IOM and its staff had developed a sort of collective expertise on the subject of AIDS that could be put to a variety of uses.65

In 1994, the Institute of Medicine published a report on substance abuse and mental health issues in AIDS research that resulted from a congressional request for the IOM to investigate the AIDS-related research programs of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). In making this request, Congress specified that the evaluation be similar to the one the IOM had already performed for the National Institutes of Health. The final report contained references to no fewer than six previous IOM reports that were relevant to the specific subject of AIDS and behavior. H. Keith H. Brodie, president emeritus and James B. Duke Professor of Psychiatry at Duke University, chaired the advisory committee. A reorganization in the Department of Health and Human Services that took effect on October 1, 1992, made his job particularly difficult. Under this reorganization, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the National Institute of Mental Health moved to the National Institutes of Health; the service-providing components of ADAMHA became part of the Substance Abuse and Mental Health Services Administration. In addition, a bill passed in July 1993 changed the allocation of money for AIDS research within the National Institutes of Health. Hence, the committee faced a moving target.

As with the study of HIV and the blood supply, the Committee on Substance Abuse and Mental Health Issues in AIDS research found a slow response on the part of the federal bureaucracy to the AIDS crisis. In the meantime, AIDS continued to grow as a public health problem. By the end of 1992, AIDS was the leading cause of death among men 25–44 years of age. Not until 1987 did the National Institute on Alcohol Abuse and Alcoholism devote more than 1 percent of its expenditures to AIDS research, and similar patterns applied to the other NIH institutes under study. When these institutes did start to spend a substantial amount of money on AIDS research in 1987, such as $139.3 million by the National Institute on Drug Abuse, they concentrated most of it on biological research and neglected behavioral research. Part of the problem was a political taboo against such activities as a "federally sponsored, national survey of sexual behavior to help determine the nature and level of risk for HIV transmission in the general population." The committee found numerous other gaps, for example, describing the effect of AIDS on those already suffering brain disorders as "remarkably understudied," and offered specific suggestions on how to close the gaps. It recommended that the three NIH institutes study how individuals



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