solution for ensuring that our health care system will provide universal access to high-quality care at reasonable cost is immediately in sight. Thus, the next few years represent another “difficult period ” during which we must seek new and innovative solutions to the challenges the country faces.

Fortunately, most of the internal governance issues that confronted the Institute in its dealings with the National Academy of Sciences (NAS) during its early years have been resolved. The leadership of the NAS and its Council has endorsed the notion of changing the Institute 's name to the “National Academy of Medicine,” although this will require final approval, by ballot, by NAS members. Whether the Institute's name changes or not, the organization itself is functioning well.

In his editorial, Dr. Page notes that “any organization is only as good as its members.” Our 519 active members and 600 senior members and foreign associates are an extraordinary group. In addition to maintaining the high quality of the membership, we have begun to achieve significant diversity among our active members as well, which now comprise 20 percent women and 8 percent underrepresented minorities. Our attempts to maintain the highest standards for membership while achieving diversity are succeeding, although much still needs to be done.

Dr. Page also states that “the Institute is not intended only as an honor.” Indeed, each year between 30 and 40 percent of our members participate in an IOM project in some way—as committee members or report reviewers, or as members of IOM boards or the IOM Council. Their leadership, expertise, and participation constitute an invaluable resource. To all of the members who have been active, we are particularly grateful. We continue to look for ways to increase opportunities for member participation. Dr. Page hoped that IOM members would “be drawn chiefly from men and women approximately 50 years or younger.” In this, we have been less successful. Although the average age of our members is less than that for the NAS, it remains at 56. Clearly, we need to increase efforts to identify the best and the brightest at a younger age.

In 1968, Dr. Walsh McDermott, another Charter member, described two possible “concepts” for the Institute. In the first type, the Institute would “speak from within the medical profession concerning problems that involve medicine.” According to the second, the Institute would “speak to the issues from the position of all-around competency rather than one that would speak from within medicine. ” He went on to say, “I am deeply convinced that what is needed is a institution based on Concept II.” The Institute has been quite faithful to this latter concept, as reflected in the breadth and diversity of experience, outlook, and expertise represented by our committee members and in the objectivity of our reports.

This volume seeks to identify a few of the major themes that have interested the Institute and its members over the past 25 years. By necessity, many other important areas to which the IOM has contributed are not dealt with in



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