For the Public Good Highlights from the Institute of Medicine, 1970-1995 (1995) / Chapter Skim
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THE INSTITUTE OF MEDICINE CONFRONTS AIDS POLICY-MAKING
THE INSTITUTE OF MEDICINE CONFRONTS AIDS POLICY-MAKING
Pages 167-176
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From page 167... ...
Senior Policy Analyst, Office ofthe Assistant Secretary for Health, Department of Health and Human Services In the early 1980s, with the appearance of the first reported cases of AIDS, few scientists, public health officials, and policymakers were prepared for what was to follow: the growing spread of HTV infection and the myriad scientific and public health policy questions, ethical dilemmas, and sometimes bitter controversies engendered by this devastating epidemic. Recognizing the need to focus national attention on this widening public health crisis, the Institute of Medicine (TOM)
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From page 168... ...
The update conveyed new information in epidemiology and biomedical research and provided recommendations for fixture action in the areas of health care, public health, research, and federal policymaking. Like its predecessor, this report also received wide media and public attention, and once again underscored the need for strong federal leadership in formulating coherent national AIDS policy.
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From page 169... ...
These screening proposals have frequently engendered spirited debates about what constitutes an acceptable balance between the medical and public health benefits and the consequent personal and societal costs of HIV screening. Such a vigorous debate has surrounded the formulation of rational HIV testing and screening policies for pregnant women and newborns.
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From page 170... ...
In its final report, HIV Screening of Pregnant Women and Newborns (IOM, 199Ic) , the committee recommended voluntary HIV screening (with specific informed consent)
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From page 171... ...
These gaps in our knowledge, many researchers argue, have frustrated efforts to develop truly effective therapies and vaccines against HIV infection. As the second decade of the HIV/AIDS epidemic progresses, a number of scientists have urged a reexamination of the balance and direction of the AIDS research enterprise and, in particular, enhanced investment in fundamental research targeted at HIV infection and AIDS (Fields, 1994; Paul, 19954.
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From page 172... ...
For example, the committee joined a growing chorus of voices in urging the expansion of AIDS-related behavioral research, specifically the conduct of the NICHD's National Survey of Health and AIDS Risk Prevalence, which would provide information critical to understanding the dimensions of various risk behaviors and to developing effective educational and behavioral interventions. Several years after the release of The AIDS Research Program, the TOM was asked to assess the AIDS programs of the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and National Institute of Mental Health, all of which were formerly part of the Alcohol, Drug Abuse, and Mental Health Administration.
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From page 173... ...
Recognizing the need for such ongoing dialogue and following specific endorsement by the lOM/NAS AIDS Activities Oversight Committee, in December 1988 the TOM established the Roundtable for the Development of Drugs and Vaccines Against AIDS as a convening mechanism to explore and help resolve impediments to the rapid availability of safe, effective drugs and vaccines against HIV infection and AIDS. This group was composed of leaders from government, the pharmaceutical and biotechnology industries, academia, and patient advocacy communities, representing a unique blend of expertise and viewpoints on scientific and public policy questions pertaining to HIV/AIDS drug and vaccine development.
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From page 174... ...
In its other workshops, the roundtable has dealt with a variety of topiC5 such as progress in HIV vaccine research and policy issues related to vaccine development and evaluation, development of drugs for infants and children with HIV infection, development of effective therapies for AIDSrelated infections, gene therapy approaches for treating HIV infection, government and industry collaboration in AIDS drug development, and the changing demographics of the HIV epidemic and implications for clinical research. Over the course of the past 6 years, the roundtable has provided a neutral forum in which to explore and debate a variety of thorny issues surrounding AIDS drug and vaccine development and has fostered increased communication among various public- and private-sector representatives interested in furthering the research and development of effective HIV/AIDS therapeutics.
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From page 175... ...
The 1986 and 1988 Confronting AIDS reports have had, perhaps, the greatest impact in shaping national AIDS policy and pointing the direction for specific legislative actions. Even today, many of their recommendations constitute sound advice for policymakers struggling with the ethical dilemmas and public health challenges posed by the HIV/AIDS epidemic.
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From page 176... ...
l991c. HIV Screening of Pregnant Women and New borr~s, L.M.
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