The Institute of Medicine (IOM) is independent and authoritative

On Oct. 14, 1988, I published a Special Communication by Irvine H. Page, one of the founders of the Institute of Medicine (IOM) in JAMA. Dr. Page criticized the IOM at age 18 for failing to live up to the vision of its founders. This was accompanied by a rejoinder and a prospective by then IOM President Samuel O. Thier. My editorial was entitled “Still Needed — A National Academy of Medicine.”

This is 2011 and much has changed. As the health arm of the National Academy of Sciences (NAS), the IOM has made great progress under a sequence of brilliant leaders.

But its identity remains confusing to some.

Even physicians mistakenly believe that the IOM is a branch of government. It is not. It is a prestigious organization of members from the medical and related health professions elected by their predecessors.

Fewer than one in 1,000 American physicians belong. Membership is an honor, but members are expected to work.

Because of its small size and demographics, the IOM is not intended to be representative and is pointedly apolitical. It is nonprofit, independent, and authoritative.

It serves as adviser to the nation, including the Congress, on concerns of health and healthcare. As part of the 501c3 NAS, the IOM is prohibited from lobbying.

Consider the topics of some of the IOM reports from 2010:

  1. Enhancing Food Safety
  2. The Future of Nursing
  3. Dietary Reference Intakes for Calcium and Vitamin D
  4. A National Cancer Clinical Trials System for the 21st Century
  5. A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension, and
  6. Strategies to Reduce Sodium Intake in the United States

Although the IOM has come a long way, it can still strive to fully satisfy the vision of its founders.

Who in American medicine do you trust? Tough question.

Many medical people and organizations seem largely governed by self-interest and politics. I trust the IOM more than any other medical or health organization in the U.S.

I am an IOM member, but I believe that my bias is that of being informed, not of simply belonging.

I think you can usually trust the IOM and its reports. Try it.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • http://minochahealth.typepad.com doc

    I enjoy reading medical literature just like other health care providers do. No one is perfect. It is my opinion (anecdotal and not evidence-based) that organizations like Institute of Medicine and Cochrane Database Reviews provide much more evidence-based, non-biased information for us than do the paid “thought leaders” and sometimes better than even the professional societies whose positions might be laced to protect the financial interests of the members they represent.

  • http://www.KnowYourD.com Craig Keebler, MD

    The Institute of Medicine’s stated objectives are laudable – to “provide unbiased and authoritative advice to decision makers and the public” and to serve as an “ adviser to the nation to improve health.” The IOM November 2010 Report Brief on Calcium and Vitamin D falls far short of these lofty goals. At best, it is a disservice to the nation. At worst, it could contribute to at least 145,000 preventable cancer deaths this year.

    The Institute of Medicine’s power lies in the fact that consumers, physicians, and federal agencies listen to what it says. When advice is based on solid evidence, the impact is positive. When advice is faulty and ignores solid evidence in favor of defending an outdated paradigm, the IOM’s advice becomes dangerous and detrimental to the nation’s health.

    I know physicians who will not test their pregnant patients’ vitamin D levels because the recent IOM report states, “a majority of the population is meeting its needs for vitamin D.” Research shows most pregnant women to have low levels that continue to drop during pregnancy. A recent randomized clinical trial found half the rate of premature deliveries and infections in women receiving 4,000 units of vitamin D throughout pregnancy compared to those getting 400 units, the amount in a prenatal vitamin.

    The IOM insistence that the majority of the population has adequate levels of vitamin D flies in the face of the NIH NHANES data. Adit Ginde (Arch Intern Med 2009;169:626) demonstrated this data to show a minimum of 77% of all Americans having low levels. She used 30 ng/mL as her cut off for adequacy, the lowest value accepted by any senior D researcher.

    I know of a young man suffering from osteopenia whose vitamin D was 22 ng/mL. He was refused treatment with vitamin D to raise levels and potentially correct his osteopenia because 20 ng/mL is what “the IOM committee found to be the level that is needed for good bone health for practically all individuals.”

    The most experienced researchers on vitamin D and bone health have found that bone density does not stop improving at 20 ng/mL but continues to increase well above 35 ng/mL. Renowned researcher, Heiki Bischoff-Ferrari of the Harvard School of Public Health, has written a scathing condemnation of the IOM committee for calling 20 ng/mL the level of vitamin D that is needed for good bone health. http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d-fracture-prevention/index.html

    Most disturbing is the IOM committee’s total dismissal of roles for vitamin D other than bone health despite the burgeoning of research to the contrary. Among the other health benefits is vitamin D’s role in cancer prevention. Population studies, basic science research, and a four-year clinical trial all show the dramatic impact adequate levels of vitamin D have on cancer incidence. The most senior vitamin D researcher, Cedric F. Garland, and his colleagues used this data to show that keeping all North Americans at vitamin D levels of 55 ng/mL or higher would prevent 60,000 cases of colon cancer and 85,000 of breast cancer every year. Yet, as long as the IOM is telling patients, doctors, and government agencies that all we need is 20 ng/mL, little will change.

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      when the literature proves that a VitaminD level of 55 ng/ml or higher actually prevents colon and breast cancer without causing other problems, the IOM will probably adjust their recommendations. So far the relationship between Vitamin D and disease is still controversial and the IOM report reflects that.

  • http://minochahealth.typepad.com/gut/2010/06/vitamin-d-vitamind.html doc

    Both Dr. Keebler and Dr. Reznick make good points. While I do not entirely agree with IOM position on vitamin D issue, no one is perfect and everyone is entitled to their opinion. That does not detract me from the respect I hold for IOM’s statements since I do not have to be worried about vested interests.

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