Advice for the President

For the Oversight Committee, preparing a white paper on AIDS for the next administration became an immediate priority after issuing the update. Earlier in the year, the presidents of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine had decided to produce a series of short issue-oriented papers on critical issues in science and technology, with the incoming administration as the intended audience. AIDS emerged as an obvious choice for such a paper, with the 1988 update report serving as the basic source of data. It fell to Robin Weiss, director for AIDS activities at the Institute of Medicine, to summarize the update report in a way that highlighted actions George Bush and his administration should take to stem the epidemic.45

In the interim between the update report and the white paper, an important piece of legislation, the AIDS Amendments of 1988, changed the political outlook on AIDS. This legislation followed the advice of the Institute of Medicine and established a National Commission on Acquired Immune Deficiency Syndrome. Under the term of the law, the President would appoint two members to the commission and would in addition ask the Secretary of Health and Human Services, the Administrator of the Department of Veterans Affairs, and the Secretary of Defense to serve ex officio as nonvoting members. In the white paper, the IOM urged the President-elect to choose "senior experts" on AIDS, without regard to political ideology. Congress was to play the dominant role in the appointment of voting members, with five Senate and five House appointees to be chosen.46

The white paper had the compressed tone of a document written to attract the attention of a busy person. Aware that the President-elect would not have time for a leisurely examination of even a 13-page document when he received it in December 1988, Frank Press and Samuel Thier wrote a 3-page cover letter in which they summarized the white paper. They began with the stark fact that during George Bush's term in office, AIDS would kill 200,000 Americans. Another 1.3 million were infected with HIV, and most would die. Press and Thier urged Bush to "use the newly legislated national commission on AIDS to develop a forceful and coherent national policy," to encourage antidiscrimination legislation, to express support for an "aggressive, unambiguous education program," and to recognize America's "special responsibility in international efforts to control the spread of HIV infection." "Your Administration inherits the opportunity to harness our knowledge and turn the tide against AIDS," wrote Press and Thier.47

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