projecting an air of competence that both reassured and energized people. Among many other positive attributes, Samuel Thier was a quick study. Even before he took over on a full-time basis, he realized the need to build a strong endowment that would allow the IOM to set its own agenda. Turning a disadvantage into an advantage, he used the Sproull Report as a form of leverage. Because the foundations had subjected the Institute of Medicine to such a probing and painful analysis and because the Institute of Medicine had begun to put its house in order, Thier argued that the foundations now had a moral obligation to come to the IOM's aid. He hastened to reassure these foundations that he had absorbed the many criticisms of the IOM and would take steps to remedy the problems. Under his leadership, he promised, the IOM would strive to complete its studies more quickly, with the goal of cutting in half the time necessary to complete studies. Using the IOM's convening power, he planned to bring together the parties interested in drug development and health technology assessment in order to facilitate communication among participants in these particular fields. Finally, Thier vowed to make the IOM more visible to the government, so that government agencies turned reflexively to it for advice.2

Like his predecessors, Thier was a respected academic doctor who had produced more than 80 research papers in his chosen field of kidney function. More importantly, however, he had early shown a penchant for medical administration and proved himself to be a superior clinician. The son of a physician, Thier decided to follow his father's profession. "My father was a general practitioner and loved what he was doing and I just thought it was an exciting life," he explained. Thier graduated from the State University of New York Upstate Medical Center at Syracuse in 1960 and then entered the elite echelons of the medical profession by taking his internship and residency at Massachusetts General Hospital in Boston. By 1966, he had earned the coveted position of chief resident at Massachusetts General, which prepared him for a career in academic medicine that included positions as chief of the renal service at Massachusetts General and vice chairmanship of the Department of Medicine at the University of Pennsylvania. In 1975, only 15 years removed from medical school, he became chairman of the Department of Medicine at Yale. Fellow doctors admired both his ability to respond to emerging trends in medicine and his clinical skills in diagnosis and treatment.3

By the time Thier arrived at the Institute of Medicine at the end of 1985, he had already played an active role in the organization's affairs and in medical affairs more generally. Elected to the IOM in 1978, Thier had chaired the Board on Health Sciences Policy and been a

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