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To Improve Human Health: A History of the Institute of Medicine
the studies necessary to determine exposure levels be conducted in the most neutral way possible, which meant that much of the work should be done by "independent, nongovernmental scientific panels." In this spirit, the committee recommended that "a nongovernmental organization with appropriate experience in historical exposure reconstruction should be commissioned to develop and test models of herbicide exposure for use in studies of Vietnam veterans."9
In this way, the Institute of Medicine came to play a credible role in the Agent Orange controversy. Although it did not resolve this controversy, it did summarize and analyze the data in a way that was helpful to policymakers. Armed with this report, IOM leaders could testify before Congress and add a scientific voice to what inevitably was an emotional debate that involved not just Agent Orange but the larger issue of the meaning of the Vietnam War and the debt America owed its Vietnam veterans. Congress knew that the IOM was as impartial as any organization could be. At the same time, recommendations for further research, even those produced by a thorough and dispassionate review of the evidence, inevitably introduced subtle conflicts of interest. By suggesting a nongovernmental panel to examine a particular issue, as the IOM did in the Agent Orange study, it risked the charge that it was drumming up business for itself. Such conflicts were unavoidable, because the IOM was removed from the subject under study—the defense and chemical industries—but not from the business of medical research.
If the Agent Orange study exemplified the work of the Division of Health Promotion and Disease Prevention in the public service mode, the unintended pregnancy study, another project of this division in the Shine era, illustrated its public education mode. In this project, as in the project on tobacco, the IOM showed its desire to alert the nation to a public health hazard and to suggest ways of alleviating the hazard. Published in 1995 and conducted during a period of widespread interest in health care reform, the study, chaired by Harvard psychiatrist and veteran IOM member Leon Eisenberg, made the simple point that all pregnancies should be intended at the time of conception. All pregnancies should be the result of a conscious desire on the part of men and women to have children. The committee marshaled evidence to show that most pregnancies in America were unintended. Using 1987 data, the committee demonstrated that less than half of the pregnancies in America were intended and resulted in live births; 8 percent were unwanted pregnancies that resulted in live births, and 29 percent were unwanted or mistimed pregnancies that ended in abortion. The high rate of unintended pregnancies held dire public health consequences. An unwanted pregnancy diminished the