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~ ~ I ~ ~ ~ ~ The Institute of Medicine: A Unique National Resource Unprecedented opportunities and challenges face the nation and the world as we seek to improve human health through re- search, prevention, and clinical care. The federal government plays a pivotal role in shaping the opportunities and meeting the challenges through the policies it establishes, the programs it funds, and the leadership it provides. Over the next 4 years, scientific and policy issues both predictable arid unpredictable will conDont the administration arid Congress. The health sector now constitutes more than 14% of the nation's Gross Domestic Product (GDPi a level~projected to rise to 160/0 within the next few years. Approximately half this amount is spent through the public sector, a share that will also rise in the coming decade. Policymakers face difficult decisions about how to obtain the best value for these large and growing expenditures. For science-based advice about these issues, the nation's leaders often turn to an institution that was created specifically for this pur- pose: the Institute of Medicme (IOM) of The National Academies. The IOM a nonprofit organization chartered in 1970 as a component

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Informing the Future: Critical Issues in Health of the National Academy of Sciences (NAS - provides a public serv- ice by working outside the framework of government to ensure inde- pendent guidance on matters of science and medicine. The lOM's mission is to advance and disseminate scientific knowledge to im- prove human health. The Institute provides objective, timely, authon- tative information and advice concernung health and science policy to government, the corporate sector, the professions, and the public. The Institute and The National Academies use an unusual process to obtain the most authontative, objective, and scientifically balanced answers to difficult questions of national importance. Our work is conducted by committees of volunteer scientists the country's leading experts who serve without compensation. Committees are carefully composed to assure the requisite expertise and to avoid bias or conflict of interest. Every report produced by our committees un- dergoes extensive review and evaluation by a group of experts who are anonymous to the committee, and whose names are revealed once the study is published. The results of these committee deliberations have been relied upon for 30 years to provide policymakers with ob- jective advice. The Institute's work centers principally on committee reports or studies on subjects ranging from HIV prevention to how to provide clinical care in extended space flight; from research opportunities at the National Institute of Health (NISI) to protecting the nation's food supply We also conduct Roundtables, workshops or symposia that provide an opportunity for public- and pnvate-sector experts to openly discuss contentious issues in an environment that facilitates evidence-based dialogue. Additionally, for 26 years, the IOM has managed The Robert Wood Johnson Health Policy Fellowships Pro- gram, which is designed to develop the capacity of outstanding mid- career health professionals in academic and community-based set- tings to assume leadership roles in health policy and management (for more information, see page 95~. The majority of our studies and other activities are requested and funded by the federal government. How- ever, private industry, foundations, and state and local governments also initiate studies, as does the IOM itself. -

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The Institute of Medicine: A Unique Public Resource The objective in all of these activities is to improve decision- making by identifying scientifically sound evidence to inform the de- liberative process. Over its history, the IOM has become recognized through its projects as a national resource of judgment and veracity in the analysis of issues relating to human health. Depending on the re- quest, studies may be narrow in scope, designed to answer very spe- cific and technical questions, or they may be broad-based examina- tions that span myriad academic disciplines, industnes, and even international borders. Many of today's major news reports concern issues that we have previously addressed; others, like tobacco harry reduction, are currently under study. IOM MEMBERS The Institute of Medicine is both an honorific membership organiza- tion and a policy research organization. The Institute's members, elected on the basis of their professional achievement, serve without compensation in the conduct of studies and other activities on matters of national policy for health. Election to active membership is both an honor and a commitment to serve in Institute affairs. On reaching the age of 66, members automatically are transferred to senior status. The bylaws of TOM specify that no more than 60 new active mem- bers shall be elected annually. The announcement of newly elected members occurs at the lOM Annual Meeting in October. The number of regular and senior members plus foreign associates currently stands at 1,375. An unusual diversity of talent among Institute members is assured by the charter stipulation that at least one-quarter of them be selected from professions other than those pnmanly concerned with medicine and health. More than a hundred of the regular members are in the natural, social, and behavioral sciences, law, administration, arid en- gineering. They, together with the health professionals in the mem- bership, bring a breadth and depth of competence necessary for stud- ies of today's health problems, which have many more dimensions than the traditional concerns of medicine. 3

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Informing the Future: Critical Issues in Health FOR THE PUBLIC GOOD This booklet provides a brief look at the work of the Institute and highlights some of the policy areas that we believe will be im- portant in the next several years. It is organized into three sections. The first section illustrates a number of reports that have provided a basis for developing or negotiating policy over a range of scientific issues; the second section samples work that we have recently com- pleted or have under way, organized into areas of continuing national concern; arid the third section provides a comprehensive bibliography of IOM reports published over the past several years. 4