NATIONAL ISSUES
IN
SCIENCE AND TECHNOLOGY
1993
Science and Technology Leadership in American Government: Ensuring the Best Presidential Appointments
Climate Change Policy: Establishing United States Leadership Under the Climate Change Convention
Technology Policy and Industrial Innovation: The Federal Government's Role
Toward More Effective Health Care Reform: Selected Issues from Reports of the Institute of Medicine
Summaries of Selected Recent Reports of the National Research Council
NATIONAL ACADEMY OF SCIENCES
NATIONAL ACADEMY OF ENGINEERING
INSTITUTE OF MEDICINE
NATIONAL RESEARCH COUNCIL
NATIONAL ACADEMY PRESS
Washington, DC 1993
NOTICE: The production of this volume was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The material included in the volume is based on the work of duly appointed study committees, the members of which were chosen for their special competencies and with regard for appropriate balance. The white papers and report summaries presented here are drawn from--and faithfully represent--the reports produced by these study committees, which were reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
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. Frank Press 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. Robert M. White 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 services 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. Kenneth I. Shine 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 of advising the federal government. Functioning in accordance with general policies determined by the Academy, 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. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council.
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Copyright 1993 by the National Academy of Sciences. All rights reserved.
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PREFACE
Following the precedent established during the Presidential transition in 1988, the presidents of the National Academy of Sciences (NAS), the National Academy of Engineering (NAE), and the Institute of Medicine (IOM) decided again in 1992 to authorize the preparation of a series of short "white papers" on important national policy issues in which science and technology play a central role. Each paper was drawn from studies undertaken by the Academy complex in recent years. One of the papers—dealing with the problem of recruiting the most outstanding scientific and technical talent for senior Presidential appointments—was conveyed shortly after the election to Warren Christopher and others managing the President-elect's transition effort. The other papers were made available to senior officials of the Clinton administration in the weeks following the Inauguration.
Four white papers are presented: (1) "Science and Technology Leadership in American Government: Ensuring the Best Presidential Appointments"; (2) "Climate Change Policy: Establishing United States Leadership under the Climate Change Convention"; (3) "Technology Policy and Industrial Innovation: The Federal Government's Role"; and (4) "Toward More Effective Health Care Reform". The first three papers are distillations of major reports of blue ribbon panels organized under the auspices of the Academies' Committee on Science, Engineering, and Public Policy (COSEPUP). The fourth paper is a new synthesis of major health policy issues that previously have been addressed by the Institute of Medicine.
The NAS, NAE, and IOM Presidents also authorized the preparation of brief summaries of ten potentially high impact reports issued during the previous 18–24 months by various committees of the National Research Council (NRC), which they jointly manage. The summaries are representative of the more than 200 studies produced annually by the NRC. Copies of the complete NRC reports summarized in this volume, as well as the COSEPUP and IOM reports on which the white papers are based, may be obtained by contacting the National Academy Press (202/334-3313).
Many individuals on or associated with the professional staff of the National Research Council contributed to or commented on the material presented in this volume. The white papers that were based on COSEPUP reports were in each case prepared by the individual who had previously served as director of the study (listed in the same order as above): Michael G.H. McGeary, Robert A. Coppock, and John S. Wilson. Karl D. Yordy, director of the IOM Division of Health Care Services, and Kathleen N. Lohr and Marilyn J. Field, also of the IOM Division of Health Care Services, wrote the IOM white paper. The ten brief summaries of the recent NRC reports were prepared by professional writers Steve Olson and Ethel M. ("Pepper") Leeper and were reviewed extensively by the originating NRC program units. Members of the NRC staff who provided review comments and suggestions were: Stephen R. Godwin, Anne Y. Kester, Mehadevan Mani, Peter B. Myers, Stephen Rattien, Susanne A. Stoiber, Robert E.
Skinner, Miron L. Straf, Paul R. Thomas, Raymond A. Wassel, Arch L. Wood, Suzanne H. Woolsey, and Catherine E. Woteki. Decisions on the selection of NRC reports to be included and quality management of the white papers was undertaken by an editorial committee consisting of: Lawrence E. McCray, Stephen A. Merrill, Don I. Phillips, and Myron F. Uman. The committee was chaired by Mitchel B. Wallerstein, deputy executive officer of the NRC, who also managed the production of this volume.
