elevate stress into a metaphor for the Carter years, with their series of wrenching events such as the radiation accident at Three Mile Island and the Iran hostage crisis. The press would therefore seize on the report and be eager to find a simplistic theme with which to characterize it, but the IOM and NSF committees that reviewed the report would demand more. Describing this review process, Hamburg said that "there's a lot of feedback ... and some of it is jarring. I mean it is quite difficult.... [T]o retain a high degree of consensus in the face of a stiff critique is not simple, but I think it is very important."49

As Hamburg had predicted, the report ran into difficulties in the review process that delayed its release until the end of 1981. Although three of the IOM reviewers approved the report, two had strong reservations. They believed that the report failed to support its recommendations and complained that it was full of "tautologies, nebulous notions, and old research." "All of these statements are true," conceded the IOM staff members in charge, ''the committee was not in a position to remake the stress field, which has been characterized by just those problems for many years." What the report tried to do was present results that "transcended those limitations" and replace "tautologies with insights, old research with new and well-designed studies, and vague ideas with hard data." The final report suggested that investigators move ''beyond questions about whether stress can affect health and explore more fully the mechanisms through which stressors might produce such consequences." They should do so even though the stress response was a "complex, interactive process."50

The process of collaborating with and advising the Carter administration extended well beyond the area of health and human behavior. In fiscal year 1979 alone, the Institute reviewed HEW's planning process, reported on food safety policy and on the health hazards of sleeping pills for the FDA, investigated the research agenda of the National Institute on Alcohol Abuse and Alcoholism, and studied health in Egypt for AID.51 It also tried to be of service in the legislative battle over national health insurance.

Working with the Carter Administration: The Dental Study and the Surgeon General's Report

A good example of such service concerned the study of dental care that the IOM started in 1976 before the Carter administration took office. From the beginning of this study, the IOM had national health



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