Human Health: A History of the Institute of Medicine     NAS Committees and Boards (1968), Board on Medicine: Panels, Further Institutional Forms Ad Hoc, NAS Records. 57.   Julius Comroe form letter, July 8, 1968, in Meeting July 22, 1968: Agenda, Attendance File, Board on Medicine Records; Comroe to Board on Medicine, July 26, 1968, in Agenda Book, Background Materials on Further Institutional Forms for the Board on Medicine, Board on Medicine Records; File July 22, 1968, Meeting Transcript, p. 42, Board on Medicine Records. 58.   Julius Comroe to Irvine Page, August 16, 1968, File NAS-Board on Medicine, July–September 1968, Page Papers. The members of the panel were Irving London, Julius Comroe, Robert J. Glaser, Henry Riecken, Walter Rosenblith, and Dwight Wilbur, with James Shannon listed as a consultant. 59.   Board on Medicine Meeting Transcript, September 25, 1968, p. 164, Board on Medicine Files, "Notes on the Meeting of the Ad Hoc Panel of Further Institutional Forms for the Board on Medicine," September 27, 1968, 1968, NAS Records. 60.   Joseph Murtaugh to Fred Seitz, October 8, 1968, NAS Records. 61.   Irving S. Wright to Irvine Page, November 13, 1968, Container 2, File NAS-Board on Medicine Correspondence, November-December 1968, Page Papers. 62.   Carleton B. Chapman, M.D., Dean, Dartmouth Medical School, to Irvine Page, December 18, 1968; Page to Chapman, December 27, 1968; and Page to Francis D. Moore, December 26, 1968, all in File NAS-Board on Medicine Correspondence, November–December 1968, Page Papers. 63.   Irvine Page to Irving London, November 14, 1968, NAS Committees and Board, Future Institutional Forms, NAS Records. 64.   Irvine Page, "The Two-Concept Idea," Background Materials for Further Institutional Forms, Board on Medicine Files. 65.   "Notes on the Meeting in Boston, November 18, 1968, of the Ad Hoc Panel on Further Institutional Forms, Agenda Book, Background Materials for Further Institutional Forms, Board on Medicine Files. 66.   Transcript of Board on Medicine Meeting, November 20–21, 1968, Board on Medicine Records. See particularly pp. 133–134. 67.   Irvine Page to Francis Moore, December 26, 1968, and Dwight Wilbur to Page, January 3, 1969, both in File NAS-Board on Medicine Correspondence, January-February 1969, Page Papers. 68.   Joseph S. Murtaugh to Members, Board on Medicine, January 9, 1969, in Drawer One, Board on Medicine Records; NAS Press Release, January 17, 1969, Drawer One, Board on Medicine Records. 69.   "Summary Notes on the Meeting of January 20, 1969," January 27, 1969, and Robert A. Kevan to Joseph Murtaugh, January 28, 1969, both in Study on Biomedical Education for the Future File, Board on Medicine Records. 70.   Robert Glaser to Irvine Page, February 13, 1969, and Page to Glaser, February 20, 1969, both in File NAS-Board on Medicine Correspondence January-February 1969, Page Papers. 71.   Irving M. London to Walsh McDermott, March 7, 1969, NAS Records.

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To Improve Human Health: A History of the Institute of Medicine 72.   "A Proposal for a National Academy of Medicine," February 28, 1969, Committee and Boards, Panel: Further Institutional Forms, Ad Hoc, General, 1969, NAS Records. 73.   Irvine Page to Dwight Wilbur, March 3, 1969, File NAS-Board on Medicine Correspondence March-April 1969, Page Papers. 74.   Transcript of Board on Medicine Meeting, March 12, 1969, pp. 113, 126–127, 256, Board on Medicine Records; Walsh McDermott to Irvine Page, March 21, 1969, and Julius Comroe to Page, March 17, 1969, both in File NAS-Board on Medicine Correspondence March-April 1969, Page Papers. 75.   Walsh McDermott to Fred Seitz, March 24, 1969, NAS Council, Executive Committee Meeting, March 29, 1969, NAS Records; McDermott to Board on Medicine, May 22, 1969, NAS Records; McDermott to Irving London, April 15, 1969, NAS Records; Minutes of NAS Council, April 26–27, 1969, NAS Records. 76.   Transcript of Board on Medicine Meeting, May 7–8, 1969, pp. 53, 105–108, Board on Medicine Files. 77.   Joseph S. Murtaugh to Members, Board on Medicine, "Summary Report on Board on Medicine Meeting, May 7–8, 1969," McDermott Files, Board on Medicine Records; McDermott to the President and Members of the Council of the National Academy of Sciences, May 29, 1969, Agenda Book, June 25–26, 1969, Meeting, Board on Medicine Records. 78.   Ronald Kotulak, "Plan Super Agency to Advise on Health," Chicago Tribune, April 25, 1969; David Rhinelander, "Health Expert Wants Medicine Academy," Hartford Courant, May 4, 1969; and "Scheme for Medical Academy," Nature, 223 (August 9, 1969). 79.   Minutes of the Council Meeting, June 7, 1969, NAS Records; Joseph Murtaugh to McDermott, Glaser, London, Yarmolinsky, and Shannon, June 12, 1969, NAS Records. 80.   Council Meeting, June 7, 1969, Executive Session, Restricted, NAS Records. 81.   Philip Handler to the Council, National Academy of Sciences, June 17, 1990, McDermott Files, Board on Medicine Records. 82.   Joseph Murtaugh to Members, Board on Medicine, June 11, 1969, NAS Records. 83.   NAS Executive Committee Meeting, July 19, 1969, NAS Records. 84.   Joseph Murtaugh, "Notes on the Meeting of the Delegation of the Board on Medicine with the Executive Committee of the NAS Council, July 20, 1969, at Woods Hole, Massachusetts," July 28, 1969, NAS Records. 85.   Philip Handler to Walsh McDermott, July 29, 1969, NAS Records. 86.   Transcript of Board on Medicine Meeting, July 30, 1969, Board on Medicine Records. 87.   Irvine Page to James Shannon, August 1, 1969, and Page to Cecil Andrus, August 6, 1969, both in File NAS-Board on Medicine Correspondence July-August 1969, Page Papers. 88.   Robert Q. Marston to Ivan Bennett, June 20, 1969, Meeting File for September 29–30, 1969, Board on Medicine Records; Robert A. Kevan to C. H.

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To Improve Human Health: A History of the Institute of Medicine     William Ruhe, August 7, 1969, Reorganization File for the Study on Biomedical Education for the Future, Board on Medicine Records. 89.   Philip Handler to Philip H. Abelson et al., August 1, 1969, "Background Materials," September 9–10, 1969, Meeting of the Ad Hoc Committee on Further Institutional Forms of the Board on Medicine, Board on Medicine Records; Telegram from Walsh McDermott to Philip Handler, August 5, 1969, National Academy of Medicine Proposal File, 1969, Board on Medicine Records; Handler to Joseph Murtaugh, August 5, 1969, McDermott Files, Board on Medicine Records; Handler, memoranda for file, August 12 and August 13, 1969, NAS Records. 90.   Philip Handler to Walsh McDermott, August 12, 1969, Board on Medicine: Meetings, Resolution to Create National Academy of Medicine, July 1969 File, NAS Records; McDermott to Handler, n.d., NAS Records. 91.   "Meeting of the Ad Hoc Panel on Further Institutional Forms, New York City, September 9–10, 1969," Board on Medicine Records. 92.   Irvine Page to Julius Comroe, September 11, 1969, Container 2, File NAS-Board on Medicine Correspondence September-December 1969, Page Papers; Comroe to Page, August 25, 1969, NAS-Board on Medicine Correspondence July-August 1969, Page Papers. 93.   Transcript of Board on Medicine Meeting, September 29–30, 1969, Board on Medicine Records. 94.   Walsh McDermott to Philip Handler, October 6, 1969, Bennett Committee File, Board on Medicine Records; Handler to McDermott, September 8, 1969, McDermott Files, Board on Medicine Records; NAS Council Minutes, September 27, 1969, NAS Records. 95.   Ivan Bennett to Irvine Page, October 16, 1969, File NAS-Board on Medicine Correspondence September-December 1969, Page Papers; Page to Bennett, November 4, 1969, File NAS-Board on Medicine Correspondence November-December 1969, Page Papers. 96.   "Summary Report of the Meeting of the Board on Medicine," November 12, 1969, Board on Medicine Records. 97.   Walsh McDermott to Philip Handler, November 13, 1969, and Handler to McDermott, November 25, 1969, NAS Records. 98.   "NAS Spikes Proposal for Academy of Medicine," Biomedical News , January 1970; "Ivory Tower of Medicine: Is 'No' Final?" Medical World News, January 2, 1970, both in Institute of Medicine Proposed, 1970 File, NAS Records; Research Notes, January 7, 1970, Institute of Medicine—General File, NAS Records. 99.   Transcript of Board on Medicine Meeting, January 21–22, 1970, Board on Medicine Records. 100.   Irvine Page to Julius Comroe, January 22, 1970, and Page to Gerald S. Berenson, M.D., February 19, 1970, both in File NAS-Board on Medicine Correspondence, January-April 1970, Page Papers. 101.   Joseph Murtaugh to John Coleman, January 30, 1970, Loose File, Board on Medicine Records. 102.   Transcript of Board on Medicine Meeting, May 13–14, 1970, Board on Medicine Records.

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To Improve Human Health: A History of the Institute of Medicine 103.   "Proposal to Council of NAS by Board on Medicine," June 5, 1970, NAS Records. 104.   Minutes of the Council Meeting, June 5–6, 1970, NAS Records. 105.   NAS Press Release, June 10, 1970, NAS Records; Philip Handler to Walsh McDermott, June 10, 1970, NAS Records. 106.   Transcript of Board on Medicine Meeting, June 24, 1970, Board on Medicine Records; "Brief Minutes," June 29, 1970, McDermott Files, Board on Medicine Records. 107.   Institute of Medicine, Charter and Bylaws, 1970, NAS Records. 108.   Douglas Bond, M.D., President, Grant Foundation, to Irvine Page, July 21, 1970, and Robert Glaser to Page, August 10, 1970, both in File NAS-Board on Medicine July-September 1970, Page Papers; Irvine Page, "The Institute of Medicine of the National Academy of Sciences," Modern Medicine, October 5, 1970, pp. 95–97. 109.   "Dr. Robert J. Glaser Named Acting President of Institute of Medicine," NAS Press Release, December 21, 1970, NAS Records; Institute of Medicine, Meeting of Executive Committee, December 17, 1970, NAS Records.