There is also an increased tension between reliance on and mistrust of technology. This is not a new phenomenon. Nearly 200 years ago, reacting to the economic disruptions caused by the Industrial Revolution, Ned Ludd led a band of cottage handweavers through the countryside of Northern England smashing power looms and burning textile mills. In 1813, 24 Luddites were hanged.2 Similarly, but, we hope, with less dire consequences, we are now experiencing what has been described as “a widespread, powerful, corrosive hostility toward science.”3 In the words of one congressman, “the science community seems to think that as long as the money is flowing, I'm okay, you're okay, we're all okay and [it] doesn't get involved in setting priorities. . . . I wish science studies could work to the same rhythm that legislatures have to. . . .”4 But what form would such an arrangement take? As Avedis Donabedian queries in his chapter, “would the next step be an actual partnership with consumers as equals in serving the public interest?” Forging new partnerships with the public will require changes at the IOM. Shorter reports, less technical versions aimed at the lay public, fast-track studies, and electronic access to IOM reports or information about the Institute via the Internet and the World Wide Web are four possible ways to increase timeliness and accessibility to the public.

It has been said that journalism is the first draft of history.5 In this volume, we have identified six themes that capture some of the work of the IOM's first 25 years. Through the chapters written by staff members and the accompanying commentaries by IOM members, we can look back on the Institute's first two and one-half decades and put its work into historical context with the issues and problems the country faced during that time. This is an important exercise, because looking back gives us a solid footing for looking ahead. Looking ahead requires that we keep in mind that we will always be a reflection of our times. Looking ahead also means that we must examine both the structure and the function of the IOM. Balance and breadth are key elements of IOM's success and are attributes that we must maintain. In contrast, a senior policy advisor has described the involvement of the scientific community in shaping public policy as “a combination of arrogance and ignorance.”6 To avoid distortion, irrelevance, or prejudice, we should be vigilant in maintaining and, where necessary, increasing diversity in the Institute's membership and committees, in the selection of studies, in the peer-review process, and in dissemination activities. In addition, keeping an open mind means keeping our processes as open to outsiders as possible and putting together committees in such a way that we balance intellectual biases while avoiding conflicts of interest.

One important role of the IOM over the years has been to elevate emerging issues to greater public attention and scrutiny. Some of the studies with the greatest impact (e.g., Confronting AIDS and Growing Up Tobacco Free) have been initiated within the IOM itself. The balance between being reactive and



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