I.O.M. :  Mhmoires & I'Accouchement

BY

Donald S. Fredrickson

An essay prepared by invitation in connection with

     The twentieth anniversary of

       The Institute of Medicine

June 12, 1990

Quotation from or reproduction of this ms. only upon permission of the author


Jntroduction

   I've a good-sized personal investment in the history of the

Institute of Medicine.  It includes one of the important turning

points in my career.  Someone might view it as merely the briefest

stopping point, considering that I served as IOM president for only

a year.  But I had been exposed to the attractions of an "academy

of medicine" well before I walked away in 1974 from a twenty-year

career in clinical investigation and a large laboratory at NIH in

the peak of its productivity.  At the time,  I explained the move

as resulting from an irresistible compulsion to listen to "other

drums", the yielding to a powerful urge to explore the other sides

of my profession as a physician. Here follows a description of what

happened.

Birth of an IdeR

   By the time Irvine Page's first editorial appeared in the

summer of 1964, I,  like many others,  had already heard the

originator spell out his reasons for the need for an Academy of
Medicine."  In the early 60s I was a member of his Stouffer Prize

Committee,  which gathered annually in Cleveland to decide who

should be that year's recipient(s) of a then gigantic reward of

$50,000   for discovery relating to either atherosclerosis or

hypertension.     This   bolus of  recognition   tossed   upon an

embarrassingly circumscribed area of medical research was provided

by Vernon Stouffer, the food magnate.   The idea was generally

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acknowledged to have been inspired by Irv Page.  Page's personal

crusade for an academy of medicine was something much more serious

than the Stouffer Prize.   One had only to listen briefly to his

arguments to believe that his was a genuine, deep belief that
medicine was a singular profession rising out of a tradition to

serve humanity through a combination of scientific,  moral and

social actions.  He considered that an institution was needed to

honor the intrinsic values or ideals of medicine, to save them from

depreciation, and to help sustain their humanitarian purpose. By

the end of the 6Os,  Page had collected a distinguished company of

supporters who shared his ambition.

     I was not among those who attended the first organizational
meeting of about twenty people at the Cleveland Clinic in January

1967.  Nor was I a member of the Board on Medicine that was set up
in June of that year by president Frederick Seitz and the Council
of the National Academy of Science for the purpose of founding a

National Academy of Medicine.   I remained among numerous other

cognoscenti from the worlds of academia and biomedical research who

were privy to the ensuing action,  however,  including the
disagreements and the disillusionment of some of the founders by

the time the Institute was chartered in 1970.

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Joinian the Council

   I became a member of IOM in 1971,  the first year of its

existence.  In the autumn of that year I received a telephone call

from Julius Comroe in San Francisco.   Julius was getting up a

petition  and wanted to know if I would accept nomination as a

candidate for the Council of the Institute.   He said that he and

certain other founders were concerned that another scientist should

be added to the list of nominees for Council at the next election.

I agreed to run and joined the Council in 1972.  John Hogness was

in the second year of his term as the first President of the

Institute of Medicine.

   I have several clear recollections of my experiences on the

Council.  The quality of the members was high. *'    Drawn from a

broad pool of minds and experiences, their talk was heady, the
debates cogent and often highly literate. There was a rich mixture
of the dialects and ethics operative in the world outside the
laboratory walls where I had theretofore spent most of my time.
In the frequent Council meetings one encountered the better sides
of the law, economics, commerce, as well as a broad selection of

the healing  arts and different disciplines  of science.    We

councilors felt that we shared a perch with an unparalleled view

of the complex field of human health.    We also savored the

anticipation of  practical  engagement  with the many serious

discrepancies between need and promise existing in so rich a land

as America.  This exposure stimulated receptors I had not much used

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before, and the experience was addictive.

   Other more disturbing sensations impinged on the enjoyment.

We were aware that the terrain upon which the brand new Institute

stood was unsettled,  and there was a premonition of seismic

disturbance, the results of tensions that then existed between the

leadership cadres of IOM and the parent NAS.

   In placing the epicenter of this instability in the office of

the new president of NAS who succeeded Seitz in 1969, I must tender

an offer of apology.  This is not the space in which to attempt

either a full explanation of the affairs of the "Academy complex"

in the early  1970s or a proper defense of president Philip

Handler's execution of the difficult role in which he was cast at

the birth of the Institute of Medicine.    A brief sketch of the

situation is unavoidable, however, to frame my own small part in

the whole.

Growinn Painq.

   In 1969, the Academy was still in the process of assimilating

the new National Academy of Engineering.  Created in the early 6Os,

the NAE had undergone development that foreshadowed the ontogeny

of the future IOM.  Seeking recognition of achievement in their

profession beyond that available in the restricted election of

members to the NAS,  a group of engineers had decided to create

their own academy,  largely but not exclusively for honorific

functions.  There was much concern that such a separatist move

would particularly ill-serve the needs of the National Research

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Council.   The latter had been for years the principal arm for

carrying out the numerous and important studies for the government

mandated by the NAS charter going back to Abraham Lincoln. After

much negotiation, agreement was reached on a way to keep science

and technology together in the same House.  A key condition of the

partnership struck between NAS and NAE was that most of the

business of the two academies would be done through NRC, and the

Governing Board of the Research Council would be constituted of

members from both bodies.

   Philip Handler was burdened not only with this crucial process

of amalgamation, but also with a long-overdue re-organization of

the NRC itself.  He was pouring both imagination and considerable

energy into the restructuring of this sprawling house of agencies

and groups  that had slowly been growing more chaotic and

independent as its load increased over the years.  The oversight

by the different classes of academicians had proved insufficient.

New commissions and assemblies were now being created that were

intended to take over many of these responsibilities.

A New Accommodation.

   Into this mise-en-scene there was suddenly thrust the proposal

for an Academy of Medicine.  For many in the NAS leadership there

was an unpleasant sense of having to begin all over again, a

distaste perhaps compounded by wariness of a population they

understood even less well than engineers.

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   While it had a few distinguished physician-scientists among

its members, the NAS had never pretended to recognize physicians

per se.    In the conservative views held by many NAS members,

physicians were in the main to be seen as artisans, technicians,

or high-priced professionals   whose  qualifications were not

measurable by the traditional standards of the Academy.    More

disturbing, however,  was the activist bent of this new group of

would-be academy founders.  They insisted that members be elected

for limited terms under a condition of agreement to serve in the

projected heavy work of the new organization.  It was also obvious

that membership could not be limited to physicians; a far broader

representation of peoples and professions would have to be chosen.

   After his first meeting with Handler, Page summed up his

perception of the initial reactions of the new NAS president to the

whole idea:  "to him, @'a National Academy was non-negotiable as was
any independent co-equal organization under the NAS charter". "

Nevertheless, Handler, a biochemist, and most of the leadership of

the Academy were left uncomfortably aware that, compared to all

the other disciplines, this half of the twentieth century was most

likely to be dominated by revolutionary growth in the life

sciences.   Moreover, the biological and behavioral sciences were

only part of a sweeping spectrum of technological developments,

professional    and   para-professional   education,    social

responsibilities,  and issues of service and economics that could

not be ignored by an eminent quasi-public institution such as the

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National Academy of Sciences.  If the Academy complex did not find

place for "IOM@*, it would have to create its competitor.  The key

question was how to fit the new creature into the box.

   A number of the conditions for co-existence were still being

negotiated and resolved as the IOM began the first years of its

existence.

    The accommodation of IOM had created two special problems.

It wished to run some studies with its own staff, contrary to the

new thrust for all programs to be overseen by the NRC Governing

Board.   The failure of the IOM to submit its studies to the

supervision of the Board was considered a serious threat to the

18symmetry*' of the newly-constructed Academy structure.  This also

meant that the NAS Council must go through the arithmetic again of

apportioning representation of another partner to the Board.   The

outcome had to appeal to the sensitivities of all the groups at

interest, while assuring retention of an executive majority by the

NAS .  To add to the potential for conflict, an Assembly of Life

Sciences was chartered in 1973-4 to oversee the NRC action in the

biological sciences-- including the fractious, quasi-independent

Division of Medical Sciences.  The sentiment of the NAS leadership

was thoroughly dis-inclined to hand over to IOM the sciences most

relevant to its work and there was a general feeling that the

Institute ought to be content with a residual, collectively called

@'health.88

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   Thus clouds still hung broodingly over the busy House of the
Academy in mid-1973 when John Hogness announced to the Council of
IOM that he had received an invitation earlier identified as the

one offer he would be unable to refuse.  He planned to stay until
mid-1974, when he would assume the presidency of the University of

Washington.  The Council began to prepare a slate of candidates for
his replacement to be placed before the president of the NAS.

   Pressure for Solutions

   One of the high-water marks  in the history of the long
struggle to establish the "Academy of Medicine" was the dispatch
of a letter from Phil Handler to Hogness--who was now a lame duck-

-and the IOM Council on November 7,  1973.    In it,  the NAS

president expressed his concern that long discussions had left
unresolved serious questions about the modus   onerandi of the

Institute within the Academy complex.  I recall that formal
acceptance by IOM of the assignment of two among 13 representatives
to the NRC Governing Board was one of the outstanding issues.   In

his letter, moreover, Phil Handler had suggested the IOM Council

must choose one of three "scenarios II in adjusting to the wishes of
the NAS Council and the new design of the NRC.   One of these was

the unacceptable possibility that the IOM might function only as

an "honorific body".

   John Hogness called for a special IOM Council meeting to
consider his answer to this challenge.  I will not attempt here to
provide details of the accommodations  eventually reached even

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though they are important parts of the definitive history of the

institutions involved.  I will turn instead to a brief record of

more  personal  involvement,  including   the  beginning of my
acquaintance with Philip Handler a few weeks later. */

   A Meetinn with Handler.

   I had been elected to membership in the NAS in the Spring of
1973, but Phil Handler and I were strangers until November 20 of

that year when he invited me to his office.  As I sat down, Phil

said, 'IThe Council of the IOM thinks I ought to talk to you about

John's (Hognessl) job."  Phil explained that his only awareness of
my views of the Institute was an expression of belief on the floor
of an IOM meeting that the Division of Medical Sciences should be

under the supervision of IOM.   He then reminded me that the old

Board on Medicine had repeatedly refused to accept responsibility

for "that can of worm~'~ before, and implied that IOM had forfeited

any further chances of oversight through the default of its

progenitors.

   Our conversation that day lasted nearly three hours, and
included a long discussion of my analyses of the choice of the
"three scenarios" he had recently offered IOM in his recent letter.
I received his protest that he had not meant to cause alarm, and

certainly no crisis,  by their presentation.  Before our leaving

that subject, however, I told Phil that it was necessary for the
Councils of IOM and NAS to reach agreement on IOM status before I

could further consider standing for the presidency.

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   Among the topics we discussed was also the concern of the NAS

Council as to how IOM would establish criteria for its membership

in accord with the heterogeneity of representation demanded by its

charter.   I defended those stipulations and insisted that the
pluralism of health issues required admission of members whose
qualifications couldn't be measured in the traditional NAS manner,

that  'ecumenism'  was essential for meaningful activity in the

health area, and that what he perceived as 'noise in the system'
was a redeeming and necessary sign of life [in the IOM].

  We parted with what I interpreted as mutual respect for each

other's positions.  I was launched on a long path of getting to

know Phil Handler, and that acquaintance would emerge much later,

on my part,  in affection and admiration for his dedicated, if

sometimes ostentatious stewardship of the Academies.

Decisions

   In the next several weeks I talked to John Hogness, who I

feared was possibly much too optimistic about the strength of the
Charter as security for the integrity of IOM.   I expressed my

admiration for the diplomacy and restraint he had displayed during

this period.   The next several days I also visited with Roger

Bulger, the executive officer, and many of the staff of the still
tiny IOM, the majority housed on the third floor east of the NAS
Building.'/  I hastened to assure Roger, that if I were to become

president,  I would make it a condition that he stayed.   I never

ceased to admire his flair for patient understatement, steadfast

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loyalty, and invaluable partnership in sharing the command of the

daily affairs of a ship on an overly-long trial voyage.

   I also had several brief meetings with Phil Handler about

"perks and amenities"  and other details on which I needed his

reading.   On December 12,  the IOM Council met to discuss the

Handler letter and work over a reply from John Hogness.   About a

week later,  Roger read a draft to me over the telephone and I

suggested one or two minor changes.  I left town the next day with

my older son Eric.  Our itinerary included first, Switzerland--for
twelve days skiing in the Oberengadine and, I hoped, some thinking-

time to sort out the rest of my life.   We were then to fly to

Finland and Sweden where I was invited to give some lectures on my

specialty of lipoproteins before returning home.

The Ouestion

   My diary records: "Helsinki, January 7-9, Hotel Vaakuna,

saunas,  and heaps of Johansson's temptation."   From other notes

I've pieced together it seems that on the first day we were taken
to the famous old restaurant Konig by Essko Nikkila and his team

of lipidologists.  There we spent an unforgettable evening in a

room revered as the favorite meeting place of Sibelius and his

cronies.  We did honor to the spirit of the immortals with a feast

of ptarmigan,  ending with brandy and cigars.   What better life

could there be than full membership in the fraternity of science?

   At the hotel a message: Handler had phoned. Now I should have

to answer both his question and my own.   I called back, the voice

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at the other end was impatient, perhaps imperious ( I would come

to understand this mannerism as the shield hiding a sensitive

nature.)

Our dialogue was brief.

II I need to know by next weekend."

II I understand: first, however, I am most interested in
   your answer to the Hogness [December] letter."

"1 see no trouble with this and had asked two members of
   the [NAS] Council who also see no trouble with it.*@

II Good, this is most important to me."

Back at NIH by the 14th of January.  Culliton speculates in

Science:  "Fredrickson may head 1OM.l'   On the 18th, after much

final discussion with family,  I decided in the affirmative and

phoned Phil Handler in the afternoon.    'IHe   seems  genuinely

pleased," I recorded.   "Would I also be tomorrow?"

Commencement

The Spring meeting of IOM was held on May 8, 1974.   John

Hogness was presented an illuminated scroll of tribute. I gave a

brief inaugural address, and Philip Handler, V'lacking a mace or

similar symbol of authority to represent the Institute presidency,"
presented me with my telephone credit card. 6/

To the assembled members,  I had spelled out what I thought

that mandate of the Institute was:

I'     Our commitment is to lend the scientific method
to thd direction of a whole social movement. There have
been many  encouraging  signs of  acceptance  of the
Institute of Medicine as uniquely qualified to perform
this public service. . . And the acceptance, the success,

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and the meaning of this organization rests upon its
having the essence, not Tlmerely  the appearance, of
nonpartisan objectivity."

As I now re-read my remarks on that occasion, I note that I

inserted an apology near the end of my oration:

"1 have subjected all of us to the risk of drowning in
metaphor to emphasize the scale of our commitment".

This disclaimer ultimately failed to spare the rhetoric of the

second president of the IOM from the merciless parody it richly

deserved. */

The Too-Brief Seaso O .

I had concluded my inaugural remarks with a sincere expression

of what I had come to believe:

I'    that criticality and skepticism and the orthodoxy
of iethod that one encounters in the biological sciences
is transferable to problems more social or economic in
content. . . the ferment of scholarly colloquia, the joys
of discovery and the pleasure of labor to better the
human condition are to be found no $ess in this Academy
than in the laboratory or clinic." .

Indeed, I found that this prediction was true in the brief season

that I was to work in this new vineyard.  There many new things to

learn.  Shortly after I had accepted the position and before my

inaugural, I accompanied John Hogness on a round of solicitation

of donors for funds to keep the new organization in a state of

solvency.  It was something for which I had no prior training,

having spent my entire career in the federal government, where the

pitch for funds is a very different art form.  The skills of my

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successors in matching the aims of philanthropic organizations to

the requirements of a public service organization with little or

now endowment has my full respect.

   Thanks to the patience  and generosity of several major

foundations we had enough success in this task of institution

preservation to remain solvent during my tenure. Among my prized

possessions is a work by the gifted cartoonist Vint Lawrence, in

which my visage is discernible, bounded by a gigantic   "K" , two

J's,  and a large fragment of a watermelon,  easily recognized

symbols for three of our major supporters at that time.

       Because the staff of the IOM was increasing and space had

become a premium,  our efforts to achieve a higher ration of the

bulging Joseph Henry Building was unsuccessful.   The alternative

offered by the Academy was indeed far more exotic.   It had leased

a portion of the Watergate Building,  assigning to us the suite

involved in a recent, most infamous crime.  The space allotted for

the use of the president had been the office of one Mr. Lawrence

O'Brien, an  important   official of   the   Democratic  party.

Unfortunately,  the NAS had already placed a partition in these

quarters,  rendering them less than opulent.   But the famous door

that had been left open was unchanged.    Business was  not

infrequently interrupted by tourists attracted to the site. To

assist their gaining the historical instruction available here,

Wally Waterfall and I prepared a memorial plague, and had the

inscription edited by Phil Handler himself.  I presume the plague

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and its message are still attached to the door. "

   These capers aside, Phil Handler and I also got to know each

other better.  Reflecting upon those early days at a dinner in

honor of Phil and Lucy Handler (1981) I recalled:

II    I can't say that our association at first was easy
or ihit it was ever really intimate,  because whenever we
approached each other, we each seemed to be carrying a
heavy piece from two different structures, the ends of
which we were constantly trying to fit together to work
harmoniously. . .

11    That first few months were spent in making rules.
Hiv;? you read Piaget on how children learn the rules of
games, make them up,  and then unlearn them? That was the
nature of the early relationship of the Academy and the
IOM. The Upper Child, the Academy, and the Upstart Baby
were trying to play a game . . .to govern the NRC. . .
to survive the wicked tyrannies of the report review
process. . . while pretending to be on the  same

. .  It helped us get to know each other better. lg/lanem

The more  solid achievements  of this  relationship,   the

development of Council,  staff and membership and the projects

undertaken during my presidency  deserve better treatment than I

am able to give in this memoir.  Alas, I had not yet completed the

first six months before events conspired to create another fateful

diversion in my career.

Ominous Sinus.

The Nixon years had been accompanied by unusual perturbation

of the NIH and the academic community.  Someone referred to the IOM

at that time as a *#camp of exiles from the administration", and

perhaps our most prominent fugitive when I took over was Robert Q.

Marston,  who had succeeded James A.  Shannon as Director of NIH.

Marston was serving as a Distinguished Scholar in Residence of the

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Institute while sorting out his future options after being forced

to leave his post at NIH.  The cause had been his resistance to the

actions of Administration and the Congress in the passage of the

National Cancer Act of 1971.  A schism of the NIH into two bodies,

one devoted to cancer research and the other to all the rest of

medicine   and  biology   had   been  narrowly   averted as   this

controversial bill went through passage by   Congress.    The

resulting politicization of the position of the director, however,

had left an indelible scar.   Those of us who had begun our careers
at NIH had believed that high science could be done in the midst

of government, with preservation of the academic style.   The year
1973 had barely begun when Marston's chair become vacant.  During
this year the IOM Council debated whether it should review the
five-year cancer research plan which had been mandated by the

National Cancer Act.  It decided that the plan encompassed most of
biology, if not all of life, and could not be analyzed objectively.
Neither could all the passion be cooled by pure reason;  there was

more upheaval to come.

   In May, 1973, the Assistant Secretary of Health Dr. Charles
Edwards introduced Dr. Robert S. Stone as the new director of NIH.

When I left NIH in May, calm had recaptured the campus.  By autumn
I was recieving evening phone calls from the '1ASH8V that made it
clear he and the new NIH director were at loggerheads.   Edwards
signaled that he was going to remove Stone from his position and,

one night in December,  inquired of my interest in returning to

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Bethesda.  I protested vehemently that I was now responsible for

IOM and that nothing could be worse than another turnover of NIH

directors as a result of political action.

    The director's position was unfilled again with the dawn of

1975.  Just as abruptly the position of the ASH was vacant. 11/
Suddenly, the fabric of my presidential chair began unraveling.

    On January 7, 1975, I had a call from a Mr. Howard Cohen at
the White House. 12/  "Your name is on lists of candidates for both

Assistant Secretary of Health and for Director of NIH*', said Cohen.

Would I be willing to come over for a chat?.  Apparently my name

had "been added to the lists", by Edwards and Ted Cooper his

assistant,  and by others who notably included IOM staffers Ruth

Hanft,  and her assistant Barbara Cohen (the latter by curious

coincidence being the wife of Howard Cohen.)   "Betrayed by my own

troops",  I thought,  but the members of the fifth column soon

confessed they had not failed to notice my eyes glowing with old

love whenever I described the NIH in IOM staff meetings.

   On January  9 --exactly a year to the day after Handler's call

to me in Helsinki-- I found myself in room 153 in the Old Executive

Office Building.   As Howard Cohen and I sat down to talk,

conflicting loyalties had my mind in turmoil.   I dismissed any

interest  in talking  about the ASH position  and added that

consideration of the NIH position depended upon three things.
First was the question of how to protect IOM from destabilization

by departure of a leader whose five-year term had barely begun.

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Secondly I demanded to know what the Ford administration intended

to do about eliminating the politicization of the NIH.   Finally,

I said I would have to withold agreement to any offer until I knew

who would be my  superior,   the new ASH.    There have been

administrations in which this last bravado would have halted my

career at the gate.  Cohen, however, kept up a running report on

who was now being considered, and I found I had acquired unexpected

leverage, a power I used sparingly, but at least once.

   One day I was briefly introduced to Bill Walker, Cohen's

superior in the head-hunting expedition.   He wanted to know what

IOM was and listened to what I considered NIH's problems.   They

both concluded that I should now talk to HEW Secretary Weinberger.

A Visit to the DeDrrtment.

   The Secretary's invitation came swiftly, in accord with the
pace of all the events in this unfolding scenario. At two o'clock

on the 13th of January I entered his office in the HEW North

Building.  I was reminded by the familiar doors and divans that I

had been summoned here before for a similar reason.   It had been

eight years since I had convinced John Gardner, that most admirable

and persuasive of men, to drop me as a candidate to succeed James

A. Shannon, due to retire in 1968, after 13 outstanding years as

NIH Director.  Shortly thereafter, Secretary Gardner took leave of

President Lyndon Johnson's cabinet.  His undersecretary, the late

Wilbur Cohen,  called me back for 'lcouch sessions" to overcome my

adverseness to upward mobility.  My objections centered around my

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recent return to the laboratory full-time after serving a year as

director of the National Heart Institute.   I held firm to my

ambition to remain there despite the devitalizing effect of
numerous proffered cigars offered by my second interrogator. 13/

   Caspar Weinberger's reputation as "Cap the Knife" when head

of the OMB had proceeded him to HEW.   I was not surprised to see

him wearing a suit of mortician's black. Maroon socks over the ends

of long underwear were visible beneath his cuffs, and I noted that

the thermostats were now set low in the upper reaches of HEW.   But

I also found the Secretary to be less than fearsome.   He began

talking quietly, sometimes answering his own questions.  Did I know

the present Institute directors?  Was I willing to consider the NIH

directorship?  After ten minutes of such interchange I indicated

I had some specific inquiries.   I still have the four sheets of

yellow foolscap on which I had drawn up the issues I intended to

press upon my interrogator.  The sheets remained in my pocket, but

I methodically got through every point:  my views of the NIH-NC1

problem;  did the Secretary intend to leave peer review intact?

Would he now leave appointments of advisors to the scientists?
Was he aware of the need for more training funds? And, as a final

thrust, did he not think that a presidential statement to reassure

the scientific community should be emitted? The Secretary listened

patiently, and nodded at various places.  I felt I had been heard,

although without victory,  as he rose and it was time for me to

leave.  The departing ASH, Dr. Edwards, was there most of the time

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and we afterwards went over some of my points again.

    The Waiting Game.

In the first break in this schedule I went to see Phil

Handler.  He reported that Secretary Weinberger had told him that

the choice requires a  "scientist with impeccable credentials--

someone like Lewis Thomas or youl@.

@@It's not a job; it's a cause,ll I said.   I found myself

attempting both to explain to him how one could leave IOM so
quickly, and to myself, how the loss of salary and amenities simply

had to be forgotten in the decision.  Phil nodded, did not argue,

and asked me when I would have to leave.  We agreed, that if the

decision was inevitable, I should try to delay my departure until

the end of June.

  The next several days I was in New York at Macy meeting on
biomedical research run by Jim Shannon."'   Lew Thomas was one of

the speakers.  He fixed an eye on me and uttered: "Mirabile dictu"-

-do it".

  Within a few days I entertained new members of the IOM Council

at dinner at the Academy.  Leon Eisenberg, Robert Ball, Lee Shore,

Alain Einthoven, Mel Glasser, Bernard Greenberg and Robert Haggerty

were there.  I guiltily said nothing about the rising probability

of my possible defection.  The next morning,  before the Council

meeting, I breakfasted with Adam Yarmolinsky, whose legal talents

and tenacious defense of the Charter IOM had been invaluable to the

Institute from its inception.    I admitted to him I might be

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leaving.   Adam argued that I would have a greater influence on

science if I stayed at IOM.  Walking from his hotel to the Council

meeting,  we continued the debate,  but I turned to the troublesome

matter of the Charter being silent about who should govern the

Institute in the absence of a president.  Adam concluded we should

select a vice chairman.  We would have to preclude that person from
running for the presidency and have the approval of the President

and Council of the NAS.

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   At my request, the Council went into executive session and I

spoke squarely about the rumors that had begun to fly about

Washington.  Bill Baker spoke in favor of my going to NIH; others

expressed fear for IOM and urged me to stay.   Lewis Thomas had

already declared his position in the matter.   Guido Calabresi,
elegant but eminently practical, moved that a Vice Chairman be

appointed.  Provision for such an appointment was made.

   In the last week of February,  I was informed by the White

House that President Ford had been handed a staff memorandum
containing four nominees for the Assistant Secretary position and

one for NIH.  On Friday the 28th,  a call came from Howard Cohen to
say that the president had approved Cooper and Fredrickson.  Within

ten minutes Secretary Weinberger called with the same message,

adding the @lyou need to get to NIH soon because of the morale

problemgl.

   Officially, of course, nothing had happened.  The security
clearances, the conflict-of-interest papers, and other untied ends
always mean the keeping of official silence about presidential

appointments,  from lowest to high.   The Secretary obtained

permission to spill the beans, however, in an appearance on April
19 before hundreds of NIH alumni under a great tent pitched on the

campus.  There was a roar of relief upon announcement that the
vacant chair would soon be filled and politics subdued.

   During the last week of April Cooper and I paid the requisite
courtesy visits to the Hill, and our confirmation hearings before

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the Senate Health Committee took place on May 2. "I

President Ford, whom neither Cooper nor I had seen during the

entire period of recruitment, came to NIH on July 1, 1975, and
stood by as Caspar Weinberger administered the oath of office to

each of us.

Formal Farewellq.

On April 25 I had addressed a formal letter to the Council:

`I      My decision  represents a  choice between two
i&it&ions for which I have great affection and whose
causes are both high in public interest.   I have chosen
the one whose immediate needs seem more critical."

I'
lie;  I am not unmindful of the potential for harm that
  in twice changing the presidency of IOM during the
first four years of its existence.  Had I any question
of the ability of the IOM to survive its President, I
would have chosen to remain."

I also expressed in this note my deep gratitude to Julius Richmond

who had agreed to serve as the vice-chairman of the IOM Council

until a new president could be recruited.

   It was on April 23, that I had also made my first and last
report on IOM to the annual meeting of the NAS.  Distinct among my

memories of that occasion is Phil Handler's deep and unmistakable

chuckle at my closing remark:

I9 I have confidence that we will meet our obligations.
. . despite the transitory image of our Presidents."

* * *

That confidence has proved to have been correct, and

I acknowledge my share of our debt to John Hogness, David Hamberg,

Fred Robbins and Sam Thier, who have been the principle stones

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bearing the weight as IOM has risen to its present height.   It is

beyond my capacity to recognize singly all those who contributed

to the noteworthy parts of my own brief appearance in the twenty

years of growth and development that are being recognized on this

anniversary.

    To Irvine Page, and others among the surviving founders who

continue to compare their earlier conceptions with the present

reality, I offer my belief that, in the form and function of IOM,

an academy of medicine now exists that guards the ancient ideals

and values of the healing arts and is working hard and successfully

to maintain the implicit promise to carefully use the best of in

the interest of science humanely  for the health of people

everywhere.

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NOTES

1.

2.

3.

4.

5.

6.

7.

8.

9.

IO.

Irvine Ii. Page. Papers 1917-1989; MSC 386, Box 1. Division of the History of Medicine, National Library
of Medicine.

The members who served on the IDM Council during 1972-4 included: William 0. Baker, Ivan L. Bennett,
Jr., Guido Calabresi, Martin Cherkasky, C. Gardner Child III, Clifton 0. Dumnett, Lloyd C.
Elm, Rashi Fein, Loretta C. Ford, Donald S. Fredrickson, Robert J. Glaser, Bernard G.
Greenberg, David A. Hasburg, Houard H. Hiatt, Alvin J. Ingrern, Irving II. London, Walsh
McDermott, David Mechanic,  Dorothy P. Rice, Henry U. Riecken, Julius Richmond, Ualter A.
Rosenblith, Ernest Saward, Ruth M. Schlotfeldt, Nathan J. Stark, Eugene A. Stead, Lewis Thomas,
Adzns Yarmolinsky, Joseph F. Volker, Alonzo S. Yerby, and Kerr L. Uhite.

Irvine H. Page. Papers 1917-1989; USC 586, Box 2, NAS-BOIL Correspondence, Sept.-Oct., 1969. Division
of the History of Medicine, National Library of Medicine.

During the early 19708, 1 began compiling a diary of more than ordinary events. At first I used U.S.
Government issue green cloth-bound notebooks in uhich many of us kept cur lab notes. It uas
in the first and second voluaes of these "Green Diaries 11 that my conversations uith Phil
Handler and recollections of certain other events in this essay were recorded.

Among those me&ers of the staff visited at that time were: Bob Ball (OOScholar in ResidenceP), Martha
Bloxall, Roger Bulger, Lew Cranford, Jean George, Jim Goodnan, Karen Grimn, Ruth Hanft, Ingar
Hermann, John Ingle, Bob Marston (PDistinguished Scholar"), Paul Rettick, Dick Seggel, Larry
Tancredi, Ualter Unger, Jim Veney, Ually Uaterfall, and Karl Yordy. Joseph Perpich, I&IO became
a member of the staff in 1974, later folloued me to NIH as an associate director and to Howard
Hughes Medical Institute as a vice president.

llFredrickson Installed*l. Institute of Medicine Newsletter, June, 1974, p.1.

Files Institute of Medicine.

The IOn files also contain the docuaent: I'Excerpts from the collected works of Donald S. Fredrickson
(Read aloud on the occasion of his farewell fete)".  This hardhearted script was than used by Roger
Bulger, and the Mesdames Martha Bloxall and Sarah Brown to Pperform simultaneous dissections
in different amphitheaters" of the prose of the second president, using vintage illustrations
which include: The inaugural address (May 8, 1974), the "fall meeting notes (Novhr 1974),"
a Wamorandun to the abortion study draft (Dee-r i974)e, the +esponse to Sherman (Uarch
1975)", and laletter to Harry Schwartz (April `74).

Our bronze plaque was engraved with the following message:

                           II  SITE OF WATERGATE
Through this door, in the early Morning of June 17, 1972, five men gained urlauful entrance
to the offices then occupied by the Democratic National Comsittee and Mere arrested.  That act
gave the sobriquet Watergate" to a series of subsequent disclosures that culminated in the
resignation from office of President Richard M. Nixon on August 9, 1974."   Fran Donald S.
Fredrickson. IlAesculapian merry-go-rounde,Transactions of the Association of American
Physicians, XC, 1977: pp. 59-73.

Donald S. Fredrickson. Remarks, NAS, Council of Academy, Dinner in honor of Handler, P. and Mac Lane,
S.D., June, 1981, Archives of the National Academy of Sciences.
   Even after I had returned to NIH as Director, Phil and I occasionally were at odds over the

conditions by which the NAS carried out nuserous NIH contracts, differences through uhich our
relationship gradually matured.  One night in September, 1980, being Wrs of a delegation
to Africa under the leadership of Frank Press, Phil and I discovered that we had purchased
identical safari jackets in a Nairobi store.  Ue celebrated satorical kinship uith a cup of
coffee in a screened porch surrOunded by the steemy night and renewed an understanding that
uhatever our differences in the early 1011 days, there was no doubt between us that

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Notes - Page 2

   our views on principles of science were convergent.  Our last official appearance together uas as the
   lead-off witnesses to a Congressional hearing on scientific fraud before Mr. Gore (D. Ark) on
    March 31, 1981.  I have a copy of the letter Phil later wrote Mr. Gore, complaining that the
   latter lacked the necessary understanding of the neture of science. Phil Handler took science
   and the stances of its premier Academy very seriously.

11.   In an op-ed article, 18NIH and leadership. II Uashinaton Post, January 20, 1973, Charles Edwrds, the
former Assistant Secretary for Health (who had just resigned to take a position in industry), ackrwledged the
resulting dismsy at NIH but defended his action: "the director of NIH must be an advocate for his agency . .
but also convey the realities of public policy to the research camnaiity.H

12.

Houard Cohen was a ym lawyer serving a %-day detail in the Hite House, assisting the Ford
achinistration in its recruiting.  Uhen, early in January, Hanft had cane to Roger Bulger with
the premature news that Weave just lost our presidenV~,  I learned about her well-meaning
VarplicityP in my eventual departure.

13.

Uhen Uilbur Cohen left the Secretary's post, I mede sure I was in the queue to say goodbye to him; I
genuinely liked him and wanted to present him with a box of Schissselpennincks in memory of our
sessions.

14.   Jim Shannon uas one of those intimately involved in the early activities of the Board on Medicine.
   He clearly believed that the primary role of the neu 1011 uas that of providing more support for a
    larger NIH budget.  At this meeting, and during my brief reign he didn't conceal from me his
   disappointment with how often the IDN uas distracted from this mission.

15.

Among the matriculation rites attending presidential appointment, the courtesy visits to key me&et-s
of Congress and the formal hearing before Senate confirmation of appointment are among the required
courses.  Selected notes from the Green Diary provide a set of ilrpressions of these events:
llArwil 28, Cooper and I meet with Congressman Robert Michel (R Ill), ranking minority me&et- of the
House Appropriations Subcomsittee for Labor and Health. Ue were ferniliars, for I had testified
before him an institute director in 1967-68.

ADril 30 Tim Lee Carter, <R Ky), ranking minority me&er of the Roger's Health subccwmsittee of the
House Comsittee on Interstate Comserce. Gne of two physicians in the Congress, he has operated
on kitchen tables in dim-lit homes.  He had lost a son to cancer, and uhile given to cryptic
questions in hearings, he was willing to leave party principles to add to the research budget.

Senator Gaylord Nelson (D Uisc.) on the Health subcosaiittee, was the son of a physician, and an honest
populist who thought drugs were too expensive and physician's fees too high.  [Gaylord Nelson uas
valuable and consistent public servant. Dne day he dealt a coq~ de grBce to Senator Kennedy's bi 11 that
I thought gravely threatened recanbinant DNA research.  A few weeks later he had me up before
him in a windy caucus rocm qwstioning the propriety of a ruling that Stanford might seek a
patent on the basic splicing technique used in such research--"and developed with public
flmds". I

Dur visit to Senator Uarren G. Magrwson, (D Uash)uas preceeded by a brief orientation by his staff man,
Featherstone Reid. Suddenly eMaggiell appeared, florid, slightly tremulous, bluff and shrewd.
At the time cne of the most powerful supporters of biomedical research, Magnuson was chairmsn
of the Health and Labor slrbcomnittee of the Senate appropriations cansittee. He signed off
our brief visit with with a warning that "in the past few years, NIH has lay doun without
fighting the charges of the A&inistration.0'

Senator Jennings Randolph, (D UVa) meets us in the Senate reception area of the Capitol, is a courtly
politician of the old school.  Ue line up for pictures and sanecne whispers *#it's the c-try
boys who get the photographer out. . 11 The Senator then quickly disappears onto the Senate
floor.

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Notes - Page 3

Senator Thomas Eagleton, (D MO) sees us in his office.  He's a father of the Aging Institute on his
and he's got in on his mind.  Uhen is there going to be a director? How many grants are out now?

Arriving panting in the reception area again, we find Jay Cutler, aide to Senator Jacob Javits
(R NY); we explain that we expect an objection from an NIH scientist and her Lawyer at the
hearing.  As uas often his way, Senator Javits materialized for a moment, said he expected us
to be confirmed, and vanished.

It is 4:30, and we've been waiting for half-an hour in a hall in the vast Rayburn building. The King
of Thailand and a vast retinue are visiting Congressman Paul RoBers (D Fla). Uhen he finally
appears, Mr. Rogers is polite and affable as always.  He is wily, too, and justly revered for
having saved the Cancer Act from cleavirq NIH in tuo pieces.

Senator Richard Schweicker (R Pa) is our visit for the day.  He has a high interest in health, and wants
to know uhether demonstration and control projects belong in NIH. [Like Paul Rogers, the
senator and I are destined to play several inportent scenes together in the years to come.le

The diary omits mention of our most wforgettable confirmstion visit.  As we uaited on the House side
of the Capitol reception area, a guant figure emerged through the door, carrying a cane like
a swagger stick in a parody of a Barrymore entrance.  His hair uas parted sharply in the
middle, and a highly waxed horn of a mustache flowed out laterally from each nostril.  He wore
a green tweed suit, with brighter green velvet lapels. Tan spsts were visible fras the trouser
cuffs to the tops of his suede black shoes.  He sniffed and touched his nose with a flourish
of a white handkerchief and looked doun his Long nose into our faces. Congressman Daniel Flood
(D Pa) chairman of the labor and health subcommittee, was no stranger to me.  I had been tested
in his forge in hearings on the Heart Institute budget in 1967-68.  It looked like I would soon
be back in the hot seat again.

"On May 1, Cooper and I continued the row&.  Senator Stafford left no recollections. Senator Edward
Brooke (R Mass), would be rems&ered for his distinguished swner and handsome office; Senator
Pell (D RI), a lean, intelligent harried-appearing man, sped by us for a brief pass off the
Senate floor; Senator Cranston (D Cal), appeared briefly like Harley's ghost, brought in by
a disagreeable staff person; the ghost was only interested in the Arthritis Ccumnission; Senator
Mathias (R Md) was cordial, plump, affable, and smart.

Our hearings uere held May 2.  Senator Eduard Kemedy had us brought to the Senate reception area for
a few minutes before.  I handed him the answers to five questions he had sent me a day before,
through Lee Goltin of his staff.  I had no do&t that Gol&an, who had a reputation for being
notoriously difficult, had actually written them.  Senator Harrison Uilliams (D NJ) uho
presided, also gave me a questionnaire on affirmstive action to return. Senators Laxhalt CR
Nev) and Randolph made brief appearances.  Dr. Barbara Davis and her lawyer gave testimony
against my confirmstion on the grounds that she had been discriminated against in my
laboratory. This latter became the subject of a trial in the Federal Courts IDavis vs.
Ueinberger et al, WC-DC 75-0205, in which the Court fand for the defendants.3 Ted Cooper
proved too short for the witness chair and gave his testimony sitting on the telephone book.

On May 8, word that I had been unanimcusly confirmed arrived at the ICM as I uas conducting a
preliminary seance with men&rs Charles Fried, Tom Schelling, Leon Eisenberg, and Bob Ball to
prepare for the annual meeting in Wove&w.  Now it was certain I uould not be presiding over
it after all.

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