suggestions, such as targeting reviews on "questionable patterns of care," to increase the effectiveness of existing review programs. As part of the same project, the IOM also studied the reliability of information on abstracts of hospital discharge records, finding wide discrepancies between the results obtained by an IOM team of researchers and the results in the hospital discharge records.

This study focused on the inner mechanics of health policy and the technical aspects of health care and answered questions posed by Congress, rather than by IOM members themselves. Within a very limited circle, such as the National Standards Review Council and professional conferences on disease classification, the study received wide play. The study fit the traditional NAS and National Research Council (NRC) model in which the Academy advised the government on technical and scientific issues. Indeed, Philip Handler welcomed competition between the NRC and the IOM in responding to requests to the Academy from the government. Even as Hamburg presided over the dissemination of the study on quality assurance, however, he hoped that the IOM woul be able to break free of this mold and initiate its own studies.26

The Malpractice Study and the Polio Study

The medical malpractice project exemplified the sort of study that the IOM had wished to do for a long time. First discussed in the era of John Hogness, it came to fruition during the presidency of David Hamburg. Like many IOM studies, it took a great deal of time to complete and involved a considerable amount of turmoil within the staff and the steering committee. The final study, for all of the effort that went into it, turned out to be a brief report with few policy recommendations.

The project began when John Hogness appointed an Ad Hoc Committee on Medical Malpractice, which met for a few months in 1973, at the time the HEW Secretary's Commission on Medical Malpractice was about to issue its report. This commission recommended that a uniform body of legal rules governing medical malpractice be created for courts to use throughout the country. The IOM Ad Hoc Committee found many deficiencies in the report, such as its failure to address the deterioration of the physician-patient relationship and the creation of conditions in which patients might well bring a tort action against their doctors. The committee asked that there be an IOM policy statement on this subject. The project then languished for lack of funds. When David Hamburg arrived in



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