February 19, 2026 • 37 mins
The Flexner Report shook up medicine in the United States when it was released in 1910 and it's never been the same since. For better or worse.
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Speaker 1 (00:01):
Welcome to Stuff you should know, a production of iHeartRadio.
Speaker 2 (00:11):
Hey, and welcome to the podcast. I'm Josh, and there's
Chuck and jar Jar Binks is here too, and this
is stuff you should know about the Flexner Report.
Speaker 1 (00:20):
That's right. This was a suggestion by my wife.
Speaker 2 (00:25):
Oh, that's a good one.
Speaker 1 (00:26):
Yeah. Emily, of course everyone knows if they listen to
the show. As an organic gardner and an herbalist, she said,
has long asked me to do one on the Flexner Report,
which is a report written in nineteen ten that did
a lot of things basically kind of revamped how medicine
(00:47):
worked in the United States, moving forward to medical school
in particular.
Speaker 2 (00:50):
Right.
Speaker 1 (00:51):
But Emily was interested because another thing it did a
byproduct was it basically completely squashed what we would now
call altern medicine homeopathy, basically saying it has zero value
and we're not doing that anymore. It sure did biff, Yeah,
and it was also racist and sexist.
Speaker 2 (01:13):
It was definitely of its time. This is a document
produced in nineteen ten, for sure. Yeah, and it definitely
stinks of eugenics and all that.
Speaker 1 (01:21):
Yeah. So it's one of those weird things where like
you can see it from all sides, because it did
a lot of good and it also maybe didn't do
some good in certain areas.
Speaker 2 (01:32):
Yeah, for sure. And there's there's not many people who
are like, no, the Flexner Report sucks. It was all
bad because it If you enjoy being treated successfully for cancer,
you can pretty much thank the Flexner Report for that.
But at the same time, yeah, if you believe that
there are alternative therapies that are as good or better
(01:54):
than medications, then yeah, you probably don't like that part
of the Flexner Report. But I think on the whole
it was a good thing. There seems to be now
among you know, thinking people who don't just wait and
wallow and dogma, saying like, we needed a new Flexner
Report for the twenty first century because it's basically run
(02:16):
its course and now again it's become dogma and we
need to do something about that.
Speaker 1 (02:19):
Right. I think that's a great setup, and maybe we
should paint a little bit of a picture about what
medicine and medical school look like in the United States
pre Flexner Report.
Speaker 2 (02:31):
Who was bad?
Speaker 1 (02:32):
It was bad, I guess quickly we should say that
Europe was doing it right before we were. In France,
especially they had some pretty top notch medical schools where
they embrace real science and we're practicing medicine on people
like as practice in colleges and stuff like that. But
in the United States that was around eighteen fifty. In
(02:53):
the US, in eighteen fifty they had fifty two medical schools.
This is what fifty sixty years before the Flexner Report,
and medicine was not you know, to be a doctor
was not some prestigious thing. Medicine was a trade. If
you were associated with the university at all. As a
medical school, it was a two year program. The curriculum
(03:14):
was very, very broad. They were super underfunded. Even at
places like Harvard, they had to pay for their own
teaching supplies. And those were the good ones that were
attached to universities.
Speaker 2 (03:25):
Yeah, I mean, there were plenty of diploma mills. There
were a lot of proprietary medical schools where it was
just some people got together and created a for profit
school where they would teach you how to become a doctor.
But they were not doing a very good job of it.
And your admission requirement was the ability to pay the
(03:45):
tuition fees. Essentially.
Speaker 1 (03:47):
Yeah, for sure, you might have like redundant classes that
literally went over the same things. You might not have
your hands on a scalpel ever, you might not have
an exam ever, you may not see patience, you might
not have any contact with another human being at that
medical school.
Speaker 2 (04:08):
It'd be kind of like if you went to go
skydive and in the class before you go skydive, they
just talk about how hard the ground can be if
you hit it, and then they take you up in
a plane and push you out. It's similar to something
like that. That's good, thanks, I like it.
Speaker 1 (04:25):
But then everybody the Civil War came around in the
eighteen sixties and there was wartime doctoring happening. And after
the Civil War people came out of that saying we're
in trouble. Everybody, like the doctoring wasn't so great in
this war and we need to fix this.
Speaker 2 (04:44):
Well, what I interpreted is that they went out and
got real world experience and realized, like the stuff they
learned at school was not preparing them for actual medicine.
Speaker 1 (04:53):
Oh yeah, I mean I think it was a little
bit of both. I think the person who had their
leg chopped off unnecessarily complained, and I think the doctor
who did the chopping might have complained as well.
Speaker 2 (05:03):
Right, they didn't teach me that patient's complain in medical school. Yeah,
so yes, regardless, by the by the eighteen sixties, like,
it was quite clear that American medicine was lacking tremendously
and that the main reason for that was that the
doctors who were practicing medicine had virtually no actual training
(05:24):
in medicine. They was lectures, textbooks, That's basically it. So
there were there was a part of the progressive era,
this actually this push to create a movement to make
medicine in America better and by by focusing on the
medical school education that that came around in about the
(05:46):
eighteen seventies. It was led by Harvard. Yeah, but really
Johns Hopkins University was the one that really hopped on it.
Speaker 1 (05:55):
Yeah, for sure, Like Harvard got the ball rolling for
a couple of decades, and by the time Johns Hopkins
opened in eighteen ninety three, they became kind of the
standard for the American model moving forward, which SBC was
based on the German model. Right, you had to have
a first of all, you had to have a college
degree just to get in, and that was previously not
(06:16):
necessarily the case. Secondly, they had full time faculty. They
were medical scientists, so they weren't doctors on the side
as well. They were just fully employed to teach, and
they had a four year like a full four year
course of study where it was hands on and a
lot of laboratory work.
Speaker 2 (06:37):
Yeah, and yes, where they were actually working with patients
or assisting other actual doctors in working with patients. Like
it wasn't just like sit there and listen to this lecture. Yeah,
that was. And that essentially that Johns Hopkins model is
what became the model for American medical school. And there's
(06:57):
a lot of there's a lot of talk at parties
if you stop and listen about whether this would have
happened on its own or not. And for the most part,
it seems that, yes, this progressive era movement would have
gotten there eventually. Yeah, just because it was a good idea.
The Flexner Report helped it happen on a dime, because
(07:18):
not only did it show to everybody else this is
the way to do it, it also said this is
very expensive, and here's how we need to get the
money for it. And did get the money for it,
Like that's how it was implemented.
Speaker 1 (07:30):
Yeah, for sure. The American Medical Association was founded in
eighteen forty seven. And one of the reasons, and you know,
again this is stuff that I learned from sort of
Emily's urgings. One of the reasons the American Medical Association
was founded to begin with was like on a mission
(07:51):
to squash homeopathy. It says so in its charter. And
when the AMA was founded, they discouraged any association or
communication with those kinds of doctors and had a code
of ethics that was a clause in there known as
a consultation clause that said, if you even talk to
a quote unquote non regular practitioner, then you're going to
(08:14):
lose your license to practice medicine. They carved out exemptions
for Massachusetts and New York because it was homeopathy was really, really,
really popular at the time among the elite, wealthy Americans,
like the major politicians, the corporate leaders. I think it
was Rockefeller. I think it was Rockefeller that was under
(08:36):
the care of a homeopathic doctor for like fifty years.
Speaker 2 (08:38):
Wow.
Speaker 1 (08:39):
So they carved out exceptions for those two states for
a while until they were able. You know, all those
people died off basically and they were able to completely
squash it.
Speaker 2 (08:48):
Right, Rockefeller died, So I guess the homeopathy he didn't work.
Speaker 1 (08:52):
Well. He lived another like forty eight years after being
told he didn't have long to live.
Speaker 2 (08:57):
I think, oh wow, it's a homeopathy works case closed.
So yes, I think that you really put your finger
on that. The AMA became the arbiter of what qualifies
as medicine in the United States thanks to this Flexner report.
It basically strengthened all of its position. And yes, they
(09:17):
were the driving force behind this. Initially they went to
the Carnegie the Carnegie Foundation, and said, hey, you got
a lot of money, why don't you help us figure
out how to change American medical education in the exact
way we want it, and we'll help you figure out
who to do that with. We like the Johns Hopkins model.
(09:39):
We basically want a report that says the Johns Hopkins
model is great. Let's get an outsider in here. And
that is how Abraham Flexner enters this story.
Speaker 1 (09:49):
Yeah, and you know this is not to say that
he was like cooking the books or anything like that,
and no, this is all a sham, but that was
just sort of The AMA was definitely after that well.
Speaker 2 (09:57):
One of the reasons he was selected is he was
already a person, an educator who espoused exactly this kind
of stuff, just not necessarily as it applied to medical education.
He just wasn't exposed to medical education at the time.
But he was an educational philosopher and theorists and he
was fully on board with that kind of thinking.
Speaker 1 (10:17):
Yeah, I mean he wrote a book. I guess we
should say he did go to Johns Hopkins, but not
for medicine. I think he studied classic civilizations and he
was a teacher in his hometown in Louisville, Kentucky. Eventually
he was a private school headmaster that he founded the school,
and after earning a degree in psychology from Harvard, he
(10:38):
wrote a book called The American College, which was sort
of the Flexner Report of the university system as a whole.
And this guy named Henry Pritchett, who was the president
of the Carnegie Foundation at the time, was like, yeah,
like Josh Clark of the future will say, this is
our guy, because did you see the way he came
at the regular universities, like wayde till he finds out
(10:59):
what's happening in medical schools exactly.
Speaker 2 (11:02):
And then one of the other reasons that he was
such a great candidate because he was an outsider and
a non physician, is that they were quite aware that
there was going to be a lot of blowback, that
there was going to be a lot of bruce digos
and stepped on toes, and that somebody outside of the
profession would be less likely to suffer, say like a
professional injury or being ostracized for the rest of their career. Yeah.
(11:27):
Flexner was like, I don't care what you think of me, doctors.
Speaker 1 (11:30):
That's right. So he started out by researching the European models,
the American models. Like I said, he was really impressed
with the German model, and in fact, a couple of
years after the American and Canadian as we'll see Flexner Report,
he published a European version which critiqued well Europe basically
(11:51):
everybody but Germany. He was very uncritical of the German system,
and we also need to point out some of the
bad things he said. There were several anti Semitic passages
in the European version of the Flexner Report because he
was so enamored of how the Germans did their medicining.
Speaker 2 (12:10):
Yeah, this was Yeah, that German model also inspired the
guy who founded Johns Hopkins Medical School, William Welch, and
that was essentially so essentially, the Flexner report said, the
Johns Hopkins model is what we want. Johns Hopkins said
the German model is what we want, and the Germans said, yeah, yeah, yeah,
(12:31):
dah yeah, no, that's Russian, das boot, that's German.
Speaker 1 (12:36):
Nice. What else?
Speaker 2 (12:39):
The heimlich maneuver, Yeah, that's it, brought worst cider. Okay, yeah,
all that stuff october Fest, but with a k should.
Speaker 1 (12:50):
We take a break? Yeah, all right, you're gonna think
did you say?
Speaker 2 (12:54):
Yeah?
Speaker 1 (12:55):
Yeah, We're gonna think of some more German words or
Deutsche words, and we're gonna be back with more on
what Flexner said right after this.
Speaker 2 (13:28):
Chuck, I could only come up with one more, and
it was strudal. But it's the best one.
Speaker 1 (13:32):
Mmmm yeah.
Speaker 2 (13:33):
Oh wait Frankenstein, Yeah, that's it.
Speaker 1 (13:37):
Do you see that new Frankenstein movie.
Speaker 2 (13:40):
The Bride?
Speaker 1 (13:41):
No, no, no, the what's his name is new Frankenstein movie?
Speaker 2 (13:46):
I don't, I don't know the rock.
Speaker 1 (13:48):
Now the director Guillermo del Toro's.
Speaker 2 (13:52):
Oh no, what did you think of it?
Speaker 1 (13:54):
That was pretty good? I got a little bored, but
it was everyone said it was really great. I think
I was just a maki.
Speaker 2 (14:01):
Jillenhall is redoing the bride in like a really strange,
like out there kind of fashion that looks interesting.
Speaker 1 (14:08):
Yeah, I saw that. I thought it seemed super interesting,
and I love Mags, so I'm down.
Speaker 2 (14:13):
Okay, well that's fine, I'll allow it.
Speaker 1 (14:16):
So back to the Flexen report. He started that research
in nineteen oh eight. I think the thing came out
in nineteen ten, is like we said. But he went
around all over the place. He went to one hundred
and five one hundred and fifty five medical schools, one
hundred and forty eight of which were in the United States,
seven were in Canada. Spends a couple of days there
with his nose turned up, and he did this for
(14:38):
about eighteen months.
Speaker 2 (14:40):
Yeah, just to be clear here, this guy was not
phoning this in. He definitely took the assignment and did
it to like he did it like all of those
those one hundred and fifty five medical schools in the
US and Canada. That was every medical school in the
US and Canada, including ones that taught alternative medicine and
black medical schools. In the United States. So like, he
(15:03):
definitely went through the paces. It wasn't just like a, yeah,
let's look at Johns Hopkins and here's my report.
Speaker 1 (15:09):
Yeah, for sure. And you mentioned the black medical schools
because they come up pretty front and center here in
a minute. But Johns Hopkins was like the gold standard,
so that was his comparison point for all of them.
He looked at everything. He looked at how they financed
their school. He looked at how big the classrooms were,
how many teachers they had per student, like admissions, what
(15:33):
it took to get in, what they were actually teaching,
laboratory stuff, facilities kind of everything. And what he came
out with was one of three determinations in the end
for each school. The school is good, you can stay,
you can keep your doors open. Your school is not
so great, but you show promise, so maybe if you
(15:53):
have some more funding and you change these things, you
can be okay, and then I'm sorry, please close your
doors forever.
Speaker 2 (16:00):
Yeah, there was a lot of them that he categorized
as hopelessly deficient.
Speaker 1 (16:04):
A lot most in fact.
Speaker 2 (16:06):
Yeah, And it wasn't just like him being a snooty
butt head like the as we said, like the medical
schools in the United States were in a lot of
cases hopelessly deficient, and that's a problem when you're producing doctors,
you know. So he did make a pretty good case
that that there were a lot they were hopelessly deficient,
but the deficient ones they actually had different rankings. For example,
(16:31):
Iowa State University's medical school. He basically said, they know
what they're wanting to do, but the hospital associated with
it is too small. And the your clinical faculty, the
people who are supposed to be doing research and teaching
medicine to the students, they all have their own private
practices because they have to support themselves. So if you
(16:54):
gave this this group enough funding, they could create a
top notch medical school. In the Johns Hopkins model that
was kind of like that deficient category, the varying degrees
of how much money you would need and whether you
were you're headed in the right direction.
Speaker 1 (17:10):
Yeah, for sure. The way he wrote in what was
called Carnegie Foundation Bulletin number four or Medical Education in
the United States and Canada aka Flexner Report, was that
very muckbreaking style. It's not the kind of report you
would people wouldn't write it this way. Today because he
(17:33):
did get a little It seems like he enjoyed sort
of the put downs and coming up with new ways
of saying how bad a school.
Speaker 2 (17:39):
Was, so people would write it that way today and unfortunately.
Speaker 1 (17:42):
Well, you're probably right one of them, he said. Apparently
the inexcusable degree of ignorance begins just where the ability
to pay fees leaves off.
Speaker 2 (17:50):
Oh yeah, and so he was basically taking them to
task over low admission requirements if any. But you didn't
say low admission requirements. He also used the word reeks,
which you don't usually see in academic studies. Yeah, he said.
The osteopathic schools in the United States, there are eight
of them. That they reek of commercialism, that they attract
(18:12):
students with a mass of hysterical exaggerations that confidently appeals
to the crude boys or disappointed men and women whom
it successfully exploits. We should say osteopathy isn't accepted form
medicine in the United States now, but a lot of
people still view it as a pseudo scientific alternative medicine. Yeah.
Speaker 1 (18:35):
I mean, he had a site set on them, on chiropractors,
on all kinds of things that a lot of people
put a lot of great value in today. So he
was off based on some stuff for sure. But again
this was nineteen ten.
Speaker 2 (18:50):
So of the underfunded medical schools and this was a
problem too. This is actually one of the things that
befell black medical schools is we'll see in a minute.
If you were underfunded, that was it. Sorry, no amount
of funding is going to bring you up. Well, maybe
some amount of funding is going to bring you up
to speed, but we need that money to bring other
(19:11):
medical schools that are closer up because we can bring
more of them up to snuff, or we can bring
fewer up to snuff and basically get the ones that
are at least funded. His whole premise was just close
those poorly funded ones because they're just not going to
be able to do this.
Speaker 1 (19:26):
Yeah, and you know he was probably onto something there
because there was a glut of bad schools. And his
quote was the curse of medical education is the excessive
number of schools. This situation can improve only as weaker
and superfluous schools are extinguished. Right, Like I said, it
was Canada and the US. Canada fared much better our
northern friends up there. Of the seven Canadian medical schools.
(19:49):
He only recommended one for closure.
Speaker 2 (19:52):
So one seventh of them, that's.
Speaker 1 (19:54):
Right, the one hundred and forty eight medical schools in
the United States, more than half of them he recommended closing.
And I think it ended up being more than that even, right.
Speaker 2 (20:06):
Yeah, he actually recommended reducing the full number of schools
in the US and Canada from one hundred and fifty
five down to thirty one. Yeah, that's four fifths. So yeah,
I mean, like he was basically a hatchet man. They
brought him in to basically get rid of competing, poorly funded,
(20:27):
poorly run medical schools. He said, if you're a proprietary
medical school, it doesn't matter what you're doing, you're closed.
He saw med school as a public trust, that it
should be publicly funded. Ergo, they should be associated or
attached to public universities, and that the reason that doctors
were being produced was to help society along. That you
(20:49):
should not have a board or stockholders to whom you
were really kind of beholden to so they would affect
your decision making. No, you needed to be beholden to
science right ideally to patients, although he didn't put much
emphasis on that part.
Speaker 1 (21:05):
Yeah, and we'll talk about that at the end. So
every single proprietary school was immediately on the list, basically
from the jump, like, if you weren't affiliated with the university,
you had no hope for surviving this. All the holistic
or what we call alternative medical systems were completely shut down.
Five of the seven black medical schools were recommended for closure.
(21:30):
I think Howard University in DC and Mahari Medical College
right here in Georgia he thought might be salvageable. But
there are a couple of chapters in there. Chapter fourteen, specifically,
the Medical Education of the Negro was the title of
that chapter, where he shows a real disdain for black
medical schools. He said they were wasting money, small sums
(21:52):
of money annually, that undisciplined men whose lack of real
training is covered up by imposing MD degrees. And he
basically ended up saying, like close most of these, and
my suggestion is just to make black medical schools to
train black doctors to treat black patients only, and they
should really just concentrate on hygiene.
Speaker 2 (22:14):
Yeah, they should focus on public health in order to
keep black people from spreading disease to white people. That
was essentially his take on the purpose for the existence
of black doctors. Out of three hundred and forty six
pages in the initial version of the report, two chapter
fourteen was two pages long, and that is shocking in
(22:36):
and of itself. But the Flexner Report was essentially the
first document about medicine and medical school that even acknowledged
the existence of black medical schools. Up to this point,
they were totally invisible, completely ignored. So the fact in
a really silver lining to the cloud way of looking
(22:57):
at this, the fact that Howard Universe and Mahari Medical
College in Georgia made the cut, Yeah, was really substantial,
Like that was a that was sadly a really big
positive for black medical schools. Unfortunately.
Speaker 1 (23:14):
Yeah, for sure. You know, I mentioned sexism too. The
AMA and the Carnegie Foundation were also not too hot
on the idea of the three women's medical college colleges
even existing. In Flexner himself basically came out and said,
I don't think women can withstand the mental rigors of
(23:34):
being a doctor.
Speaker 2 (23:36):
You never met Elizabeth Blackwell.
Speaker 1 (23:38):
Yeah, no kidding, And he literally said, you know, women
make better patients than doctors.
Speaker 2 (23:46):
This is the nineteen tens.
Speaker 1 (23:48):
Yeah, it's not like eighteen ten.
Speaker 2 (23:50):
So yeah, so this was I mean, I guess on
the other way of approaching this too. So we've talked
about everything that he was giving the hatchet too. He
had a version of what made an idea ideal medical education,
and again it was based on the German model, which
the Johns Hopkins model was based on, and he essentially said, so,
(24:11):
you need to have rigorous instruction, you need to have
rigorous admissions requirements, and you have to enforce them too.
And in doing so, he basically said, you're going to
you're going to weed out candidates who aren't they don't
have they can't make the cut for this new kind
of doctor. So that meant you had to have money
(24:32):
to even get started because this new model was so
much more expensive than the old model. Three to tuition
I think need to do increase three to four times
just to start to meet the funding for this. So
you're like you just out of the gate, had to
have money to even try to apply to medical school.
And then the academic requirements meant that even if you
(24:56):
had money, if you didn't have what it took to
like really dedicate yourself to learning this stuff, you were
going to fail. Out too. So in that sense, it
took doctors from being just ordinary trades people and said,
these people are responsible for keeping the population of the
United States healthy and we're making sure that they are
(25:16):
up to the task. In return, they're rich.
Speaker 1 (25:21):
Now it's right, And you know, you know, part of
it was says medical school was expensive was because or
ended up being more expensive, is because they needed better facilities,
they needed better equipment. I know, we already mentioned that
teachers were working part time as doctors just because they
had to make a living. But one of his big
key recommendations was you have to have a full time
(25:43):
faculty that is just doing biomedical research, like they're not
doctoring on the side. And in order to come up
with this kind of money, it was expensive. The idea
of medical philanthropy really really took off because you know,
Johns Hopkins was one thing, but if you wanted to
have more than one Johns Hopkins like model out there,
you had to lay out this roadmap of basically you know,
(26:06):
starting in nineteen ten and over the next few decades
and continuing today, these huge foundations were created and also
local groups just donating money to make sure The Flexner
Report was enacted, like the Rockefeller Foundation, they gave hundreds
of millions of dollars to get these programs going across
(26:26):
the country.
Speaker 2 (26:27):
Yeah, and it worked, but again it took hundreds of
millions of dollars in I think nineteen ten money too.
Speaker 1 (26:33):
Should we take a break. Let's take a break, all right,
We'll be right back with the closing act of the
Flexner Report. So we're back. One of the results we
(27:05):
talked about was all these schools shutting down, I think
more within ten years, I'm sorry, Within five years of
the report's release, more than fifty of the medical schools
in the United States shut down, and twenty years on,
only seventy six of the original one hundred and forty
eight in the United States remained. Like you said, five
of the seven black medical schools, eighty percent of the
(27:28):
alternative medicine programs were shut down, and the handful of
schools that had admitted women were either shut down or
not admitting women anymore for a while.
Speaker 2 (27:39):
Right, So, like this was a huge impact on the
way that doctors were created in the United States and
again the profession of doctoring in the first place. And
it happened very quickly, as you just mentioned, and there
are a lot of positives to it, but there are
a lot of criticisms to the outcomes too. One of
(28:00):
the big ones is the impact that the flexner had
on producing black doctors in the United States. I saw
an estimate that had all seven of the black medical
schools stayed open and been funded so that they could
follow this model, another thirty thousand doctors Black doctors would
have been produced to the United States between nineteen ten
(28:22):
and twenty twelve, I think, which is a big deal
because apparently right now two percent of American doctors are black,
but the percentage of the Black population in the American
population overall is thirteen percent, so they're grossly underrepresented, which
is another problem in and of itself, because studies show
(28:42):
that black patients are likelier to follow the orders and
instructions of black doctors than they are of doctors of
other races. They just it's just a question of.
Speaker 1 (28:53):
Comfort, yeah, for sure. And you could also make an
argument that that gave rise to things like the Tuskegee
experiments and other like awful experiments carried out by white
doctors on black patients that led to the cycle of
mistrust of the you know, the medical profession as a whole.
Speaker 2 (29:10):
Yeah, there was a whole like part of this, this
emphasis on science. And because Flexner was not a physician,
he really ignored the idea of the physician as a healer.
The physician is somebody who was meant to see their
patients as human and instead, because of this focus on
rationalism over humanism, the patient became essentially just a walking
(29:32):
bag of medical issues that needed to be diagnosed and treated.
They weren't a person. That stuff didn't matter. The point
of the doctor was to treat their illnesses and make
them better, not to be their friend. And in doing that,
like the medical profession lost a lot of I guess
connection with the rest of us, where you know, doctors
(29:52):
are kind of looked at is looking at the rest
of us is not fully human and that doesn't really
jibe and feel good, you know when you're a patient.
Speaker 1 (30:03):
Yeah, for sure, I think I can't find it. It's
not in front of me now. But I sent you
one study from a few years ago where I think
the long and shortage it was they were surveying people
that how happy they were with like the end of
care care for relatives, and I think only forty percent
of the people were satisfied with like how their the
(30:25):
end of the lives of their relatives went. And a
lot of that had to do with pain management, and
that sort of ties back to what you were saying
about just sort of the rigorous you know, eyeballs on
a microscope and not like eyeballs on a human. You know,
it's all sort of tied in together, I think.
Speaker 2 (30:45):
Yeah, And the other way that that manifested itself was
a huge emphasis on separating academic physicians from practicing physicians
so that academics could just focus on research. And then
they emphasized the research that the act academics we're producing,
like that's the most important thing. You clinicians, listen to
the research doctors and what they're finding, and then you
(31:07):
can go apply it to your practice. And so they
were like, well, you've taken these people away from patients
and they're just using like this this scientific mentality and
there's no humanism to it. And they critics say that
was one of the ways that this whole idea of
science losing its humanity or medicine losing part of its
(31:27):
humanity or soul came about.
Speaker 1 (31:29):
Yeah, for sure, you know, I know, I've already mentioned
a little bit about eliminating sort of all kinds of
alternative medicines, and that homeopathy was homeopathy homeopathy, what do
you say, I've heard both, Okay, both at the same time.
Was very popular at the time. I mean, there are
people that think that they were doing pretty well with
(31:52):
homeopathy and curing disease with natural remedies. Other people will say, no,
you've got your tinfoil hat on, and that's not the case.
They just didn't know real science at the time. So
there's a lot of raging debate online about that kind
of stuff. But another point of this all is that
psychiatric medicine lost a lot of I guess curricular elements
(32:15):
that were very beneficial at the time for mental health treatment.
They were making a lot of strides at the time
with things like meditation and like how nutrition food can
alter like a person's or lifestyle can alter a person's
mental health. And that was all just sort of flushed
down the toilet because of this, and the neurochemical model
(32:35):
came out of mental illness, and the same people that
were arguing for homeopathy basically said, you know what, the
flex and report really did was, among other things, was
let us down the path of people like the Rockefeller
Foundation creating big pharma essentially and getting people on endless
(32:57):
amounts of medicine that just don't heal you. They're just
never ending and make big, farmer, bigger.
Speaker 2 (33:03):
Yeah, psychiatric medicine is a good example of that. They
just took the neurochemical model of mental illness and that
that was that.
Speaker 1 (33:10):
I mean, I think a lot of that stuff has
come back now. Yeah, it's just not super funded and
you're not going to find any like huge medical schools
that tout their homeopathy departments or anything like that. But
I think there's underground movements for all that stuff, like hey,
(33:31):
meditation can help your mental health, and maybe these herbs
can make you feel better, or this honey that you
rub on your cut is better than vactine or whatever.
Speaker 2 (33:40):
It really is. If you see a good psychiatrist, especially
probably a younger one these days, one of the first
things they're going to ask you is how are you sleeping,
are you exercising? What your diet? Like, yeah, totally, And
then they'll start to go into meds. But like they're
gonna say, like, you need to really pay attention to
these three things, and if you still need meds, it'll
still drastically reduced the kind or amount of meds you'll
(34:04):
probably need.
Speaker 1 (34:05):
Right if you're taking care of yourself in the other.
Speaker 2 (34:07):
Ways exactly, So that has definitely come back in psychiatry.
And that's a really good example of what a lot
of people point to. The Flexner Report suppressed that for
one hundred years, it derailed black doctors, it derailed women doctors,
it derailed alternative medicines. It even took the stuff that
was part of the medical establishment and twisted it around,
(34:28):
and it took a full century for things to start
to even come back, And that again is a really
big criticism of the whole thing. But overall, you can
point to a lot of stuff, a lot of lives
that were saved, a lot of lives that were improved,
a lot of life spans that were extended because of
this Johns Hopkins German model that the Flexner Report essentially
(34:52):
with the AMA, got the Rockefeller Foundation to fund and
create this new model for America.
Speaker 1 (35:00):
This is one of those rare episodes where there's truly
like two ways to look at it. I mean, he
definitely threw the baby out with the bathwater. In a
lot of cases, oh well put. But you could also
argue that, like it was such a mess that like
something drastic had to happen or else. You know, who
knows how many more decades it would have taken. I mean,
(35:22):
I definitely agree with you that like it would have
happened at some point. I doubt if we'd still be
sitting here today had the Flexner Report and not been written,
and like I'm sitting here with like a leech on
my forehead.
Speaker 2 (35:31):
Right or I have typhus Yeah exactly. Yeah, I agree
with you, Chuck. This is a good one. Thank you
Emily for it.
Speaker 1 (35:43):
Thanks, Josh, You're welcome.
Speaker 2 (35:44):
That was a great Emily.
Speaker 1 (35:45):
I seen you in San Francisco, buddy.
Speaker 2 (35:47):
Yeah, it was great to see you too. I don't
know why I'm talking like you, but I am. If
you want to know more about the flex And Report,
go out and read it. Three hundred and forty six
pages of muck raking gold. And since I just wrapped
up this episode as if it were from twenty ten,
I think it's Chuck time for listener mail.
Speaker 1 (36:07):
That's right, This is from Kyle. Hey, guys, I'm sure
you've heard this over the years, maybe receive snarky emails
from people saying, what do you mean I should know this?
Speaker 2 (36:17):
Oh yeah, I like this email.
Speaker 1 (36:19):
Thanks for picking it in a way it makes it
seem like they interpret it as stuff you should already know.
But I always took the approach that a Quintessential SYSK
episode sheds light on something that a person should know
in order to give voice two situations, regions, historical events,
things like that, something we should know today to help
learn and grow. Kyle, That's of course always been the case.
Speaker 2 (36:41):
Yeah, it's stuff that we think you should know, which
we want to share with you.
Speaker 1 (36:45):
But it is interesting to learn how the son of
the Jackamer works. I found I see what you're doing there, Kyle.
I found that the Helen Keller and a Sullivan episode
was exactly what I think of as a great stuff
you should know episode. My only knowledge of Helen Keller
was what I had learned from the late nineties and
aughts media and pop culture. So thank you for showing
me how amazing both of them were as people, activist advocates,
(37:06):
and his friends. The lives of Keller and Suliman is
something everyone should know. Thank you. That is from Kyle.
Speaker 2 (37:14):
Thank you right back. Kyle. That was a world class email, don't.
Speaker 1 (37:17):
You think, Chuck, Yes, Kyle, that was wonderful.
Speaker 2 (37:21):
Yeah. So, if you want to knock it out of
the park with an email like Kyle did, wrap it up,
spank it on the bottom, and send it off to
Stuff podcast at iHeartRadio dot com.
Speaker 1 (37:34):
Stuff you Should Know is a production of iHeartRadio. For
more podcasts my heart Radio, visit
Speaker 2 (37:39):
The iHeartRadio app, Apple Podcasts, or wherever you listen to
your favorite shows.
Welcome to Stuff you should know, a production of iHeartRadio.
Speaker 2 (00:11):
Hey, and welcome to the podcast. I'm Josh, and there's
Chuck and jar Jar Binks is here too, and this
is stuff you should know about the Flexner Report.
Speaker 1 (00:20):
That's right. This was a suggestion by my wife.
Speaker 2 (00:25):
Oh, that's a good one.
Speaker 1 (00:26):
Yeah. Emily, of course everyone knows if they listen to
the show. As an organic gardner and an herbalist, she said,
has long asked me to do one on the Flexner Report,
which is a report written in nineteen ten that did
a lot of things basically kind of revamped how medicine
(00:47):
worked in the United States, moving forward to medical school
in particular.
Speaker 2 (00:50):
Right.
Speaker 1 (00:51):
But Emily was interested because another thing it did a
byproduct was it basically completely squashed what we would now
call altern medicine homeopathy, basically saying it has zero value
and we're not doing that anymore. It sure did biff, Yeah,
and it was also racist and sexist.
Speaker 2 (01:13):
It was definitely of its time. This is a document
produced in nineteen ten, for sure. Yeah, and it definitely
stinks of eugenics and all that.
Speaker 1 (01:21):
Yeah. So it's one of those weird things where like
you can see it from all sides, because it did
a lot of good and it also maybe didn't do
some good in certain areas.
Speaker 2 (01:32):
Yeah, for sure. And there's there's not many people who
are like, no, the Flexner Report sucks. It was all
bad because it If you enjoy being treated successfully for cancer,
you can pretty much thank the Flexner Report for that.
But at the same time, yeah, if you believe that
there are alternative therapies that are as good or better
(01:54):
than medications, then yeah, you probably don't like that part
of the Flexner Report. But I think on the whole
it was a good thing. There seems to be now
among you know, thinking people who don't just wait and
wallow and dogma, saying like, we needed a new Flexner
Report for the twenty first century because it's basically run
(02:16):
its course and now again it's become dogma and we
need to do something about that.
Speaker 1 (02:19):
Right. I think that's a great setup, and maybe we
should paint a little bit of a picture about what
medicine and medical school look like in the United States
pre Flexner Report.
Speaker 2 (02:31):
Who was bad?
Speaker 1 (02:32):
It was bad, I guess quickly we should say that
Europe was doing it right before we were. In France,
especially they had some pretty top notch medical schools where
they embrace real science and we're practicing medicine on people
like as practice in colleges and stuff like that. But
in the United States that was around eighteen fifty. In
(02:53):
the US, in eighteen fifty they had fifty two medical schools.
This is what fifty sixty years before the Flexner Report,
and medicine was not you know, to be a doctor
was not some prestigious thing. Medicine was a trade. If
you were associated with the university at all. As a
medical school, it was a two year program. The curriculum
(03:14):
was very, very broad. They were super underfunded. Even at
places like Harvard, they had to pay for their own
teaching supplies. And those were the good ones that were
attached to universities.
Speaker 2 (03:25):
Yeah, I mean, there were plenty of diploma mills. There
were a lot of proprietary medical schools where it was
just some people got together and created a for profit
school where they would teach you how to become a doctor.
But they were not doing a very good job of it.
And your admission requirement was the ability to pay the
(03:45):
tuition fees. Essentially.
Speaker 1 (03:47):
Yeah, for sure, you might have like redundant classes that
literally went over the same things. You might not have
your hands on a scalpel ever, you might not have
an exam ever, you may not see patience, you might
not have any contact with another human being at that
medical school.
Speaker 2 (04:08):
It'd be kind of like if you went to go
skydive and in the class before you go skydive, they
just talk about how hard the ground can be if
you hit it, and then they take you up in
a plane and push you out. It's similar to something
like that. That's good, thanks, I like it.
Speaker 1 (04:25):
But then everybody the Civil War came around in the
eighteen sixties and there was wartime doctoring happening. And after
the Civil War people came out of that saying we're
in trouble. Everybody, like the doctoring wasn't so great in
this war and we need to fix this.
Speaker 2 (04:44):
Well, what I interpreted is that they went out and
got real world experience and realized, like the stuff they
learned at school was not preparing them for actual medicine.
Speaker 1 (04:53):
Oh yeah, I mean I think it was a little
bit of both. I think the person who had their
leg chopped off unnecessarily complained, and I think the doctor
who did the chopping might have complained as well.
Speaker 2 (05:03):
Right, they didn't teach me that patient's complain in medical school. Yeah,
so yes, regardless, by the by the eighteen sixties, like,
it was quite clear that American medicine was lacking tremendously
and that the main reason for that was that the
doctors who were practicing medicine had virtually no actual training
(05:24):
in medicine. They was lectures, textbooks, That's basically it. So
there were there was a part of the progressive era,
this actually this push to create a movement to make
medicine in America better and by by focusing on the
medical school education that that came around in about the
(05:46):
eighteen seventies. It was led by Harvard. Yeah, but really
Johns Hopkins University was the one that really hopped on it.
Speaker 1 (05:55):
Yeah, for sure, Like Harvard got the ball rolling for
a couple of decades, and by the time Johns Hopkins
opened in eighteen ninety three, they became kind of the
standard for the American model moving forward, which SBC was
based on the German model. Right, you had to have
a first of all, you had to have a college
degree just to get in, and that was previously not
(06:16):
necessarily the case. Secondly, they had full time faculty. They
were medical scientists, so they weren't doctors on the side
as well. They were just fully employed to teach, and
they had a four year like a full four year
course of study where it was hands on and a
lot of laboratory work.
Speaker 2 (06:37):
Yeah, and yes, where they were actually working with patients
or assisting other actual doctors in working with patients. Like
it wasn't just like sit there and listen to this lecture. Yeah,
that was. And that essentially that Johns Hopkins model is
what became the model for American medical school. And there's
(06:57):
a lot of there's a lot of talk at parties
if you stop and listen about whether this would have
happened on its own or not. And for the most part,
it seems that, yes, this progressive era movement would have
gotten there eventually. Yeah, just because it was a good idea.
The Flexner Report helped it happen on a dime, because
(07:18):
not only did it show to everybody else this is
the way to do it, it also said this is
very expensive, and here's how we need to get the
money for it. And did get the money for it,
Like that's how it was implemented.
Speaker 1 (07:30):
Yeah, for sure. The American Medical Association was founded in
eighteen forty seven. And one of the reasons, and you know,
again this is stuff that I learned from sort of
Emily's urgings. One of the reasons the American Medical Association
was founded to begin with was like on a mission
(07:51):
to squash homeopathy. It says so in its charter. And
when the AMA was founded, they discouraged any association or
communication with those kinds of doctors and had a code
of ethics that was a clause in there known as
a consultation clause that said, if you even talk to
a quote unquote non regular practitioner, then you're going to
(08:14):
lose your license to practice medicine. They carved out exemptions
for Massachusetts and New York because it was homeopathy was really, really,
really popular at the time among the elite, wealthy Americans,
like the major politicians, the corporate leaders. I think it
was Rockefeller. I think it was Rockefeller that was under
(08:36):
the care of a homeopathic doctor for like fifty years.
Speaker 2 (08:38):
Wow.
Speaker 1 (08:39):
So they carved out exceptions for those two states for
a while until they were able. You know, all those
people died off basically and they were able to completely
squash it.
Speaker 2 (08:48):
Right, Rockefeller died, So I guess the homeopathy he didn't work.
Speaker 1 (08:52):
Well. He lived another like forty eight years after being
told he didn't have long to live.
Speaker 2 (08:57):
I think, oh wow, it's a homeopathy works case closed.
So yes, I think that you really put your finger
on that. The AMA became the arbiter of what qualifies
as medicine in the United States thanks to this Flexner report.
It basically strengthened all of its position. And yes, they
(09:17):
were the driving force behind this. Initially they went to
the Carnegie the Carnegie Foundation, and said, hey, you got
a lot of money, why don't you help us figure
out how to change American medical education in the exact
way we want it, and we'll help you figure out
who to do that with. We like the Johns Hopkins model.
(09:39):
We basically want a report that says the Johns Hopkins
model is great. Let's get an outsider in here. And
that is how Abraham Flexner enters this story.
Speaker 1 (09:49):
Yeah, and you know this is not to say that
he was like cooking the books or anything like that,
and no, this is all a sham, but that was
just sort of The AMA was definitely after that well.
Speaker 2 (09:57):
One of the reasons he was selected is he was
already a person, an educator who espoused exactly this kind
of stuff, just not necessarily as it applied to medical education.
He just wasn't exposed to medical education at the time.
But he was an educational philosopher and theorists and he
was fully on board with that kind of thinking.
Speaker 1 (10:17):
Yeah, I mean he wrote a book. I guess we
should say he did go to Johns Hopkins, but not
for medicine. I think he studied classic civilizations and he
was a teacher in his hometown in Louisville, Kentucky. Eventually
he was a private school headmaster that he founded the school,
and after earning a degree in psychology from Harvard, he
(10:38):
wrote a book called The American College, which was sort
of the Flexner Report of the university system as a whole.
And this guy named Henry Pritchett, who was the president
of the Carnegie Foundation at the time, was like, yeah,
like Josh Clark of the future will say, this is
our guy, because did you see the way he came
at the regular universities, like wayde till he finds out
(10:59):
what's happening in medical schools exactly.
Speaker 2 (11:02):
And then one of the other reasons that he was
such a great candidate because he was an outsider and
a non physician, is that they were quite aware that
there was going to be a lot of blowback, that
there was going to be a lot of bruce digos
and stepped on toes, and that somebody outside of the
profession would be less likely to suffer, say like a
professional injury or being ostracized for the rest of their career. Yeah.
(11:27):
Flexner was like, I don't care what you think of me, doctors.
Speaker 1 (11:30):
That's right. So he started out by researching the European models,
the American models. Like I said, he was really impressed
with the German model, and in fact, a couple of
years after the American and Canadian as we'll see Flexner Report,
he published a European version which critiqued well Europe basically
(11:51):
everybody but Germany. He was very uncritical of the German system,
and we also need to point out some of the
bad things he said. There were several anti Semitic passages
in the European version of the Flexner Report because he
was so enamored of how the Germans did their medicining.
Speaker 2 (12:10):
Yeah, this was Yeah, that German model also inspired the
guy who founded Johns Hopkins Medical School, William Welch, and
that was essentially so essentially, the Flexner report said, the
Johns Hopkins model is what we want. Johns Hopkins said
the German model is what we want, and the Germans said, yeah, yeah, yeah,
(12:31):
dah yeah, no, that's Russian, das boot, that's German.
Speaker 1 (12:36):
Nice. What else?
Speaker 2 (12:39):
The heimlich maneuver, Yeah, that's it, brought worst cider. Okay, yeah,
all that stuff october Fest, but with a k should.
Speaker 1 (12:50):
We take a break? Yeah, all right, you're gonna think
did you say?
Speaker 2 (12:54):
Yeah?
Speaker 1 (12:55):
Yeah, We're gonna think of some more German words or
Deutsche words, and we're gonna be back with more on
what Flexner said right after this.
Speaker 2 (13:28):
Chuck, I could only come up with one more, and
it was strudal. But it's the best one.
Speaker 1 (13:32):
Mmmm yeah.
Speaker 2 (13:33):
Oh wait Frankenstein, Yeah, that's it.
Speaker 1 (13:37):
Do you see that new Frankenstein movie.
Speaker 2 (13:40):
The Bride?
Speaker 1 (13:41):
No, no, no, the what's his name is new Frankenstein movie?
Speaker 2 (13:46):
I don't, I don't know the rock.
Speaker 1 (13:48):
Now the director Guillermo del Toro's.
Speaker 2 (13:52):
Oh no, what did you think of it?
Speaker 1 (13:54):
That was pretty good? I got a little bored, but
it was everyone said it was really great. I think
I was just a maki.
Speaker 2 (14:01):
Jillenhall is redoing the bride in like a really strange,
like out there kind of fashion that looks interesting.
Speaker 1 (14:08):
Yeah, I saw that. I thought it seemed super interesting,
and I love Mags, so I'm down.
Speaker 2 (14:13):
Okay, well that's fine, I'll allow it.
Speaker 1 (14:16):
So back to the Flexen report. He started that research
in nineteen oh eight. I think the thing came out
in nineteen ten, is like we said. But he went
around all over the place. He went to one hundred
and five one hundred and fifty five medical schools, one
hundred and forty eight of which were in the United States,
seven were in Canada. Spends a couple of days there
with his nose turned up, and he did this for
(14:38):
about eighteen months.
Speaker 2 (14:40):
Yeah, just to be clear here, this guy was not
phoning this in. He definitely took the assignment and did
it to like he did it like all of those
those one hundred and fifty five medical schools in the
US and Canada. That was every medical school in the
US and Canada, including ones that taught alternative medicine and
black medical schools. In the United States. So like, he
(15:03):
definitely went through the paces. It wasn't just like a, yeah,
let's look at Johns Hopkins and here's my report.
Speaker 1 (15:09):
Yeah, for sure. And you mentioned the black medical schools
because they come up pretty front and center here in
a minute. But Johns Hopkins was like the gold standard,
so that was his comparison point for all of them.
He looked at everything. He looked at how they financed
their school. He looked at how big the classrooms were,
how many teachers they had per student, like admissions, what
(15:33):
it took to get in, what they were actually teaching,
laboratory stuff, facilities kind of everything. And what he came
out with was one of three determinations in the end
for each school. The school is good, you can stay,
you can keep your doors open. Your school is not
so great, but you show promise, so maybe if you
(15:53):
have some more funding and you change these things, you
can be okay, and then I'm sorry, please close your
doors forever.
Speaker 2 (16:00):
Yeah, there was a lot of them that he categorized
as hopelessly deficient.
Speaker 1 (16:04):
A lot most in fact.
Speaker 2 (16:06):
Yeah, And it wasn't just like him being a snooty
butt head like the as we said, like the medical
schools in the United States were in a lot of
cases hopelessly deficient, and that's a problem when you're producing doctors,
you know. So he did make a pretty good case
that that there were a lot they were hopelessly deficient,
but the deficient ones they actually had different rankings. For example,
(16:31):
Iowa State University's medical school. He basically said, they know
what they're wanting to do, but the hospital associated with
it is too small. And the your clinical faculty, the
people who are supposed to be doing research and teaching
medicine to the students, they all have their own private
practices because they have to support themselves. So if you
(16:54):
gave this this group enough funding, they could create a
top notch medical school. In the Johns Hopkins model that
was kind of like that deficient category, the varying degrees
of how much money you would need and whether you
were you're headed in the right direction.
Speaker 1 (17:10):
Yeah, for sure. The way he wrote in what was
called Carnegie Foundation Bulletin number four or Medical Education in
the United States and Canada aka Flexner Report, was that
very muckbreaking style. It's not the kind of report you
would people wouldn't write it this way. Today because he
(17:33):
did get a little It seems like he enjoyed sort
of the put downs and coming up with new ways
of saying how bad a school.
Speaker 2 (17:39):
Was, so people would write it that way today and unfortunately.
Speaker 1 (17:42):
Well, you're probably right one of them, he said. Apparently
the inexcusable degree of ignorance begins just where the ability
to pay fees leaves off.
Speaker 2 (17:50):
Oh yeah, and so he was basically taking them to
task over low admission requirements if any. But you didn't
say low admission requirements. He also used the word reeks,
which you don't usually see in academic studies. Yeah, he said.
The osteopathic schools in the United States, there are eight
of them. That they reek of commercialism, that they attract
(18:12):
students with a mass of hysterical exaggerations that confidently appeals
to the crude boys or disappointed men and women whom
it successfully exploits. We should say osteopathy isn't accepted form
medicine in the United States now, but a lot of
people still view it as a pseudo scientific alternative medicine. Yeah.
Speaker 1 (18:35):
I mean, he had a site set on them, on chiropractors,
on all kinds of things that a lot of people
put a lot of great value in today. So he
was off based on some stuff for sure. But again
this was nineteen ten.
Speaker 2 (18:50):
So of the underfunded medical schools and this was a
problem too. This is actually one of the things that
befell black medical schools is we'll see in a minute.
If you were underfunded, that was it. Sorry, no amount
of funding is going to bring you up. Well, maybe
some amount of funding is going to bring you up
to speed, but we need that money to bring other
(19:11):
medical schools that are closer up because we can bring
more of them up to snuff, or we can bring
fewer up to snuff and basically get the ones that
are at least funded. His whole premise was just close
those poorly funded ones because they're just not going to
be able to do this.
Speaker 1 (19:26):
Yeah, and you know he was probably onto something there
because there was a glut of bad schools. And his
quote was the curse of medical education is the excessive
number of schools. This situation can improve only as weaker
and superfluous schools are extinguished. Right, Like I said, it
was Canada and the US. Canada fared much better our
northern friends up there. Of the seven Canadian medical schools.
(19:49):
He only recommended one for closure.
Speaker 2 (19:52):
So one seventh of them, that's.
Speaker 1 (19:54):
Right, the one hundred and forty eight medical schools in
the United States, more than half of them he recommended closing.
And I think it ended up being more than that even, right.
Speaker 2 (20:06):
Yeah, he actually recommended reducing the full number of schools
in the US and Canada from one hundred and fifty
five down to thirty one. Yeah, that's four fifths. So yeah,
I mean, like he was basically a hatchet man. They
brought him in to basically get rid of competing, poorly funded,
(20:27):
poorly run medical schools. He said, if you're a proprietary
medical school, it doesn't matter what you're doing, you're closed.
He saw med school as a public trust, that it
should be publicly funded. Ergo, they should be associated or
attached to public universities, and that the reason that doctors
were being produced was to help society along. That you
(20:49):
should not have a board or stockholders to whom you
were really kind of beholden to so they would affect
your decision making. No, you needed to be beholden to
science right ideally to patients, although he didn't put much
emphasis on that part.
Speaker 1 (21:05):
Yeah, and we'll talk about that at the end. So
every single proprietary school was immediately on the list, basically
from the jump, like, if you weren't affiliated with the university,
you had no hope for surviving this. All the holistic
or what we call alternative medical systems were completely shut down.
Five of the seven black medical schools were recommended for closure.
(21:30):
I think Howard University in DC and Mahari Medical College
right here in Georgia he thought might be salvageable. But
there are a couple of chapters in there. Chapter fourteen, specifically,
the Medical Education of the Negro was the title of
that chapter, where he shows a real disdain for black
medical schools. He said they were wasting money, small sums
(21:52):
of money annually, that undisciplined men whose lack of real
training is covered up by imposing MD degrees. And he
basically ended up saying, like close most of these, and
my suggestion is just to make black medical schools to
train black doctors to treat black patients only, and they
should really just concentrate on hygiene.
Speaker 2 (22:14):
Yeah, they should focus on public health in order to
keep black people from spreading disease to white people. That
was essentially his take on the purpose for the existence
of black doctors. Out of three hundred and forty six
pages in the initial version of the report, two chapter
fourteen was two pages long, and that is shocking in
(22:36):
and of itself. But the Flexner Report was essentially the
first document about medicine and medical school that even acknowledged
the existence of black medical schools. Up to this point,
they were totally invisible, completely ignored. So the fact in
a really silver lining to the cloud way of looking
(22:57):
at this, the fact that Howard Universe and Mahari Medical
College in Georgia made the cut, Yeah, was really substantial,
Like that was a that was sadly a really big
positive for black medical schools. Unfortunately.
Speaker 1 (23:14):
Yeah, for sure. You know, I mentioned sexism too. The
AMA and the Carnegie Foundation were also not too hot
on the idea of the three women's medical college colleges
even existing. In Flexner himself basically came out and said,
I don't think women can withstand the mental rigors of
(23:34):
being a doctor.
Speaker 2 (23:36):
You never met Elizabeth Blackwell.
Speaker 1 (23:38):
Yeah, no kidding, And he literally said, you know, women
make better patients than doctors.
Speaker 2 (23:46):
This is the nineteen tens.
Speaker 1 (23:48):
Yeah, it's not like eighteen ten.
Speaker 2 (23:50):
So yeah, so this was I mean, I guess on
the other way of approaching this too. So we've talked
about everything that he was giving the hatchet too. He
had a version of what made an idea ideal medical education,
and again it was based on the German model, which
the Johns Hopkins model was based on, and he essentially said, so,
(24:11):
you need to have rigorous instruction, you need to have
rigorous admissions requirements, and you have to enforce them too.
And in doing so, he basically said, you're going to
you're going to weed out candidates who aren't they don't
have they can't make the cut for this new kind
of doctor. So that meant you had to have money
(24:32):
to even get started because this new model was so
much more expensive than the old model. Three to tuition
I think need to do increase three to four times
just to start to meet the funding for this. So
you're like you just out of the gate, had to
have money to even try to apply to medical school.
And then the academic requirements meant that even if you
(24:56):
had money, if you didn't have what it took to
like really dedicate yourself to learning this stuff, you were
going to fail. Out too. So in that sense, it
took doctors from being just ordinary trades people and said,
these people are responsible for keeping the population of the
United States healthy and we're making sure that they are
(25:16):
up to the task. In return, they're rich.
Speaker 1 (25:21):
Now it's right, And you know, you know, part of
it was says medical school was expensive was because or
ended up being more expensive, is because they needed better facilities,
they needed better equipment. I know, we already mentioned that
teachers were working part time as doctors just because they
had to make a living. But one of his big
key recommendations was you have to have a full time
(25:43):
faculty that is just doing biomedical research, like they're not
doctoring on the side. And in order to come up
with this kind of money, it was expensive. The idea
of medical philanthropy really really took off because you know,
Johns Hopkins was one thing, but if you wanted to
have more than one Johns Hopkins like model out there,
you had to lay out this roadmap of basically you know,
(26:06):
starting in nineteen ten and over the next few decades
and continuing today, these huge foundations were created and also
local groups just donating money to make sure The Flexner
Report was enacted, like the Rockefeller Foundation, they gave hundreds
of millions of dollars to get these programs going across
(26:26):
the country.
Speaker 2 (26:27):
Yeah, and it worked, but again it took hundreds of
millions of dollars in I think nineteen ten money too.
Speaker 1 (26:33):
Should we take a break. Let's take a break, all right,
We'll be right back with the closing act of the
Flexner Report. So we're back. One of the results we
(27:05):
talked about was all these schools shutting down, I think
more within ten years, I'm sorry, Within five years of
the report's release, more than fifty of the medical schools
in the United States shut down, and twenty years on,
only seventy six of the original one hundred and forty
eight in the United States remained. Like you said, five
of the seven black medical schools, eighty percent of the
(27:28):
alternative medicine programs were shut down, and the handful of
schools that had admitted women were either shut down or
not admitting women anymore for a while.
Speaker 2 (27:39):
Right, So, like this was a huge impact on the
way that doctors were created in the United States and
again the profession of doctoring in the first place. And
it happened very quickly, as you just mentioned, and there
are a lot of positives to it, but there are
a lot of criticisms to the outcomes too. One of
(28:00):
the big ones is the impact that the flexner had
on producing black doctors in the United States. I saw
an estimate that had all seven of the black medical
schools stayed open and been funded so that they could
follow this model, another thirty thousand doctors Black doctors would
have been produced to the United States between nineteen ten
(28:22):
and twenty twelve, I think, which is a big deal
because apparently right now two percent of American doctors are black,
but the percentage of the Black population in the American
population overall is thirteen percent, so they're grossly underrepresented, which
is another problem in and of itself, because studies show
(28:42):
that black patients are likelier to follow the orders and
instructions of black doctors than they are of doctors of
other races. They just it's just a question of.
Speaker 1 (28:53):
Comfort, yeah, for sure. And you could also make an
argument that that gave rise to things like the Tuskegee
experiments and other like awful experiments carried out by white
doctors on black patients that led to the cycle of
mistrust of the you know, the medical profession as a whole.
Speaker 2 (29:10):
Yeah, there was a whole like part of this, this
emphasis on science. And because Flexner was not a physician,
he really ignored the idea of the physician as a healer.
The physician is somebody who was meant to see their
patients as human and instead, because of this focus on
rationalism over humanism, the patient became essentially just a walking
(29:32):
bag of medical issues that needed to be diagnosed and treated.
They weren't a person. That stuff didn't matter. The point
of the doctor was to treat their illnesses and make
them better, not to be their friend. And in doing that,
like the medical profession lost a lot of I guess
connection with the rest of us, where you know, doctors
(29:52):
are kind of looked at is looking at the rest
of us is not fully human and that doesn't really
jibe and feel good, you know when you're a patient.
Speaker 1 (30:03):
Yeah, for sure, I think I can't find it. It's
not in front of me now. But I sent you
one study from a few years ago where I think
the long and shortage it was they were surveying people
that how happy they were with like the end of
care care for relatives, and I think only forty percent
of the people were satisfied with like how their the
(30:25):
end of the lives of their relatives went. And a
lot of that had to do with pain management, and
that sort of ties back to what you were saying
about just sort of the rigorous you know, eyeballs on
a microscope and not like eyeballs on a human. You know,
it's all sort of tied in together, I think.
Speaker 2 (30:45):
Yeah, And the other way that that manifested itself was
a huge emphasis on separating academic physicians from practicing physicians
so that academics could just focus on research. And then
they emphasized the research that the act academics we're producing,
like that's the most important thing. You clinicians, listen to
the research doctors and what they're finding, and then you
(31:07):
can go apply it to your practice. And so they
were like, well, you've taken these people away from patients
and they're just using like this this scientific mentality and
there's no humanism to it. And they critics say that
was one of the ways that this whole idea of
science losing its humanity or medicine losing part of its
(31:27):
humanity or soul came about.
Speaker 1 (31:29):
Yeah, for sure, you know, I know, I've already mentioned
a little bit about eliminating sort of all kinds of
alternative medicines, and that homeopathy was homeopathy homeopathy, what do
you say, I've heard both, Okay, both at the same time.
Was very popular at the time. I mean, there are
people that think that they were doing pretty well with
(31:52):
homeopathy and curing disease with natural remedies. Other people will say, no,
you've got your tinfoil hat on, and that's not the case.
They just didn't know real science at the time. So
there's a lot of raging debate online about that kind
of stuff. But another point of this all is that
psychiatric medicine lost a lot of I guess curricular elements
(32:15):
that were very beneficial at the time for mental health treatment.
They were making a lot of strides at the time
with things like meditation and like how nutrition food can
alter like a person's or lifestyle can alter a person's
mental health. And that was all just sort of flushed
down the toilet because of this, and the neurochemical model
(32:35):
came out of mental illness, and the same people that
were arguing for homeopathy basically said, you know what, the
flex and report really did was, among other things, was
let us down the path of people like the Rockefeller
Foundation creating big pharma essentially and getting people on endless
(32:57):
amounts of medicine that just don't heal you. They're just
never ending and make big, farmer, bigger.
Speaker 2 (33:03):
Yeah, psychiatric medicine is a good example of that. They
just took the neurochemical model of mental illness and that
that was that.
Speaker 1 (33:10):
I mean, I think a lot of that stuff has
come back now. Yeah, it's just not super funded and
you're not going to find any like huge medical schools
that tout their homeopathy departments or anything like that. But
I think there's underground movements for all that stuff, like hey,
(33:31):
meditation can help your mental health, and maybe these herbs
can make you feel better, or this honey that you
rub on your cut is better than vactine or whatever.
Speaker 2 (33:40):
It really is. If you see a good psychiatrist, especially
probably a younger one these days, one of the first
things they're going to ask you is how are you sleeping,
are you exercising? What your diet? Like, yeah, totally, And
then they'll start to go into meds. But like they're
gonna say, like, you need to really pay attention to
these three things, and if you still need meds, it'll
still drastically reduced the kind or amount of meds you'll
(34:04):
probably need.
Speaker 1 (34:05):
Right if you're taking care of yourself in the other.
Speaker 2 (34:07):
Ways exactly, So that has definitely come back in psychiatry.
And that's a really good example of what a lot
of people point to. The Flexner Report suppressed that for
one hundred years, it derailed black doctors, it derailed women doctors,
it derailed alternative medicines. It even took the stuff that
was part of the medical establishment and twisted it around,
(34:28):
and it took a full century for things to start
to even come back, And that again is a really
big criticism of the whole thing. But overall, you can
point to a lot of stuff, a lot of lives
that were saved, a lot of lives that were improved,
a lot of life spans that were extended because of
this Johns Hopkins German model that the Flexner Report essentially
(34:52):
with the AMA, got the Rockefeller Foundation to fund and
create this new model for America.
Speaker 1 (35:00):
This is one of those rare episodes where there's truly
like two ways to look at it. I mean, he
definitely threw the baby out with the bathwater. In a
lot of cases, oh well put. But you could also
argue that, like it was such a mess that like
something drastic had to happen or else. You know, who
knows how many more decades it would have taken. I mean,
(35:22):
I definitely agree with you that like it would have
happened at some point. I doubt if we'd still be
sitting here today had the Flexner Report and not been written,
and like I'm sitting here with like a leech on
my forehead.
Speaker 2 (35:31):
Right or I have typhus Yeah exactly. Yeah, I agree
with you, Chuck. This is a good one. Thank you
Emily for it.
Speaker 1 (35:43):
Thanks, Josh, You're welcome.
Speaker 2 (35:44):
That was a great Emily.
Speaker 1 (35:45):
I seen you in San Francisco, buddy.
Speaker 2 (35:47):
Yeah, it was great to see you too. I don't
know why I'm talking like you, but I am. If
you want to know more about the flex And Report,
go out and read it. Three hundred and forty six
pages of muck raking gold. And since I just wrapped
up this episode as if it were from twenty ten,
I think it's Chuck time for listener mail.
Speaker 1 (36:07):
That's right, This is from Kyle. Hey, guys, I'm sure
you've heard this over the years, maybe receive snarky emails
from people saying, what do you mean I should know this?
Speaker 2 (36:17):
Oh yeah, I like this email.
Speaker 1 (36:19):
Thanks for picking it in a way it makes it
seem like they interpret it as stuff you should already know.
But I always took the approach that a Quintessential SYSK
episode sheds light on something that a person should know
in order to give voice two situations, regions, historical events,
things like that, something we should know today to help
learn and grow. Kyle, That's of course always been the case.
Speaker 2 (36:41):
Yeah, it's stuff that we think you should know, which
we want to share with you.
Speaker 1 (36:45):
But it is interesting to learn how the son of
the Jackamer works. I found I see what you're doing there, Kyle.
I found that the Helen Keller and a Sullivan episode
was exactly what I think of as a great stuff
you should know episode. My only knowledge of Helen Keller
was what I had learned from the late nineties and
aughts media and pop culture. So thank you for showing
me how amazing both of them were as people, activist advocates,
(37:06):
and his friends. The lives of Keller and Suliman is
something everyone should know. Thank you. That is from Kyle.
Speaker 2 (37:14):
Thank you right back. Kyle. That was a world class email, don't.
Speaker 1 (37:17):
You think, Chuck, Yes, Kyle, that was wonderful.
Speaker 2 (37:21):
Yeah. So, if you want to knock it out of
the park with an email like Kyle did, wrap it up,
spank it on the bottom, and send it off to
Stuff podcast at iHeartRadio dot com.
Speaker 1 (37:34):
Stuff you Should Know is a production of iHeartRadio. For
more podcasts my heart Radio, visit
Speaker 2 (37:39):
The iHeartRadio app, Apple Podcasts, or wherever you listen to
your favorite shows.
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