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To Improve Human Health: A History of the Institute of Medicine
1975, he found the project moribund but the subject compelling and asked IOM staff to find out what had happened in the field of medical malpractice between 1973 and 1975. Staff members Barbara Cohen, who had both Capitol Hill and White House connections, and Michael Pollard, who had both a law and a public health degree, made a round of Washington visits and came up with a new proposal for a study in the area of medical injury compensation. The Henry J. Kaiser and the William and Flora Hewlett Foundations contributed the money to fund the project.
John Hogness agreed to chair the steering committee, which met for the first time in August 1976, in part because he wanted to show his continuing interest in IOM affairs and in part because the subject was one about which he knew little and wanted to learn more. The committee contained an interesting mix of medical practitioners, such as Jeremiah Barondess, a professor of medicine at Cornell University Medical College; social scientists, such as Stanford sociologist Richard Scott and Wisconsin economist Burton Weisbrod; and legal scholars, such as Guido Calabresi of the Yale Law School (who later became its dean). The group also included Jonathan Spivak, the Wall Street Journal correspondent who followed events in the health care field closely.
Like nearly all IOM studies of this era, the work of the Medical Malpractice Committee became delayed. Barbara Cohen, the staff director, left the IOM, and Michael Pollard stepped in to take her place on the study. The budget for the project was tight, and Hamburg had to ask the sponsors for another $30,000 to complete it. Guido Calabresi received the staff draft of the final report in July 1977 and objected so strongly to it that he decided to resign from the steering committee. He complained about the report's loose grasp of economic theory, as in the statement that the cost of rising insurance premiums was passed along to customers.27
The final report, dated March 1978, stated at the end of 64 closely reasoned and heavily annotated pages, that "the focus of public policy and research that relate to medical injury should not be unduly restricted to instances of medical malpractice." Instead, policymakers should concentrate on "the incidence of medically related injury, possible techniques for preventing injury, and financially sound methods for compensating injured patients." In other words, the emphasis should not be on fault, as it was in the present tort system, but rather on prevention and on outcomes. The system should strive to prevent disability and alleviate its consequences, not encourage the deterioration of the physician-patient relationship. Beyond these important insights, the report offered few specific suggestions for