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How the Flexner Report Changed Medicine · Stuff You Should Know

0:01
Speaker 1: Welcome to Stuff you should know, a production of iHeartRadio.
0:11
Speaker 2: Hey, and welcome to the podcast. I'm Josh, and there's
0:13
Speaker 2: Chuck and jar Jar Binks is here too, and this
0:17
Speaker 2: is stuff you should know about the Flexner Report.
0:20
Speaker 1: That's right. This was a suggestion by my wife.
0:25
Speaker 2: Oh, that's a good one.
0:26
Speaker 1: Yeah. Emily, of course everyone knows if they listen to
0:29
Speaker 1: the show. As an organic gardner and an herbalist, she said,
0:34
Speaker 1: has long asked me to do one on the Flexner Report,
0:38
Speaker 1: which is a report written in nineteen ten that did
0:43
Speaker 1: a lot of things basically kind of revamped how medicine
0:47
Speaker 1: worked in the United States, moving forward to medical school
0:49
Speaker 1: in particular.
0:50
Speaker 2: Right.
0:51
Speaker 1: But Emily was interested because another thing it did a
0:54
Speaker 1: byproduct was it basically completely squashed what we would now
0:59
Speaker 1: call altern medicine homeopathy, basically saying it has zero value
1:06
Speaker 1: and we're not doing that anymore. It sure did biff, Yeah,
1:10
Speaker 1: and it was also racist and sexist.
1:13
Speaker 2: It was definitely of its time. This is a document
1:16
Speaker 2: produced in nineteen ten, for sure. Yeah, and it definitely
1:19
Speaker 2: stinks of eugenics and all that.
1:21
Speaker 1: Yeah. So it's one of those weird things where like
1:25
Speaker 1: you can see it from all sides, because it did
1:27
Speaker 1: a lot of good and it also maybe didn't do
1:30
Speaker 1: some good in certain areas.
1:32
Speaker 2: Yeah, for sure. And there's there's not many people who
1:35
Speaker 2: are like, no, the Flexner Report sucks. It was all
1:38
Speaker 2: bad because it If you enjoy being treated successfully for cancer,
1:44
Speaker 2: you can pretty much thank the Flexner Report for that.
1:48
Speaker 2: But at the same time, yeah, if you believe that
1:50
Speaker 2: there are alternative therapies that are as good or better
1:54
Speaker 2: than medications, then yeah, you probably don't like that part
1:58
Speaker 2: of the Flexner Report. But I think on the whole
2:00
Speaker 2: it was a good thing. There seems to be now
2:04
Speaker 2: among you know, thinking people who don't just wait and
2:08
Speaker 2: wallow and dogma, saying like, we needed a new Flexner
2:12
Speaker 2: Report for the twenty first century because it's basically run
2:16
Speaker 2: its course and now again it's become dogma and we
2:18
Speaker 2: need to do something about that.
2:19
Speaker 1: Right. I think that's a great setup, and maybe we
2:21
Speaker 1: should paint a little bit of a picture about what
2:25
Speaker 1: medicine and medical school look like in the United States
2:28
Speaker 1: pre Flexner Report.
2:31
Speaker 2: Who was bad?
2:32
Speaker 1: It was bad, I guess quickly we should say that
2:34
Speaker 1: Europe was doing it right before we were. In France,
2:38
Speaker 1: especially they had some pretty top notch medical schools where
2:40
Speaker 1: they embrace real science and we're practicing medicine on people
2:47
Speaker 1: like as practice in colleges and stuff like that. But
2:51
Speaker 1: in the United States that was around eighteen fifty. In
2:53
Speaker 1: the US, in eighteen fifty they had fifty two medical schools.
2:56
Speaker 1: This is what fifty sixty years before the Flexner Report,
3:00
Speaker 1: and medicine was not you know, to be a doctor
3:03
Speaker 1: was not some prestigious thing. Medicine was a trade. If
3:07
Speaker 1: you were associated with the university at all. As a
3:10
Speaker 1: medical school, it was a two year program. The curriculum
3:14
Speaker 1: was very, very broad. They were super underfunded. Even at
3:17
Speaker 1: places like Harvard, they had to pay for their own
3:20
Speaker 1: teaching supplies. And those were the good ones that were
3:23
Speaker 1: attached to universities.
3:25
Speaker 2: Yeah, I mean, there were plenty of diploma mills. There
3:28
Speaker 2: were a lot of proprietary medical schools where it was
3:33
Speaker 2: just some people got together and created a for profit
3:36
Speaker 2: school where they would teach you how to become a doctor.
3:39
Speaker 2: But they were not doing a very good job of it.
3:41
Speaker 2: And your admission requirement was the ability to pay the
3:45
Speaker 2: tuition fees. Essentially.
3:47
Speaker 1: Yeah, for sure, you might have like redundant classes that
3:51
Speaker 1: literally went over the same things. You might not have
3:54
Speaker 1: your hands on a scalpel ever, you might not have
3:57
Speaker 1: an exam ever, you may not see patience, you might
4:04
Speaker 1: not have any contact with another human being at that
4:06
Speaker 1: medical school.
4:08
Speaker 2: It'd be kind of like if you went to go
4:10
Speaker 2: skydive and in the class before you go skydive, they
4:14
Speaker 2: just talk about how hard the ground can be if
4:17
Speaker 2: you hit it, and then they take you up in
4:18
Speaker 2: a plane and push you out. It's similar to something
4:21
Speaker 2: like that. That's good, thanks, I like it.
4:25
Speaker 1: But then everybody the Civil War came around in the
4:28
Speaker 1: eighteen sixties and there was wartime doctoring happening. And after
4:33
Speaker 1: the Civil War people came out of that saying we're
4:38
Speaker 1: in trouble. Everybody, like the doctoring wasn't so great in
4:41
Speaker 1: this war and we need to fix this.
4:44
Speaker 2: Well, what I interpreted is that they went out and
4:47
Speaker 2: got real world experience and realized, like the stuff they
4:50
Speaker 2: learned at school was not preparing them for actual medicine.
4:53
Speaker 1: Oh yeah, I mean I think it was a little
4:55
Speaker 1: bit of both. I think the person who had their
4:57
Speaker 1: leg chopped off unnecessarily complained, and I think the doctor
5:01
Speaker 1: who did the chopping might have complained as well.
5:03
Speaker 2: Right, they didn't teach me that patient's complain in medical school. Yeah,
5:09
Speaker 2: so yes, regardless, by the by the eighteen sixties, like,
5:13
Speaker 2: it was quite clear that American medicine was lacking tremendously
5:17
Speaker 2: and that the main reason for that was that the
5:20
Speaker 2: doctors who were practicing medicine had virtually no actual training
5:24
Speaker 2: in medicine. They was lectures, textbooks, That's basically it. So
5:29
Speaker 2: there were there was a part of the progressive era,
5:33
Speaker 2: this actually this push to create a movement to make
5:38
Speaker 2: medicine in America better and by by focusing on the
5:42
Speaker 2: medical school education that that came around in about the
5:46
Speaker 2: eighteen seventies. It was led by Harvard. Yeah, but really
5:49
Speaker 2: Johns Hopkins University was the one that really hopped on it.
5:55
Speaker 1: Yeah, for sure, Like Harvard got the ball rolling for
5:58
Speaker 1: a couple of decades, and by the time Johns Hopkins
6:01
Speaker 1: opened in eighteen ninety three, they became kind of the
6:04
Speaker 1: standard for the American model moving forward, which SBC was
6:08
Speaker 1: based on the German model. Right, you had to have
6:11
Speaker 1: a first of all, you had to have a college
6:13
Speaker 1: degree just to get in, and that was previously not
6:16
Speaker 1: necessarily the case. Secondly, they had full time faculty. They
6:21
Speaker 1: were medical scientists, so they weren't doctors on the side
6:24
Speaker 1: as well. They were just fully employed to teach, and
6:28
Speaker 1: they had a four year like a full four year
6:31
Speaker 1: course of study where it was hands on and a
6:35
Speaker 1: lot of laboratory work.
6:37
Speaker 2: Yeah, and yes, where they were actually working with patients
6:41
Speaker 2: or assisting other actual doctors in working with patients. Like
6:44
Speaker 2: it wasn't just like sit there and listen to this lecture. Yeah,
6:49
Speaker 2: that was. And that essentially that Johns Hopkins model is
6:52
Speaker 2: what became the model for American medical school. And there's
6:57
Speaker 2: a lot of there's a lot of talk at parties
7:00
Speaker 2: if you stop and listen about whether this would have
7:02
Speaker 2: happened on its own or not. And for the most part,
7:06
Speaker 2: it seems that, yes, this progressive era movement would have
7:10
Speaker 2: gotten there eventually. Yeah, just because it was a good idea.
7:13
Speaker 2: The Flexner Report helped it happen on a dime, because
7:18
Speaker 2: not only did it show to everybody else this is
7:21
Speaker 2: the way to do it, it also said this is
7:23
Speaker 2: very expensive, and here's how we need to get the
7:26
Speaker 2: money for it. And did get the money for it,
7:29
Speaker 2: Like that's how it was implemented.
7:30
Speaker 1: Yeah, for sure. The American Medical Association was founded in
7:34
Speaker 1: eighteen forty seven. And one of the reasons, and you know,
7:39
Speaker 1: again this is stuff that I learned from sort of
7:43
Speaker 1: Emily's urgings. One of the reasons the American Medical Association
7:47
Speaker 1: was founded to begin with was like on a mission
7:51
Speaker 1: to squash homeopathy. It says so in its charter. And
7:57
Speaker 1: when the AMA was founded, they discouraged any association or
8:01
Speaker 1: communication with those kinds of doctors and had a code
8:05
Speaker 1: of ethics that was a clause in there known as
8:06
Speaker 1: a consultation clause that said, if you even talk to
8:11
Speaker 1: a quote unquote non regular practitioner, then you're going to
8:14
Speaker 1: lose your license to practice medicine. They carved out exemptions
8:18
Speaker 1: for Massachusetts and New York because it was homeopathy was really, really,
8:23
Speaker 1: really popular at the time among the elite, wealthy Americans,
8:28
Speaker 1: like the major politicians, the corporate leaders. I think it
8:32
Speaker 1: was Rockefeller. I think it was Rockefeller that was under
8:36
Speaker 1: the care of a homeopathic doctor for like fifty years.
8:38
Speaker 2: Wow.
8:39
Speaker 1: So they carved out exceptions for those two states for
8:41
Speaker 1: a while until they were able. You know, all those
8:44
Speaker 1: people died off basically and they were able to completely
8:47
Speaker 1: squash it.
8:48
Speaker 2: Right, Rockefeller died, So I guess the homeopathy he didn't work.
8:52
Speaker 1: Well. He lived another like forty eight years after being
8:55
Speaker 1: told he didn't have long to live.
8:57
Speaker 2: I think, oh wow, it's a homeopathy works case closed.
9:02
Speaker 2: So yes, I think that you really put your finger
9:04
Speaker 2: on that. The AMA became the arbiter of what qualifies
9:08
Speaker 2: as medicine in the United States thanks to this Flexner report.
9:13
Speaker 2: It basically strengthened all of its position. And yes, they
9:17
Speaker 2: were the driving force behind this. Initially they went to
9:20
Speaker 2: the Carnegie the Carnegie Foundation, and said, hey, you got
9:24
Speaker 2: a lot of money, why don't you help us figure
9:27
Speaker 2: out how to change American medical education in the exact
9:32
Speaker 2: way we want it, and we'll help you figure out
9:36
Speaker 2: who to do that with. We like the Johns Hopkins model.
9:39
Speaker 2: We basically want a report that says the Johns Hopkins
9:42
Speaker 2: model is great. Let's get an outsider in here. And
9:45
Speaker 2: that is how Abraham Flexner enters this story.
9:49
Speaker 1: Yeah, and you know this is not to say that
9:51
Speaker 1: he was like cooking the books or anything like that,
9:53
Speaker 1: and no, this is all a sham, but that was
9:54
Speaker 1: just sort of The AMA was definitely after that well.
9:57
Speaker 2: One of the reasons he was selected is he was
9:59
Speaker 2: already a person, an educator who espoused exactly this kind
10:03
Speaker 2: of stuff, just not necessarily as it applied to medical education.
10:08
Speaker 2: He just wasn't exposed to medical education at the time.
10:10
Speaker 2: But he was an educational philosopher and theorists and he
10:14
Speaker 2: was fully on board with that kind of thinking.
10:17
Speaker 1: Yeah, I mean he wrote a book. I guess we
10:19
Speaker 1: should say he did go to Johns Hopkins, but not
10:22
Speaker 1: for medicine. I think he studied classic civilizations and he
10:27
Speaker 1: was a teacher in his hometown in Louisville, Kentucky. Eventually
10:31
Speaker 1: he was a private school headmaster that he founded the school,
10:35
Speaker 1: and after earning a degree in psychology from Harvard, he
10:38
Speaker 1: wrote a book called The American College, which was sort
10:41
Speaker 1: of the Flexner Report of the university system as a whole.
10:45
Speaker 1: And this guy named Henry Pritchett, who was the president
10:48
Speaker 1: of the Carnegie Foundation at the time, was like, yeah,
10:50
Speaker 1: like Josh Clark of the future will say, this is
10:54
Speaker 1: our guy, because did you see the way he came
10:56
Speaker 1: at the regular universities, like wayde till he finds out
10:59
Speaker 1: what's happening in medical schools exactly.
11:02
Speaker 2: And then one of the other reasons that he was
11:04
Speaker 2: such a great candidate because he was an outsider and
11:06
Speaker 2: a non physician, is that they were quite aware that
11:10
Speaker 2: there was going to be a lot of blowback, that
11:12
Speaker 2: there was going to be a lot of bruce digos
11:15
Speaker 2: and stepped on toes, and that somebody outside of the
11:18
Speaker 2: profession would be less likely to suffer, say like a
11:21
Speaker 2: professional injury or being ostracized for the rest of their career. Yeah.
11:27
Speaker 2: Flexner was like, I don't care what you think of me, doctors.
11:30
Speaker 1: That's right. So he started out by researching the European models,
11:35
Speaker 1: the American models. Like I said, he was really impressed
11:39
Speaker 1: with the German model, and in fact, a couple of
11:42
Speaker 1: years after the American and Canadian as we'll see Flexner Report,
11:46
Speaker 1: he published a European version which critiqued well Europe basically
11:51
Speaker 1: everybody but Germany. He was very uncritical of the German system,
11:57
Speaker 1: and we also need to point out some of the
11:58
Speaker 1: bad things he said. There were several anti Semitic passages
12:04
Speaker 1: in the European version of the Flexner Report because he
12:06
Speaker 1: was so enamored of how the Germans did their medicining.
12:10
Speaker 2: Yeah, this was Yeah, that German model also inspired the
12:14
Speaker 2: guy who founded Johns Hopkins Medical School, William Welch, and
12:19
Speaker 2: that was essentially so essentially, the Flexner report said, the
12:22
Speaker 2: Johns Hopkins model is what we want. Johns Hopkins said
12:25
Speaker 2: the German model is what we want, and the Germans said, yeah, yeah, yeah,
12:31
Speaker 2: dah yeah, no, that's Russian, das boot, that's German.
12:36
Speaker 1: Nice. What else?
12:39
Speaker 2: The heimlich maneuver, Yeah, that's it, brought worst cider. Okay, yeah,
12:46
Speaker 2: all that stuff october Fest, but with a k should.
12:50
Speaker 1: We take a break? Yeah, all right, you're gonna think
12:54
Speaker 1: did you say?
12:54
Speaker 2: Yeah?
12:55
Speaker 1: Yeah, We're gonna think of some more German words or
12:59
Speaker 1: Deutsche words, and we're gonna be back with more on
13:03
Speaker 1: what Flexner said right after this.
13:28
Speaker 2: Chuck, I could only come up with one more, and
13:29
Speaker 2: it was strudal. But it's the best one.
13:32
Speaker 1: Mmmm yeah.
13:33
Speaker 2: Oh wait Frankenstein, Yeah, that's it.
13:37
Speaker 1: Do you see that new Frankenstein movie.
13:40
Speaker 2: The Bride?
13:41
Speaker 1: No, no, no, the what's his name is new Frankenstein movie?
13:46
Speaker 2: I don't, I don't know the rock.
13:48
Speaker 1: Now the director Guillermo del Toro's.
13:52
Speaker 2: Oh no, what did you think of it?
13:54
Speaker 1: That was pretty good? I got a little bored, but
13:57
Speaker 1: it was everyone said it was really great. I think
13:59
Speaker 1: I was just a maki.
14:01
Speaker 2: Jillenhall is redoing the bride in like a really strange,
14:05
Speaker 2: like out there kind of fashion that looks interesting.
14:08
Speaker 1: Yeah, I saw that. I thought it seemed super interesting,
14:10
Speaker 1: and I love Mags, so I'm down.
14:13
Speaker 2: Okay, well that's fine, I'll allow it.
14:16
Speaker 1: So back to the Flexen report. He started that research
14:19
Speaker 1: in nineteen oh eight. I think the thing came out
14:21
Speaker 1: in nineteen ten, is like we said. But he went
14:24
Speaker 1: around all over the place. He went to one hundred
14:26
Speaker 1: and five one hundred and fifty five medical schools, one
14:30
Speaker 1: hundred and forty eight of which were in the United States,
14:32
Speaker 1: seven were in Canada. Spends a couple of days there
14:35
Speaker 1: with his nose turned up, and he did this for
14:38
Speaker 1: about eighteen months.
14:40
Speaker 2: Yeah, just to be clear here, this guy was not
14:42
Speaker 2: phoning this in. He definitely took the assignment and did
14:46
Speaker 2: it to like he did it like all of those
14:49
Speaker 2: those one hundred and fifty five medical schools in the
14:51
Speaker 2: US and Canada. That was every medical school in the
14:55
Speaker 2: US and Canada, including ones that taught alternative medicine and
15:00
Speaker 2: black medical schools. In the United States. So like, he
15:03
Speaker 2: definitely went through the paces. It wasn't just like a, yeah,
15:07
Speaker 2: let's look at Johns Hopkins and here's my report.
15:09
Speaker 1: Yeah, for sure. And you mentioned the black medical schools
15:12
Speaker 1: because they come up pretty front and center here in
15:16
Speaker 1: a minute. But Johns Hopkins was like the gold standard,
15:21
Speaker 1: so that was his comparison point for all of them.
15:23
Speaker 1: He looked at everything. He looked at how they financed
15:26
Speaker 1: their school. He looked at how big the classrooms were,
15:28
Speaker 1: how many teachers they had per student, like admissions, what
15:33
Speaker 1: it took to get in, what they were actually teaching,
15:36
Speaker 1: laboratory stuff, facilities kind of everything. And what he came
15:40
Speaker 1: out with was one of three determinations in the end
15:43
Speaker 1: for each school. The school is good, you can stay,
15:46
Speaker 1: you can keep your doors open. Your school is not
15:49
Speaker 1: so great, but you show promise, so maybe if you
15:53
Speaker 1: have some more funding and you change these things, you
15:55
Speaker 1: can be okay, and then I'm sorry, please close your
15:59
Speaker 1: doors forever.
16:00
Speaker 2: Yeah, there was a lot of them that he categorized
16:02
Speaker 2: as hopelessly deficient.
16:04
Speaker 1: A lot most in fact.
16:06
Speaker 2: Yeah, And it wasn't just like him being a snooty
16:09
Speaker 2: butt head like the as we said, like the medical
16:12
Speaker 2: schools in the United States were in a lot of
16:15
Speaker 2: cases hopelessly deficient, and that's a problem when you're producing doctors,
16:21
Speaker 2: you know. So he did make a pretty good case
16:24
Speaker 2: that that there were a lot they were hopelessly deficient,
16:26
Speaker 2: but the deficient ones they actually had different rankings. For example,
16:31
Speaker 2: Iowa State University's medical school. He basically said, they know
16:36
Speaker 2: what they're wanting to do, but the hospital associated with
16:39
Speaker 2: it is too small. And the your clinical faculty, the
16:44
Speaker 2: people who are supposed to be doing research and teaching
16:47
Speaker 2: medicine to the students, they all have their own private
16:49
Speaker 2: practices because they have to support themselves. So if you
16:54
Speaker 2: gave this this group enough funding, they could create a
16:57
Speaker 2: top notch medical school. In the Johns Hopkins model that
17:00
Speaker 2: was kind of like that deficient category, the varying degrees
17:05
Speaker 2: of how much money you would need and whether you
17:08
Speaker 2: were you're headed in the right direction.
17:10
Speaker 1: Yeah, for sure. The way he wrote in what was
17:14
Speaker 1: called Carnegie Foundation Bulletin number four or Medical Education in
17:20
Speaker 1: the United States and Canada aka Flexner Report, was that
17:25
Speaker 1: very muckbreaking style. It's not the kind of report you
17:30
Speaker 1: would people wouldn't write it this way. Today because he
17:33
Speaker 1: did get a little It seems like he enjoyed sort
17:36
Speaker 1: of the put downs and coming up with new ways
17:38
Speaker 1: of saying how bad a school.
17:39
Speaker 2: Was, so people would write it that way today and unfortunately.
17:42
Speaker 1: Well, you're probably right one of them, he said. Apparently
17:45
Speaker 1: the inexcusable degree of ignorance begins just where the ability
17:48
Speaker 1: to pay fees leaves off.
17:50
Speaker 2: Oh yeah, and so he was basically taking them to
17:54
Speaker 2: task over low admission requirements if any. But you didn't
17:58
Speaker 2: say low admission requirements. He also used the word reeks,
18:01
Speaker 2: which you don't usually see in academic studies. Yeah, he said.
18:06
Speaker 2: The osteopathic schools in the United States, there are eight
18:08
Speaker 2: of them. That they reek of commercialism, that they attract
18:12
Speaker 2: students with a mass of hysterical exaggerations that confidently appeals
18:16
Speaker 2: to the crude boys or disappointed men and women whom
18:19
Speaker 2: it successfully exploits. We should say osteopathy isn't accepted form
18:26
Speaker 2: medicine in the United States now, but a lot of
18:29
Speaker 2: people still view it as a pseudo scientific alternative medicine. Yeah.
18:35
Speaker 1: I mean, he had a site set on them, on chiropractors,
18:39
Speaker 1: on all kinds of things that a lot of people
18:43
Speaker 1: put a lot of great value in today. So he
18:46
Speaker 1: was off based on some stuff for sure. But again
18:48
Speaker 1: this was nineteen ten.
18:50
Speaker 2: So of the underfunded medical schools and this was a
18:53
Speaker 2: problem too. This is actually one of the things that
18:56
Speaker 2: befell black medical schools is we'll see in a minute.
19:00
Speaker 2: If you were underfunded, that was it. Sorry, no amount
19:03
Speaker 2: of funding is going to bring you up. Well, maybe
19:05
Speaker 2: some amount of funding is going to bring you up
19:07
Speaker 2: to speed, but we need that money to bring other
19:11
Speaker 2: medical schools that are closer up because we can bring
19:14
Speaker 2: more of them up to snuff, or we can bring
19:16
Speaker 2: fewer up to snuff and basically get the ones that
19:19
Speaker 2: are at least funded. His whole premise was just close
19:22
Speaker 2: those poorly funded ones because they're just not going to
19:25
Speaker 2: be able to do this.
19:26
Speaker 1: Yeah, and you know he was probably onto something there
19:28
Speaker 1: because there was a glut of bad schools. And his
19:31
Speaker 1: quote was the curse of medical education is the excessive
19:34
Speaker 1: number of schools. This situation can improve only as weaker
19:38
Speaker 1: and superfluous schools are extinguished. Right, Like I said, it
19:42
Speaker 1: was Canada and the US. Canada fared much better our
19:46
Speaker 1: northern friends up there. Of the seven Canadian medical schools.
19:49
Speaker 1: He only recommended one for closure.
19:52
Speaker 2: So one seventh of them, that's.
19:54
Speaker 1: Right, the one hundred and forty eight medical schools in
19:57
Speaker 1: the United States, more than half of them he recommended closing.
20:02
Speaker 1: And I think it ended up being more than that even, right.
20:06
Speaker 2: Yeah, he actually recommended reducing the full number of schools
20:10
Speaker 2: in the US and Canada from one hundred and fifty
20:14
Speaker 2: five down to thirty one. Yeah, that's four fifths. So yeah,
20:20
Speaker 2: I mean, like he was basically a hatchet man. They
20:23
Speaker 2: brought him in to basically get rid of competing, poorly funded,
20:27
Speaker 2: poorly run medical schools. He said, if you're a proprietary
20:30
Speaker 2: medical school, it doesn't matter what you're doing, you're closed.
20:34
Speaker 2: He saw med school as a public trust, that it
20:38
Speaker 2: should be publicly funded. Ergo, they should be associated or
20:42
Speaker 2: attached to public universities, and that the reason that doctors
20:46
Speaker 2: were being produced was to help society along. That you
20:49
Speaker 2: should not have a board or stockholders to whom you
20:53
Speaker 2: were really kind of beholden to so they would affect
20:55
Speaker 2: your decision making. No, you needed to be beholden to
20:58
Speaker 2: science right ideally to patients, although he didn't put much
21:03
Speaker 2: emphasis on that part.
21:05
Speaker 1: Yeah, and we'll talk about that at the end. So
21:08
Speaker 1: every single proprietary school was immediately on the list, basically
21:11
Speaker 1: from the jump, like, if you weren't affiliated with the university,
21:14
Speaker 1: you had no hope for surviving this. All the holistic
21:19
Speaker 1: or what we call alternative medical systems were completely shut down.
21:24
Speaker 1: Five of the seven black medical schools were recommended for closure.
21:30
Speaker 1: I think Howard University in DC and Mahari Medical College
21:33
Speaker 1: right here in Georgia he thought might be salvageable. But
21:37
Speaker 1: there are a couple of chapters in there. Chapter fourteen, specifically,
21:42
Speaker 1: the Medical Education of the Negro was the title of
21:44
Speaker 1: that chapter, where he shows a real disdain for black
21:48
Speaker 1: medical schools. He said they were wasting money, small sums
21:52
Speaker 1: of money annually, that undisciplined men whose lack of real
21:56
Speaker 1: training is covered up by imposing MD degrees. And he
22:00
Speaker 1: basically ended up saying, like close most of these, and
22:04
Speaker 1: my suggestion is just to make black medical schools to
22:08
Speaker 1: train black doctors to treat black patients only, and they
22:11
Speaker 1: should really just concentrate on hygiene.
22:14
Speaker 2: Yeah, they should focus on public health in order to
22:17
Speaker 2: keep black people from spreading disease to white people. That
22:21
Speaker 2: was essentially his take on the purpose for the existence
22:25
Speaker 2: of black doctors. Out of three hundred and forty six
22:28
Speaker 2: pages in the initial version of the report, two chapter
22:32
Speaker 2: fourteen was two pages long, and that is shocking in
22:36
Speaker 2: and of itself. But the Flexner Report was essentially the
22:40
Speaker 2: first document about medicine and medical school that even acknowledged
22:45
Speaker 2: the existence of black medical schools. Up to this point,
22:48
Speaker 2: they were totally invisible, completely ignored. So the fact in
22:54
Speaker 2: a really silver lining to the cloud way of looking
22:57
Speaker 2: at this, the fact that Howard Universe and Mahari Medical
23:01
Speaker 2: College in Georgia made the cut, Yeah, was really substantial,
23:07
Speaker 2: Like that was a that was sadly a really big
23:10
Speaker 2: positive for black medical schools. Unfortunately.
23:14
Speaker 1: Yeah, for sure. You know, I mentioned sexism too. The
23:17
Speaker 1: AMA and the Carnegie Foundation were also not too hot
23:22
Speaker 1: on the idea of the three women's medical college colleges
23:27
Speaker 1: even existing. In Flexner himself basically came out and said,
23:32
Speaker 1: I don't think women can withstand the mental rigors of
23:34
Speaker 1: being a doctor.
23:36
Speaker 2: You never met Elizabeth Blackwell.
23:38
Speaker 1: Yeah, no kidding, And he literally said, you know, women
23:42
Speaker 1: make better patients than doctors.
23:46
Speaker 2: This is the nineteen tens.
23:48
Speaker 1: Yeah, it's not like eighteen ten.
23:50
Speaker 2: So yeah, so this was I mean, I guess on
23:54
Speaker 2: the other way of approaching this too. So we've talked
23:57
Speaker 2: about everything that he was giving the hatchet too. He
23:59
Speaker 2: had a version of what made an idea ideal medical education,
24:05
Speaker 2: and again it was based on the German model, which
24:07
Speaker 2: the Johns Hopkins model was based on, and he essentially said, so,
24:11
Speaker 2: you need to have rigorous instruction, you need to have
24:14
Speaker 2: rigorous admissions requirements, and you have to enforce them too.
24:20
Speaker 2: And in doing so, he basically said, you're going to
24:23
Speaker 2: you're going to weed out candidates who aren't they don't
24:26
Speaker 2: have they can't make the cut for this new kind
24:28
Speaker 2: of doctor. So that meant you had to have money
24:32
Speaker 2: to even get started because this new model was so
24:36
Speaker 2: much more expensive than the old model. Three to tuition
24:40
Speaker 2: I think need to do increase three to four times
24:43
Speaker 2: just to start to meet the funding for this. So
24:46
Speaker 2: you're like you just out of the gate, had to
24:48
Speaker 2: have money to even try to apply to medical school.
24:51
Speaker 2: And then the academic requirements meant that even if you
24:56
Speaker 2: had money, if you didn't have what it took to
24:58
Speaker 2: like really dedicate yourself to learning this stuff, you were
25:02
Speaker 2: going to fail. Out too. So in that sense, it
25:05
Speaker 2: took doctors from being just ordinary trades people and said,
25:09
Speaker 2: these people are responsible for keeping the population of the
25:13
Speaker 2: United States healthy and we're making sure that they are
25:16
Speaker 2: up to the task. In return, they're rich.
25:21
Speaker 1: Now it's right, And you know, you know, part of
25:25
Speaker 1: it was says medical school was expensive was because or
25:29
Speaker 1: ended up being more expensive, is because they needed better facilities,
25:32
Speaker 1: they needed better equipment. I know, we already mentioned that
25:35
Speaker 1: teachers were working part time as doctors just because they
25:38
Speaker 1: had to make a living. But one of his big
25:40
Speaker 1: key recommendations was you have to have a full time
25:43
Speaker 1: faculty that is just doing biomedical research, like they're not
25:46
Speaker 1: doctoring on the side. And in order to come up
25:49
Speaker 1: with this kind of money, it was expensive. The idea
25:53
Speaker 1: of medical philanthropy really really took off because you know,
25:57
Speaker 1: Johns Hopkins was one thing, but if you wanted to
25:59
Speaker 1: have more than one Johns Hopkins like model out there,
26:03
Speaker 1: you had to lay out this roadmap of basically you know,
26:06
Speaker 1: starting in nineteen ten and over the next few decades
26:09
Speaker 1: and continuing today, these huge foundations were created and also
26:14
Speaker 1: local groups just donating money to make sure The Flexner
26:18
Speaker 1: Report was enacted, like the Rockefeller Foundation, they gave hundreds
26:23
Speaker 1: of millions of dollars to get these programs going across
26:26
Speaker 1: the country.
26:27
Speaker 2: Yeah, and it worked, but again it took hundreds of
26:30
Speaker 2: millions of dollars in I think nineteen ten money too.
26:33
Speaker 1: Should we take a break. Let's take a break, all right,
26:36
Speaker 1: We'll be right back with the closing act of the
26:38
Speaker 1: Flexner Report. So we're back. One of the results we
27:05
Speaker 1: talked about was all these schools shutting down, I think
27:07
Speaker 1: more within ten years, I'm sorry, Within five years of
27:10
Speaker 1: the report's release, more than fifty of the medical schools
27:14
Speaker 1: in the United States shut down, and twenty years on,
27:18
Speaker 1: only seventy six of the original one hundred and forty
27:20
Speaker 1: eight in the United States remained. Like you said, five
27:24
Speaker 1: of the seven black medical schools, eighty percent of the
27:28
Speaker 1: alternative medicine programs were shut down, and the handful of
27:33
Speaker 1: schools that had admitted women were either shut down or
27:37
Speaker 1: not admitting women anymore for a while.
27:39
Speaker 2: Right, So, like this was a huge impact on the
27:44
Speaker 2: way that doctors were created in the United States and
27:48
Speaker 2: again the profession of doctoring in the first place. And
27:52
Speaker 2: it happened very quickly, as you just mentioned, and there
27:55
Speaker 2: are a lot of positives to it, but there are
27:57
Speaker 2: a lot of criticisms to the outcomes too. One of
28:00
Speaker 2: the big ones is the impact that the flexner had
28:03
Speaker 2: on producing black doctors in the United States. I saw
28:07
Speaker 2: an estimate that had all seven of the black medical
28:11
Speaker 2: schools stayed open and been funded so that they could
28:13
Speaker 2: follow this model, another thirty thousand doctors Black doctors would
28:19
Speaker 2: have been produced to the United States between nineteen ten
28:22
Speaker 2: and twenty twelve, I think, which is a big deal
28:26
Speaker 2: because apparently right now two percent of American doctors are black,
28:30
Speaker 2: but the percentage of the Black population in the American
28:35
Speaker 2: population overall is thirteen percent, so they're grossly underrepresented, which
28:39
Speaker 2: is another problem in and of itself, because studies show
28:42
Speaker 2: that black patients are likelier to follow the orders and
28:46
Speaker 2: instructions of black doctors than they are of doctors of
28:50
Speaker 2: other races. They just it's just a question of.
28:53
Speaker 1: Comfort, yeah, for sure. And you could also make an
28:56
Speaker 1: argument that that gave rise to things like the Tuskegee
28:59
Speaker 1: experiments and other like awful experiments carried out by white
29:03
Speaker 1: doctors on black patients that led to the cycle of
29:06
Speaker 1: mistrust of the you know, the medical profession as a whole.
29:10
Speaker 2: Yeah, there was a whole like part of this, this
29:13
Speaker 2: emphasis on science. And because Flexner was not a physician,
29:17
Speaker 2: he really ignored the idea of the physician as a healer.
29:21
Speaker 2: The physician is somebody who was meant to see their
29:24
Speaker 2: patients as human and instead, because of this focus on
29:28
Speaker 2: rationalism over humanism, the patient became essentially just a walking
29:32
Speaker 2: bag of medical issues that needed to be diagnosed and treated.
29:36
Speaker 2: They weren't a person. That stuff didn't matter. The point
29:39
Speaker 2: of the doctor was to treat their illnesses and make
29:42
Speaker 2: them better, not to be their friend. And in doing that,
29:46
Speaker 2: like the medical profession lost a lot of I guess
29:50
Speaker 2: connection with the rest of us, where you know, doctors
29:52
Speaker 2: are kind of looked at is looking at the rest
29:57
Speaker 2: of us is not fully human and that doesn't really
30:00
Speaker 2: jibe and feel good, you know when you're a patient.
30:03
Speaker 1: Yeah, for sure, I think I can't find it. It's
30:06
Speaker 1: not in front of me now. But I sent you
30:07
Speaker 1: one study from a few years ago where I think
30:10
Speaker 1: the long and shortage it was they were surveying people
30:12
Speaker 1: that how happy they were with like the end of
30:15
Speaker 1: care care for relatives, and I think only forty percent
30:21
Speaker 1: of the people were satisfied with like how their the
30:25
Speaker 1: end of the lives of their relatives went. And a
30:28
Speaker 1: lot of that had to do with pain management, and
30:29
Speaker 1: that sort of ties back to what you were saying
30:31
Speaker 1: about just sort of the rigorous you know, eyeballs on
30:37
Speaker 1: a microscope and not like eyeballs on a human. You know,
30:43
Speaker 1: it's all sort of tied in together, I think.
30:45
Speaker 2: Yeah, And the other way that that manifested itself was
30:48
Speaker 2: a huge emphasis on separating academic physicians from practicing physicians
30:54
Speaker 2: so that academics could just focus on research. And then
30:58
Speaker 2: they emphasized the research that the act academics we're producing,
31:01
Speaker 2: like that's the most important thing. You clinicians, listen to
31:04
Speaker 2: the research doctors and what they're finding, and then you
31:07
Speaker 2: can go apply it to your practice. And so they
31:09
Speaker 2: were like, well, you've taken these people away from patients
31:13
Speaker 2: and they're just using like this this scientific mentality and
31:18
Speaker 2: there's no humanism to it. And they critics say that
31:21
Speaker 2: was one of the ways that this whole idea of
31:24
Speaker 2: science losing its humanity or medicine losing part of its
31:27
Speaker 2: humanity or soul came about.
31:29
Speaker 1: Yeah, for sure, you know, I know, I've already mentioned
31:32
Speaker 1: a little bit about eliminating sort of all kinds of
31:35
Speaker 1: alternative medicines, and that homeopathy was homeopathy homeopathy, what do
31:41
Speaker 1: you say, I've heard both, Okay, both at the same time.
31:45
Speaker 1: Was very popular at the time. I mean, there are
31:47
Speaker 1: people that think that they were doing pretty well with
31:52
Speaker 1: homeopathy and curing disease with natural remedies. Other people will say, no,
31:57
Speaker 1: you've got your tinfoil hat on, and that's not the case.
32:00
Speaker 1: They just didn't know real science at the time. So
32:03
Speaker 1: there's a lot of raging debate online about that kind
32:05
Speaker 1: of stuff. But another point of this all is that
32:09
Speaker 1: psychiatric medicine lost a lot of I guess curricular elements
32:15
Speaker 1: that were very beneficial at the time for mental health treatment.
32:18
Speaker 1: They were making a lot of strides at the time
32:20
Speaker 1: with things like meditation and like how nutrition food can
32:25
Speaker 1: alter like a person's or lifestyle can alter a person's
32:29
Speaker 1: mental health. And that was all just sort of flushed
32:31
Speaker 1: down the toilet because of this, and the neurochemical model
32:35
Speaker 1: came out of mental illness, and the same people that
32:39
Speaker 1: were arguing for homeopathy basically said, you know what, the
32:43
Speaker 1: flex and report really did was, among other things, was
32:48
Speaker 1: let us down the path of people like the Rockefeller
32:50
Speaker 1: Foundation creating big pharma essentially and getting people on endless
32:57
Speaker 1: amounts of medicine that just don't heal you. They're just
33:00
Speaker 1: never ending and make big, farmer, bigger.
33:03
Speaker 2: Yeah, psychiatric medicine is a good example of that. They
33:06
Speaker 2: just took the neurochemical model of mental illness and that
33:09
Speaker 2: that was that.
33:10
Speaker 1: I mean, I think a lot of that stuff has
33:12
Speaker 1: come back now. Yeah, it's just not super funded and
33:16
Speaker 1: you're not going to find any like huge medical schools
33:21
Speaker 1: that tout their homeopathy departments or anything like that. But
33:26
Speaker 1: I think there's underground movements for all that stuff, like hey,
33:31
Speaker 1: meditation can help your mental health, and maybe these herbs
33:34
Speaker 1: can make you feel better, or this honey that you
33:36
Speaker 1: rub on your cut is better than vactine or whatever.
33:40
Speaker 2: It really is. If you see a good psychiatrist, especially
33:44
Speaker 2: probably a younger one these days, one of the first
33:47
Speaker 2: things they're going to ask you is how are you sleeping,
33:50
Speaker 2: are you exercising? What your diet? Like, yeah, totally, And
33:53
Speaker 2: then they'll start to go into meds. But like they're
33:55
Speaker 2: gonna say, like, you need to really pay attention to
33:57
Speaker 2: these three things, and if you still need meds, it'll
34:00
Speaker 2: still drastically reduced the kind or amount of meds you'll
34:04
Speaker 2: probably need.
34:05
Speaker 1: Right if you're taking care of yourself in the other.
34:07
Speaker 2: Ways exactly, So that has definitely come back in psychiatry.
34:11
Speaker 2: And that's a really good example of what a lot
34:12
Speaker 2: of people point to. The Flexner Report suppressed that for
34:16
Speaker 2: one hundred years, it derailed black doctors, it derailed women doctors,
34:21
Speaker 2: it derailed alternative medicines. It even took the stuff that
34:25
Speaker 2: was part of the medical establishment and twisted it around,
34:28
Speaker 2: and it took a full century for things to start
34:32
Speaker 2: to even come back, And that again is a really
34:35
Speaker 2: big criticism of the whole thing. But overall, you can
34:38
Speaker 2: point to a lot of stuff, a lot of lives
34:41
Speaker 2: that were saved, a lot of lives that were improved,
34:43
Speaker 2: a lot of life spans that were extended because of
34:46
Speaker 2: this Johns Hopkins German model that the Flexner Report essentially
34:52
Speaker 2: with the AMA, got the Rockefeller Foundation to fund and
34:57
Speaker 2: create this new model for America.
35:00
Speaker 1: This is one of those rare episodes where there's truly
35:03
Speaker 1: like two ways to look at it. I mean, he
35:06
Speaker 1: definitely threw the baby out with the bathwater. In a
35:08
Speaker 1: lot of cases, oh well put. But you could also
35:11
Speaker 1: argue that, like it was such a mess that like
35:15
Speaker 1: something drastic had to happen or else. You know, who
35:20
Speaker 1: knows how many more decades it would have taken. I mean,
35:22
Speaker 1: I definitely agree with you that like it would have
35:23
Speaker 1: happened at some point. I doubt if we'd still be
35:25
Speaker 1: sitting here today had the Flexner Report and not been written,
35:28
Speaker 1: and like I'm sitting here with like a leech on
35:30
Speaker 1: my forehead.
35:31
Speaker 2: Right or I have typhus Yeah exactly. Yeah, I agree
35:36
Speaker 2: with you, Chuck. This is a good one. Thank you
35:41
Speaker 2: Emily for it.
35:43
Speaker 1: Thanks, Josh, You're welcome.
35:44
Speaker 2: That was a great Emily.
35:45
Speaker 1: I seen you in San Francisco, buddy.
35:47
Speaker 2: Yeah, it was great to see you too. I don't
35:49
Speaker 2: know why I'm talking like you, but I am. If
35:52
Speaker 2: you want to know more about the flex And Report,
35:54
Speaker 2: go out and read it. Three hundred and forty six
35:56
Speaker 2: pages of muck raking gold. And since I just wrapped
36:00
Speaker 2: up this episode as if it were from twenty ten,
36:03
Speaker 2: I think it's Chuck time for listener mail.
36:07
Speaker 1: That's right, This is from Kyle. Hey, guys, I'm sure
36:10
Speaker 1: you've heard this over the years, maybe receive snarky emails
36:14
Speaker 1: from people saying, what do you mean I should know this?
36:17
Speaker 2: Oh yeah, I like this email.
36:19
Speaker 1: Thanks for picking it in a way it makes it
36:21
Speaker 1: seem like they interpret it as stuff you should already know.
36:24
Speaker 1: But I always took the approach that a Quintessential SYSK
36:27
Speaker 1: episode sheds light on something that a person should know
36:30
Speaker 1: in order to give voice two situations, regions, historical events,
36:34
Speaker 1: things like that, something we should know today to help
36:36
Speaker 1: learn and grow. Kyle, That's of course always been the case.
36:41
Speaker 2: Yeah, it's stuff that we think you should know, which
36:43
Speaker 2: we want to share with you.
36:45
Speaker 1: But it is interesting to learn how the son of
36:47
Speaker 1: the Jackamer works. I found I see what you're doing there, Kyle.
36:50
Speaker 1: I found that the Helen Keller and a Sullivan episode
36:53
Speaker 1: was exactly what I think of as a great stuff
36:54
Speaker 1: you should know episode. My only knowledge of Helen Keller
36:58
Speaker 1: was what I had learned from the late nineties and
37:00
Speaker 1: aughts media and pop culture. So thank you for showing
37:03
Speaker 1: me how amazing both of them were as people, activist advocates,
37:06
Speaker 1: and his friends. The lives of Keller and Suliman is
37:10
Speaker 1: something everyone should know. Thank you. That is from Kyle.
37:14
Speaker 2: Thank you right back. Kyle. That was a world class email, don't.
37:17
Speaker 1: You think, Chuck, Yes, Kyle, that was wonderful.
37:21
Speaker 2: Yeah. So, if you want to knock it out of
37:23
Speaker 2: the park with an email like Kyle did, wrap it up,
37:26
Speaker 2: spank it on the bottom, and send it off to
37:28
Speaker 2: Stuff podcast at iHeartRadio dot com.
37:34
Speaker 1: Stuff you Should Know is a production of iHeartRadio. For
37:37
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37:42
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