Informing the Future

CRITICAL ISSUES IN HEALTH

FOURTH EDITION

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES



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Informing the Future CritiCal issues in HealtH FourtH edition

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INSTITUTE OF MEDICINE 500 Fifth Street, N.W. Washington, DC 20001 Funding: This document was produced using internal IOM funds. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the ser- vices of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Acad- emy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. 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.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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Contents Contents Institute of Medicine: Advising the Nation, Improving Health 1 Quality of Care: A Health Professional Duty 5 Pharmaceuticals: The Good and the Bad 13 Children and Youth: A Healthy Start 19 Public Health: The Big Picture 27 Active-Duty Military and Veterans: America’s Heroes 41 Global Health: The Strength of Nations 47 Health Research: The Path to Knowledge 55 Clinical Medicine: Best Practices for Better Health 67 Forums and Roundtables: The Power of Convening 75 Fellowships at the Institute of Medicine: Tomorrow’s Health Leaders 81 Recent and Upcoming Reports 85 Contact Us 113 

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