The report was decidedly tentative in tone. On the one hand, the group noted that for significant acute events, such as a heart attack or stroke, age 60 did not mark the beginning of a period of special risk. On the other hand, the group concluded that "subtle changes that may adversely affect pilot performance" increased with age. A pilot's skills deteriorated with age, yet there was great variation among individuals in any particular age group. The committee implied that tests of individual acuity should be developed that could take the place of a blanket exclusionary rule. In the end then, the report called, as did nearly every IOM report, for further research that would make such tests possible.12

Another study on the backlist concerned nursing education and marked a throwback to the large data-gathering studies that had been done by Ruth Hanft. Just as the IOM was asked to investigate how the federal government should subsidize medical education at the beginning of the 1970s, so it received a similar request to investigate nursing education at the end of the decade. In the Nurse Training Amendments, passed in 1979, Congress sought the IOM's help in resolving a controversy over whether there should be continued federal support of nursing education. Although the study would not involve the data-gathering efforts that had marked the earlier study supervised by Hanft, it was nonetheless a large and ambitious undertaking that was scheduled to take two years to complete.13

The Institute of Medicine asked Arthur Hess to head the steering committee that included some truly distinguished practitioners in the field of health services research. Hess was a veteran bureaucrat from the Social Security Administration who had helped launch the Medicare program. Other members included Otis Bowen, a medical doctor from Indiana who later became governor of Indiana and Secretary of Health and Human Services; Stuart Altman, dean of the Heller School of Social Welfare at Brandeis; Saul Farber, head of the Department of Medicine at New York University; John Thompson, a professor of nursing education at Yale; Isabel Sawhill, a specialist in manpower policy at the Urban Institute; and Linda Aiken, a nurse with a Ph.D. in sociology who worked for the Robert Wood Johnson Foundation. This panel plunged into the complexities of federal subsidies for nursing education.

The tone of the 1983 report, a product of the IOM's Division of Health Care Services, revealed some of the differences that had occurred over the course of a decade in the field of social policy. The nursing report, unlike the IOM's earlier report on federal support for medical education, did not reflexively call for more federal spending or regulation. On the contrary, the group concluded that "no specific



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