Institute of Medicine

Division of Health Promotion and Disease Prevention

Committee to Study Priorities for Vaccine Development

Vaccines have made it possible to eradicate the scourge of smallpox, promise the same for polio, and have profoundly reduced the threat posed by other diseases such as whooping cough, measles, and meningitis. What is next? There are many pathogens, autoimmune diseases, and cancers that may be promising targets for vaccine research and development. This volume provides an analytic framework and quantitative model for evaluating disease conditions that can be applied by those setting priorities for vaccine development over the coming decades. The committee describes an approach for comparing potential new vaccines based on their impact on morbidity and mortality and on the costs of both health care and vaccine development. The book examines: Lessons to be learned from the polio experience. Scientific advances that set the stage for new vaccines. Factors that affect how vaccines are used in the population. Value judgments and ethical questions raised by comparison of health needs and benefits. The committee provides a way to compare different forms of illness and set vaccine priorities without assigning a monetary value to lives. Their recommendations will be important to anyone involved in science policy and public health planning: policymakers, regulators, health care providers, vaccine manufacturers, and researchers.

A Tool for Decisionmaking

Vaccines for the 21st Century

Committee to Study Medical Professional Liability and the Delivery of Obstetrical Care

The second volume of an overall look at the "malpractice crisis" sheds fresh light on the civil justice and insurance systems, medical liability issues, and their combined effect on health care for mothers and children. Topics include the liability implications of the rising rate of Cesarean sections, an evaluation of the American Medical Association's proposed alternative to the justice system for resolving medical liability disputes, and a review of legislative proposals under consideration.

Volume II, An Interdisciplinary Review

Medical Professional Liability and the Delivery of Obstetrical Care

Division of Health Sciences Policy

Committee for Evaluating Medical Technologies in Clinical Use

New drugs, new devices, improved surgical techniques, and innovative diagnostic procedures and equipment emerge rapidly. But development of these technologies has outpaced evaluation of their safety, efficacy, cost-effectiveness, and ethical and social consequences. This volume, which is "strongly recommended" by The New England Journal of Medicine "to all those interested in the future of the practice of medicine," examines how new discoveries can be translated into better care, and how the current system's inefficiencies prevent effective health care delivery. In addition, the book offers detailed profiles of 20 organizations currently involved in medical technology assessment, and proposes ways to organize U.S. efforts and create a coordinated national system for evaluating new medical treatments and technology.

Assessing Medical Technologies

Committee on Health Effects Associated with Exposures During the Gulf War

The men and women who served in the Gulf War theater were potentially exposed to a wide range of biological and chemical agents. Gulf War and Health: Volume 1 assesses the scientific literature concerning the association between these agents and the adverse health effects currently experienced by a large number of veterans.

Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and Vaccines

Gulf War and Health

Committee on the Elimination of Tuberculosis in the United States

Tuberculosis emerged as an epidemic in the 1600s, began to decline as sanitation improved in the 19th century, and retreated further when effective therapy was developed in the 1950s. TB was virtually forgotten until a recent resurgence in the U.S. and around the world-ominously, in forms resistant to commonly used medicines. What must the nation do to eliminate TB? The distinguished committee from the Institute of Medicine offers recommendations in the key areas of epidemiology and prevention, diagnosis and treatment, funding and organization of public initiatives, and the U.S. role worldwide. The panel also focuses on how to mobilize policy makers and the public to effective action. The book provides important background on the pathology of tuberculosis, its history and status in the U.S., and the public and private response. The committee explains how the U.S. can act with both self-interest and humanitarianism in addressing the worldwide incidence of TB.

The Elimination of Tuberculosis in the United States

Ending Neglect

Committee on HIV Prevention Strategies in the United States

The United States has spent two productive decades implementing a variety of prevention programs. While these efforts have slowed the rate of infection, challenges remain. The United States must refocus its efforts to contain the spread of HIV and AIDS in a way that would prevent as many new HIV infections as possible. No Time to Lose presents the Institute of Medicineâ€™s framework for a national prevention strategy.

Getting More from HIV Prevention

No Time to Lose

Committee to Review the Evidence Regarding the Link Between Exposure to Agent Orange and Diabetes

In response to the concerns voiced by Vietnam veterans and their families, Congress called upon the National Academy of Sciences (NAS) to review the scientific evidence on the possible health effects of exposure to Agent Orange and other herbicides. This call resulted in the creation of the first NAS Institute of Medicine Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides in 1992. The committee published its initial findings in the 1994 report Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. This report is the result of a 1999 request from the Department of Veterans Affairs (DVA) under the aegis of the Veterans and Agent Orange research program. Specifically, DVA asked the committee to examine evidence regarding the association, if any, between Type 2 diabetes and exposure to dioxin and other chemical compounds in herbicides used in Vietnam. Veterans and Agent Orange: Herbicide/Dioxin Exposure and Type 2 Diabetes reviews the scientific evidence regarding the association, if any, between Type 2 diabetes1 and exposure to dioxin2 and other chemical compounds in herbicides used in Vietnam. This report examines, to the extent that available data permitted meaningful determinations, (1) whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiologic methods used to detect the association; (2) the increased risk of the disease among those exposed to herbicides during Vietnam service; and (3) whether there is a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

Herbicide/Dioxin Exposure and Type 2 Diabetes

Veterans and Agent Orange

Committee on the Assessment of Asthma and Indoor Air

Since about 1980, asthma prevalence and asthma-related hospitalizations and deaths have increased substantially, especially among children. Of particular concern is the high mortality rate among African Americans with asthma. Recent studies have suggested that indoor exposures--to dust mites, cockroaches, mold, pet dander, tobacco smoke, and other biological and chemical pollutants--may influence the disease course of asthma. To ensure an appropriate response, public health and education officials have sought a science-based assessment of asthma and its relationship to indoor air exposures. Clearing the Air meets this need. This book examines how indoor pollutants contribute to asthma-- its causation, prevalence, triggering, and severity. The committee discusses asthma among the general population and in sensitive subpopulations including children, low-income individuals, and urban residents. Based on the most current findings, the book also evaluates the scientific basis for mitigating the effects of indoor air pollutants implicated in asthma. The committee identifies priorities for public health policy, public education outreach, preventive intervention, and further research.

Division of Health Promotion and Disease Prevention

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