could ill afford. These differences in institutional outlook between the NAS and the IOM often took the form of personal confrontations between I presidents John Hogness and Donald Fredrickson and NAS President Philip Handler.

Even as Hogness and Fredrickson dealt with these constant pressures, they faced the more mundane task of running the IOM on a daily basis. The invention of routines that would guide the new organization through its first five years fell to them. Much of their work centered on the task of recruitment. They had to hire staff members who would set the tone for the Institute's subsequent development, select members who would initiate key committees such as the Program Committee, and make vital contacts with the foundation officers and public officials whose decisions on funding grant proposals held the key to the Institute's very survival.

Neither of these presidents served for a long time. John Hogness spent three years in office before leaving to become president of the University of Washington; Donald Fredrickson stayed at the IOM for less than a year, much of it spent in distracting and ultimately successful negotiations with federal officials over whether he would become the head of the National Institutes of Health (NIH). The turnover made the difficult endeavor of starting the IOM that much harder. Because Hogness and particularly Fredrickson left so quickly, the organization failed to establish a sense of continuity. Those in the foundation and health policy communities in positions to fund the IOM and increase its visibility found it difficult to gain a "fix" on the organization's identity. Nonetheless, Hogness and Fredrickson both made enduring impressions on the Institute of Medicine's history. Under their leadership in the years between 1971 and 1975, the IOM perfected its form of governance through establishment of the IOM Council and experimented with different ways of influencing health policy. IOM leaders came to realize that the organization possessed the means of convening the nation's leading experts to consider important issues in health policy. As a result, the IOM influenced President Nixon's war on cancer and established an important methodology for estimating the costs of medical education. By the end of the period, the IOM, if not a household name, had become known to the Washington health policy community as an organization with the potential to serve as a useful and influential source of impartial advice.



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