Health and Medicine

Report Calls for National Effort to Improve Health Literacy

Nearly half of all American adults -- 90 million people -- have difficulty understanding and acting upon health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy, says a new Institute of Medicine report. Limited health literacy is associated with billions of dollars in avoidable health care costs.


Behavioral, Social Sciences Should Be Part of Medical Training

Medical education should be modified to help students fully recognize and respond to social and behavioral factors that affect the care and treatment of their patients, says a new Institute of Medicine report. The report outlines core behavioral and social science content that should be included in medical training and recommends ways to overcome barriers to incorporating these disciplines into the four-year medical school curriculum.


Indoor Mold, Dampness Are Linked to Respiratory Problems

Scientific evidence links mold and other factors related to damp conditions in homes and other buildings to asthma symptoms in some asthmatics as well as to coughing, wheezing, and other upper respiratory tract symptoms in otherwise healthy people, says a new Institute of Medicine report. The available evidence does not support an association between either interior dampness or mold and the wide range of other health complaints that have been ascribed to them, but the possibility of a link cannot be ruled out.


MMR Vaccine and Thimerosal-Containing Vaccines Are Not Associated With Autism

Based on a thorough review of clinical and epidemiological studies, neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine are associated with autism, says a new Institute of Medicine report. Hypotheses regarding how the MMR vaccine and thimerosal could trigger autism lack supporting evidence and are theoretical only. Further research to find the cause of autism should be directed toward other lines of inquiry that are supported by current knowledge and evidence and offer more promise for providing an answer.


Government Should Expand Its Role in Financing HIV/AIDS Treatment

The federal government should expand its role in the financing of HIV/AIDS treatment for low-income Americans to ensure that the thousands of HIV-infected people not receiving care through existing programs gain access to the services they need, says a new Institute of Medicine report. Ensuring that all low-income infected inviduals have access to necessary services will require a new national program with uniform eligibility and benefits.


Creating New Smallpox Therapies Requires Gov't, Private Coalition

Efficiently developing new drugs to combat smallpox requires closer collaboration among universities, pharmaceutical companies, and the federal government, says an article by participants of a recent National Academies workshop. The article, which proposes policies, incentives, and an infrastructure to help foster such collaboration, appears in the latest issue of Proceedings of the National Academy of Sciences.


Immediate, Careful Action Needed to Address HIV/AIDS in the Developing World

Aid organizations and governments should immediately launch their large-scale HIV/AIDS treatment programs in the developing world, while also determining ways to reduce the likelihood of treatment failure and drug resistance, says a new Institute of Medicine report. Addressing a critical shortage of qualified health care workers and support personnel in the countries where the epidemic is most severe will require partnerships, technology transfer, and the mobilization of a Peace Corps-like group of technical specialists.


More Access to High-Quality Mammography Needed to Reduce Cancer Deaths

While new technologies hold promise for increasing the accuracy of breast cancer detection, improving access to mammography and broadening the pool of medical personnel who can interpret mammograms offer the greatest potential for immediately reducing the number of breast cancer deaths in the United States, says a new report from the Institute of Medicine and the National Research Council.


More Funding Needed to Improve First-Line Malaria Treatment

Within the next five years, international organizations and world leaders should begin collectively to contribute 300 million dollars to 500 million dollars annually to create a global subsidy that would make new combination malaria treatments available to the poor for as little as 10 cents per treatment course, says a new Institute of Medicine report. Without significant investments in these new treatments, the malaria mortality rate in Africa and Asia could double in a few decades.


MEETING: Youth Population and Military Recruitment: Physical and Medical Standards

This committee will meet November 1-2 at the Academies' Keck Center in Washington DC. An agenda for open sessions will be posted by October 18. If you would like to attend or have any questions in the meantime, please contact Wendy Keenan, by e-mail at wkeenan@nas.edu or by telephone at (202) 334-1759.


National Effort Needed to Combat Childhood Obesity

Reversing the rapid rise in obesity among American children and youth will require a multipronged approach by schools, families, communities, industry, and government that is as comprehensive and ambitious as national anti-smoking efforts, according to a new Institute of Medicine report.


Report Examines Complementary and Alternative Medicine

Stating that health care should strive to be both comprehensive and evidence-based, a new Institute of Medicine report calls for conventional medical treatments and complementary and alternative treatments to be held to the same standards for demonstrating clinical effectiveness. Both also should follow the same general research principles, although new research methods to test some therapies may have to be devised.


Report Assesses Health Implications of Perchlorate Exposure

A new report by the National Academies' Board on Environmental Studies and Toxicology on the health effects of perchlorate -- a chemical that in high doses can decrease thyroid function in humans and that is present in many public drinking-water supplies -- says daily ingestion of up to 0.0007 milligrams per kilogram of body weight can occur without adversely affecting the health of even the most sensitive populations. That amount is more than 20 times the "reference dose" proposed by the US Environmental Protection Agency in a recent draft risk assessment.


Latest Gulf War Report Confirms Link Between Lung Cancer and Combustion Products

The available evidence is too sparse or of insufficient quality to determine whether the majority of health problems that may be experienced by Gulf War veterans could be associated with exposures to fuels for military vehicles, propellents in Scud missiles, or substances given off by combustion sources such as oil-well fires, exhausts, and tent heaters, says a new Institute of Medicine report. However, data from studies of occupational and environmental exposures to air pollution, vehicle exhaust, and other combustion products led the committee that wrote the report to conclude that exposure to such substances is associated with an increased risk of lung cancer.


Independent Oversight of Vaccine Safety Data Program Needed

Two new oversight groups are needed to ensure that the practices of the Vaccine Safety Datalink and its data-sharing program are implemented as fairly and openly as possible, says a new report from the Institute of Medicine of the National Academies. The Centers for Disease Control and Prevention, which oversees VSD and the data-sharing program, should create a new, independent committee to review researchers' proposals to use VSD data, monitor adherence to protocols, and advise the agency and its partners on when and how to release preliminary findings based on the data, the report says. In addition, CDC should use a new or existing NVAC subcommittee to enable stakeholders to review and provide input on the VSD research plan every year.


Human Transmission of Avian Virus Documented

The avian influenza virus can spread from human to human, according to a new study of the 2003 bird flu outbreak in the Netherlands. Previously it was not known whether the virus could only be transmitted through direct contact with birds. The indirect transmission of the virus means that large-scale human-to-human transmission is possible and could spark a pandemic if the virus mutates. Several Institute of Medicine resources examine issues related to influenza infection: + The report "Public Health Risks of Disasters: Communication, Infrastructure, and Preparedness" (2005) discusses ways to respond to public health disasters through interagency and interdisciplinary preparation. + The IOM Forum on Microbial Threats examines issues related to the prevention, detection, and management of emerging and re-emerging infectious diseases and dangerous pathogens. A June 2004 Forum workshop examined strategies for prevention and response. + Another IOM workshop, Pandemic Influenza: Assessing Capabilities for Prevention and Response, examines ways of preparing the public and policymakers for an influenza pandemic.


New Approaches Needed to Expand Spinal Cord Injury Research

Recent discoveries about the central nervous system could lead to progress for spinal cord injury patients, says a new report from the Institute of Medicine of the National Academies. Research that combines therapies and ways to treat injuries at different stages could speed progress toward a cure. The report also calls for the National Institutes of Health to establish a Spinal Cord Injury Research Network.


Perinatal HIV Prevention Study Data Valid

A Ugandan drug trial's findings that the AIDS medication nevirapine is effective and safe in preventing HIV transmission from mother to unborn child during birth were well supported, according to a new report from the National Academies' Institute of Medicine. This report is the subject of a one-hour public briefing on April 8 at 11:00a.m. EDT.


New Structure Proposed for Coordinating Cord Blood Banks

The US Department of Health and Human Services should establish a new National Cord Blood Policy Board to set rules for the banking and use of life-saving stem cells derived from donated umbilical cord blood, says a new report from the Institute of Medicine of the National Academies. The department's Health Resources and Services Administration also should call for proposals to identify an organization that would manage daily operations of cord blood banking and allocation nationwide.


Changes Proposed to Update Foods Offered Through WIC Program

Changes should be made to the WIC nutrition assistance program to encourage participants to consume more whole grains, fruits, and vegetables, as well as to promote breast-feeding and other goals, says a new report from the Institute of Medicine. If implemented, these revisions would be the most substantial changes to the mix of foods offered through WIC since the supplemental nutrition program was launched in 1974.


New Organization Needed to Build HIV/AIDS Work Force

The federal government should create an organization called the United States Global Health Service to mobilize highly skilled health care professionals and other experts to help combat HIV/AIDS in hard-hit African, Caribbean, and Southeast Asian countries, says a new report from the Institute of Medicine.


New Requirements Needed to Enhance Mammogram Interpretation

To help breast imaging facilities determine how accurately they are interpreting mammograms, FDA should require the facilities to collect specific data that can be used to better measure their staffs' performance, says a report from the Institute of Medicine. Questions about the quality of mammography interpretation have lingered since passage of the Mammography Quality Standards Act in 1992.


Confronting the Nation's Health Disparities

"Confronting the Nation's Health Disparities" is the topic of the Spring 2005 Institute of Medicine (IOM) Newsletter, which is now also available to read online.


Low Levels of Ionizing Radiation May Cause Harm

A preponderance of scientific evidence shows that even low doses of ionizing radiation, such as gamma rays and X-rays, are likely to pose some risk of adverse health effects, says a new report from the National Research Council. In living organisms, such radiation can cause DNA damage that could eventually lead to cancers. The report provides a comprehensive assessment of these risks based on a review of the scientific literature from the past 15 years. It is the seventh in a series of assessments from the Research Council called the Biological Effects of Ionizing Radiation.


FDA Needs System to Monitor Safety of Medical Devices on the Market

The US Food and Drug Administration lacks effective procedures to monitor safety studies that manufacturers are sometimes required to undertake when they put medical devices on the market, says a new report from the Institute of Medicine that specifically examines FDA's surveillance of medical devices used with children. Congress should ensure that the agency establishes a reliable system to track these postmarket studies and that key information about these studies is made public.


IOM President Discusses Thimerosal and Autism

On the August 7 broadcast of NBC's "Meet the Press," Institute of Medicine President Harvey V. Fineberg discussed the evidence that led an expert committee of the Institute to conclude in a 2004 report that thimerosal, a preservative once used in vaccines, is not associated with autism.


Nutrition Standards for Foods in Schools

The Institute of Medicine has established a committee to review and make recommendations on appropriate nutritional standards for the availability, sale, content, and consumption of foods at school. The committee will consider whether a single set of nutritional standards is appropriate for elementary, middle, and secondary schools, or if more than one set is needed; develop nutritional standards for foods and beverages offered in schools, with particular attention to foods offered in competition with federally reimbursed meals or snacks; and develop benchmarks to guide future evaluation studies of the application of the standards. The committee's report and recommendations will be released in fall 2006.


Promising Research in Fight Against Infectious Disease

Humans coexist with millions of harmless microorganisms, but emerging diseases, resistance to antibiotics, and the threat of bioterrorism are forcing scientists to look for new ways to confront the microbes that do pose a danger. A new National Research Council report identifies innovative approaches to the development of antimicrobial drugs and vaccines based on a greater understanding of how the human immune system interacts with both good and bad microbes. Development of a single superdrug to fight all infectious agents is unrealistic, however, the report says.


Strategy Needed to Address Mental Health, Substance-Use Problems

Without a comprehensive strategy to improve the quality of health care for people with mental conditions and alcohol or drug problems, high-quality care in the nation's overall health system and better health for the public are goals that will remain unmet, says a new report from the Institute of Medicine.


Initiatives Needed to Improve Care for Cancer Survivors

Citing shortfalls in the care currently provided to the United States' 10 million cancer survivors, a new report from the Institute of Medicine and National Research Council calls for better coordination between specialists and primary care providers and recommends that each cancer patient receive a "survivorship care plan" to guide follow-up care.


New System Needed to Measure and Report Health Care Performance

Improving the quality of health care in the United States requires a universally accepted system to measure and report on the performance of health care providers and organizations, says a new report from the Institute of Medicine. Congress should establish a new board within HHS to coordinate the development of standardized performance measures and monitor the nation's progress toward a better health care system.


Food Marketing Aimed at Kids Influences Poor Nutritional Choices

Food and beverage marketing targeted to children ages 12 and under leads them to request and consume high-calorie, low-nutrient products, according to a new report from the Institute of Medicine. The report offers the most comprehensive review to date of the scientific evidence on the influence of food marketing on the diets of children and youth.


Stem Cell Research Guidelines to Be Updated

The National Academies' National Research Council and Institute of Medicine are convening a new committee to provide updated guidelines on the conduct of human embryonic stem cell research. The guidelines are voluntary and intended to enhance the integrity of human embryonic stem cell research by encouraging responsible practices. They were issued last year by the Academies and will be periodically updated to reflect advances in stem cell science.


Materials from Vietnam Vet Health Study Should Remain Available for Research

The Air Force Health Study that was begun in 1979 to assess possible health effects of military personnel's exposure to Agent Orange and other defoliants sprayed during the Vietnam War will end September 30, 2006. The study data, records, and specimens merit further examination and should be transferred to a new custodian that would make the materials available for ongoing research, says a new report from the Institute of Medicine.


Polio Antivirals Should Be Developed

A new workshop report from the National Research Council says that polio antiviral drugs may be useful in the final stages of polio eradication and recommends that planning for the development of such drugs be initiated now. The World Health Organization plans to stop using oral polio vaccine three years after the last transmission of wild polio virus is detected, and an antiviral drug may be needed to control potential outbreaks of the disease in the future.


EPA Standard for Fluoride in Drinking Water Not Protective

Children exposed to drinking water containing 4 milligrams of fluoride per liter -- the Environmental Protection Agency's maximum allowable concentration -- risk developing severe tooth enamel fluorosis, says a new National Research Council report. About 200,000 Americans have drinking water with that much fluoride, which comes from both naturally occurring sources and pollution. A majority of the committee that wrote the report also said that people who consume water containing that much fluoride over a lifetime are likely at increased risk for bone fractures. The report does not examine artificially fluoridated water, which contains much less fluoride.


Efforts Needed to Boost Sleep Research, Treatment, and Awareness

Too few scientists study sleep disorders and too few health care professionals are trained in sleep medicine to meet the needs created by this underappreciated health problem, says a new report from the Institute of Medicine. The report recommends steps to improve diagnosis and care for people experiencing sleep problems, and calls for a national public awareness campaign on the importance of sleep.


No Simple Way to Reuse Facemasks During a Flu Pandemic

Given predictions that disposable facemasks will be in short supply if a flu pandemic strikes in the near future, the Institute of Medicine investigated whether these devices can be safely reused. A new report from the IOM says that there is currently no simple, reliable way to decontaminate disposable medical masks or respirators in order to enable people to safely use them more than once.


Report Identifies Best Ways to Increase Organ Donation

After examining a wide range of proposals to increase rates of organ donation, a new report from the Institute of Medicine urges greater efforts to educate the public about the benefits of organ donation and to boost opportunities for people to record their decisions to donate. Additional efforts to sustain quality improvements in the donation system are also needed.


Asbestos Exposure Is Linked to Cancer of the Larynx

Sufficient scientific evidence indicates that asbestos exposure can cause laryngeal cancer, says a new report from the Institute of Medicine. There is suggestive but ultimately insufficient evidence that asbestos exposure can cause pharyngeal, stomach, or colorectal cancer; the evidence about esophageal cancer and asbestos is indeterminate.


Emergency Care System Needs Funds, Coordination

The nation's emergency medical system is overburdened, underfunded, and highly fragmented, says a new series of three reports from the Institute of Medicine. The reports call for a significant infusion of funds to bolster the system's capabilities and recommend actions to reduce crowding of emergency departments, boost the number of specialists involved in emergency care, and increase regional collaboration among all emergency medical services in an area.


IOM Names New Health Policy Fellows

The Institute of Medicine has named seven new Robert Wood Johnson Foundation Health Policy Fellows for 2006-07. The fellows will spend a year in Washington DC enriching their understanding of public policy practices so that they can apply their experiences to improving health policy and management in their states and communities.


Premature Births Cost US $26 Billion Each Year

The high rate of premature births in the United States constitutes a public health concern that costs society at least $26 billion a year, according to a new report from the Institute of Medicine. "Preterm Birth: Causes, Consequences, and Prevention" also notes troubling disparities in preterm birth rates among different racial and ethnic groups. The report recommends a multidisciplinary research agenda to improve the prediction and prevention of preterm labor and better understand the health and developmental problems to which preterm infants are more vulnerable. In addition, the report recommends that guidelines be issued to reduce the number of multiple births -- a significant risk factor for preterm birth -- resulting from infertility treatments.


Comprehensive Strategy Needed to Prevent Medication Errors

Medication errors harm at least 1.5 million people every year and result in billions of dollars in extra medical costs, says a new report from the Institute of Medicine. The report recommends improved communication between health care providers and patients, nationwide use of electronic prescribing systems, and efforts to address problems associated with drug naming and labeling, among other steps to reduce drug-related mistakes.


Biomonitoring Advances Pose Scientific, Communication Challenges

New technologies make biomonitoring -- the measurement of toxic chemicals in the body -- a valuable tool in studying environmental contaminants, but more research is needed on the implications for human health, says a new National Research Council report. The report provides a framework for developing and using biomarkers, including research to improve the interpretation of data, ways to communicate findings to the public, and a review of ethical issues.


Evidence Growing on TCE's Health Risks

A new National Research Council report recommends research to advance understanding of how trichloroethylene, an environmental contaminant often referred to as TCE, causes cancer and other adverse health effects, but adds that enough information exists for EPA to complete a credible human health risk assessment now.


'Transdisciplinary' Research Needed to Understand Determinants of Health

A shift from research conducted within individual disciplines to projects that engage investigators from a range of fields is needed to capitalize on expanding knowledge of how genetic, social, and environmental factors interact to influence health, says a new report from the Institute of Medicine. Funders and academic research centers should revise their grant and reward mechanisms to support this type of research.


Posttraumatic Stress Disorder: Diagnosis and Assessment

At the request of the Department of Veterans Affairs, the Institute of Medicine conducted a study on Posttraumatic Stress Disorder (PTSD). All veterans deployed to a war zone are at risk for the development of PTSD. The report recommends therefore (1) that health professionals query veterans about their wartime experiences and their symptoms when they present at health facilities and (2) that the disorder be diagnosed and assessed by a health professional with experience in diagnosing psychiatric disorders (e.g., primary care physicians, nurses, social workers) using the DSM-IV criteria.


ALS Associated With Gulf War Service, But No Unique Syndrome

Evidence suggests there may be an elevated rate of amyotrophic lateral sclerosis (ALS) among Gulf War veterans as well as increased risk for developing certain psychological conditions, says a new report from the Institute of Medicine. Although these veterans report symptoms of illness at high rates, studies have not found a cluster of symptoms that constitutes a unique syndrome.


Progress Is Slow in Reversing Childhood Obesity Trend

Innovative actions and interventions to reduce childhood obesity are encouraging, but most of the programs are not being evaluated, making it difficult to identify effective practices, according to a new report from the Institute of Medicine. The report, based on a study funded by the Robert Wood Johnson Foundation, provides an evaluation framework to assess progress for a range of childhood obesity prevention efforts across different sectors and settings, measures progress related to recommendations in the 2005 report, and offers recommendations for leadership and commitment to childhood obesity prevention efforts.


Preventing HIV Infection among Injecting Drug Users in High Risk Countries

The sharing of contaminated injecting equipment has become a driving force behind the global AIDS epidemic and is the primary mode of HIV transmission in many countries, including in Eastern Europe, the Commonwealth of Independent States, and much of Asia. HIV spreads rapidly from drug users to their partners through sexual transmission, and from drug users and their partners to newborns. With funding from the Bill & Melinda Gates Foundation, the Institute of Medicine has evaluated strategies for preventing HIV transmission among injecting drug users and, in its report "Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence," finds that several key approaches can reduce the use and injection of illegal drugs and curb other drug- and sex-related risk behavior that increases the risk of HIV infection.


Strengthening the US Drug Safety System

A lack of clear regulatory authority, chronic underfunding, organizational problems, and scarcity of data hamper the US Food and Drug Administration's ability to evaluate and address the safety of prescription drugs after they have reached the market, according to a new report from the Institute of Medicine. The report recommends steps to strengthen FDA's authority and enforcement tools to help protect the health of the public.


Medicare Should Gradually Adopt Pay-for-Performance System

Because Medicare's current fee-for-service payment system does little to promote improvements in health care quality, it should be gradually replaced with a new pay-for-performance system for reimbursing participating health care providers, says a new report from the Institute of Medicine. The new system should be phased in to build on lessons learned along the way and to avoid unintended negative consequences.


Addressing Foodborne Threats to Health

Foodborne agents have been estimated to cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,200 deaths in the United States each year. The potential impact on human health of deliberate adulteration of food can be estimated from documented examples of unintentional outbreaks of foodborne disease, some of which have sickened hundreds of thousands of people and killed hundreds. The Institute of Medicine's Forum on Microbial Threats hosted a public workshop to examine issues critical to the protection of the nation's food supply, including existing knowledge and unanswered questions about the nature and extent of foodborne threats to health. This report is a summary of that workshop.


Infections Linked to Long-Term Health Problems in Some Veterans

A comprehensive assessment of scientific literature shows that nine infectious diseases -- brucellosis, three diarrheal diseases, leishmaniasis, malaria, Q fever, tuberculosis, and West Nile virus infection -- diagnosed in US military personnel during the Persian Gulf War and current military operations in Afghanistan and Iraq are associated with long-term adverse health outcomes, says a new Institute of Medicine report.


Consumers Need Better Guidance to Weigh Benefits and Risks of Seafood

The fragmented information that consumers receive about the nutritional value and health risks associated with seafood can result in confusion or misperceptions about this food source, says a new report by the Institute of Medicine. The report reviews the scientific evidence on seafood's benefits and risks and offers examples of how such information might be presented in a more coherent way to the public.


Vaccine Exemptions May Have Increased Rates of Whooping Cough

Rates of whooping cough were almost 90 percent higher in the 19 states where parents can exempt their children from vaccinations for personal beliefs than in states that allow exemptions only for medical or religious reasons, according to a study published in the Journal of the American Medical Association. The Institute of Medicine (IOM) has issued many reports on concerns about the safety of childhood immunization. The reports found no causal link between vaccines and autism or sudden infant death syndrome. The Institute also offers an informational website about immunization safety.


Studies Find That Blacks Receive Lower-Quality Health Care

A series of studies on race and health published in the Journal of the American Medical Association has shown that racial minorities regularly receive lower-quality health care than whites in the United States. They are less likely to undergo major surgeries at hospitals that specialize in those procedures. Among Medicare enrollees, black patients fared worse than white patients on several health measures regardless of the quality of their insurance plans. In addition, black women are less likely to survive breast cancer than their white counterparts.


Possible Link Between Military Service and Lou Gehrig's Disease

A limited number of studies suggest an association between military service -- including in the Gulf War -- and later development of amyotrophic lateral sclerosis, a rare but fatal disorder also known as Lou Gehrig's disease, according to a new report from the Institute of Medicine. Because there are so few studies, more research is needed to confirm this link.


Dearth of Evidence on Pandemic Flu Interventions

Computer models and analyses of past flu outbreaks indicate that there is a role for community-wide intervention -- such as isolating infected people or voluntary quarantine -- to control illnesses and deaths during the next pandemic flu, says a new report from the Institute of Medicine. It adds, however, that government and community leaders should not overstate the certainty about their effectiveness.


Cancer Control Opportunities in Low- and Middle-Income Countries

Cancer is generally low or absent on the health agenda of most of the world’s low- and middle-income countries (LMCs), even as it is growing as a share of these countries' overall disease burden. The Institute of Medicine's new report "Cancer Control Opportunities in Low- and Middle-Income Countries" describes a series of appropriate and feasible "next steps" that will help LMCs begin to lessen the toll that cancer takes on their citizens.


Risks of Egg Donation for Stem Cell Research: Workshop Summary

Stem cell research has the potential to revolutionize the treatment of many health problems including chronic heart disease, Type I diabetes, Parkinson's disease, and spinal cord injuries. This research, however, would require a steady supply of stem cells, particularly human embryonic stem cells, which are created from eggs (oocytes) harvested from the ovaries of female donors. The egg donation process is not without risks to donors. The National Academies held a workshop in September 2006 to discuss what is known about these risks, what needs to be known, and what can be done to minimize them. This workshop summary includes discussions of the comparative risks of donating eggs for research vs. reproductive purposes, and the likelihood of experiencing medical problems, psychological harm, or complications resulting from the surgical extraction of eggs.


Improving the Process for Disability Determination

The US Social Security Administration should conduct research to validate and improve the screening tool it uses to identify applicants who are clearly disabled and should be granted benefits without further scrutiny, says a new report by the Institute of Medicine. The agency can also improve its process for making such revisions by tapping its own program data and obtaining more input from outside disability experts.


Influence of Pregnancy Weight on Maternal and Child Health: Workshop Report

A new report from the National Research Council and Institute of Medicine summarizes views presented at a workshop on recent US trends in women's weight before, during, and after pregnancy, and its impact on the health of mothers and their children. The workshop was held last May in Washington DC.


Smart Prosthetics Conference Summary

Last November the National Academies Keck Futures Initiative held a conference where more than 150 researchers from various disciplines gathered to discuss challenges in the prosthetics field. A summary of the conference recaps these discussions, which explored different problems to developing smart assistive devices and possible solutions.


IOM Gets the "Safe-Rx Evangelist" Award

In recognition of the Institute of Medicine's outstanding leadership on the issue of patient safety and preventable medication errors, a coalition of community pharmacies and patient safety advocates presented the IOM with the Safe-Rx Evangelist Award. The award -- presented by the National Association of Chain Drug Stores, the National Community Pharmacists Association, and SureScripts -- goes to a single person or organization whose advocacy has made an exceptional impact on the awareness and prevention of medication errors.


Cancer in Elderly People: Workshop Proceedings

The IOM's National Cancer Policy Forum sponsored a public workshop addressing several issues related to cancer and aging, including cancer rehabilitation, increased prevalence of cancer survivors, end of life care, the role of nurses, and Medicare costs in geriatric oncology.


US HIV/AIDS Efforts Should Shift Focus to Sustainability

The US government's global HIV/AIDS relief program known as PEPFAR is making significant contributions to addressing the pandemic in hard-hit countries, but should shift its primary focus from providing immediate, emergency relief to building the capacity of affected nations to sustain their fight against HIV/AIDS over future decades, says a new report from the Institute of Medicine and National Research Council.


Comprehensive Plan Needed for Biomarker R&D

Federal agencies and other research funders, academic scientists, and private industry should take a comprehensive approach to research and development in cancer biomarkers, a field now hindered by piecemeal and unorganized efforts, says a new report from the Institute of Medicine.


US HIV/AIDS Efforts Should Shift Focus to Sustainability

The US government's global HIV/AIDS relief program, known as PEPFAR, is making significant contributions to addressing the pandemic in hard-hit countries, but it should shift its primary focus from providing immediate, emergency relief to building the capacity of affected nations to sustain their fight against HIV/AIDS over future decades, says a new report from the Institute of Medicine and National Research Council.


Adverse Drug Event Reporting

All drugs undergo extensive safety and efficacy studies before being released; however, these studies can fail to identify potential adverse reactions that are rare or develop over a long period of use. As a result, serious adverse reactions may not be fully appreciated until a drug has been on the market for many years. Although the FDA monitors postmarket adverse drug events through its Adverse Event Reporting System and periodic reports submitted by the drugs' sponsors, concern has been raised about the effectiveness of the current post-market review system. An IOM workshop addressed this critical concern; the resulting workshop summary explores issues associated with the reporting of adverse drug events and considers ways to enhance the roles of clinicians and patients in reporting such events.


The Learning Healthcare System: Workshop Summary

This summary of an Institute of Medicine workshop on The Learning Healthcare System is the first in a series that will focus on issues important to improving the development and application of evidence in healthcare decision making. The workshop was hosted by the Roundtable on Evidence-Based Medicine.


Nutrition Standards Proposed for 'Competitive' Foods in Schools

A new report by the Institute of Medicine proposes a set of nutritional standards for foods and drinks available in schools that compete with the national school meal programs. The standards promote consumption of fruits, vegetables, whole grains, and nonfat or low-fat dairy products and limit the amount of saturated fat, salt, added sugars, and total calories. The standards also recommend against the sale of caffeinated items.


Outdated Policies Are Impediment for Americans with Disabilities

Although the Americans with Disabilities Act has helped increase awareness of barriers faced by people with disabilities, and advances in science and engineering have led to better assistive technologies that make it easier for individuals to lead productive, independent lives, outdated regulations too often impede access to health care coverage and assistive devices for many who need them, says a new report by the Institute of Medicine.


VA Should Revise the Way it Evaluates, Compensates Vets for PTSD

The US Department of Veterans Affairs needs to revise its methods of evaluating former military personnel for service-connected post-traumatic stress disorder (PTSD) and of determining appropriate compensation, says a new report from the Institute of Medicine and National Research Council. The report also addresses questions about when symptoms can manifest and about handling claims related to sexual assault during military service.


Two-Pronged Approach Needed to Tackle Tobacco Problem

To further curb smoking in the United States requires not only strengthening current tobacco control measures but also creating a stronger role for federal oversight of the production, promotion, and sale of tobacco products, says a new report from the Institute of Medicine. Among other steps, the report recommends a combination of higher excise taxes, indoor smoking bans nationwide, and regulation of marketing and distribution.


Mining Safety and Health Research

The US mining sector has the highest fatality rate of any industry in the country. Advances made over the past three decades in mining technology, equipment, processes, procedures, and workforce education and training have significantly improved safety and health. The National Institute for Occupational Safety and Health (NIOSH) Mining Safety and Health Research Program (Mining Program) has played a large role in these improvements. This report assesses the relevance of the NIOSH Mining Program research and makes suggestions to further increase its effectiveness.


Shortage of Public Health Physicians a Concern

To attract physicians to public health careers and adequately prepare them for current and emerging challenges, more funding is needed to strengthen and sustain public health training programs and to offer financial incentives to keep these professionals in the field, says a new Institute of Medicine report. The estimated number of practicing physicians in public health is about half of what may be needed in the near future.


Report Calls for New Approach to Toxicity Testing

Recent advances in systems biology and related scientific fields offer the potential to fundamentally change the way chemicals are tested for risks they may pose to humans, says a new report from the National Research Council. The report outlines a new approach that would rely less on animal studies and more on in vitro methods that use cells or cellular components, preferably of human origin.


Report Release -- Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress

Military service in a war zone increases service members' chances of developing post-traumatic stress disorder (PTSD), other anxiety disorders, and depression, says a new report from the Institute of Medicine. Serving in a war also increases the chances of alcohol abuse, accidental death, and suicide within the first few years after leaving the war zone, and marital and family conflict, including domestic violence, said the committee that wrote the report at the request of the U.S. Department of Veterans Affairs, which asked for a comprehensive analysis of the scientific and medical evidence concerning associations between deployment-related stress and long-term, adverse effects on health.


Podcast: What Works for Health Care?

There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. This podcast looks at some of the basic findings of the IOM report.


Efforts Needed to Expand Health Care Work Force for Aging Nation

Aging Americans will face a health care work force that is too small and woefully unprepared to meet their specific health needs unless efforts start now to ensure all health care providers know how to treat the common conditions associated with aging and to boost recruitment and retention of geriatric specialists and direct- care aides, says a new report from the Institute of Medicine.


Knowing What Works in Health Care: A Roadmap for the Nation

There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. The United States must substantially strengthen its capacity for assessing evidence on what is known and not known about "what works" in health care. Knowing What Works in Health Care looks at the three fundamental health care issues in the United States--setting priorities for evidence assessment, assessing evidence (systematic review), and developing evidence-based clinical practice guidelines--and how each of these contributes to the end goal of effective, practical health care systems.


National Discussion Needed on Antiviral Drug Distribution During a Flu Pandemic

Uncertainties about availability and effectiveness of antiviral drugs against the next pandemic strain of flu virus require officials to begin a national discussion about the difficult choices they may be forced to make about the drugs' distribution in the event of an outbreak, says a new report from the Institute of Medicine.


Initial Guidance for an Update of the National Vaccine Plan: A Letter Report to the National Vaccine Program Office

Like other medical products, vaccines have benefits and risks, and in recent decades vaccine safety has emerged as an important topic both for the public health and medical communities and for the public. Research on vaccine safety has increased and regulatory attention to safety has intensified.

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Assessment of the Role of Intermittent Preventive Treatment for Malaria in Infants: Letter Report

Intermittent Preventive Treatment for Malaria in Infants (IPTi) is a new strategy which aims to combine the short-term protection of chemoprophylaxis with the long-term protection of naturally acquired immunity. The Bill and Melinda Gates Foundation requested that the Institute of Medicine (IOM) conduct an independent assessment (with emphasis on the work done by the IPTi consortium) of the utility, safety, and operational aspects of IPTi to provide a comprehensive, and transparent analysis. In order to fully examine the issue of IPTi, the IOM convened a committee to evaluate the evidence concerning Intermittent Preventive Treatment for Malaria in Infants using sulfadoxine-pyrimethamine (IPTi-SP). Overall, the Committee finds that the evidence presented supports the case for continued investment in IPTi-SP as a promising public health strategy to diminish the morbidity from malaria infections among infants at high risk.

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Challenges and Successes in Reducing Health Disparities: Workshop Summary

In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities.

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Addressing the Barriers to Pediatric Drug Development: Workshop Summary

Decades of research have demonstrated that children do not respond to medications in the same way as adults. Addressing the Barriers to Pediatric Drug Development is the summary of a workshop, held in Washington, D.C. on June 13, 2006, that was organized to identify barriers to the development and testing of drugs for pediatric populations, as well as ways in which the system can be improved to facilitate better treatments for children.

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Dispensing Medical Countermeasures for Public Health Emergencies: Workshop Summary

Countermeasure dispensing must harness all types of imaginative partnerships between public and private institutions, working together in ways tailored to meet individual community needs. This workshop summary highlights the presentations and subsequent discussion that occurred at the workshop.

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National Immunization Awareness Month

The U.S. Centers for Disease Control and Prevention recognize August as National Immunization Awareness Month. While many people are routinely immunized, there are still tens of thousands of deaths around the world caused by vaccine-preventable diseases. The IOM considers the national immunization system to be highly successful, providing invaluable protection against infectious disease. While many people already participate in the vaccination program, a new approach toward financing and distributing vaccines would achieve broader public access to immunization throughout the U.S. and also help sustain the development and production of vaccines in the future.

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Community Perspectives on Obesity Prevention in Children

The Institute of Medicine conducted a workshop in June 2008 about community perspectives on childhood obesity prevention. This workshop featured site-leaders and evaluators representing different locally-based childhood obesity prevention programs. These participants are key stakeholders in community led initiatives for obesity prevention. A discussion about the challenges and promising approaches for evaluating and acting on complex policy as well as programmatic interventions to prevent obesity and its health consequences are documented in the summary entitled Community Perspectives on Childhood Obesity Prevention.

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Global Climate Change and Extreme Weather Events: Understanding the Potential Contributions to the Spread of Infectious Disease

Long before the “germ theory” of disease was described, late in the nineteenth century, humans knew that climatic conditions influence the appearance and spread of epidemic diseases.Ancient notions about the effects of weather and climate on disease remainembedded in our collective consciousness—through expressionssuch as “cold” for rhinovirus infections; “malaria,” derived from the Latin for “bad air;” and the common complaint of feeling “under the weather.” Today, evidence is mounting that earth’s climate is changing at a faster rate than previously appreciated, leading researchers to view the longstanding relationships between climate and disease with new urgency and from a global perspective. On December 4 and 5, 2007, the Forum on Microbial Threats hosted a public workshop in Washington, DC to consider the possible infectious disease impacts of global climate change and extreme weather events on human, animal, and plant health, as well as their expected implications for global and national security.

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Guidelines for Embryonic Stem Cell Research Amended

The National Academies have updated their guidelines for the responsible conduct of research using human embryonic stem cells. These voluntary guidelines are based on a joint National Research Council-Institute of Medicine committee's review of scientific, ethical, and policy issues that have arisen since the guidelines were last updated in 2007.

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Emergency Room Wait Times Continue to Increase

The number of emergency room visits in the United States increased by 20 percent between 1995 and 2005, according to the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics. Wait times have also been on the rise. In 2006 the Institute of Medicine produced Hospital-Based Emergency Care: At the Breaking Point to address quality-of-care concerns as society’s requirements of emergency room medicine have evolved. The book is part of the three-volume Future of Emergency Care series, which provides recommendations for addressing issues that face an overtaxed emergency health care system.

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From Molecules to Minds: Challenges for the 21st Century

On June 25, 2008, the IOM Forum on Neuroscience and Nervous System Disorders hosted more than 70 of the leading neuroscientists in the world, for a workshop titled From Molecules to Minds: Challenges for the 21st Century. The objective of the workshop was to explore a set of common goals or "Grand Challenges" posed by participants that could inspire and rally both the scientific community and the public to consider the possibilities for neuroscience in the 21st century.

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Largest Children’s Health Study in U.S. Gets Under Way

In January 2009 the National Children’s Study, or NCS, will start recruiting 100,000 mothers-to-be for the largest study of U.S. children ever with the goal of examining how the environment and other factors affect children’s health. The study plans to examine everything from the mother’s diet during pregnancy to the effects of chemicals used in plastics, and will follow each child until he or she reaches 21 years of age. In May of this year, the National Research Council and Institute of Medicine released a report titled “The National Children's Study Research Plan: A Review,” which evaluated the study’s research plan and assessed its scientific rigor. The report concluded that if NCS is conducted as proposed, the database derived from the study should be valuable, although there are important weaknesses and shortcomings in the plan which diminish the study’s value.

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Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes and Innovation

The Roundtable on Evidence Based Medicine is convening a workshop November 17-18, 2008 in Washington, D.C. to explore approaches to assessing and improving value, including case studies of tools that are currently being used to promote value, as well as developments on the horizon that may impact the value proposition.

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From Molecules to Minds: Challenges for the 21st Century: Workshop Summary

Neuroscience has made phenomenal advances over the past 50 years and the pace of discovery continues to accelerate. On June 25, 2008, the Institute of Medicine (IOM) Forum on Neuroscience and Nervous System Disorders hosted more than 70 of the leading neuroscientists in the world, for a workshop titled "From Molecules to Minds: Challenges for the 21st Century." The objective of the workshop was to explore a set of common goals or "Grand Challenges" posed by participants that could inspire and rally both the scientific community and the public to consider the possibilities for neuroscience in the 21st century.

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For additional information visit The National Academies Subject page.