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To Improve Human Health: A History of the Institute of Medicine
other words, was still conducting the war that he had waged in the Board on Medicine against Walsh McDermott. For Shannon, there was too much on "legal and ethical issues" (category 10), "health maintenance" (category 6), and "environmental influences on health" (category 2). Philip Handler found himself in full agreement. Science always came first with him. Roger Bulger conceded that the categories were rather loose but thought it important just ''to get started." Even the Program Committee did not regard the categories as fixed. After consulting with members, for example, the committee realized that ''government regulations and health administration" (category 9) intersected with nearly all the other categories and would have to be dropped.72
At the end of 1972, the Program Committee took the process a step further and issued a general statement that suggested four basic principles to guide the IOM program. These followed directly from the deliberations that had led to the IOM's founding. The organization should rise above "any particular interest, viewpoint, or profession" in favor of "the protection and advancement of the health of the public." The Institute's program should involve its members in its work. The IOM should recognize a "fundamental unity of health policy issues" and not attempt to attack them piecemeal. Finally, the "Institute should initiate activities as well as respond to external requests." There followed a long laundry list of projects that the IOM might undertake, such as an "analysis and redefinition of health manpower functions and roles" or a "study of the interaction between the physicians and the FDA on drug utilization."73
A fundamental lack of money kept the IOM from following its general principles and undertaking these specific projects. Fund-raising, so vital to the IOM's survival, became a source of considerable anxiety during the IOM's first 15 years. "The financial support of the Institute of Medicine was, to put it mildly, a bit shaky at first," Hogness recalled.74 In time, however, Hogness attracted a core group of five foundations that came to the IOM's aid. For the first few years, the IOM included a statement in each of its studies that it received its principal funding from the five foundations and listed them by name.
During the long period of discussion with the National Academy of Sciences, the Board on Medicine had put its fund-raising efforts on hold, with the result that the IOM had little to spend in its first