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When the Institute of Medicine reports, the country listens: An interview with IOM president Harvey V. Fineberg, MD, PhD

With an agenda as broad as health care itself, few topics are off limits.

By — Posted Aug. 10, 2009

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The IOM reports are intended to inspire action, and they have.

Reports on quality and safety continue to encourage changes ranging from hand-washing guidelines to electronic health records systems. A report on resident work hours is stimulating renewed discussion on the balance between learning opportunities and work-hour restrictions. In April, the institute issued a report warning that conflicts of interest between physicians and drug companies could undermine the integrity of medicine.

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Dr. Fineberg

American Medical News recently spoke with IOM President Harvey V. Fineberg, MD, PhD, about the agency's role and mission. Here are portions of that interview.

AMNews:How do you decide what to report on?

Dr. Fineberg: Ideas come from many sources. They may come from an agency of government that turns to the IOM for help sorting out an issue. Last week I met with officials of the CDC who are working day and night in preparation for the H1N1 pandemic. They asked us if we could help on certain aspects of advice to health care workers.

Or Congress may ask us for a report. We were asked to design a way of setting research priorities and identifying the initial topics that deserve to be assessed in a comparative way.

From time to time, we will receive letters or other communications from physicians or physician [organizations] who will bring a topic to our attention and say this is something that deserves scrutiny. A couple of years ago, we received a letter about the sorry state of emergency services. We were able to assemble the funding necessary to carry out this project, and we produced three reports on emergency services in the nation.

Sometimes we hear from professional societies.

As these ideas come in, we have a set of boards that focus on a cluster of topics. For example, we have a Board on Health Care Services, a Board on Health Sciences Policy and so on. There are nine boards. The boards are the way we review, assess and prioritize and also seek support for report ideas.

AMNews: How do you select members for the committees that issue reports?

Dr. Fineberg: We have a large roster of people who served previously. We also seek input from leaders of the various sections of the elected members. This is one link between elected members and our purposeful advisory function. We identify the types of people by background and expertise. We try to develop a pool of candidates. And we assemble a committee by balance and mix and willingness to serve. ...

All appointments are subject to public comment and our review for conflict of interest and bias. We are scrupulous about trying to eliminate conflicts, which in our terms are financial conflicts, and bias, which means a pre-formed view. And many experts have pre-formed views.

We ask people to adopt an open mind to the evidence they will review together. And we try to balance the committees in terms of backgrounds and predispositions. We try very hard to keep conflict of interest out of our committees so the people who serve do not have a financial stake in the outcome.

AMNews: What has been the impact of some of the reports?

Dr. Fineberg: The classic reports on quality and safety, "Crossing the Quality Chasm" and "To Err is Human," created a tremendous response immediately -- everything from a White House conference to a $50 million appropriation by Congress to the Agency for Healthcare Research and Quality to Senate activities that have continued and even accelerated to this day. They had a profound impact.

At the request of Congress, we did a review of the President's Emergency Plan for AIDS Relief at the time Congress was considering its renewal. The report the IOM produced was instrumental in reshaping the PEPFAR program [launched in 2003 to work in partnership with other nations to treat, prevent and care for people with AIDS, as well as children orphaned by the disease].

Take another controversial report, the report on residency duty hours. This report has stimulated a renewed discussion. It is now coming back to the Joint Commission and the accreditation bodies to rethink it and re-.

Will there be changes in conformity with the [report's] recommendations? That remains to be seen. It has certainly stimulated an examination of our current practices.

AMNews:Is there anything in the world of medicine that is off limits to the IOM?

Dr. Fineberg: Nothing is off limits. If a subject matters to medicine, sooner or later it is likely to come up on the agenda of the IOM.

Some subjects are very touchy. We just completed a report on conflict of interest that was very difficult and emotional. I think we developed a thoughtful, balanced, yet critical report.

I like to tell people that I'm based in Washington, and my only real job is to tell the truth. It's a great job.

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ADDITIONAL INFORMATION

Harvey V. Fineberg, MD, PhD

Title: President, Institute of Medicine

Medical school: Harvard Medical School

Age: 63

Wife: Mary Elizabeth Wilson, MD, associate professor in the Dept. of Global Health and Population at Harvard School of Public Health and associate clinical professor at Harvard Medical School.

Hometown: Pittsburgh

Work experience: Provost of Harvard University, 1997-2001; dean of Harvard School of Public Health, 1984-1997. Helped create and served as president of the Society for Medical Decision Making. Co-author of The Epidemic that Never Was: Policy-making & the Swine Flu Scare, an analysis of the government's 1976 immunization program.

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