on an interim basis. At the end of the year, the Institute of Medicine announced the formal appointment of Shine, who assumed the job on a full-time basis on July 1, 1992.

In selecting Shine, the Institute of Medicine preserved the tradition of having a leading academic health administrator as its president. Although Shine grew up in modest circumstances in Providence, Rhode Island, a special scholarship for talented students of the Providence public schools enabled him to go to Harvard College and then to Harvard Medical School. Like Samuel Thier, Kenneth Shine took his internship and residency at the Massachusetts General Hospital, another institution with a Harvard affiliation. At Massachusetts General, he developed an expertise in the muscles of the heart and sought an appropriate postdoc laboratory experience. He found it at UCLA and remained there as he worked his way up the academic and administrative ranks to become dean. Along the way, he developed expertise in the fields of cardiology, physiology, and academic administration, and as a result of his work with the Association of American Medical Colleges and the American Heart Association, he also became interested in public policy.

Kenneth Shine inherited a large and complex organization from Samuel Thier. Each division produced numerous reports every year, and each division also played a part in the IOM's convening function by administering a special committee, forum, lecture series, or award. Enriqueta Bond, the IOM's executive officer, did a masterful job of keeping these activities on track during the year between Thier's departure and Shine's arrival on a full-time basis. When Shine took over the daily operations of the IOM in the summer of 1992, the country was in the middle of an election campaign that would bring the Democrats back into power. One of the key decisions that Shine faced was how to position the Institute of Medicine in an era of Democratic rule.

The Inner Details of Health Care Policy

As Shine contemplated how to approach his presidency, each division continued the work that led to reports on a wide variety of subjects. For example, a project on the implications of regional health care data bases for health policy fell into the bailiwick of the Division of Health Care Services, still headed by Karl Yordy, who had come to the IOM in the era of John Hogness and would remain until his retirement in October 1993. Roger Bulger, another old IOM hand



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