Having invested time and effort in creating the white paper and composing the cover letter, Thier set out to get Bush to read it. At Thier's urging, Monroe Trout, chairman of the board at American Healthcare Systems, wrote to Barbara Bush asking her help "to get a paper read by George." He advised Mrs. Bush that she might want to read the paper herself, "even though it is not the most pleasant of subjects." Trout then told Thier that he had sent off the material to the Vice President's office and "hopefully he will read it." How Bush felt about the white paper or whether or not he read it remains unclear. Thier and Press did receive a letter from him thanking them for the white paper and containing some general remarks about AIDS. "The work of the National Academy of Sciences and the Institute of Medicine has strengthened my determination to see to it that out of this international tragedy some good may come; and that America's unparalleled medical resources [will] be stronger for having fought this fight," wrote Bush.48

The Institute's AIDS Activities

After the excitement of preparing the update, the AIDS Oversight Committee settled into the role of advising the IOM on its AIDS activities. One of the first projects scrutinized by the committee was a proposed IOM evaluation of the NIH AIDS programs. David Baltimore regarded the evaluation study as a way of continuing the IOM's leadership in the field. It would offer an opportunity to evaluate the NIH response to the epidemic, to suggest an "ideal" research program, and to offer insights on how NIH should respond to future public health threats. A good study could also examine how money to fight AIDS was divided among the various institutes, explain why NIH responded so slowly to AIDS, and determine how NIH coordinated its activities with other parts of the Department of Health and Human Services. The Oversight Committee even suggested names for the steering committee and created a detailed plan of action for the study, complete with a list of people who should testify at a public hearing.49

For all of the hopes of the AIDS Oversight Committee about the many things the study might accomplish, it was similar to many other evaluations of the government's research programs that the IOM had undertaken over the years, and it was likely to produce the same sort of recommendations. In this case, the IOM responded in 1988 to a specific request from James B. Wyngaarden, the director of the National Institutes of Health, and Anthony S. Fauci, the associate



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