spirit, the 1991 report advised that instead of basing the AIDS program on the annual budget process, NIH should develop a five-year plan to set priorities and identify research fields that needed to be strengthened. The IOM study group also suggested, as had the 1984 group, that the NIH director be given more discretion over resource allocation in order to be able to respond to health crises. The committee recommended an annual discretionary fund of $20 million and the authority to transfer up to 1 percent of each NIH appropriation account.51

In addition to the study of NIH, the AIDS Oversight Committee took particular interest in the Roundtable for the Development of Drugs and Vaccines Against AIDS. Establishment of the Roundtable, which met for the first time in February 1989, reflected the use of the Institute's convening function. The idea was to "help resolve impediments to AIDS drug and vaccine development" by bringing together representatives of government, academia, the pharmaceutical industry, and patient advocates for regular conversations on pertinent topics. Harold Ginsberg, a professor of medicine and microbiology at Columbia, and Sheldon Wolff cochaired the sessions. Robin Weiss supervised the staff, which was headed by Richard Berzon.52

At its first meeting, the group discussed the state of vaccine development, with one conferee noting that the search for a vaccine was "in abeyance," and identified more promising topics for workshops or conferences. The group selected clinical trials as a subject worthy of special discussion, wondering, in particular, about using "prolonged survival" as the sole criterion on which to base FDA approval of new HIV drugs. Perhaps more important "surrogate endpoints," such as particular levels of "p 24 core antigen" or particular points on quality of life scales, could be identified. The discussion led to a conference on this subject in September 1989 attended by FDA Commissioner Frank Young and NIH Associate Director for AIDS Anthony Fauci.53

On June 26, 1989, the Roundtable used its regularly scheduled meeting to discuss the potential value of consortia in the AIDS drug and vaccine development processes. The discussion took the form of a workshop in response to a congressionally mandated request for information on this topic and led to a formal Roundtable report to the Public Health Service. The group, which consisted of the usual Roundtable members plus four outside experts, decided that the development of animal models, in particular, could benefit from collaborative efforts through research consortia. Such an approach might ease the problem of what one Roundtable member described as



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