Part 1: How healthcare became the system it is today: The 1880’s-1910’s introduced The Flexner Report, and how it laid the paving stones that forever changed patient focused healthcare.
Healthcare is, quite frankly, a dumpster fire. Covid has exposed the inferno, but it has been a slow burn for many decades prior to covid. To understand current day, we have to go way way back to where the corruption of healthcare began.
Today is the first in a series of looking at how healthcare has become what it was today. The early roots of change were back in the late 1800’s to early 1900’s with Abraham Flexner and the great “Flexner Report”. Many of you remember the TV show “Little House on the Prairie”. Good ol’ Doc Baker would make house calls, barter chickens for medical services, and was devoted to only the care of his patients. Keeping townspeople safe, seeing them through measles, flu, accidents, etc. Flexner and the oligarchs known as Hopkins, Carnegie, and Rockefeller saw to it that the bedside model of physician care went away, with a focus on science and research with NO direct patient care as the incoming focus.
How the Flexner report changed modern medicine is found here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/
Healthcare was an altruistic “help the people” profession. Until the early 1900’s. There was a pivotal event in 1910 called the “Flexner Report”. This report had one goal: to eliminate proprietary schools (little independent schools, osteopathic schools, chiropractor and homeopathy schools) and establish the biomedical allopathic physician model as THE gold standard for training and creation of future physicians. The rest of you be damned. Biomedical healthcare training was already alive and well in Germany and other European countries, and the United States decided they needed to utilize that approach as well. While the biomedical model is beneficial, it solely relies on that approach, and removed the ART & SCIENCE from medicine. A group of men, known as the Hopkins Circle, led this initiative. Notable members of the Hopkins circle are William Welch of John’s Hopkins, Fredrick Gates who was an advisor to John D. Rockefeller, and Abraham Flexner. Flexner attended John’s Hopkins for his college studies, but did not come from the wealth of the Hopkins and Rockefeller families. He was the “every day folk” in this circle of vast wealth. Flexner was only able to GO to college due to a “scholarship” that his brother, who was a pharmacist in Louisville, helped him get. His brother in later years became a key leader and figure at the Rockefeller institute. Flexner majored in philosophy and Greek studies at Hopkins, and went back to Louisville to teach high school. His educational philosophy was the belief that students learned by doing, by solving problems, rather than rote memorization that was the more common at the time.
Flexner went on to get a masters in Philosophy overseas, and paid particular attention to the medical education that European colleges were focused on. (Wonder who paid for that degree?) He wrote a book called The American College which described the vast differences in American trained physicians versus European trained physicians. This book “caught” the eye of Carnegie family and they invited him to discuss how to improve medical education in the United States. (I am 90% sure this was a planned book paid for by Hopkins circle funds, as was Flexner’s time in Europe).
*OK so pause for the cause recap here. We have a high school philosophy teacher who went abroad to study for his masters in philosophy. His original education was funded by his pharmacist brother who was a future key figure of the Rockefeller institute. His education was done at John’s Hopkins. And his subsequent book about caught the attention of the Carnegie family. A book about transforming MEDICAL TRAINING written by a non-medical individual. Does this smell a little suspect? How did a poor young lad from Kentucky who had his education paid for by his Rockefeller associated pharmacist brother suddenly have the attention of some of the wealthiest and most influential people in the world/United States?
Flexner came back to the United States, partnered up with the Carnegies, the American Medical Association, Welch from John’s Hopkins, and they stated that physician training MUST be focused in laboratory investigation, that medical professionals should be pumping out new data and information at a regular pace. Universities need to establish labs and research facilities to focus on the science of healthcare. Remember, this is the early 1900’s. Technology is not what it is today by any stretch. Flexner believed that science should be the primary theme of every physicians life and career. (Goodbye bedside care and house calls, listening to patients, observing symptoms and illness, and hello lab and science work). What big change came from this? Welch changed the curriculum at Johns Hopkins. ALL students were required to do TWO YEARS of lab science courses prior to medical school. He implemented the German model at Hopkins. This not only generated more money for Hopkins by extending the required college training to become a physician, but it also made them an “elite college” that could charge more for that education. Again…….all based on a book by a philosopher traveling through Europe. There was no scientific evidence that the German model of medical training was in any way superior or better to how American’s were training their physicians.
Over the next 10 years, Flexner traveled the entire country “evaluating” medical training institutions. They were given a grade. To quote the article “He crisscrossed the United States and evaluated institutions from the point of view of an educator and not a medical practitioner. Questions regarding the clinical facilities available for teaching purposes were few and brief to the dean and professors of the clinical departments. Flexner was mainly interested in the extent to which the school enjoyed rights or merely courtesies in the hospitals identified in the school catalogue. Admission standards, physical facilities, especially well- equipped laboratories, and instruction by physician scientists were the other major criteria for judging the quality of the education offered.” They were judged on 3 criteria: 1, they met the standards of “Hopkins”, 2nd tier were “substandard, but could be brought up to standards”, and 3, defunct, deficient, and were tagged BY FLEXNER to be CLOSED/SHUT DOWN. Guess who was shut down?? Osteopathic, homeopathic, naturopathic, chiropractic, and alternative eastern medicine schools. This initiative led to the closure of ONE THIRD OF AMERICAN PHYSICIAN COLLEGE INSTITUTIONS. This was done under the guise of “we are eliminating poorly trained physician programs and preserving the best ones”. What it did was limit the access to education, limited the curriculum that was taught, made it unaffordable, and took everything a step further by requiring a state license to practice medicine. That state license testing was DESIGNED AND CREATED BY FLEXNER AND HOPKINS. You don’t teach it the way they want you to? You won’t pass licensure. Schools closed because their graduates were not passing the new licensing exam. What better way to progress your agenda and delete the competition than to make sure you test them on content only taught at your approved schools!
In 1910, Flexner issued his official report to Congress. They agreed with the findings of Flexner and his report was adopted into law. The success of the Flexner report being passed into law and the mandate of this law towards medical schools adopting this proposed gutting of healthcare education program was guaranteed by “large financial grants and funding” by the Carnegie and Rockefeller Foundations”. “this single model of medical education required large sums to support the scientific focus at its core. The powerful stimulus of philanthropy money also affected the fashion in which medical faculty would live their lives in academic medicine; this was the important introduction of the full-time system in medical schools. Medical professors were to be freed from any major responsibilities for patient care and could dedicate their lives to research and teaching. It was the example established in German universities during the 1880s, where the practice was observed by Welch, who became a major proponent of the innovation. The advancement of knowledge was to trump all other involvements in the academic physician’s life. Provision of an adequate salary for the full-time faculty would guarantee that fees generated from patient care would not be pursued and distract from research. A McGhee Harvey, chairman of the Department of Medicine at Hopkins at mid-century, believed that no single event had a more profound effect upon medical education and medical practice than this movement.”
WOW.
Those opposed to what Flexner and his tribe of billionaires were doing stated “the primary role of physicians are as beneficent healers; the delicate balance of patient care and research could have been pursued with mutual benefits for both sides. As it was, the science of medicine eclipsed the active witnessing of our patients. Edmund Pellegrino’s lament was proven true that doctors had become neutered technicians with patients in the service of science rather than science in the service of patients.”
This was the beginning phase of a massive shift in healthcare. The Flexner Report of 1910 effectively ended healthcare as it was intended to be, and turned it into a money making profit driven industry. This was just the foundation and bedrock laying for so many things that should not have happened. And remember, Flexner was not in healthcare, not trained as a physician, he was a philosopher. One could ask what his credentials even were to promote such a change in healthcare. He had no medical background to even understand the why and how of how medical health education ran. But he was certainly backed by some very wealthy people. Did big industry money lead the change to healthcare for their OWN benefit? Yes. Did big money sway congress to enact the Flexner report into law? YES.