For the Public Good Highlights from the Institute of Medicine, 1970-1995 (1995) / Chapter Skim
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COMMENTARIES
COMMENTARIES
Pages 177-194
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From page 177... ...
From the time of the 1985 annual meeting forward, multidisciplinary talent and expertise, provided in part by TOM members and expanded through appointment of IOM-sponsored committees, has facilitated rapid, authoritative policy guidance that has been a critical supplement to the hesitant and somewhat passive response of other voices of leadership. The first important contribution was the study jointly sponsored by the TOM and the National Academy of Sciences (NAS)
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From page 178... ...
They called for initiation of public discussion about sexuality and about realistic approaches to substance abuse, topics that had rarely surfaced in national discourse before and that would have been difficult for the political leadership to introduce without the unassailable, independent backing provided by the TOM. Epidemiologic investigations during the first years of the AIDS epidemic had quickly yielded the finding that AIDS was primarily a bloodborne or sexually transmitted disease and that it was difficult to transmit (once the blood supply was secured in 1985)
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From page 179... ...
In the 1986 report (and reiterated in 1988) was the proposal that a broadly based commission on AIDS be created in order to facilitate policy considerations across the range of societal as well as medical topics that were sure to be raised by the far-reaching impact of the HIV epidemic.
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From page 180... ...
They addressed such topics as health manpower; health care access and financing needs; clinical research; and the impact of the epidemic on special populations including those in rural America, communities of color, adolescents, and prisoners. Specific reports dealt with housing for people with HTV/AIDS, the interlinkage of the epidemics of HIV and substance abuse, the special circumstances of the HIV epidemic in Puerto Rico, the issue of HIV in health care settings, and the importance of social science research in successfully combating the epidemic.
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From page 181... ...
owe our late colleague David Rogers a great debt of thanks for his stamina in outlasting that difficult issue; for if the rush to categorical exclusion of HTV-infected health care professionals had been allowed to go unchecked, it would have had a devastating and unnecessary impact on our ability to provide health care not to mention on the careers of well-trained health care personnel and the probable relaxation of attention to universal precautions that would have resulted would have had its own negative impact on public health as well. Less tangible contributions of the NCA may have been at least as important: A key component of the NCA's many reports and commentaries was input from hearings that were held across the country to explore the circumstances of the epidemic firsthand and to hear testimony from many hundreds of Americans directly affected by the growing epidemics of HIV, AIDS, and fear.
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From page 182... ...
As such, it was a genuinely creative contribution to the national response to AIDS, and the diligence of all its participants enriched the overall dialogue remarkably. For that, the leadership of TOM President Samue} O
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From page 183... ...
Public Health Service worked valiantly to stay abreast of the escalating demands posed by the expanding epidemic, but they were poorly positioned to counteract political pressure or to initiate controversial programs without independent validation. The Confronting AIDS reports filled what otherwise might well have been a vacuum; they did, indeed, supply policy blueprints that provided guidance for both scientists and policymakers; subsequent lOM reports served as useful resources to prevent unwise overreaction (Ms.
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From page 184... ...
1992. Preventing HIV Transmission in Health Care Settings.
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From page 185... ...
There have been successes: changes in behavior that have reduced the spread of the virus in some circumstances; care programs that make life with the virus possible for persons with few resources; support programs for families, partners, and friends of affected individuals; research efforts that have illuminated more pieces of the puzzle; legislative advocacy leading to more funding and improved public health statutes; and businesses that use their work sites as the location for prevention education and their status in the ~5
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From page 186... ...
Communities assumed that their health departments would protect "us" from "them," if only we had the political wall, as if clear circles could be drawn around the invading infection. As the widening infection demonstrated, crisp lines of demarcation around hemophiliacs, children born to infected prostitutes, blood transfusion recipients, homosexual men, needle-using substance abusers and the sexual partners of these people are impossible.
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From page 187... ...
The Institute's decision to appoint a committee with a broad charge covering research, clinical treatment, public health practice, and public policy was a move to counter the lack of national leadership in the public sector. That public health was listed first in the subtitle of the IOM's first report was an appropriate reinforcement of the need for community-we responses.
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From page 188... ...
The voices of these loud demonstrators, who were often engaged in such dramatic acts as blocking traffic, storming offices, throwing blood-colored fluids, and erecting symbolic tombstones were harsh and unpleasant. But they were insistent, and mayors, governors, public health directors, and regulators indeed, an almost endless list of officials-sooner or later came to the table to discuss what was perceived as missing and what might be done in response.
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From page 189... ...
In response to community demands, the FDA moved to release Hugs for use more quickly in cases of terminal diseases such as advanced AIDS. Today there are requests for a slower evaluation process using more conservative clinical trials.
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From page 190... ...
Yet the more complex policy issues, such as how to limit the spread of HIV infection among injecting substance abusers or how to develop effective prevention programs for the nation's youth, were avoided whenever possible. The conclusion of the presidential commission was more negative than positive.
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From page 191... ...
It is too early to fully measure the changes instituted with a new appointment that some descnbe as being more reflective of politics than public health. A major commitment of the federal government as a national role model, offering HIV prevention education in the workplace to the entire civilian work force, has been slow to develop due to tight budgets, limited central support staff, occasional mixed signals, and the delaying tactics of individuals who have yet to understand the seriousness of the epidemic and its personal relevance to them.
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From page 192... ...
Report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic.
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