A Commitment to Service:
Members and Leaders of the Institute of Medicine and the National Academy of Medicine1
The bylaws of the Institute of Medicine (IOM), which became those of the National Academy of Medicine (NAM) in 2015, specified that, in part, “membership in the Academy shall be based upon … skills and resources likely to contribute to achieving the Academy’s mission; and willingness to be an active participant in the Academy.”2 This provision originated in conversations led by charter member Irvine Page years before the founding of the IOM, in which Page was adamant that the organization should exist not only to honor professional excellence in health, medicine, and biomedical sciences, but also to serve society and improve the health of the public.
Volunteerism became established as a tenet of IOM (and later NAM) membership from the moment the organization opened its doors in 1970. IOM/NAM members volunteered their expertise to support the programmatic work of not only the IOM/NAM, but also other program divisions within the National Academies of Sciences, Engineering, and Medicine (the National Academies) (e.g., the Division on Earth and Life Studies and the Division of Behavioral and Social Sciences and Education). Many IOM/NAM members were also members of the National Academy of Sciences (NAS) and/or the National Academy of Engineering (NAE) and participated in activities of those organizations. Member service took the form of serving as chairs or members of consensus study committees; advising programmatic boards, roundtables, forums, or workshop planning committees; reviewing reports and publications; and more. Such participation was strictly without financial remuneration.
Members also volunteered for roles in the governance of the organization, including service on its Council.3 The Council, chaired by the IOM/NAM president, met several times per year and had
1 Except where otherwise noted, historical facts presented in this chapter are drawn from a 1998 history of the Institute of Medicine authored by Edward Berkowitz (IOM, 1998a).
2 National Academy of Medicine Articles of Organization, Article II: Membership, Section 3.
3 In 2021, the NAM Council comprised three officers (President, Home Secretary, and International Secretary) and 15 at-large Council members, all elected by the NAM membership.
oversight of organizational policies, procedures, funds, and activities. In addition to the president, the IOM/NAM’s governing officers included the Home Secretary and International Secretary.4 The Home Secretary was responsible for the conduct of membership affairs (chiefly, member elections), while the International Secretary served as the organization’s chief liaison and representative in global affairs.
In 2000 the organization established three annual member awards to recognize outstanding volunteer service (see Box 2-1). The Walsh McDermott Medal, named in honor of the Chair of the Board on Medicine and charter member of the IOM (see Chapter 1), recognized members for distinguished service over an extended period of time. The David Rall Medal was named for an IOM member who served as Foreign Secretary from 1994 to 1998. Rall was the Director of the National Institute of Environmental Health Studies (1971–1990) and the National Toxicology Program (1978–1990). The award in his name honored members who demonstrated particularly distinguished leadership as chair of a study committee or other activity. Finally, the Adam Yarmolinksy Medal, named for the lawyer who was lead author of the IOM’s charter and bylaws (see Chapter 1), recognized service by members representing a discipline outside the health and medical sciences.
The Yarmolinsky Medal highlighted the importance of “nontraditional” perspectives in the IOM’s work. As noted in Chapter 1, the IOM (later the NAM) bylaws specified that “no more than three-quarters of the members shall be drawn from the fields of health and medicine.”5 This requirement reflected an understanding of the role of social, political, economic, and environmental
4 The IOM/NAM President, Home Secretary, and International Secretary were the only governance positions that received financial remuneration. The President (a full-time role) received a salary, while the secretaries (part-time roles) received stipends. Prior to 2020, the International Secretary position was known as Foreign Secretary.
5 National Academy of Medicine Articles of Organization, Article II: Membership, Section 1.
factors on human health and acknowledged that solutions to national and global health challenges would require broad and diverse viewpoints.
In addition to this basic qualification, the IOM developed disciplinary “sections” to organize its membership. Election policies were designed to ensure proportionate representation in each of these sections. Each section had an elected chair and vice chair, who facilitated communication among members and shared relevant volunteer opportunities across the National Academies. The IOM also developed interest groups to allow members from across sections to convene and discuss issues of cross-cutting importance. Member sections and interest groups continued after the establishment of the NAM in 2015 (see Boxes 2-2 and 2-3).
In a 2008 address to members, then-IOM President Harvey V. Fineberg remarked that the organization’s impact depended in part on “the credibility that is earned by virtue of [members’] stature.”6 The “primary criterion” of IOM/NAM membership, alongside active engagement both within and outside the organization, was “distinguished professional achievement in a field related to medicine and health” (NAM, n.d.l). A new class of IOM/NAM members was elected annually by the existing membership. In 2021, the new class was composed of 90 members from the United States and 10 international members. The total membership numbered approximately 2,400 (NAM, n.d.l).
Since its founding in 1970, the IOM/NAM membership has included highly accomplished and influential leaders, including heads of federal agencies; Surgeons General and members of Congress; presidents and chief executive officers of foundations, universities, businesses, and health systems; and scientists, inventors, educators, and clinicians of all kinds. Internationally, the membership has included leaders of peer scientific academies, ministers of health, and heads of global multilateral organizations. More than 75 IOM/NAM members had been awarded Nobel Prizes in Physiology/Medicine, Chemistry, Peace, Physics, or Economics by 2021 (see Tables 2-1 through 2-3). In a 2019 survey of NAM members, Eva Feldman, a pioneer in stem cell implantation therapy for amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), described NAM membership as “an unparalleled opportunity to meet and interact with colleagues who are pushing the boundaries of scientific and medical innovation with a common goal: to understand and treat disease and promote health worldwide.”7
Presidential Citation for Exemplary Leadership
On October 19, 2020, at the 50th annual meeting of the NAM, then-President Victor J. Dzau presented the Academy’s first-ever Presidential Citation for Exemplary Leadership to NAM member Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) (see Figure 2-1). When the meeting occurred, the COVID-19 pandemic was in its eighth month, and the United States had seen nearly 8 million cases and more than 220,000 deaths (STAT, n.d.). As NIAID director, Fauci had become the nation’s de facto spokesperson for scientific information about the virus and a strong proponent of preventive public health measures. He was unequivocal about the danger of the pandemic, yet projected a sense of optimism that the virus could be controlled through measures such as physical distancing and face coverings—and ultimately, through a soon-to-be-developed vaccine. The presidential citation, presented on behalf of the NAM Council, recognized Fauci’s present contributions as well as his long career of federal service, which spanned six presidential administrations. The citation also recognized Fauci’s scientific contributions to the fields of human immunoregulation and the prevention and treatment of HIV/AIDS (NAM, 2020h) (see Box 2-4).
Upon accepting the award, Fauci remarked, “We are going through a time that is disturbingly anti-science in certain segments of our society…. We really need a group of scientists and physicians and health care providers to really stick together in our principles … we need to be the steadfast vocal defenders of the scientific process” (Fauci, 2020). Illustrating his point, on the same day Dzau presented the citation to Fauci, U.S. President Donald J. Trump, who had downplayed the gravity of the virus and spoken against physical distancing measures that prevented large public gatherings and resulted in the closing of businesses, was quoted as saying “People are tired of COVID…. People are tired of hearing Fauci and these idiots, all these idiots who got it wrong” (Stolberg et al., 2020). By the end of Trump’s term, U.S. COVID-19 cases had neared 24 million
6 IOM/NAM Records.
7 Internal survey of NAM members, summer 2019.
and deaths had reached more than 400,000 (STAT, n.d.). President Joseph Biden (2021–) asked Fauci to serve as his chief medical advisor and continue in his role at NIAID (Evelyn, 2020).
TABLE 2-1 Nobel Prizes in Physiology or Medicine Awarded to IOM/NAM Members
|Frederick Chapman Robbins and Thomas Huckle Weller||1954||Discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue|
|Joshua Lederberg||1958||Discoveries concerning genetic recombination and the organization of the genetic material of bacteria|
|Marshall W. Nirenberg||1968||Interpretation of the genetic code and its function in protein synthesis|
|Salvador E. Luria||1969||Discoveries concerning the replication mechanism and the genetic structure of viruses|
|Julius Axelrod||1970||Discoveries concerning the humoral transmitters in the nerve terminals and the mechanism for their storage, release, and inactivation|
|George E. Palade||1974||Discoveries concerning the structural and functional organization of the cell|
|David Baltimore and Howard Martin Temin||1975||Discoveries concerning the interaction between tumor viruses and the genetic material of the cell|
|Baruch S. Blumberg||1976||Discoveries concerning new mechanisms for the origin and dissemination of infectious diseases|
|Allan M. Cormack||1979||Development of computer assisted tomography|
|Baruj Benacerraf||1980||Discoveries concerning genetically determined structures on the cell surface that regulate immunological reactions|
|Torsten N. Wiesel||1981||Discoveries concerning information processing in the visual system|
|Sune K. Bergström, Bengt I. Samuelsson, and John R. Vane||1982||Discoveries concerning prostaglandins and related biologically active substances|
|Michael S. Brown and Joseph L. Goldstein||1985||Discoveries concerning the regulation of cholesterol metabolism|
|Gertrude B. Elion||1988||Discoveries of important principles for drug treatment|
|J. Michael Bishop and Harold E. Varmus||1989||Discovery of the cellular origin of retroviral oncogenes|
|Joseph E. Murray||1990||Discoveries concerning organ and cell transplantation in the treatment of human disease|
|Phillip A. Sharp||1993||Discovery of “split genes”|
|Alfred G. Gilman||1994||Discovery of G-proteins and the role of these proteins in signal transduction in cells|
|Peter C. Doherty||1996||Discoveries concerning the specificity of the cell-mediated immune defense|
|Stanley B. Prusiner||1997||Discovery of prions—a new biological principle of infection|
|Louis J. Ignarro and Ferid Murad||1998||Discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system|
|Günter Blobel||1999||Discovery that proteins have intrinsic signals that govern their transport and localization in the cell|
|Arvid Carlsson, Paul Greengard, and Eric R. Kandel||2000||Discoveries concerning signal transduction in the nervous system|
|Sydney Brenner and H. Robert Horvitz||2002||Discoveries concerning genetic regulation of organ development and programmed cell death|
|Linda B. Buck||2004||Discoveries of odorant receptors and the organization of the olfactory system|
|Barry J. Marshall||2005||Discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease|
|Andrew Z. Fire||2006||Discovery of RNA interference—gene silencing by double-stranded RNA|
|Mario R. Capecchi and Oliver Smithies||2007||Discoveries of principles for introducing specific gene modifications in mice by the use of embryonic stem cells|
|Françoise Barré-Sinoussi||2008||Discovery of human immunodeficiency virus|
|Harald zur Hausen||2008||Discovery of human papilloma viruses causing cervical cancer|
|Elizabeth H. Blackburn and Carol W. Greider||2009||Discovery of how chromosomes are protected by telomeres and the enzyme telomerase|
|Bruce A. Beutler||2011||Discoveries concerning the activation of innate immunity|
|Ralph M. Steinman||2011||Discovery of the dendritic cell and its role in adaptive immunity|
|John B. Gurdon and Shinya Yamanaka||2012||Discovery that mature cells can be reprogrammed to become pluripotent|
|James E. Rothman, Randy W. Schekman, and Thomas C. Südhof||2013||Discoveries of machinery regulating vesicle traffic, a major transport system in our cells|
|Edvard I. Moser and May-Britt Moser||2014||Discoveries of cells that constitute a positioning system in the brain|
|James P. Allison||2018||Discovery of cancer therapy by inhibition of negative immune regulation|
|William G. Kaelin, Jr., and Gregg L. Semenza||2019||Discoveries of how cells sense and adapt to oxygen availability|
|Harvey J. Alter||2020||Discoveries that led to the identification of a novel virus, hepatitis C virus|
|David Julius||2021||Discoveries of receptors for temperature and touch|
NOTE: In some cases, the prize was shared or split with individuals not listed in this table.
SOURCE: The Nobel Prize. https://nobelprize.org.
TABLE 2-2 Nobel Prizes in Chemistry Awarded to IOM/NAM Members
|Paul Berg||1980||Fundamental studies of the biochemistry of nucleic acids, with particular regard to recombinant-DNA|
|Thomas R. Cech||1989||Discovery of catalytic properties of RNA|
|E. J. Corey||1990||Development of the theory and methodology of organic synthesis|
|Richard R. Ernst||1991||Contributions to the development of the methodology of high-resolution nuclear magnetic resonance (NMR) spectroscopy|
|Mario J. Molina and F. Sherwood Rowland||1995||Work in atmospheric chemistry, particularly concerning the formation and decomposition of ozone|
|Peter Agre||2003||Discovery of water channels|
|Aaron Ciechanover||2004||Discovery of ubiquitin-mediated protein degradation|
|Martin Chalfie and Roger Y. Tsien||2008||Discovery and development of the green fluorescent protein (GFP)|
|Brian K. Kobilka and Robert J. Lefkowitz||2012||Studies of G-protein-coupled receptors|
|Paul Modrich and Aziz Sancar||2015||Mechanistic studies of DNA repair|
|Frances H. Arnold||2018||Directed evolution of enzymes|
|Jennifer A. Doudna||2020||Development of a method for genome editing|
NOTE: In some cases, the prize was shared or split with individuals not listed in this table.
SOURCE: The Nobel Prize. https://nobelprize.org.
TABLE 2-3 Nobel Prizes in Economics, Peace, and Physics Awarded to IOM/NAM Members
|Nobel Prize in Economics|
|Kenneth J. Arrow||1972||Pioneering contributions to general economic equilibrium theory and welfare theory|
|Thomas C. Schelling||2005||For having enhanced our understanding of conflict and cooperation through game-theory analysis|
|Nobel Peace Prize|
|Bernard Lown||1985||Accepted the prize on behalf of the International Physicians for the Prevention of Nuclear War|
|Denis Mukwege||2018||Efforts to end the use of sexual violence as a weapon of war and armed conflict|
|Nobel Prize in Physics|
|Robert Hofstadter||1961||Pioneering studies of electron scattering in atomic nuclei and for his thereby achieved discoveries concerning the structure of the nucleons|
NOTE: In some cases, the prize was shared or split with individuals not listed in this table.
SOURCE: The Nobel Prize. https://nobelprize.org.
PRESIDENTS OF THE INSTITUTE OF MEDICINE AND THE NATIONAL ACADEMY OF MEDICINE
After the IOM’s leadership structure was carefully negotiated by Yarmolinksy and colleagues in 1970 (see Chapter 1), the IOM/NAM presidency became a prestigious and influential position capable of drawing prominent IOM/NAM members away from established careers for a 6-year term in Washington, DC.8 The president served as the full-time chief executive officer of the organization as well as the vice chair of the National Research Council (NRC). Each president put his own stamp on the IOM/NAM, taking the organization in new operational and programmatic directions. Eight presidents and two acting presidents had led the IOM and NAM by 2021 (see Box 2-5), all of whom were men and all but one of whom were White.
8 The IOM/NAM presidential term was 5 years prior to Harvey Fineberg’s term (2002–2014).
John R. Hogness (Term: 1971–1974)
On March 30, 1971, approximately 3 months after the IOM’s founding, the IOM and NAS9 announced that John R. Hogness would become the first IOM president (see Figure 2-1). “With the appointment of Dr. Hogness, the Institute of Medicine becomes a reality,” said NAS President Philip Handler (IOM, 1998a, p. 55). In July, Hogness succeeded Robert J. Glaser, a charter IOM member who had served as acting president and overseen the selection of the first IOM members, as well as the presidential search process.
A 48-year-old physician and former dean of the medical school at the University of Washington, Hogness enthusiastically assumed the challenging task of building the IOM’s infrastructure and programs. He was inspired by the IOM’s mission to provide rigorous, evidence-based advice, describing the presidency as “one of the most important jobs in the health field.” Hogness declared that the IOM “alone in the health field will speak … without an axe to grind” (IOM, 1998a, p. 57). He believed strongly that the IOM should stay out of politics and be guided only by scientific evidence—and that the organization’s value was rooted in its independence.
Hogness set about establishing the IOM’s basic governing structure, beginning with the appointment of its first executive director, Roger Bulger. He also appointed the first members of the IOM Council and established Executive, Program, and Finance Committees within it. In 1972, to give the IOM’s programmatic portfolio coherence, the Program Committee issued a set of general guidelines for studies in an effort to identify projects that would fulfill the IOM leadership’s vision for the organization. The guidelines encouraged the IOM to recognize “a fundamental unity to health policy issues” instead of approaching them piecemeal (IOM, 1998a, p. 76). Accordingly, the Program Committee suggested that the IOM build capacity to initiate its own studies, rather than awaiting requests from the government.
Lack of capital proved a significant obstacle. As Hogness recalled, “the financial support of the Institute of Medicine was, to put it mildly, a bit shaky at first” (IOM, 1998a, p. 76). With a goal of raising $700,000 to support the IOM’s general operations, Hogness began to cultivate relationships with private foundations that had an interest in health and medicine. Among these was the Robert Wood Johnson Foundation (RWJF), which had not yet opened its doors when Hogness approached its soon-to-be president, fellow IOM member David Rogers, in 1971. Hogness’s argument proved persuasive, and RWJF ultimately issued a grant of $750,000 to be spent over 3 years, noting in a statement its confidence that the IOM would “make a contribution of the first importance to the outcome of the difficult and decisive policy decisions confronting the nation’s health enterprise” (IOM, 1998a, p. 77). RWJF’s contribution allowed the IOM to more than double its staff and marked the beginning of an enduring relationship between the two organizations.
Four other major foundations soon joined RWJF in supporting the IOM’s early infrastructure. The W.K. Kellogg Foundation and the Richard King Mellon Foundation each provided $100,000 per year for 3 years. The Commonwealth Fund, where Glaser was a vice president and trustee, offered $200,000 per year for 3 years; and the Andrew Mellon Foundation agreed to $750,000.
Hogness announced his intention to resign from the IOM presidency in spring 1973 after being recruited to serve as president of the University of Washington. He had accomplished a great deal in a very short time, having established the IOM’s operating structure, built strong ties with the
9 As described in Chapter 1, the NAS played a role in IOM governance until the creation of the NAM in 2015.
federal government and private foundations, and begun cultivating an endowment that would give the IOM freedom to pursue its own priorities. Following his tenure at the University of Washington, Hogness became president and chief executive of the Association for Academic Health Centers. He passed away in 2007 at the age of 85 (Altman, 2007).
Donald Fredrickson (Term: 1974–1975)
Donald Fredrickson, a senior official in the National Heart and Lung Institute, succeeded Hogness as president in 1974 but spent less than 1 year in the role before departing to become Director of the National Institutes of Health (NIH). Fredrickson had been selected as part of the IOM’s 1971 inaugural class and quickly become engaged in its activities.
Addressing IOM members during his presidency, Fredrickson spoke of bridging the worlds of science and policy, arguing that the IOM had an obligation to “lend the scientific method to the direction of a whole social movement.” He noted, as Hogness had, that the IOM’s success rested upon the “essence, not merely the appearance, of nonpartisan objectivity” (IOM, 1998a, p. 85). However, Fredrickson had little time to shape the organization. He departed in June 1975 before a successor could be appointed. During the interim, Julius Richmond, then Vice-Chair of the IOM Council, and Bulger provided leadership and day-to-day management for the organization and its staff.
David A. Hamburg (Term: 1975–1980)
David Hamburg, an academic psychiatrist who specialized in the behavioral components of health, took office as IOM president in fall 1975 (see Figure 2-3). Born in 1925, he had spent his childhood and completed his education in Indiana, where his grandfather arranged refuge for about 50 of Hamburg’s relatives who fled Eastern Europe as the Nazis took power ahead of World War II. Witnessing the Holocaust instilled in Hamburg a lifelong global sensibility, commitment to human rights, and interest in the psychological underpinnings of behavior, particularly violence (Roberts, 2019).
The same year he was recruited as IOM President, Hamburg, then Chair of the Department of Psychiatry at Stanford University, was enmeshed in a global hostage crisis involving several of his students who were kidnapped by militants in the Democratic Republic of the Congo (Roberts, 2019). The experience, he said, sharpened his motivation to unravel the “policy issues that brought about that hatred and violence and ignorance and disease and severe poverty” (Carnegie Council, 2009).
Hamburg delivered inaugural remarks to IOM members at the 1975 Annual Meeting. Like Hogness and Fredrickson, he praised the organization’s impartiality, remarking that it had “no over-riding doctrine, no party line, no cow too sacred to be examined” (IOM, 1998a, p. 97). He did, however, see potential liabilities and missed opportunities that pre-
vented the IOM from maximizing its influence. He therefore initiated a thorough review of IOM activities during his first year in office. After extensive conversations with staff, members, and funders, Hamburg decided it would be important for the IOM to build a national, even global, perspective, rather than a narrow focus on Washington, DC–centric health policy minutiae. He also concluded that the IOM needed to respond more quickly to requests in order to make a more timely impact on current policy debates.
Building on the work of Hogness’s Program Committee, Hamburg set out to “map out the terrain” and organize the IOM into five major policy areas: (1) health services, including national health insurance; (2) health sciences policy; (3) the prevention of disease; (4) education for the health professions; and (5) mental health (IOM, 1998a, p. 104). In March 1977, Hamburg announced the creation of six IOM operating divisions, each with its own staff director and advisory board composed of member and non-member experts. Elena Nightingale, an MD-PhD Holocaust survivor who became a long-serving member of the IOM staff and was elected as a member in 1985, founded and headed the Division of Health Promotion and Disease Prevention. Other inaugural divisions included the Division of Health Care Services, the Division of Health Manpower and Resources Development, the Division of Health Sciences Research, the Division of International Health, and the Division on Legal, Ethical, and Educational Aspects of Health. Later called “boards,” these divisions provided a structure for the IOM that, with variation over time that reflected current health concerns and funding streams, remained in place until the creation of the NAM in 2015 (IOM, 1998a).
Other changes to the IOM’s operating structure in the Hamburg era included the appointment of Karl Yordy as executive officer, following Bulger’s departure to become Chancellor of the University of Massachusetts and Dean of its medical school. Bulger would be elected as an IOM member in 1977. Hamburg also created two new senior staff positions in program development and finance and operations. The new structure accomplished three major goals for Hamburg and the IOM Council: it increased the participation of members, expanded the role of staff, and more clearly demonstrated the IOM’s breadth and capacity to funders and collaborators.
During Hamburg’s tenure, shared interests with President Jimmy Carter’s (1977–1981) administration—such as mental health, cost containment, health care as a component of foreign aid, and the relationship between health and behavior—facilitated a solid working relationship between the IOM and the federal government. In 1979 alone, the IOM reviewed the planning process for the Department of Health, Education, and Welfare10; reported on food safety policy and the safety of sleeping pills for the Food and Drug Administration; evaluated the research agenda of the National Institute on Alcohol Abuse and Alcoholism; and reported on health in Egypt for the Agency for International Development.
After only 3 years in office, Hamburg informed the IOM Council that he would not pursue a second 5-year term as IOM president, noting that McDermott and the IOM founding fathers were wise to encourage fresh leadership at regular intervals. In his remaining time, he said, he would focus on establishing “valuable, long-term directions for the Institute” (IOM, 1998a, p. 128). Despite the IOM’s close collaboration with the government during the Carter years, Hamburg warned that if the IOM wished to fulfill its potential, it needed to find unrestricted, nongovernmental support and an infusion of new ideas and new people in key positions.
Hamburg left office 1 month before Ronald Reagan (1981–1989) was elected president. NAS President Philip Handler thanked Hamburg for his service in a personal letter, noting that, “Under your leadership, the Institute of Medicine has been brought to maturity. It has earned a place in the Washington scene and become the instrument to which we aspired when it was first created” (IOM,
10 The Department of Health, Education, and Welfare later became the Department of Health and Human Services.
1998a, p. 139). Hamburg went on to serve as president of the Carnegie Corporation and president of the American Association for the Advancement of Science. He passed away in 2019 at the age of 93 (Roberts, 2019).
Frederick Robbins (Term: 1980–1985)
Frederick Robbins, a scientist who had earned a Nobel Prize for his work in isolating the polio virus, also limited his service to a 5-year term before retiring in 1985 (see Figure 2-4). Robbins’s term was marked by challenges that included internal turmoil at the NAS and the Reagan administration’s efforts to downsize the federal government, including the NIH.
Robbins was appointed as the IOM’s fourth president in the fall of 1980. At age 63, he was older than previous presidents and brought experience from a full and illustrious career in medical research. Arriving at the IOM after leaving his position as dean of the Case Western Reserve University School of Medicine, Robbins remarked that he was “not going to revolutionize things” (IOM, 1998a, p. 138). Instead, he wanted to maintain the program that Hamburg had built. However, this proved difficult in the atmosphere of the times.
Continuing financial shortfalls had led NAS leaders to recommend that the IOM be disbanded and its program of studies be subsumed by the NRC. The matter escalated into a controversy that occupied much of Robbins’s term and marked a crucial turning point in the organization’s struggle to move beyond its start-up phase to a new era of growth and stability.
Before leaving the IOM in 1980, Hamburg had created a taskforce to evaluate the organization’s structure and relationship to the NAS. The taskforce, which completed its work during Robbins’s presidency, was chaired by Washington University in St. Louis Chancellor William H. Danforth. The Danforth report recommended that the Division of Medical Sciences (DMS) be moved from the NRC to the IOM. In the fall of 1981, Robbins confided to the NAS’s new President Frank Press that he felt there was a “significant and disturbing problem of overlap in the interests of the IOM” and the DMS (IOM, 1998a, p. 147).
Meanwhile, NAS Vice President James Ebert undertook a parallel assessment. Ebert’s 1982 report proposed that the NRC be divided into six major units, including one devoted to human health and medicine that would encompass some functions of the DMS and some functions of the IOM. Demonstrating support for the IOM, Ebert recommended that this new unit be housed in the IOM and overseen by the IOM Council. However, the NAS Council opposed the proposal, and the recommended merger never took place.
In 1984, the IOM’s role again came under scrutiny, this time at the behest of its sponsors. Robert Ebert, president of the Milbank Memorial Fund, proposed a study of the IOM at the impetus of a group of private foundations that had supported its work, including the Commonwealth Fund and RWJF. The foundations’ leaders wanted to assess how well the IOM was fulfilling its mission and determine whether it deserved continuing philanthropic support.
A nine-person committee chaired by Robert Sproull, a distinguished physicist and president of the University of Rochester, undertook the evaluation. Robbins testified before the committee in June 1984, arguing that the IOM’s primary challenge was the lack of an endowment. He estimated that it would take $20 million to generate enough income to replace the funds that were provided by the foundations.
The Sproull committee’s report, released in November 1984, called for “a strengthening of the IOM that amounts to a rebirth” (IOM, 1998a, p. 168). Reopening the debate of more than a decade before, the committee recommended the creation of an academy of medicine to take the place of the IOM in the NAS structure. In a departure from the original vision of the IOM’s founders, the committee also recommended that the studies undertaken by the IOM be moved to the NRC.11
For many on the IOM Council, such a move would dissolve the founders’ vision for a proactive, working organization. They preferred to preserve the designation of “institute” rather than “academy,” especially if it meant preventing the transfer of the IOM’s studies to the NRC. However, it was the NAS Council that would decide whether to adopt the Sproull committee’s recommendations.
At a climactic NAS Council meeting in February 1985, Robbins expressed his views on the future of the IOM. He was disappointed by the Sproull committee’s report, stating that it contained “drastic recommendations for change” and indicated “a true lack of support for the concept of the IOM” (IOM, 1998a, p. 171). As Robbins’ term was nearing its end, the NAS Council decided to delay making a final decision on the Sproull report until the arrival of his successor. This deferral amounted to a reprieve for the IOM—the current structure would hold for the time being.
Robbins’s term was consumed by the need to repeatedly defend the IOM’s structure, even its very existence. Despite his vigorous efforts, the matter was not resolved by the end of his tenure. As a result, his successor faced the formidable task of bolstering the IOM’s position in the NAS, restoring morale, and—perhaps most difficult of all—raising enough money to keep the IOM solvent. The outlook for the fiscal year 1986 indicated a quarter-million-dollar shortfall in the IOM budget.
Robbins returned to Case Western Reserve University after leaving the IOM. The technique he and his colleagues developed to grow the polio virus in a lab continued to be used by vaccine researchers worldwide. In 2003, the year Robbins passed away at the age of 86, the technique was used to identify the virus that causes severe acute respiratory syndrome (SARS) (Altman, 2003).
Samuel Thier (Term: 1985–1991)
At the September 23, 1985, meeting of the IOM Council, NAS President Frank Press announced that Samuel Thier, a prominent kidney scientist who was then head of the Internal Medicine Department at Yale University, would become the next president of the IOM (see Figure 2-5). At the relatively young age of 48, Thier looked to the IOM as the next challenge of his career. Thier, who had been an IOM member since 1978 and had chaired the Board on Health Sciences Policy, presided over what could be considered the “rebirth” of the IOM as an expanded and reinvigorated organization.
Thier brought a new vitality and a reassuring self-confidence to the presidency of the IOM. Although he vowed to make changes, such as speeding up the report process and increasing the IOM’s visibility to the federal government, he held to the IOM’s original mission and touted the organiza-
11 The prospect of transforming the IOM into an academy of medicine would be debated repeatedly until it became a reality in 2015. See Chapter 3 for a detailed account of the decades-long campaign.
tion’s accomplishments. He believed that too much time and energy had been expended trying to determine whether the IOM should focus on health policy or health science—a false dichotomy in his mind. Thier stated that not only could the IOM do both, but it should cover “the entire spectrum of activities within the National Academy of Sciences complex that deal with human health” (IOM, 1998a, p. 181). He regarded the problems identified in the Sproull report as settled matters, and he used the report as leverage within the NAS and the foundation community. Thier believed that the foundations that had subjected the IOM to such in-depth and painful analysis had an obligation to continue to provide support in light of the internal efforts being made to improve the organization and its operations.
Thier took an assertive approach in his interactions with Press, whom he regarded as an important ally, and with the NAS Council. He secured a 2-year grace period to put the IOM’s financial affairs in order and requested additional financial support from the NAS to make up for any deficits. Thier then launched an outreach campaign to the major health foundations, starting with RWJF. Although an early supporter of the IOM, RWJF’s interest had begun to waver by Thier’s tenure, due in part to the slow pace of IOM studies. These doubts had led the foundation to become one of the driving forces behind the Sproull report.
In the fall of 1986, Thier met with a small subcommittee of the RWJF board and succeeded in securing a $5 million contribution to the IOM’s endowment. As conditions of the grant, the IOM was required to raise $2 for every $1 it received from the foundation. By March 1987, the IOM was prepared to announce a capital campaign, seeded not only by RWJF but also by sizable grants from The Commonwealth Fund, the Andrew W. Mellon Foundation, the W.K. Kellogg Foundation, and the MacArthur Foundation.
In addition to building the IOM’s endowment, which reached nearly $19 million by the end of 1989, Thier expanded the organizational scope of the IOM to include two units that were previously part of the NRC—the exact opposite of the transfers suggested in the Sproull report. On July 1, 1988, the Medical Follow-Up Agency (MFUA) and the Food and Nutrition Board (FNB)—both with histories dating to World War II—became part of the IOM, consolidating more of the NRC’s health activities under the purview of the Institute. By then, the IOM had the largest budget within the NAS complex, and the broad external support of the IOM began to quiet the criticisms that had appeared in the Sproull report.
During the Thier years, the IOM also acquired a new degree of flexibility and agility. Thier emphasized the IOM’s convening power as an alternative to the more formal consensus study for which the National Academies were known. Although he did not invent the idea of an IOM forum or roundtable, he helped popularize the mechanism and made it a staple of IOM activities. For the IOM, the forum provided a less inhibited venue for open discussion among interested parties than did the traditional study committees, which were bound by conflict-of-interest rules and required sometimes lengthy, closed-door deliberations to come to consensus. Unlike study committees, forums and roundtables did not issue recommendations, and, with the exception of planning sessions, the majority of their work was conducted publicly through workshops and other meetings.
Thier departed the IOM in 1991, during the first year of his second term as IOM president, to become the president of Brandeis University. His fundraising efforts had resulted in a larger, more influential organization. By this time, the IOM had made a decisive turn in its history and was on its way to becoming a nationally recognized force in the health policy world. IOM member Stuart Bondurant, then dean of medicine at the University of North Carolina at Chapel Hill, stepped in as Acting President during the search for Thier’s successor.
Kenneth Shine (Term: 1992–2002)
Kenneth Shine arrived as the new IOM president in the fall of 1992 (see Figure 2-6). Shine was a Harvard-trained physician and one of the nation’s most prominent cardiologists. When asked to consider the IOM presidency following Thier’s resignation, Shine was dean of the School of Medicine at the University of California, Los Angeles.
Shine informed the IOM Council that he had accepted the presidency because of the IOM’s remarkable membership, the legacy left by Thier, and the chance to respond to health challenges facing the nation—most notably a dysfunctional care system with shrinking resources. He talked about the fragile environment in which science and research were undertaken and the nation’s increased interest in health care reform. Shine’s goals for his presidency included maintaining a balance between careful, deliberative studies and timeliness; pursuing projects that would have a measurable impact on policy and practice; continuing Thier’s fundraising efforts; and exploring projects with regional or state foci.
Shine, who would became the first two-term president of the IOM, led strategic planning processes in 1993 and 1997. The 1993 plan, developed in consultation with the IOM membership and its key governing committees, was designed to help establish a consensus across numerous internal stakeholders around the goals and directions for the IOM. The first step involved structured interviews with IOM staff that featured candid discussions of the IOM’s strengths and weaknesses. The second step entailed regional dinners for IOM members held in late 1992 and early 1993 that Shine and Enriqueta Bond, by then the IOM’s executive officer, hosted in Irvine, Chicago, and Washington. These consultations led to the development of a mission statement and accompanying goals, objectives, and strategies that the IOM Council approved in November 1993.
Among the plan’s key objectives was the creation of a mechanism to identify important issues and priorities that the IOM should consider addressing, regardless of funding availability. The plan suggested the annual selection of a “special initiative” as an area of emphasis that was broad, crossed sectoral lines, and could command the focus of the entire IOM. Identifying areas in which the IOM could break new ground and achieve lasting impact was a key concern. Shine, drawing on conversations with IOM member and RAND Corporation Vice President Robert H. Brook, advanced the quality of health care as the topic of the IOM’s first special initiative.
Due to the controversy of the subject, which highlighted the fallibility of clinicians and the system in which they operated, Shine was unable to secure external funding for the initiative’s first study. Several potential sponsors he approached questioned why the IOM “would want to frighten the public with this information.”12 Ultimately, Shine used interest from the IOM’s endowment and $750,000 in a matching gift supplied by NAS President Bruce Alberts to launch the initiative under the leadership of Staff Director Janet Corrigan.13 In 1999, the initiative produced one of the IOM’s most influential reports, To Err Is Human: Building a Safer Health System.14
12 Personal communication between Kenneth Shine and Laura H. DeStefano, April 18, 2020.
14 Ibid. For more on the IOM’s Quality Initiative, see Chapter 5.
In 1994, Shine led a new push to change the IOM’s name to the National Academy of Medicine. Although the effort ultimately failed, it represented another step toward the creation of an academy, which would be realized in 2015 (see Chapter 3). The IOM’s leadership structure became more robust during Shine’s tenure, with the creation of two new officer positions within the IOM Council: Home Secretary and Foreign Secretary15 (see Box 2-6).
In 1997, at the start of Shine’s second term, he led the IOM Council in assessing progress and refining the 1993 strategic plan. Along with central goals related to the timely identification and engagement of priority issues, fundraising, membership diversity, and staff enrichment, the plan resulted in the delineation of key focus areas for the IOM to consider in the development of its program: the strength and function of the health care workforce; the implications of scientific breakthroughs (such as genetics and informatics) for the practice of health; health literacy and health communication; health of vulnerable populations; and designing health approaches for an increasingly diverse U.S. society. The IOM would go on to develop a significant body of work in each of these areas.
Shine’s presidency was marked by continued growth and stability for the organization as the world entered a new millennium. After completing his second term as IOM president in 2002, Shine served briefly as a scholar at the RAND Corporation before beginning a distinguished tenure as Chancellor ad interim and Executive Vice Chancellor for Health Affairs at the University of Texas.
15 In 2020, the NAM membership voted to change the name of this position from Foreign Secretary to International Secretary.
Harvey Fineberg (Term: 2002–2014)
Harvey Fineberg took office as the IOM’s seventh president in 2002, and, like Shine, served two full terms before leaving his post in June 2014 (see Figure 2-7).16 Fineberg came to the IOM as a distinguished medical practitioner and academic administrator with a unique blend of medical and public policy expertise.17 He completed his education at Harvard, where he also spent much of his career. Fineberg served as the Dean of the Harvard School of Public Health before being named Provost of Harvard University in 1997.
As President, Fineberg’s calm demeanor, congenial manner, and willingness to share credit endeared him to members and staff. “The IOM has this unique responsibility as the nation’s science adviser on matters of health,” Fineberg said upon news of his appointment, and described its membership as “an all-star national faculty to work on the most pressing issues of the day.” Taking office soon after the September 11, 2001, terrorist attacks, Fineberg also noted that “the tenor of the times made the job all the more appealing. It’s a great opportunity for service at a very critical time in the nation’s history” (Rakoczy, 2001).
From the beginning of his presidency, Fineberg emphasized measuring and expanding the impact of the IOM and its reports. In this regard, he expanded on work started by Shine. Within a few years of Fineberg’s arrival, he announced the creation of the Harvey V. Fineberg Impact Fund as an option to which members could contribute during annual fundraising. The Impact Fund would raise funds to initiate studies “where the need is great, where government may be disinterested or conflicted, where private sources may not be ready yet to provide support.” During his 2013 Annual Meeting address, Fineberg stated, “the Impact Fund spells out its own components: I, Initiate, M, Motivate, P, Participate, and ACT” (Fineberg, 2013).
In 2011, the IOM published a schematic, called the Degrees of Impact Thermometer (see Figure 2-8), which defined the types of impact the IOM’s activities could have and would be measured against. By the time Fineberg’s second term ended, every Council meeting included an impact report. Following the IOM-NAM transition, the Health and Medicine Division (HMD) retired its use of the Impact Thermometer in favor of a new schematic that better captured the outcomes of convening activities such as roundtables, forums, and smaller-scale studies that did not necessarily change policy but were nevertheless of important use to sponsors and participants.18
Fineberg, like his predecessors, engaged in strategic planning, which involved developing a “strategic vision” to guide the IOM between 2003 and 2008. The plan envisioned a “vibrant and vital” IOM that provided a public service by “working outside the framework of government to ensure scientifically informed analysis and independent guidance.” The portfolio of IOM studies continued to embrace the critical public issues of the day, which by Fineberg’s tenure included homeland security and the threat of bioterrorism. With Fineberg’s goal to increase impact, the IOM continued the mission begun by his predecessors to center its activities on coherent themes that promoted longer-term visibility and increased the organization’s impact on public policy and private medical practice. Themes identified as important at the time included vaccine safety, quality of
16 By the time of Fineberg’s presidency, the IOM Council had voted to extend the length of a single presidential term from 5 to 6 years.
17 Interview between Harvey Fineberg and Edward Berkowitz, October 15, 2018.
18 Personal correspondence, Clyde Behney to Laura H. DeStefano, April 2020.
care, health system redesign, global health, and genomics.19 Fineberg felt particularly strongly that the IOM needed to reinvigorate its focus on global health. The prospect of eliminating the IOM’s Board on Global Health had arisen during Shine’s tenure, which Fineberg believed “undervalued the critical importance of global health, even when taking a relatively narrow view of American interests.”20 His focus on the interconnectedness of the health of the globe led to the revitalization of the Board on Global Health and its associated activities, which has published more than 170 reports and proceedings since 1996.
In an effort to sharpen the focus of the IOM, Fineberg, in collaboration with Executive Officer Susanne Stoiber, decided to reduce the number of IOM boards from eight to six and to convert the Board on Neuroscience and Behavioral Health into a convening activity in January 2005. Part of the motivation for this reorganization was to expand and elevate the IOM’s standing convening activities (e.g., forums and roundtables), a program mechanism that the IOM had advanced under Thier. Although roundtables and forums did not issue recommendations, Fineberg emphasized that discussions and relationships formed during these activities constituted important contributions to the contemporary health policy agenda in national and international health.
The IOM’s “Perspectives” platform arose in 2011 as a mechanism for participants in roundtables and forums to comment on issues of interest. In an early article for the platform, Fineberg wrote, “In the spirit of our mandate to serve as ‘advisor to the nation to improve health,’ this new venture to share ideas and insights presents an exciting opportunity to use the IOM’s unique resource of the nation’s leading experts in health and health policy to sharpen national dialogue on today’s health challenges” (Fineberg, 2012). “Perspectives” remained with the NAM after the 2015 IOM-NAM reorganization and was reformed as a formal digital periodical called NAM Perspec
19 Institute of Medicine, “Strategic Vision 2003–2008,” April 14, 2003, IOM/NAM Records.
20 Personal correspondence, Harvey Fineberg to Laura H. DeStefano, December 2021.
tives. In 2021, 10 years after its establishment under Fineberg, NAM Perspectives became a journal indexed by the National Library of Medicine.
Like Shine’s presidency, Fineberg’s two terms in office saw continued growth and stability for the IOM. As a major element of his legacy, Fineberg began a process that would finally lead to the IOM’s reconstitution as the NAM—an endeavor that had failed several times in the past. The success of the campaign headed by Fineberg lay in its framing as the establishment of a more integrated and efficacious National Academies overall, rather than focusing solely on the future of the IOM (discussed further in Chapter 3). By the time of Fineberg’s departure in 2014, the changes were set in motion that will transform the trajectory of the IOM as well as the National Academies.
Fineberg’s next role was as president of the Gordon and Betty Moore Foundation. He remained very active in the work of the NAM and the National Academies, notably as chair of a standing committee to advise the government on its response to the COVID-19 pandemic.
Victor J. Dzau (Term: 2014–Present)
Victor Dzau became both the final president of the IOM and the first president of the newly formed NAM (see Figure 2-9). By the time Dzau took office in 2014, the IOM-NAM reorganization was already in motion, and he inherited the complex task of negotiating the details with NAS and NAE, communicating the change to membership, securing the approval votes from NAS and IOM members and navigating the transition (see Chapter 3). As the new Academy expanded its operations, Dzau spearheaded an innovative and proactive orientation that represented a significant departure from the IOM’s previous approach and ultimately led to changes throughout the National Academies (described below and further in Chapter 7).
Dzau brought a dynamic presence and distinguished clinical, academic, and administrative background to the IOM/NAM. Born in Shanghai, Dzau, an immigrant, was the first non-White president of the IOM, the first of Asian descent, and the first to be born outside the United States. A cardiologist and an active researcher in the field of gene therapy for vascular disease who made significant contributions to the development of ACE inhibitors, Dzau chaired the departments of medicine at Stanford and Brigham and Women’s Hospital before becoming the president and chief executive officer of the Duke University Health System and the chancellor in charge of the university’s many health activities. Dzau served as a member of the NAM Council for 6 years before being selected as IOM president in 2014.
After the IOM-NAM reorganization, the programs of the IOM including all six boards, which conducted consensus studies and convening activities, were moved into a new Health and Medicine Division within the National Academies. Left with close to a blank slate, Dzau set out to develop the NAM’s distinct priorities and programmatic approach. Like his predecessors, Dzau quickly undertook a strategic planning process to position the NAM for success within the National Academies complex and as a proactive, galvanizing leader on the domestic and international stage. The NAM’s strategic planning model proved so fruitful that Dzau led the NRC Strategic Plan in 2019–2020 in which fellow leaders of the National Academies adapted the NAM model to map future directions for the NRC. (The particulars of the IOM-NAM reorganization and the NAM’s strategic planning process are described in Chapter 3.)
From the start of his presidency, Dzau emphasized innovation—both in terms of the IOM/NAM’s program models and the rapid advances in science, technology, and health care to which the organization should respond. In his inaugural president’s address to the NAM membership, Dzau expressed his belief that
these days, a lot of people in health and medicine are hunkered down, operating in siloes that focus narrowly on their own problems. The world needs aspirational and audacious goals to inspire confidence that we can do more, much more, to change the course of health. Many of us believe that major breakthroughs can be achieved through partnerships of the best minds across all sectors, sharing a common vision and goals, working collectively to address big, bold problems, creating the right environment with robust resources and aligning incentives and value. (Dzau, 2015b)
To mobilize resources around such goals, Dzau developed a new “Grand Challenge” program model for the NAM, establishing the Healthy Longevity Global Grand Challenge in 2019 and the Grand Challenge on Climate Change, Human Health, and Equity in 2021.
An unwavering focus on providing leadership in the domestic and global spheres became a hallmark of Dzau’s tenure. Early in Dzau’s first term, the West African Ebola crisis presented an opportunity for another new program model focused on international leadership. Observing the slow and poorly coordinated international response to the outbreak, Dzau saw a role for the NAM in gathering global experts to collectively assess shortcomings and develop solutions to improve health security. The NAM became the Secretariat for an independent International Commission, overseen by an International Oversight Board, which issued a fast-track report with recommendations in the areas of public health, global and regional coordination, and research and development. The commission’s recommendations were embraced by the World Health Organization, the United Nations, and the World Bank. The International Commission model became part of the NAM’s new capability portfolio, next used to address human genome editing, healthy longevity, influenza vaccine preparedness, and financing pandemic preparedness.
Throughout his tenure, Dzau also maintained a strong international presence in his personal capacity, serving as a member of the Global Preparedness Monitoring Board and Access to COVID-19 Tools (ACT) Accelerator and the interim board of directors for the Coalition for Epidemic Preparedness Innovations as well as co-chair of a scientific report of the G20 global health summit, among other global engagements (G20, 2021b). He participated in the European Union’s Coronavirus Global Response Pledging Conference, which raised 7.5 billion euros to fund the global response to the COVID-19 pandemic (Borger, 2020; European Commission, 2020; European Union and Italian G20 Presidency, 2021).
Dzau believed that NAM should be an academy of action and impact, beyond providing advice. He often quoted the German philosopher Goethe: “Knowing is not enough. We must apply. Willing is not enough. We must do.” An innovative programmatic mechanism pioneered successfully under Dzau’s leadership was the “Action Collaborative,” a standing body that convened multi-sectoral stakeholders to develop collective solutions and actions around shared priorities (see Box 2-7). NAM Action Collaboratives became high-visibility vehicles for collective commitment and action around subjects of broad concern in health and medicine. The NAM’s inaugural Action Collaborative on Clinician Well-Being and Resilience achieved national recognition of the problem of clinician burnout and galvanized a new body of research to better understand the crisis and develop effective interventions. By 2022, the NAM had applied its Action Collaborative model to the U.S. opioid epidemic and the intersection of climate change, human health, and equity. The Action Collaborative on Climate and Health took on the bold goal of decarbonizing the entire U.S. health sector (NAM, 2018b, 2021m). The National Academies also adapted the model for an initiative on preventing sexual harassment in academic science, engineering, and medicine.
Dzau also focused significant efforts on fundraising, securing $10 million from RWJF to launch the Culture of Health Program in 2015, half of which was allocated to the NAM’s endowment. RWJF committed another $5 million to the program in 2020. Dzau also mobilized more than $30 million to support an international competition under the Healthy Longevity program. These and other efforts contributed significantly to a $100 million NAM capital campaign launched publicly in 2021.
Dzau believed that Academies should stand up for their foundational values and core beliefs based on science and evidence. He became one of the most publicly outspoken presidents in the history of the organization as policies during the Trump administration threatened to undercut the integrity of science and ran counter to many of the evidence-based recommendations issued by the IOM/NAM. He was quick to respond publicly after the murder of George Floyd at the hands of Minneapolis police officers in 2020, issuing a statement to NAM staff and then publicly that read, in part, “I commit to using our platform to improve the lives of people who experience disproportionate health disparities as a result of socioeconomic inequity, bias, and structural racism” (Dzau, 2020). Dzau was also motivated by, and spoke often of three “existential threats to health and well-being everywhere: COVID-19 and future pandemics, the negative impacts of structural racism, and climate change.”
In 2020, Dzau was elected by the NAM membership for a second term as president. The election was the first of its kind for the organization, enabled by governance rules in the new NAM bylaws that empowered members to elect their own president (as opposed to having one appointed by the NAS president, as dictated in the IOM bylaws). Just 8 months into Dzau’s historic second term, the global COVID-19 pandemic upended society worldwide. Dzau focused on pivoting the Academy’s programs to respond to the crisis, working with NAM members to fill a gulf in federal scientific leadership in the early days of the pandemic, and leading NAM and National Academies staff through a complex transition to remote work. In 2021, as vaccinations rose steadily in the United States, Dzau turned to promoting vaccine equity worldwide. Importantly, Dzau positioned the NAM to respond to other challenges that threatened the health and stability of an increasingly global society, such as climate change and structural racism.
INSTITUTE OF MEDICINE AND NATIONAL ACADEMY OF MEDICINE STAFF LEADERS
Building a staff of the right size and expertise was a consuming early focus of the IOM. When the institute opened its doors in 1970, then-President John Hogness had a single person on staff. He quickly determined the need for a “deputy” to assist him in priority setting and program building, and by 1972 had hired the IOM’s first executive officer, Roger Bulger (see Box 2-8). Two other significant hires that Hogness made included Karl Yordy, who would ultimately succeed Bulger as executive officer, as staff director for the IOM’s new program committee, and Ruth Hanft as senior research associate. Figure 2-10 shows many of the IOM’s staff members on the steps of the NAS Building in 1973.
Hanft, a distinguished researcher with extensive federal service who would be elected as an IOM member in 1978, led the key early studies for the organization (The Washington Post, 2011). These studies helped to build a sustainable staffing model for the IOM. In the days of the Board on Medicine (see Chapter 1), the organization relied on temporary consultants. Under Hanft, however, the IOM began increasing the numbers of dedicated, full-time staff. In 1972, Congress directed the IOM to study the costs of education of health professionals. Hanft hired a staff of 20 to collect data on the cost of educating medical students across institutions. However, the IOM’s lack of core funding meant that those staff would have to move on when the study concluded—a soft-money problem that posed an ongoing challenge.
Hanft’s study also revealed another problem that the IOM needed to solve—the division of labor and the degree of supervision between staff and the volunteer members and external experts who made up study committees. Although members of the committee were named as the formal “authors” of the study, they had limited involvement in the work of data collection, and it was Hanft, not Committee Chair Julius Richmond (who would later become U.S. Surgeon General), who presented the findings of the costs of education study to Congress.
This tension continued into Hamburg’s tenure as Hanft concluded an intensive follow-up study, this time with a staff of 45, that examined Medicare’s role in funding medical education. Hanft and Study Committee Chair Adam Yarmolinsky disagreed about the appropriate balance of data
and policy recommendations. Hanft, who favored a focus on data, prevailed. The lack of clarity around the respective roles of the IOM’s staff and its members was a focus of Hamburg’s review of the organization’s programmatic structure and approach (described earlier in this chapter). He found that both groups—members and staff—wanted more meaningful involvement in the IOM’s work. Ultimately, Hamburg’s solution was to create six program divisions (later called boards), each headed by a staff director and advised by a group of members. This practice enabled ongoing, productive collaboration among members and staff.
Hamburg’s structure became the foundation for the model that endured until the 2015 IOM-NAM transition and carried through in the structure of the new HMD. In 2021, the HMD had five boards (Food and Nutrition; Global Health; Health Care Services; Health Sciences Policy; Population Health and Public Health Practice) and a sixth (Children, Youth, and Families) shared with the Division of Behavioral and Social Sciences and Education. In addition, there was an Office of Military and Veterans’ Health. As during Hamburg’s tenure, each board was overseen by a staff director and advised by a group of members of the NAM, the NAS, and the NAE and other experts.
As they had in Hanft’s day, both HMD and NAM staff served as directors of individual studies, convening activities, and other projects, applying their own considerable expertise to synthesize the findings and recommendations of expert committees. In addition to the directors, a cadre of research, administrative, and communications staff supported the conduct of projects and the dissemination of recommendations. In 2000, in recognition of the crucial role of its staff in carrying out the work of the organization, the IOM/NAM began conferring annual awards, called Cecil Awards,21 to recognize superlative staff contributions (see Box 2-9). Upon his retirement in 2021 as Executive Director of the HMD, Clyde Behney received a special Cecil Award in recognition of “40 years of unparalleled service leading and shaping the nation’s ability to receive expert and unbiased advice on scientific and technical matters of particular priority and potential in advancing the human condition.”
21 The name “Cecil” came from IOM staff’s informal name for the serpent in the IOM/NAM’s logo. IOM reports bore the following explanation for the logo: “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 serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.”
BUILDING THE LEADERSHIP PIPELINE AND RECOGNIZING EXCELLENCE
In addition to its members, officers, and staff, the IOM/NAM developed programs to foster the next generation of health and medical leaders and recognize superlative contributions to the field.
The RWJF Health Policy Fellows program, established in 1973, is the IOM/NAM’s longest-running program as of 2021. The program began under Hogness’s tenure with a $710,000 grant from RWJF to “offset severe shortages of faculty members in the nation’s academic medical centers who are specifically qualified for research, teaching, and service in the complex field of health policy.” The foundation hoped to take advantage of the IOM’s strong connections in Washington to expose health researchers and administrators to the intricacies of policy making, with the ultimate goal of building productive relationships that would encourage a scientific approach to federal health policy and its implementation at the local level. Robert Q. Marston, former director of the NIH, served as the program’s first director.
The IOM announced its inaugural six fellows, culled from a list of 43 nominations and 12 finalists, in the spring of 1974. The fellows spent the 1974–1975 academic year in Washington, DC, beginning with an orientation at the IOM and then taking up temporary posts in congressional and executive offices on Capitol Hill. The program continued to followed this model for nearly 50 years, and many of its approximately 300 alumni went on to assume prominent roles in national health policy.
In a notable example, Jo Ivey Boufford, class of 1979–1980, became the first woman to serve as President of New York City Health and Hospitals Corporation in 1985. She then served in the Clinton administration as the principal deputy assistant secretary for health in the Department of Health and Human Services. Elected to membership in the IOM/NAM in 1992, she ultimately served as its Foreign Secretary. Karen Hein, who spent her 1993–1994 fellowship with the Senate Finance Committee, became executive officer of the IOM and president of the William T. Grant Foundation. “The rest of my life started the day I heard I had gotten this fellowship, and there’s been no looking back since then,” Hein noted.
Following the 2015 IOM-NAM transition, the RWJF Health Policy Fellows and five other fellowship programs became part of the new Academy (see Box 2-10). In 2021, the NAM announced the formation of a new Scholars in Diagnostic Excellence Program in collaboration with the Council of Medical Specialty Societies, sponsored by the Gordon and Betty Moore Foundation. The program was designed to support 10 scholars per year in a “one-year, part-time experience to advance the scholars’ diagnostic skills, reduce diagnostic errors that lead to patient harm, and accelerate their career development as national leaders in this field” (NASEM, 2021a).
Starting in 1986, the IOM began conferring the Gustav O. Lienhard Award for Advancement of Health Care. The award was named in honor of the chairman of the RWJF Board of Trustees from 1971 to 1986. Funded by RWJF and consisting of a medal and $40,000, the award recognizes individuals for outstanding achievement in improving health care services in the United States. In 1992, the IOM added the Rhoda and Bernard Sarnat International Prize in Mental Health, established by the Sarnats out of a desire to improve the science base for and the delivery of mental health services. Accompanied by a medal and $20,000, the award honored individuals or organizations for notable achievements. Like the Lienhard Award, the Sarnat Prize is open to members as well as non-members of the IOM/NAM (see Box 2-11).
In October 2021, the NAM established a new annual award, the David and Beatrix Hamburg Award for Advances in Biomedical Research and Clinical Medicine. Named for the former IOM president, who passed away in 2019, and his wife, Beatrix, an NAM member who specialized in child and adolescent psychiatry, the award recognized an “exceptional biomedical research discovery, translation, or public health intervention … that has fundamentally enriched the understanding of biology and disease” (NAM, 2021o; see Figure 2-12). The inaugural member of the Hamburg Award, which was accompanied by a $50,000 prize, was scheduled to be announced at the 2022 NAM Annual Meeting.
This chapter chronicles the people who carried out the work of the IOM/NAM. Upon acceptance of their election to the Academy, NAM members made a commitment to advance the work of the organization—and thereby further its mission of improving human health. They served and helped to steer the organization in diverse leadership as well as voluntary roles. IOM/NAM staff,
too, played a historically significant role. Executive officers served as “deputies” to the presidents and oversaw the organization’s staff and operations. Directors of boards and studies, experts in their own right, collaborated with advisory groups and consensus committees made up of members as well as external volunteers to determine programmatic direction and execute studies and convening activities. Finally, the IOM/NAM looked beyond its members and staff to foster excellence and leadership in the field of health through fellowships and awards. The collective expertise and commitment of these many individuals made the organization a powerful force for change throughout its history.