Throughout the 1970s, furthermore, both Congress and the federal bureaucracy gained a greater capacity for doing their own quantitative and analytical work. Committee staffs and bureau chiefs discovered that it took the Institute of Medicine, which had to clear its work through the National Academy of Sciences bureaucracy, a great deal of time to complete a task. Since speed was so important to a policy system in which the window for change in a given area remained open for a very short time, Congress and the federal bureaucracy often looked elsewhere. The Institute of Medicine struggled.

In the interim, before the IOM developed a large program of studies, it resembled nothing so much as an honorary organization of the sort that would have been more congenial to Irvine Page than Walsh McDermott. The highlight of the early Institute of Medicine was the annual meeting, a gathering with a great deal of intellectual content that yielded important papers on health policy but was a social occasion nonetheless. Here, members greeted one another and discussed who deserved to become part of the group. The Institute of Medicine threatened to deteriorate into a social club for the country's best physicians and medical researchers.

This never happened. Foundations began to provide the Institute of Medicine with the support necessary to hire a core staff and undertake basic activities. Hogness and the IOM Council kept the organization focused on the important issues of the day, such as President Nixon's war on cancer or the Supreme Court's decision not to interfere with a woman's right to choose abortion. Still, the IOM failed to develop a source of sustained financial support or, because of the need to undertake any project the government offered it, much of a coherent program. The fact that Hogness served only three years and his successor Donald Fredrickson less than one accentuated the problems.

David Hamburg, the IOM's third president, devoted much of his term to reorganizing the IOM into a set of divisions with distinct responsibilities. His six-division scheme, later compressed into four, served as the basis for the IOM's present structure. As the IOM became better known and better organized, it attracted more grants and research contracts. During the Hamburg years, the IOM undertook studies in health manpower, quality assurance, and the relative effectiveness of polio vaccines. Each of these topics emerged as enduring themes of the IOM's work. Hamburg also engineered an informal alliance between the IOM and the Carter administration, which led to what amounted to collaborative projects on such subjects



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