A HISTORY OF
50 YEARS OF
Laura Harbold DeStefano
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
International Standard Book Number-13: 978-0-309-69353-0
International Standard Book Number-10: 0-309-69353-5
Digital Object Identifier: https://doi.org/10.17226/26708
Library of Congress Catalog Number: 2022945951
This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2022 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Cover image credits (left to right, row by row): National Library of Medicine; Science Photo Library (SPL); iStock; Shutterstock; Unsplash (photo by Mick Haupt); Centers for Disease Control and Prevention (CDC)/ CDC Connects (photo by Rebecca Myers); Unsplash (photo by National Cancer Institute); Library of Congress; White House Archives; iStock; iStock; SC National Guard on Flickr; iStock; iStock; National Institutes of Health; Cleveland Clinic; CDC (photo by Rana Asghar); National Academy of Medicine (NAM); Dick Swanson/The LIFE Images Collection/Getty Images; Piyaset, iStock; Don Detmer; iStock; iStock; SPL; CDC (photo by Courtney Wheeler); NAM; SPL; CDC (photo by Debra Cartagena).
Suggested citation: Hammonds, E., H. Markel, D. Rosner, and R. Stevens, editors; Harbold DeStefano, L., A. Schultz, and E. Berkowitz, authors. A History of the National Academy of Medicine: 50 Years of Transformational Leadership. Washington, DC: The National Academies Press. https://doi.org/10.17226/26708.
ABOUT THE NATIONAL ACADEMY OF MEDICINE
The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
Learn more about the National Academy of Medicine at NAM.edu.
The National Academy of Medicine extends its gratitude to the following individuals for their valuable contributions to the research, writing, review, and production of this volume:
Rose Marie Martinez
J. Michael McGinnis
Action Collaborative: A program type of the National Academy of Medicine (NAM) that brings multi-sectoral stakeholders together on a term-limited basis to catalyze action around shared priorities.
Consensus Report (or Consensus Study): An evidence-based report containing findings, conclusions, and recommendations authored by an expert committee appointed by the National Academies of Sciences, Engineering, and Medicine (the National Academies).
Convening Activity: A one-time event (e.g., a public workshop) or standing mechanism (e.g., a roundtable) to convene stakeholders to discuss or advance specific issues or fields.
Council (or Councilor): A governing and oversight body to which Academy members are elected on a term-limited basis. Members of the Councils of the National Academy of Sciences (NAS), National Academy of Engineering (NAE), and the NAM are referred to as Councilors.
Division Committee: An advisory body, to which volunteers are appointed on a term-limited basis, that informs the work of the Health and Medicine Division (HMD) and other program divisions of the National Academies.
Forum (or Roundtable): A standing mechanism to convene stakeholders from a defined field and advance issues of common interest.
Health and Medicine Division (HMD): A program division of the National Academies that was created in 2015 after the Institute of Medicine (IOM) became the NAM.
Home Secretary: An officer elected from among the NAM (or the NAS or the NAE) membership to oversee member elections, interest groups, and other activities related to member engagement.
Institute of Medicine (IOM): The precursor organization to the NAM, which was known under the IOM name from 1970 until 2015.
International Secretary: An officer elected from among the NAM (or the NAS or the NAE) membership to lead and advise on international affairs. This position was called Foreign Secretary until 2021, when the name was changed to International Secretary.
Member of the IOM/NAM: An individual elected to the IOM (later the NAM) on the basis of exceptional achievement and commitment to service within the National Academies.
National Academies of Sciences, Engineering, and Medicine: The name of the organization made up of the NAS, the NAE, the NAM, and programmatic units including the HMD. The organization began using this name in 2015.
National Academy of Engineering (NAE): An independent, evidence-based advisor on matters of engineering and an honorific membership organization for exceptional leaders in engineering fields (founded in 1964).
National Academy of Medicine (NAM): An independent, evidence-based advisor on matters of biomedical science, medicine, and health and an honorific membership organization for exceptional leaders in these fields. Founded in 1970, the NAM was known as the IOM until 2015.
National Academy of Sciences (NAS): An independent, evidence-based advisor on matters of science and technology and an honorific membership organization for exceptional leaders in these fields (founded in 1863).
National Research Council (NRC): The operational arm of the NAS and the NAE, which houses programmatic units that carry out consensus studies, convenings, and other activities. The NRC name was no longer used publicly after 2015.
1 THE FOUNDING OF THE INSTITUTE OF MEDICINE
The Need for Independent Advice in Health and Medicine
Establishment of the National Academy of Sciences’ Board on Medicine and Public Health
Proposal for a National Academy of Medicine
Establishment of the Institute of Medicine
2 A COMMITMENT TO SERVICE: MEMBERS AND LEADERS OF THE INSTITUTE OF MEDICINE AND THE NATIONAL ACADEMY OF MEDICINE
Presidents of the Institute of Medicine and the National Academy of Medicine
Institute of Medicine and National Academy of Medicine Staff Leaders
Building the Leadership Pipeline and Recognizing Excellence
3 THE CREATION OF THE NATIONAL ACADEMY OF MEDICINE
History of Campaigns to Establish the National Academy of Medicine
Success of the 2013–2015 Campaign
The National Academy of Medicine’s Program Takes Shape
The Human Genome: From Sequencing to Editing
The Science of Childhood and Adolescent Development
Facilitating Progress in Cancer Research
Scientific Advisor to the U.S. Government
Building Capacity of International Science Academies
Building a Culture of Health Care Quality
A Value and Science-Driven Health System
Health Disparities and Health Equity
The Health Care Workforce and Informal Caregivers
Complex and Serious Health Conditions
Health Care Reform and Uninsurance
6 ADVANCING THE HEALTH OF THE PUBLIC IN THE UNITED STATES AND GLOBALLY
Defining and Shaping Public Health
Responding to Public Health Pandemics and Epidemics
Responding to Chronic Conditions
Protecting Health in an Interconnected World
PART III A NEW ERA: THE EARLY YEARS OF THE NATIONAL ACADEMY OF MEDICINE
7 RESPONDING TO NATIONAL AND GLOBAL CRISES, 2015–2021
Identifying, Addressing, and Inspiring Action in Response to Critical Issues (Strategic Goal 1)
Diversifying and Activating Members and Engaging Emerging Leaders (Strategic Goal 2)
Building Leadership Capacity Across Diverse Disciplines (Strategic Goal 3)
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“The tragedy of life is often not in our failure, but rather in our complacency; not in our doing too much, but rather in our doing too little; not in our living above our ability, but rather in our living below our capacities.”
—Benjamin Mays, U.S. Civil Rights Leader
I was elected as a member of the Institute of Medicine (IOM), now the National Academy of Medicine (NAM), in 1998. It was the highest honor of my career.
I was born in Shanghai, grew up in Hong Kong, and traveled to Montréal to earn my undergraduate and medical degrees at McGill University. I moved to New York for my postdoctoral training and have lived in the United States ever since—since 1990, as a proud U.S. citizen. As an immigrant, my adopted country has given me many remarkable opportunities. It is a privilege and a joy to give back by serving the mission of the NAM—to improve health for all by advancing science, accelerating health equity, and providing independent, authoritative, and trusted advice nationally and globally.
In 2014, I was appointed as the final president of the IOM and, 6 years later, elected for a second term as the first president of the newly reconstituted NAM. Although it meant spending less time with my family in North Carolina and taking a leave of absence from my role at Duke University, taking the job was a no-brainer. It is not hyperbole to say that no other organization can match the impact of the IOM/NAM.
As you will read in the chapters ahead, it was the IOM that launched the patient safety movement in U.S. health care, laid the foundation for mapping the human genome, galvanized the public health response to the AIDS epidemic, and upheld the safety of vaccines—among other impacts too numerous to list in science, medicine, and population health. IOM/NAM members are luminaries in their fields, more than 75 Nobel Prize winners among them at the time of this writing. Approximately 25 percent represent professions outside the traditional health sciences, in a nod to the inter-disciplinarity of health. I marvel at how many members give freely of their time and expertise each year to support the work of the NAM and advance the common good.
This volume details the long path to reconstitute the IOM as the NAM, an organizational transformation that had been debated almost without pause since the IOM’s founding in 1970.
When I took the helm of the IOM in 2014, the latest campaign to form an Academy, begun by my predecessor, Harvey V. Fineberg, was nearing its successful conclusion.
The establishment of the NAM, finalized in 2015, was the culmination of decades of work by IOM leaders to achieve organizational parity with the National Academy of Sciences (NAS) and the National Academy of Engineering (NAE). As an Academy, the NAM had an equal role in the governance of the overarching organization, which was rebranded alongside the NAM as the National Academies of Sciences, Engineering, and Medicine (the National Academies). The move signaled a commitment to greater integration and efficiency in an age in which society’s greatest challenges require an increasingly interdisciplinary toolkit.
Indeed, the creation of the NAM was cause for celebration. But the transition was difficult in many ways. The IOM brand was beloved among members and staff and trusted by sponsors, policy makers, and researchers in the United States and abroad. The reorganization required the IOM’s legacy boards, roundtables, and forums—and the majority of its staff—to be rehoused in a new National Academies’ Health and Medicine Division (HMD). The NAM, left with just a few programs, had to chart a new course.
It has been hard work, but I am deeply proud to say that we have succeeded. In the few short years since its creation, the NAM has established a dynamic portfolio of programs that leverage its new independence as an Academy while remaining deeply rooted in the rigorous science that propelled the IOM’s influence for 45 years.
In fact, it is my belief that the NAM has extended the impact of the organization well beyond what the IOM’s founders ever imagined. As I write, we are at a pivotal moment in history. No less than three existential crises threaten the health of humanity and the environment that sustains us: pandemics, climate change, and structural racism. The new Academy has evolved and innovated to meet these challenges head on. We do not wait until we are called on to act. Instead, we move proactively to catalyze collective action among the diverse stakeholders who hold the levers for change. Together with colleagues throughout the National Academies and partners across the world, we are pioneering solutions for the most urgent challenges of the future. A quote from the German poet Johann Wolfgang von Goethe, which appeared in the front matter of IOM reports for many years, still says it best: “Knowing is not enough; we must apply. Willing is not enough; we must do.”
In early 2020, the NAM—and the health and medical community worldwide—was put to the test when SARS-CoV-2, the virus that causes COVID-19, became the most dangerous pandemic in a century. We put the Academy’s existing programmatic priorities on hold in order to focus fully on fighting the pandemic. Alongside the HMD and other National Academies units, the NAM provided crucial scientific expertise to the government and members of the public as the crisis unfolded, on topics ranging from how COVID-19 is transmitted to the efficacy of face coverings and physical distancing, to the efficacy of testing and need for crisis standards of care. We also called for a national strategy to protect clinician well-being during the pandemic, as stressors such as lack of personal protective equipment and life-saving supplies sharply increased the strain on an already burdened workforce.
As COVID-19 vaccines drew closer to approval in fall 2020, the National Institutes of Health and the Centers for Disease Control and Prevention (CDC) turned to the NAM and the National Academies to guide the equitable allocation of an initially limited supply. We produced a consensus report in just over 3 months that helped to inform the CDC’s recommendations as well as many state-level plans for allocation. By the end of 2021, more than 60 percent of the U.S. population had been fully vaccinated against COVID-19 (Pariseault, 2021). However, the pandemic continues to evolve and challenge us. The emergence of highly contagious variants has stretched the U.S.
health care system to the breaking point. Meanwhile, populations around the world still struggle to access vaccines—a tragic inequity that threatens the health of people everywhere.
Throughout the pandemic, NAM members have been crucial leaders driving solutions in their own spheres—several as heads of government agencies and task forces, many more as scientists, clinicians, educators, and advocates. Alongside myself and the presidents of the NAS and the NAE, members spoke out against the dangerous politicization of science during the pandemic, as well as the temporary breakdown of the U.S. relationship with the World Health Organization, a critical partner in combatting COVID-19 globally. The NAM’s response to COVID-19 will continue as long as the virus continues to infect individuals anywhere across the globe.
Among many lessons, COVID-19 has taught us that quick, collective action among the scientific and medical communities is possible—and powerful. We must turn that passion and purpose toward other major challenges, both new and enduring, that threaten human health. In that spirit, I am proud that the NAM has committed to confronting structural racism and the impacts of climate change on health and equity.
There is much to be learned from looking back at what we have accomplished—and, crucially, at how we have accomplished it. The IOM/NAM continues to be impactful because of its commitment to science, evidence, and independence, as well as the dedication of countless members, volunteers, and staff who work tirelessly on behalf of its mission. This unique formula allows us to cut across geographic, political, and disciplinary divides and unite leaders around common goals—particularly in times of crisis, as recent events have demonstrated.
But we cannot and will not rest on our laurels. As rapid developments in science, technology, and communication transform the social landscape and climate change, infectious disease, and inequities fuel new threats to health, the unique contributions of the IOM/NAM are just as vital, if not more so, than 50 years ago. Decision makers at every level—within governments, organizations, communities, and households—need evidence-based solutions that support equitable good health. More than that, they need decisive leadership and innovative strategies to anticipate the formidable challenges of the future and ensure that everyone benefits from exponential gains in knowledge.
The NAM, alongside the HMD and drawing on the deep interdisciplinary expertise of the broader National Academies, stands ready to provide this crucial leadership. As we look ahead to the next half-century as an Academy, our legacy will be one of action.
—Victor J. Dzau, MD
National Academy of Medicine
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This volume was originally intended to be published in 2020 to mark the occasion of the 50th anniversary of the founding of the Institute of Medicine (IOM). The COVID-19 pandemic slowed its completion, and, as the chapters that follow detail, led to lasting changes across the organization. The final volume describes events within and outside the organization through the end of 2021. The National Academy of Medicine’s (NAM’s) response to major events in 2022, such as Russia’s invasion of Ukraine, racially motivated and other mass shootings in the United States, and the U.S. Supreme Court’s decision to overturn Roe v. Wade, are covered in the Epilogue.
This volume is organized into three parts. Part I, “Institutional History,” describes the circumstances that led to the IOM’s founding, the members and leaders who built and sustained the organization, and the process by which the NAM and the Health and Medicine Division were formed. Part II, “Impact,” details a selection of the IOM/NAM’s most influential contributions to biomedical science, U.S. health care, and population health. Finally, Part III, “A New Era: The Early Years of the National Academy of Medicine,” describes how the NAM navigated unprecedented national and global crises between 2015 and 2021 and developed an innovative programmatic approach that led to changes across the National Academies of Sciences, Engineering, and Medicine.