Introduction

by Kenneth I. Shine, M.D.

President, Institute of Medicine

In a 1971 editorial in Science, Dr. Irvine Page, one of the Institute of Medicine's (IOM's) Charter members, comments, “The Institute faces a difficult period. It must maintain its integrity, exhibit courage in its decisions, and willingly undertake study of problems that others prefer to shun.” Twenty-five years later, the same observations hold true. Fortunately, events of the last quarter-century have demonstrated that this vision, while difficult to achieve, is attainable. Whether redirecting the nation's efforts in confronting the epidemic of HIV infection and AIDS—including a study of transfusion-related HIV infection in the early 1980s, publishing studies on unintended pregnancy and RU 486, or taking on such tough issues as the effect of herbicides in Vietnam or the prevention of nicotine addiction among children and youths—the Institute has taken on difficult projects and has maintained both its objectivity and its integrity in the process.

In the year of the Institute's founding, 1970, hopes were high that some form of national health insurance might address the nation's health care needs. Twenty-five years later, we have just completed a painful experience in which efforts to reform the health care system through a coherent plan failed, and reform has been left instead to the marketplace. The Institute has focused its efforts upon issues related to access and quality of care during this period and will continue over the next several years to emphasize both issues. No final



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For the Public Good: Highlights from the Institute of Medicine, 1970–1995 Introduction by Kenneth I. Shine, M.D. President, Institute of Medicine In a 1971 editorial in Science, Dr. Irvine Page, one of the Institute of Medicine's (IOM's) Charter members, comments, “The Institute faces a difficult period. It must maintain its integrity, exhibit courage in its decisions, and willingly undertake study of problems that others prefer to shun.” Twenty-five years later, the same observations hold true. Fortunately, events of the last quarter-century have demonstrated that this vision, while difficult to achieve, is attainable. Whether redirecting the nation's efforts in confronting the epidemic of HIV infection and AIDS—including a study of transfusion-related HIV infection in the early 1980s, publishing studies on unintended pregnancy and RU 486, or taking on such tough issues as the effect of herbicides in Vietnam or the prevention of nicotine addiction among children and youths—the Institute has taken on difficult projects and has maintained both its objectivity and its integrity in the process. In the year of the Institute's founding, 1970, hopes were high that some form of national health insurance might address the nation's health care needs. Twenty-five years later, we have just completed a painful experience in which efforts to reform the health care system through a coherent plan failed, and reform has been left instead to the marketplace. The Institute has focused its efforts upon issues related to access and quality of care during this period and will continue over the next several years to emphasize both issues. No final

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For the Public Good: Highlights from the Institute of Medicine, 1970–1995 solution for ensuring that our health care system will provide universal access to high-quality care at reasonable cost is immediately in sight. Thus, the next few years represent another “difficult period ” during which we must seek new and innovative solutions to the challenges the country faces. Fortunately, most of the internal governance issues that confronted the Institute in its dealings with the National Academy of Sciences (NAS) during its early years have been resolved. The leadership of the NAS and its Council has endorsed the notion of changing the Institute 's name to the “National Academy of Medicine,” although this will require final approval, by ballot, by NAS members. Whether the Institute's name changes or not, the organization itself is functioning well. In his editorial, Dr. Page notes that “any organization is only as good as its members.” Our 519 active members and 600 senior members and foreign associates are an extraordinary group. In addition to maintaining the high quality of the membership, we have begun to achieve significant diversity among our active members as well, which now comprise 20 percent women and 8 percent underrepresented minorities. Our attempts to maintain the highest standards for membership while achieving diversity are succeeding, although much still needs to be done. Dr. Page also states that “the Institute is not intended only as an honor.” Indeed, each year between 30 and 40 percent of our members participate in an IOM project in some way—as committee members or report reviewers, or as members of IOM boards or the IOM Council. Their leadership, expertise, and participation constitute an invaluable resource. To all of the members who have been active, we are particularly grateful. We continue to look for ways to increase opportunities for member participation. Dr. Page hoped that IOM members would “be drawn chiefly from men and women approximately 50 years or younger.” In this, we have been less successful. Although the average age of our members is less than that for the NAS, it remains at 56. Clearly, we need to increase efforts to identify the best and the brightest at a younger age. In 1968, Dr. Walsh McDermott, another Charter member, described two possible “concepts” for the Institute. In the first type, the Institute would “speak from within the medical profession concerning problems that involve medicine.” According to the second, the Institute would “speak to the issues from the position of all-around competency rather than one that would speak from within medicine. ” He went on to say, “I am deeply convinced that what is needed is a institution based on Concept II.” The Institute has been quite faithful to this latter concept, as reflected in the breadth and diversity of experience, outlook, and expertise represented by our committee members and in the objectivity of our reports. This volume seeks to identify a few of the major themes that have interested the Institute and its members over the past 25 years. By necessity, many other important areas to which the IOM has contributed are not dealt with in

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For the Public Good: Highlights from the Institute of Medicine, 1970–1995 this brief treatise. For example, over the past 25 years, IOM has made innumerable contributions in the area of biomedical research, ranging from reviews of almost all of the programs of the National Institutes of Health (NIH) to studies of the structure of NIH itself. The IOM has participated in studies of clinical investigators and doctoral trainees, as well as in scores of projects on specific research issues ranging from brain imaging and brain mapping to the development of an artificial heart. Important contributions in international health include projects with Mexico, joint Israeli-Egyptian (and now Palestinian) research efforts, and meetings on global population concerns. The training of geriatricians and health services researchers, nurse staffing, and studies of disability and aging have also been important areas of concentration during this quarter-century. In subsequent publications, we anticipate documenting IOM's work in these areas more fully. In addition, later this year we will publish a guide to issues in women's health based on past IOM projects. This volume reminds us of some of the important issues on which the Institute has worked, identifies some of our successes and failures, and offers a basis from which we can think about the future. I hope you will look through the material and form your own judgments; they will be helpful to us as we approach our next quarter-century.

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For the Public Good: Highlights from the Institute of Medicine, 1970–1995