the IOM to make a formal name change. There were a number of compelling reasons for the change. The present name invited confusion between the independent Institute of Medicine and the governmental National Institutes of Health. On an international level, the name baffled foreign authorities, who could not understand why the United States chose to call its academy an institute. The word "institute" implied an organization that undertook research, and although this described part of what the IOM did, it failed to comprehend the special nature of the IOM's activities. Finally, the name implied that the IOM was somehow a second-class member of the Academy complex, which contained an academy of science, an academy of engineering, but only an institute of medicine. In retrospect, the name reflected an accident of history. When the IOM was created, Philip Handler expected the NAS to contain a number of institutes. As matters worked themselves out, the Institute of Medicine stood alone. Shine hoped to end this historical anomaly and change the organization's name to the National Academy of Medicine.

A change of this magnitude required a long series of approvals. When Shine approached Bruce Alberts, who was Frank Press's successor as head of the National Academy of Sciences, and the NAS Council, he received an encouraging response. The IOM Council was similarly positive. A final hurdle was the approval of the full NAS membership during its annual meeting. In this meeting, opposition to the name change surfaced. Dr. Francis Moore, a distinguished surgeon from Harvard who had earlier figured in the IOM's history as an opponent of the Board on Medicine's statement on heart transplants, argued against the change on the grounds that creation of the National Academy of Medicine would make it impossible for doctors to be elected to the National Academy of Sciences. Shine did not wish to push the matter on the floor of the NAS meeting; it was something that had to be done by consensus. The proposal died.

Summing Up

Walsh McDermott, who, as much as anyone, was responsible for the creation of the Institute of Medicine, would have applauded the decision to have the organization remain an institute, rather than an academy. In his work as head of the Board on Medicine, McDermott came to feel that an academy was an organization in which self-congratulation took precedence over action. He wanted an entity that was concerned not only with who would join but also with who would work on projects of social significance. It should not be an



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