1 00:00:01,480 --> 00:00:07,720 Speaker 1: Welcome to Stuff you should know, a production of iHeartRadio. 2 00:00:11,160 --> 00:00:13,440 Speaker 2: Hey, and welcome to the podcast. I'm Josh, and there's 3 00:00:13,520 --> 00:00:16,960 Speaker 2: Chuck and jar Jar Binks is here too, and this 4 00:00:17,040 --> 00:00:19,800 Speaker 2: is stuff you should know about the Flexner Report. 5 00:00:20,400 --> 00:00:24,720 Speaker 1: That's right. This was a suggestion by my wife. 6 00:00:25,440 --> 00:00:26,480 Speaker 2: Oh, that's a good one. 7 00:00:26,720 --> 00:00:29,720 Speaker 1: Yeah. Emily, of course everyone knows if they listen to 8 00:00:29,720 --> 00:00:34,600 Speaker 1: the show. As an organic gardner and an herbalist, she said, 9 00:00:34,640 --> 00:00:38,120 Speaker 1: has long asked me to do one on the Flexner Report, 10 00:00:38,159 --> 00:00:43,360 Speaker 1: which is a report written in nineteen ten that did 11 00:00:43,400 --> 00:00:47,000 Speaker 1: a lot of things basically kind of revamped how medicine 12 00:00:47,000 --> 00:00:49,480 Speaker 1: worked in the United States, moving forward to medical school 13 00:00:49,479 --> 00:00:50,120 Speaker 1: in particular. 14 00:00:50,680 --> 00:00:50,880 Speaker 2: Right. 15 00:00:51,080 --> 00:00:54,360 Speaker 1: But Emily was interested because another thing it did a 16 00:00:54,440 --> 00:00:59,200 Speaker 1: byproduct was it basically completely squashed what we would now 17 00:00:59,240 --> 00:01:05,640 Speaker 1: call altern medicine homeopathy, basically saying it has zero value 18 00:01:06,319 --> 00:01:10,520 Speaker 1: and we're not doing that anymore. It sure did biff, Yeah, 19 00:01:10,520 --> 00:01:12,760 Speaker 1: and it was also racist and sexist. 20 00:01:13,959 --> 00:01:16,440 Speaker 2: It was definitely of its time. This is a document 21 00:01:16,440 --> 00:01:19,120 Speaker 2: produced in nineteen ten, for sure. Yeah, and it definitely 22 00:01:19,160 --> 00:01:21,320 Speaker 2: stinks of eugenics and all that. 23 00:01:21,560 --> 00:01:23,920 Speaker 1: Yeah. So it's one of those weird things where like 24 00:01:25,640 --> 00:01:27,760 Speaker 1: you can see it from all sides, because it did 25 00:01:27,800 --> 00:01:30,039 Speaker 1: a lot of good and it also maybe didn't do 26 00:01:30,160 --> 00:01:32,039 Speaker 1: some good in certain areas. 27 00:01:32,400 --> 00:01:35,560 Speaker 2: Yeah, for sure. And there's there's not many people who 28 00:01:35,600 --> 00:01:38,080 Speaker 2: are like, no, the Flexner Report sucks. It was all 29 00:01:38,120 --> 00:01:43,800 Speaker 2: bad because it If you enjoy being treated successfully for cancer, 30 00:01:44,560 --> 00:01:46,959 Speaker 2: you can pretty much thank the Flexner Report for that. 31 00:01:48,480 --> 00:01:50,360 Speaker 2: But at the same time, yeah, if you believe that 32 00:01:50,480 --> 00:01:53,639 Speaker 2: there are alternative therapies that are as good or better 33 00:01:54,120 --> 00:01:58,040 Speaker 2: than medications, then yeah, you probably don't like that part 34 00:01:58,120 --> 00:02:00,000 Speaker 2: of the Flexner Report. But I think on the whole 35 00:02:00,520 --> 00:02:03,920 Speaker 2: it was a good thing. There seems to be now 36 00:02:04,080 --> 00:02:08,280 Speaker 2: among you know, thinking people who don't just wait and 37 00:02:08,400 --> 00:02:12,960 Speaker 2: wallow and dogma, saying like, we needed a new Flexner 38 00:02:12,960 --> 00:02:16,000 Speaker 2: Report for the twenty first century because it's basically run 39 00:02:16,040 --> 00:02:18,280 Speaker 2: its course and now again it's become dogma and we 40 00:02:18,280 --> 00:02:19,400 Speaker 2: need to do something about that. 41 00:02:19,960 --> 00:02:21,920 Speaker 1: Right. I think that's a great setup, and maybe we 42 00:02:21,919 --> 00:02:25,119 Speaker 1: should paint a little bit of a picture about what 43 00:02:25,680 --> 00:02:28,600 Speaker 1: medicine and medical school look like in the United States 44 00:02:28,919 --> 00:02:30,120 Speaker 1: pre Flexner Report. 45 00:02:31,000 --> 00:02:31,799 Speaker 2: Who was bad? 46 00:02:32,120 --> 00:02:34,200 Speaker 1: It was bad, I guess quickly we should say that 47 00:02:34,240 --> 00:02:38,000 Speaker 1: Europe was doing it right before we were. In France, 48 00:02:38,120 --> 00:02:40,799 Speaker 1: especially they had some pretty top notch medical schools where 49 00:02:40,840 --> 00:02:46,960 Speaker 1: they embrace real science and we're practicing medicine on people 50 00:02:47,120 --> 00:02:51,000 Speaker 1: like as practice in colleges and stuff like that. But 51 00:02:51,120 --> 00:02:53,200 Speaker 1: in the United States that was around eighteen fifty. In 52 00:02:53,240 --> 00:02:55,840 Speaker 1: the US, in eighteen fifty they had fifty two medical schools. 53 00:02:56,440 --> 00:02:59,560 Speaker 1: This is what fifty sixty years before the Flexner Report, 54 00:03:00,600 --> 00:03:03,519 Speaker 1: and medicine was not you know, to be a doctor 55 00:03:03,639 --> 00:03:07,639 Speaker 1: was not some prestigious thing. Medicine was a trade. If 56 00:03:07,680 --> 00:03:10,640 Speaker 1: you were associated with the university at all. As a 57 00:03:10,680 --> 00:03:14,679 Speaker 1: medical school, it was a two year program. The curriculum 58 00:03:14,800 --> 00:03:17,800 Speaker 1: was very, very broad. They were super underfunded. Even at 59 00:03:17,800 --> 00:03:20,399 Speaker 1: places like Harvard, they had to pay for their own 60 00:03:20,400 --> 00:03:23,720 Speaker 1: teaching supplies. And those were the good ones that were 61 00:03:23,720 --> 00:03:25,000 Speaker 1: attached to universities. 62 00:03:25,560 --> 00:03:28,360 Speaker 2: Yeah, I mean, there were plenty of diploma mills. There 63 00:03:28,400 --> 00:03:33,120 Speaker 2: were a lot of proprietary medical schools where it was 64 00:03:33,240 --> 00:03:36,240 Speaker 2: just some people got together and created a for profit 65 00:03:36,320 --> 00:03:39,360 Speaker 2: school where they would teach you how to become a doctor. 66 00:03:39,760 --> 00:03:41,840 Speaker 2: But they were not doing a very good job of it. 67 00:03:41,920 --> 00:03:45,839 Speaker 2: And your admission requirement was the ability to pay the 68 00:03:45,880 --> 00:03:47,320 Speaker 2: tuition fees. Essentially. 69 00:03:47,880 --> 00:03:51,840 Speaker 1: Yeah, for sure, you might have like redundant classes that 70 00:03:51,880 --> 00:03:54,200 Speaker 1: literally went over the same things. You might not have 71 00:03:54,280 --> 00:03:57,240 Speaker 1: your hands on a scalpel ever, you might not have 72 00:03:57,280 --> 00:04:04,080 Speaker 1: an exam ever, you may not see patience, you might 73 00:04:04,080 --> 00:04:06,600 Speaker 1: not have any contact with another human being at that 74 00:04:06,640 --> 00:04:07,360 Speaker 1: medical school. 75 00:04:08,160 --> 00:04:10,560 Speaker 2: It'd be kind of like if you went to go 76 00:04:10,640 --> 00:04:14,240 Speaker 2: skydive and in the class before you go skydive, they 77 00:04:14,320 --> 00:04:17,320 Speaker 2: just talk about how hard the ground can be if 78 00:04:17,360 --> 00:04:18,800 Speaker 2: you hit it, and then they take you up in 79 00:04:18,839 --> 00:04:21,480 Speaker 2: a plane and push you out. It's similar to something 80 00:04:21,560 --> 00:04:25,400 Speaker 2: like that. That's good, thanks, I like it. 81 00:04:25,440 --> 00:04:28,520 Speaker 1: But then everybody the Civil War came around in the 82 00:04:28,520 --> 00:04:33,719 Speaker 1: eighteen sixties and there was wartime doctoring happening. And after 83 00:04:33,760 --> 00:04:38,240 Speaker 1: the Civil War people came out of that saying we're 84 00:04:38,240 --> 00:04:41,440 Speaker 1: in trouble. Everybody, like the doctoring wasn't so great in 85 00:04:41,960 --> 00:04:44,120 Speaker 1: this war and we need to fix this. 86 00:04:44,720 --> 00:04:47,159 Speaker 2: Well, what I interpreted is that they went out and 87 00:04:47,320 --> 00:04:50,200 Speaker 2: got real world experience and realized, like the stuff they 88 00:04:50,279 --> 00:04:53,760 Speaker 2: learned at school was not preparing them for actual medicine. 89 00:04:53,839 --> 00:04:55,160 Speaker 1: Oh yeah, I mean I think it was a little 90 00:04:55,200 --> 00:04:57,760 Speaker 1: bit of both. I think the person who had their 91 00:04:57,839 --> 00:05:01,359 Speaker 1: leg chopped off unnecessarily complained, and I think the doctor 92 00:05:01,400 --> 00:05:03,840 Speaker 1: who did the chopping might have complained as well. 93 00:05:03,920 --> 00:05:09,280 Speaker 2: Right, they didn't teach me that patient's complain in medical school. Yeah, 94 00:05:09,320 --> 00:05:13,120 Speaker 2: so yes, regardless, by the by the eighteen sixties, like, 95 00:05:13,200 --> 00:05:17,560 Speaker 2: it was quite clear that American medicine was lacking tremendously 96 00:05:17,720 --> 00:05:20,440 Speaker 2: and that the main reason for that was that the 97 00:05:20,480 --> 00:05:24,800 Speaker 2: doctors who were practicing medicine had virtually no actual training 98 00:05:24,839 --> 00:05:28,719 Speaker 2: in medicine. They was lectures, textbooks, That's basically it. So 99 00:05:29,279 --> 00:05:32,279 Speaker 2: there were there was a part of the progressive era, 100 00:05:33,560 --> 00:05:38,080 Speaker 2: this actually this push to create a movement to make 101 00:05:38,240 --> 00:05:42,760 Speaker 2: medicine in America better and by by focusing on the 102 00:05:42,800 --> 00:05:46,200 Speaker 2: medical school education that that came around in about the 103 00:05:46,320 --> 00:05:49,720 Speaker 2: eighteen seventies. It was led by Harvard. Yeah, but really 104 00:05:49,839 --> 00:05:53,880 Speaker 2: Johns Hopkins University was the one that really hopped on it. 105 00:05:55,400 --> 00:05:58,120 Speaker 1: Yeah, for sure, Like Harvard got the ball rolling for 106 00:05:58,240 --> 00:06:01,160 Speaker 1: a couple of decades, and by the time Johns Hopkins 107 00:06:01,240 --> 00:06:04,279 Speaker 1: opened in eighteen ninety three, they became kind of the 108 00:06:04,320 --> 00:06:08,240 Speaker 1: standard for the American model moving forward, which SBC was 109 00:06:08,240 --> 00:06:11,280 Speaker 1: based on the German model. Right, you had to have 110 00:06:11,320 --> 00:06:13,240 Speaker 1: a first of all, you had to have a college 111 00:06:13,279 --> 00:06:16,120 Speaker 1: degree just to get in, and that was previously not 112 00:06:16,160 --> 00:06:21,480 Speaker 1: necessarily the case. Secondly, they had full time faculty. They 113 00:06:21,480 --> 00:06:24,240 Speaker 1: were medical scientists, so they weren't doctors on the side 114 00:06:24,800 --> 00:06:28,599 Speaker 1: as well. They were just fully employed to teach, and 115 00:06:28,880 --> 00:06:31,520 Speaker 1: they had a four year like a full four year 116 00:06:31,600 --> 00:06:35,040 Speaker 1: course of study where it was hands on and a 117 00:06:35,120 --> 00:06:36,279 Speaker 1: lot of laboratory work. 118 00:06:37,320 --> 00:06:41,000 Speaker 2: Yeah, and yes, where they were actually working with patients 119 00:06:41,080 --> 00:06:44,760 Speaker 2: or assisting other actual doctors in working with patients. Like 120 00:06:44,800 --> 00:06:48,599 Speaker 2: it wasn't just like sit there and listen to this lecture. Yeah, 121 00:06:49,279 --> 00:06:52,919 Speaker 2: that was. And that essentially that Johns Hopkins model is 122 00:06:52,960 --> 00:06:57,479 Speaker 2: what became the model for American medical school. And there's 123 00:06:57,520 --> 00:07:00,840 Speaker 2: a lot of there's a lot of talk at parties 124 00:07:00,880 --> 00:07:02,839 Speaker 2: if you stop and listen about whether this would have 125 00:07:02,839 --> 00:07:06,440 Speaker 2: happened on its own or not. And for the most part, 126 00:07:06,480 --> 00:07:10,280 Speaker 2: it seems that, yes, this progressive era movement would have 127 00:07:10,400 --> 00:07:13,920 Speaker 2: gotten there eventually. Yeah, just because it was a good idea. 128 00:07:13,960 --> 00:07:18,239 Speaker 2: The Flexner Report helped it happen on a dime, because 129 00:07:18,280 --> 00:07:21,080 Speaker 2: not only did it show to everybody else this is 130 00:07:21,120 --> 00:07:23,520 Speaker 2: the way to do it, it also said this is 131 00:07:23,600 --> 00:07:26,040 Speaker 2: very expensive, and here's how we need to get the 132 00:07:26,080 --> 00:07:29,160 Speaker 2: money for it. And did get the money for it, 133 00:07:29,240 --> 00:07:30,680 Speaker 2: Like that's how it was implemented. 134 00:07:30,880 --> 00:07:34,680 Speaker 1: Yeah, for sure. The American Medical Association was founded in 135 00:07:34,720 --> 00:07:39,400 Speaker 1: eighteen forty seven. And one of the reasons, and you know, 136 00:07:39,720 --> 00:07:43,120 Speaker 1: again this is stuff that I learned from sort of 137 00:07:43,120 --> 00:07:47,800 Speaker 1: Emily's urgings. One of the reasons the American Medical Association 138 00:07:47,960 --> 00:07:51,680 Speaker 1: was founded to begin with was like on a mission 139 00:07:51,720 --> 00:07:57,080 Speaker 1: to squash homeopathy. It says so in its charter. And 140 00:07:57,440 --> 00:08:01,400 Speaker 1: when the AMA was founded, they discouraged any association or 141 00:08:01,400 --> 00:08:05,040 Speaker 1: communication with those kinds of doctors and had a code 142 00:08:05,040 --> 00:08:06,680 Speaker 1: of ethics that was a clause in there known as 143 00:08:06,680 --> 00:08:11,400 Speaker 1: a consultation clause that said, if you even talk to 144 00:08:11,600 --> 00:08:14,760 Speaker 1: a quote unquote non regular practitioner, then you're going to 145 00:08:14,840 --> 00:08:18,560 Speaker 1: lose your license to practice medicine. They carved out exemptions 146 00:08:18,600 --> 00:08:23,800 Speaker 1: for Massachusetts and New York because it was homeopathy was really, really, 147 00:08:23,880 --> 00:08:28,120 Speaker 1: really popular at the time among the elite, wealthy Americans, 148 00:08:28,160 --> 00:08:32,679 Speaker 1: like the major politicians, the corporate leaders. I think it 149 00:08:32,720 --> 00:08:36,080 Speaker 1: was Rockefeller. I think it was Rockefeller that was under 150 00:08:36,080 --> 00:08:38,400 Speaker 1: the care of a homeopathic doctor for like fifty years. 151 00:08:38,720 --> 00:08:39,080 Speaker 2: Wow. 152 00:08:39,120 --> 00:08:41,600 Speaker 1: So they carved out exceptions for those two states for 153 00:08:41,640 --> 00:08:44,880 Speaker 1: a while until they were able. You know, all those 154 00:08:44,880 --> 00:08:47,160 Speaker 1: people died off basically and they were able to completely 155 00:08:47,160 --> 00:08:47,640 Speaker 1: squash it. 156 00:08:48,280 --> 00:08:51,720 Speaker 2: Right, Rockefeller died, So I guess the homeopathy he didn't work. 157 00:08:52,559 --> 00:08:55,760 Speaker 1: Well. He lived another like forty eight years after being 158 00:08:55,760 --> 00:08:56,959 Speaker 1: told he didn't have long to live. 159 00:08:57,000 --> 00:09:00,920 Speaker 2: I think, oh wow, it's a homeopathy works case closed. 160 00:09:02,240 --> 00:09:04,559 Speaker 2: So yes, I think that you really put your finger 161 00:09:04,600 --> 00:09:08,720 Speaker 2: on that. The AMA became the arbiter of what qualifies 162 00:09:08,760 --> 00:09:12,839 Speaker 2: as medicine in the United States thanks to this Flexner report. 163 00:09:13,320 --> 00:09:17,720 Speaker 2: It basically strengthened all of its position. And yes, they 164 00:09:17,760 --> 00:09:20,280 Speaker 2: were the driving force behind this. Initially they went to 165 00:09:20,360 --> 00:09:24,600 Speaker 2: the Carnegie the Carnegie Foundation, and said, hey, you got 166 00:09:24,640 --> 00:09:27,360 Speaker 2: a lot of money, why don't you help us figure 167 00:09:27,360 --> 00:09:32,160 Speaker 2: out how to change American medical education in the exact 168 00:09:32,200 --> 00:09:36,280 Speaker 2: way we want it, and we'll help you figure out 169 00:09:36,280 --> 00:09:39,400 Speaker 2: who to do that with. We like the Johns Hopkins model. 170 00:09:39,440 --> 00:09:42,199 Speaker 2: We basically want a report that says the Johns Hopkins 171 00:09:42,240 --> 00:09:45,679 Speaker 2: model is great. Let's get an outsider in here. And 172 00:09:45,720 --> 00:09:49,160 Speaker 2: that is how Abraham Flexner enters this story. 173 00:09:49,440 --> 00:09:51,120 Speaker 1: Yeah, and you know this is not to say that 174 00:09:51,160 --> 00:09:52,920 Speaker 1: he was like cooking the books or anything like that, 175 00:09:53,080 --> 00:09:54,640 Speaker 1: and no, this is all a sham, but that was 176 00:09:54,679 --> 00:09:57,520 Speaker 1: just sort of The AMA was definitely after that well. 177 00:09:57,520 --> 00:09:59,440 Speaker 2: One of the reasons he was selected is he was 178 00:09:59,480 --> 00:10:03,719 Speaker 2: already a person, an educator who espoused exactly this kind 179 00:10:03,760 --> 00:10:07,880 Speaker 2: of stuff, just not necessarily as it applied to medical education. 180 00:10:08,280 --> 00:10:10,800 Speaker 2: He just wasn't exposed to medical education at the time. 181 00:10:10,840 --> 00:10:14,680 Speaker 2: But he was an educational philosopher and theorists and he 182 00:10:14,800 --> 00:10:16,920 Speaker 2: was fully on board with that kind of thinking. 183 00:10:17,240 --> 00:10:19,000 Speaker 1: Yeah, I mean he wrote a book. I guess we 184 00:10:19,000 --> 00:10:22,880 Speaker 1: should say he did go to Johns Hopkins, but not 185 00:10:22,960 --> 00:10:27,760 Speaker 1: for medicine. I think he studied classic civilizations and he 186 00:10:27,840 --> 00:10:31,800 Speaker 1: was a teacher in his hometown in Louisville, Kentucky. Eventually 187 00:10:31,840 --> 00:10:34,720 Speaker 1: he was a private school headmaster that he founded the school, 188 00:10:35,360 --> 00:10:38,520 Speaker 1: and after earning a degree in psychology from Harvard, he 189 00:10:38,559 --> 00:10:41,480 Speaker 1: wrote a book called The American College, which was sort 190 00:10:41,520 --> 00:10:44,520 Speaker 1: of the Flexner Report of the university system as a whole. 191 00:10:45,400 --> 00:10:48,280 Speaker 1: And this guy named Henry Pritchett, who was the president 192 00:10:48,280 --> 00:10:50,720 Speaker 1: of the Carnegie Foundation at the time, was like, yeah, 193 00:10:50,960 --> 00:10:54,560 Speaker 1: like Josh Clark of the future will say, this is 194 00:10:54,600 --> 00:10:56,440 Speaker 1: our guy, because did you see the way he came 195 00:10:56,480 --> 00:10:59,480 Speaker 1: at the regular universities, like wayde till he finds out 196 00:10:59,480 --> 00:11:02,040 Speaker 1: what's happening in medical schools exactly. 197 00:11:02,080 --> 00:11:03,960 Speaker 2: And then one of the other reasons that he was 198 00:11:04,000 --> 00:11:06,880 Speaker 2: such a great candidate because he was an outsider and 199 00:11:06,920 --> 00:11:10,760 Speaker 2: a non physician, is that they were quite aware that 200 00:11:10,800 --> 00:11:12,840 Speaker 2: there was going to be a lot of blowback, that 201 00:11:12,880 --> 00:11:15,240 Speaker 2: there was going to be a lot of bruce digos 202 00:11:15,280 --> 00:11:18,520 Speaker 2: and stepped on toes, and that somebody outside of the 203 00:11:18,520 --> 00:11:21,800 Speaker 2: profession would be less likely to suffer, say like a 204 00:11:21,840 --> 00:11:27,400 Speaker 2: professional injury or being ostracized for the rest of their career. Yeah. 205 00:11:27,440 --> 00:11:30,560 Speaker 2: Flexner was like, I don't care what you think of me, doctors. 206 00:11:30,679 --> 00:11:35,040 Speaker 1: That's right. So he started out by researching the European models, 207 00:11:35,480 --> 00:11:39,280 Speaker 1: the American models. Like I said, he was really impressed 208 00:11:39,280 --> 00:11:42,040 Speaker 1: with the German model, and in fact, a couple of 209 00:11:42,080 --> 00:11:46,200 Speaker 1: years after the American and Canadian as we'll see Flexner Report, 210 00:11:46,600 --> 00:11:51,800 Speaker 1: he published a European version which critiqued well Europe basically 211 00:11:51,800 --> 00:11:56,079 Speaker 1: everybody but Germany. He was very uncritical of the German system, 212 00:11:57,120 --> 00:11:58,920 Speaker 1: and we also need to point out some of the 213 00:11:58,960 --> 00:12:03,880 Speaker 1: bad things he said. There were several anti Semitic passages 214 00:12:04,000 --> 00:12:06,680 Speaker 1: in the European version of the Flexner Report because he 215 00:12:06,720 --> 00:12:09,800 Speaker 1: was so enamored of how the Germans did their medicining. 216 00:12:10,600 --> 00:12:14,160 Speaker 2: Yeah, this was Yeah, that German model also inspired the 217 00:12:14,280 --> 00:12:19,000 Speaker 2: guy who founded Johns Hopkins Medical School, William Welch, and 218 00:12:19,440 --> 00:12:22,520 Speaker 2: that was essentially so essentially, the Flexner report said, the 219 00:12:22,600 --> 00:12:25,240 Speaker 2: Johns Hopkins model is what we want. Johns Hopkins said 220 00:12:25,240 --> 00:12:31,160 Speaker 2: the German model is what we want, and the Germans said, yeah, yeah, yeah, 221 00:12:31,400 --> 00:12:35,600 Speaker 2: dah yeah, no, that's Russian, das boot, that's German. 222 00:12:36,200 --> 00:12:36,920 Speaker 1: Nice. What else? 223 00:12:39,080 --> 00:12:46,280 Speaker 2: The heimlich maneuver, Yeah, that's it, brought worst cider. Okay, yeah, 224 00:12:46,320 --> 00:12:50,599 Speaker 2: all that stuff october Fest, but with a k should. 225 00:12:50,360 --> 00:12:53,599 Speaker 1: We take a break? Yeah, all right, you're gonna think 226 00:12:54,040 --> 00:12:54,480 Speaker 1: did you say? 227 00:12:54,559 --> 00:12:55,079 Speaker 2: Yeah? 228 00:12:55,280 --> 00:12:59,160 Speaker 1: Yeah, We're gonna think of some more German words or 229 00:12:59,400 --> 00:13:03,080 Speaker 1: Deutsche words, and we're gonna be back with more on 230 00:13:03,160 --> 00:13:04,880 Speaker 1: what Flexner said right after this. 231 00:13:28,200 --> 00:13:29,840 Speaker 2: Chuck, I could only come up with one more, and 232 00:13:29,920 --> 00:13:31,800 Speaker 2: it was strudal. But it's the best one. 233 00:13:32,040 --> 00:13:33,160 Speaker 1: Mmmm yeah. 234 00:13:33,200 --> 00:13:37,480 Speaker 2: Oh wait Frankenstein, Yeah, that's it. 235 00:13:37,520 --> 00:13:39,200 Speaker 1: Do you see that new Frankenstein movie. 236 00:13:40,880 --> 00:13:41,439 Speaker 2: The Bride? 237 00:13:41,920 --> 00:13:45,559 Speaker 1: No, no, no, the what's his name is new Frankenstein movie? 238 00:13:46,440 --> 00:13:47,800 Speaker 2: I don't, I don't know the rock. 239 00:13:48,320 --> 00:13:52,320 Speaker 1: Now the director Guillermo del Toro's. 240 00:13:52,160 --> 00:13:54,480 Speaker 2: Oh no, what did you think of it? 241 00:13:54,840 --> 00:13:57,240 Speaker 1: That was pretty good? I got a little bored, but 242 00:13:57,360 --> 00:13:59,559 Speaker 1: it was everyone said it was really great. I think 243 00:13:59,559 --> 00:14:01,439 Speaker 1: I was just a maki. 244 00:14:01,559 --> 00:14:05,040 Speaker 2: Jillenhall is redoing the bride in like a really strange, 245 00:14:05,200 --> 00:14:07,920 Speaker 2: like out there kind of fashion that looks interesting. 246 00:14:08,200 --> 00:14:10,280 Speaker 1: Yeah, I saw that. I thought it seemed super interesting, 247 00:14:10,360 --> 00:14:12,120 Speaker 1: and I love Mags, so I'm down. 248 00:14:13,559 --> 00:14:15,480 Speaker 2: Okay, well that's fine, I'll allow it. 249 00:14:16,720 --> 00:14:19,440 Speaker 1: So back to the Flexen report. He started that research 250 00:14:19,480 --> 00:14:21,440 Speaker 1: in nineteen oh eight. I think the thing came out 251 00:14:21,480 --> 00:14:24,920 Speaker 1: in nineteen ten, is like we said. But he went 252 00:14:24,960 --> 00:14:26,600 Speaker 1: around all over the place. He went to one hundred 253 00:14:26,600 --> 00:14:30,360 Speaker 1: and five one hundred and fifty five medical schools, one 254 00:14:30,440 --> 00:14:32,280 Speaker 1: hundred and forty eight of which were in the United States, 255 00:14:32,760 --> 00:14:35,760 Speaker 1: seven were in Canada. Spends a couple of days there 256 00:14:35,800 --> 00:14:38,880 Speaker 1: with his nose turned up, and he did this for 257 00:14:38,920 --> 00:14:40,200 Speaker 1: about eighteen months. 258 00:14:40,560 --> 00:14:42,760 Speaker 2: Yeah, just to be clear here, this guy was not 259 00:14:42,920 --> 00:14:46,160 Speaker 2: phoning this in. He definitely took the assignment and did 260 00:14:46,200 --> 00:14:49,280 Speaker 2: it to like he did it like all of those 261 00:14:49,360 --> 00:14:51,800 Speaker 2: those one hundred and fifty five medical schools in the 262 00:14:51,920 --> 00:14:55,280 Speaker 2: US and Canada. That was every medical school in the 263 00:14:55,400 --> 00:14:59,800 Speaker 2: US and Canada, including ones that taught alternative medicine and 264 00:15:00,000 --> 00:15:03,240 Speaker 2: black medical schools. In the United States. So like, he 265 00:15:03,800 --> 00:15:06,920 Speaker 2: definitely went through the paces. It wasn't just like a, yeah, 266 00:15:07,080 --> 00:15:09,280 Speaker 2: let's look at Johns Hopkins and here's my report. 267 00:15:09,880 --> 00:15:12,200 Speaker 1: Yeah, for sure. And you mentioned the black medical schools 268 00:15:12,240 --> 00:15:15,960 Speaker 1: because they come up pretty front and center here in 269 00:15:16,000 --> 00:15:21,120 Speaker 1: a minute. But Johns Hopkins was like the gold standard, 270 00:15:21,160 --> 00:15:23,320 Speaker 1: so that was his comparison point for all of them. 271 00:15:23,760 --> 00:15:26,400 Speaker 1: He looked at everything. He looked at how they financed 272 00:15:26,440 --> 00:15:28,720 Speaker 1: their school. He looked at how big the classrooms were, 273 00:15:28,800 --> 00:15:33,000 Speaker 1: how many teachers they had per student, like admissions, what 274 00:15:33,040 --> 00:15:35,440 Speaker 1: it took to get in, what they were actually teaching, 275 00:15:36,880 --> 00:15:40,440 Speaker 1: laboratory stuff, facilities kind of everything. And what he came 276 00:15:40,480 --> 00:15:43,160 Speaker 1: out with was one of three determinations in the end 277 00:15:43,160 --> 00:15:46,560 Speaker 1: for each school. The school is good, you can stay, 278 00:15:46,640 --> 00:15:49,600 Speaker 1: you can keep your doors open. Your school is not 279 00:15:49,640 --> 00:15:53,240 Speaker 1: so great, but you show promise, so maybe if you 280 00:15:53,280 --> 00:15:55,600 Speaker 1: have some more funding and you change these things, you 281 00:15:55,600 --> 00:15:59,000 Speaker 1: can be okay, and then I'm sorry, please close your 282 00:15:59,000 --> 00:15:59,560 Speaker 1: doors forever. 283 00:16:00,440 --> 00:16:02,840 Speaker 2: Yeah, there was a lot of them that he categorized 284 00:16:02,840 --> 00:16:04,600 Speaker 2: as hopelessly deficient. 285 00:16:04,640 --> 00:16:06,400 Speaker 1: A lot most in fact. 286 00:16:06,920 --> 00:16:09,520 Speaker 2: Yeah, And it wasn't just like him being a snooty 287 00:16:09,760 --> 00:16:12,920 Speaker 2: butt head like the as we said, like the medical 288 00:16:12,920 --> 00:16:15,480 Speaker 2: schools in the United States were in a lot of 289 00:16:15,520 --> 00:16:21,200 Speaker 2: cases hopelessly deficient, and that's a problem when you're producing doctors, 290 00:16:21,560 --> 00:16:24,240 Speaker 2: you know. So he did make a pretty good case 291 00:16:24,280 --> 00:16:26,400 Speaker 2: that that there were a lot they were hopelessly deficient, 292 00:16:26,440 --> 00:16:30,720 Speaker 2: but the deficient ones they actually had different rankings. For example, 293 00:16:31,080 --> 00:16:36,640 Speaker 2: Iowa State University's medical school. He basically said, they know 294 00:16:36,760 --> 00:16:39,880 Speaker 2: what they're wanting to do, but the hospital associated with 295 00:16:39,920 --> 00:16:44,400 Speaker 2: it is too small. And the your clinical faculty, the 296 00:16:44,440 --> 00:16:46,800 Speaker 2: people who are supposed to be doing research and teaching 297 00:16:47,240 --> 00:16:49,880 Speaker 2: medicine to the students, they all have their own private 298 00:16:49,920 --> 00:16:54,280 Speaker 2: practices because they have to support themselves. So if you 299 00:16:54,400 --> 00:16:57,560 Speaker 2: gave this this group enough funding, they could create a 300 00:16:57,880 --> 00:17:00,800 Speaker 2: top notch medical school. In the Johns Hopkins model that 301 00:17:00,920 --> 00:17:05,080 Speaker 2: was kind of like that deficient category, the varying degrees 302 00:17:05,160 --> 00:17:08,359 Speaker 2: of how much money you would need and whether you 303 00:17:08,359 --> 00:17:10,160 Speaker 2: were you're headed in the right direction. 304 00:17:10,800 --> 00:17:14,679 Speaker 1: Yeah, for sure. The way he wrote in what was 305 00:17:14,880 --> 00:17:20,280 Speaker 1: called Carnegie Foundation Bulletin number four or Medical Education in 306 00:17:20,320 --> 00:17:23,800 Speaker 1: the United States and Canada aka Flexner Report, was that 307 00:17:25,640 --> 00:17:30,760 Speaker 1: very muckbreaking style. It's not the kind of report you 308 00:17:30,760 --> 00:17:33,280 Speaker 1: would people wouldn't write it this way. Today because he 309 00:17:33,320 --> 00:17:36,400 Speaker 1: did get a little It seems like he enjoyed sort 310 00:17:36,400 --> 00:17:38,200 Speaker 1: of the put downs and coming up with new ways 311 00:17:38,200 --> 00:17:39,720 Speaker 1: of saying how bad a school. 312 00:17:39,560 --> 00:17:43,119 Speaker 2: Was, so people would write it that way today and unfortunately. 313 00:17:42,640 --> 00:17:45,320 Speaker 1: Well, you're probably right one of them, he said. Apparently 314 00:17:45,359 --> 00:17:48,920 Speaker 1: the inexcusable degree of ignorance begins just where the ability 315 00:17:48,960 --> 00:17:50,560 Speaker 1: to pay fees leaves off. 316 00:17:50,840 --> 00:17:54,040 Speaker 2: Oh yeah, and so he was basically taking them to 317 00:17:54,119 --> 00:17:58,040 Speaker 2: task over low admission requirements if any. But you didn't 318 00:17:58,080 --> 00:18:00,880 Speaker 2: say low admission requirements. He also used the word reeks, 319 00:18:01,640 --> 00:18:06,120 Speaker 2: which you don't usually see in academic studies. Yeah, he said. 320 00:18:06,119 --> 00:18:08,960 Speaker 2: The osteopathic schools in the United States, there are eight 321 00:18:08,960 --> 00:18:12,400 Speaker 2: of them. That they reek of commercialism, that they attract 322 00:18:12,480 --> 00:18:16,600 Speaker 2: students with a mass of hysterical exaggerations that confidently appeals 323 00:18:16,600 --> 00:18:19,640 Speaker 2: to the crude boys or disappointed men and women whom 324 00:18:19,720 --> 00:18:26,680 Speaker 2: it successfully exploits. We should say osteopathy isn't accepted form 325 00:18:26,800 --> 00:18:29,560 Speaker 2: medicine in the United States now, but a lot of 326 00:18:29,600 --> 00:18:35,840 Speaker 2: people still view it as a pseudo scientific alternative medicine. Yeah. 327 00:18:35,880 --> 00:18:39,560 Speaker 1: I mean, he had a site set on them, on chiropractors, 328 00:18:39,200 --> 00:18:42,520 Speaker 1: on all kinds of things that a lot of people 329 00:18:43,359 --> 00:18:45,919 Speaker 1: put a lot of great value in today. So he 330 00:18:46,040 --> 00:18:48,400 Speaker 1: was off based on some stuff for sure. But again 331 00:18:48,440 --> 00:18:49,520 Speaker 1: this was nineteen ten. 332 00:18:50,119 --> 00:18:53,320 Speaker 2: So of the underfunded medical schools and this was a 333 00:18:53,359 --> 00:18:56,719 Speaker 2: problem too. This is actually one of the things that 334 00:18:56,760 --> 00:18:59,440 Speaker 2: befell black medical schools is we'll see in a minute. 335 00:19:00,320 --> 00:19:03,320 Speaker 2: If you were underfunded, that was it. Sorry, no amount 336 00:19:03,359 --> 00:19:05,879 Speaker 2: of funding is going to bring you up. Well, maybe 337 00:19:05,920 --> 00:19:07,879 Speaker 2: some amount of funding is going to bring you up 338 00:19:07,880 --> 00:19:10,800 Speaker 2: to speed, but we need that money to bring other 339 00:19:11,160 --> 00:19:14,440 Speaker 2: medical schools that are closer up because we can bring 340 00:19:14,480 --> 00:19:16,880 Speaker 2: more of them up to snuff, or we can bring 341 00:19:16,920 --> 00:19:19,480 Speaker 2: fewer up to snuff and basically get the ones that 342 00:19:19,520 --> 00:19:22,719 Speaker 2: are at least funded. His whole premise was just close 343 00:19:22,800 --> 00:19:25,240 Speaker 2: those poorly funded ones because they're just not going to 344 00:19:25,280 --> 00:19:26,080 Speaker 2: be able to do this. 345 00:19:26,440 --> 00:19:28,760 Speaker 1: Yeah, and you know he was probably onto something there 346 00:19:28,760 --> 00:19:30,959 Speaker 1: because there was a glut of bad schools. And his 347 00:19:31,080 --> 00:19:34,720 Speaker 1: quote was the curse of medical education is the excessive 348 00:19:34,760 --> 00:19:38,520 Speaker 1: number of schools. This situation can improve only as weaker 349 00:19:38,560 --> 00:19:42,399 Speaker 1: and superfluous schools are extinguished. Right, Like I said, it 350 00:19:42,440 --> 00:19:46,239 Speaker 1: was Canada and the US. Canada fared much better our 351 00:19:46,280 --> 00:19:49,560 Speaker 1: northern friends up there. Of the seven Canadian medical schools. 352 00:19:49,960 --> 00:19:52,320 Speaker 1: He only recommended one for closure. 353 00:19:52,320 --> 00:19:54,119 Speaker 2: So one seventh of them, that's. 354 00:19:54,040 --> 00:19:57,320 Speaker 1: Right, the one hundred and forty eight medical schools in 355 00:19:57,359 --> 00:20:02,760 Speaker 1: the United States, more than half of them he recommended closing. 356 00:20:02,880 --> 00:20:04,880 Speaker 1: And I think it ended up being more than that even, right. 357 00:20:06,640 --> 00:20:10,440 Speaker 2: Yeah, he actually recommended reducing the full number of schools 358 00:20:10,480 --> 00:20:14,119 Speaker 2: in the US and Canada from one hundred and fifty 359 00:20:14,119 --> 00:20:20,840 Speaker 2: five down to thirty one. Yeah, that's four fifths. So yeah, 360 00:20:20,880 --> 00:20:23,160 Speaker 2: I mean, like he was basically a hatchet man. They 361 00:20:23,160 --> 00:20:26,680 Speaker 2: brought him in to basically get rid of competing, poorly funded, 362 00:20:27,040 --> 00:20:30,520 Speaker 2: poorly run medical schools. He said, if you're a proprietary 363 00:20:30,600 --> 00:20:33,640 Speaker 2: medical school, it doesn't matter what you're doing, you're closed. 364 00:20:34,000 --> 00:20:38,800 Speaker 2: He saw med school as a public trust, that it 365 00:20:38,800 --> 00:20:42,280 Speaker 2: should be publicly funded. Ergo, they should be associated or 366 00:20:42,280 --> 00:20:46,640 Speaker 2: attached to public universities, and that the reason that doctors 367 00:20:46,640 --> 00:20:49,879 Speaker 2: were being produced was to help society along. That you 368 00:20:49,920 --> 00:20:53,399 Speaker 2: should not have a board or stockholders to whom you 369 00:20:53,400 --> 00:20:55,800 Speaker 2: were really kind of beholden to so they would affect 370 00:20:55,840 --> 00:20:58,800 Speaker 2: your decision making. No, you needed to be beholden to 371 00:20:58,880 --> 00:21:03,640 Speaker 2: science right ideally to patients, although he didn't put much 372 00:21:03,680 --> 00:21:04,879 Speaker 2: emphasis on that part. 373 00:21:05,320 --> 00:21:07,840 Speaker 1: Yeah, and we'll talk about that at the end. So 374 00:21:08,280 --> 00:21:11,720 Speaker 1: every single proprietary school was immediately on the list, basically 375 00:21:11,760 --> 00:21:14,960 Speaker 1: from the jump, like, if you weren't affiliated with the university, 376 00:21:14,960 --> 00:21:19,000 Speaker 1: you had no hope for surviving this. All the holistic 377 00:21:19,160 --> 00:21:23,120 Speaker 1: or what we call alternative medical systems were completely shut down. 378 00:21:24,760 --> 00:21:29,360 Speaker 1: Five of the seven black medical schools were recommended for closure. 379 00:21:30,119 --> 00:21:33,680 Speaker 1: I think Howard University in DC and Mahari Medical College 380 00:21:33,760 --> 00:21:37,439 Speaker 1: right here in Georgia he thought might be salvageable. But 381 00:21:37,640 --> 00:21:42,359 Speaker 1: there are a couple of chapters in there. Chapter fourteen, specifically, 382 00:21:42,400 --> 00:21:44,879 Speaker 1: the Medical Education of the Negro was the title of 383 00:21:44,920 --> 00:21:48,639 Speaker 1: that chapter, where he shows a real disdain for black 384 00:21:48,680 --> 00:21:52,879 Speaker 1: medical schools. He said they were wasting money, small sums 385 00:21:52,880 --> 00:21:56,120 Speaker 1: of money annually, that undisciplined men whose lack of real 386 00:21:56,160 --> 00:22:00,560 Speaker 1: training is covered up by imposing MD degrees. And he 387 00:22:00,640 --> 00:22:04,520 Speaker 1: basically ended up saying, like close most of these, and 388 00:22:04,840 --> 00:22:08,240 Speaker 1: my suggestion is just to make black medical schools to 389 00:22:08,320 --> 00:22:11,479 Speaker 1: train black doctors to treat black patients only, and they 390 00:22:11,480 --> 00:22:13,879 Speaker 1: should really just concentrate on hygiene. 391 00:22:14,359 --> 00:22:17,720 Speaker 2: Yeah, they should focus on public health in order to 392 00:22:17,840 --> 00:22:20,960 Speaker 2: keep black people from spreading disease to white people. That 393 00:22:21,119 --> 00:22:25,480 Speaker 2: was essentially his take on the purpose for the existence 394 00:22:25,520 --> 00:22:28,880 Speaker 2: of black doctors. Out of three hundred and forty six 395 00:22:28,920 --> 00:22:32,520 Speaker 2: pages in the initial version of the report, two chapter 396 00:22:32,560 --> 00:22:36,480 Speaker 2: fourteen was two pages long, and that is shocking in 397 00:22:36,520 --> 00:22:40,639 Speaker 2: and of itself. But the Flexner Report was essentially the 398 00:22:40,680 --> 00:22:45,800 Speaker 2: first document about medicine and medical school that even acknowledged 399 00:22:45,800 --> 00:22:48,560 Speaker 2: the existence of black medical schools. Up to this point, 400 00:22:48,560 --> 00:22:53,919 Speaker 2: they were totally invisible, completely ignored. So the fact in 401 00:22:54,000 --> 00:22:57,720 Speaker 2: a really silver lining to the cloud way of looking 402 00:22:57,760 --> 00:23:01,520 Speaker 2: at this, the fact that Howard Universe and Mahari Medical 403 00:23:01,560 --> 00:23:06,840 Speaker 2: College in Georgia made the cut, Yeah, was really substantial, 404 00:23:07,080 --> 00:23:10,479 Speaker 2: Like that was a that was sadly a really big 405 00:23:10,640 --> 00:23:13,800 Speaker 2: positive for black medical schools. Unfortunately. 406 00:23:14,200 --> 00:23:17,320 Speaker 1: Yeah, for sure. You know, I mentioned sexism too. The 407 00:23:17,359 --> 00:23:22,200 Speaker 1: AMA and the Carnegie Foundation were also not too hot 408 00:23:22,240 --> 00:23:27,160 Speaker 1: on the idea of the three women's medical college colleges 409 00:23:27,200 --> 00:23:31,760 Speaker 1: even existing. In Flexner himself basically came out and said, 410 00:23:32,160 --> 00:23:34,679 Speaker 1: I don't think women can withstand the mental rigors of 411 00:23:34,720 --> 00:23:35,760 Speaker 1: being a doctor. 412 00:23:36,359 --> 00:23:38,560 Speaker 2: You never met Elizabeth Blackwell. 413 00:23:38,119 --> 00:23:42,600 Speaker 1: Yeah, no kidding, And he literally said, you know, women 414 00:23:42,640 --> 00:23:45,040 Speaker 1: make better patients than doctors. 415 00:23:46,000 --> 00:23:47,760 Speaker 2: This is the nineteen tens. 416 00:23:48,040 --> 00:23:49,920 Speaker 1: Yeah, it's not like eighteen ten. 417 00:23:50,960 --> 00:23:54,359 Speaker 2: So yeah, so this was I mean, I guess on 418 00:23:54,440 --> 00:23:57,000 Speaker 2: the other way of approaching this too. So we've talked 419 00:23:57,000 --> 00:23:59,480 Speaker 2: about everything that he was giving the hatchet too. He 420 00:23:59,560 --> 00:24:04,720 Speaker 2: had a version of what made an idea ideal medical education, 421 00:24:05,600 --> 00:24:07,760 Speaker 2: and again it was based on the German model, which 422 00:24:07,800 --> 00:24:11,359 Speaker 2: the Johns Hopkins model was based on, and he essentially said, so, 423 00:24:11,440 --> 00:24:14,520 Speaker 2: you need to have rigorous instruction, you need to have 424 00:24:14,960 --> 00:24:19,040 Speaker 2: rigorous admissions requirements, and you have to enforce them too. 425 00:24:20,440 --> 00:24:22,639 Speaker 2: And in doing so, he basically said, you're going to 426 00:24:23,080 --> 00:24:26,400 Speaker 2: you're going to weed out candidates who aren't they don't 427 00:24:26,400 --> 00:24:28,280 Speaker 2: have they can't make the cut for this new kind 428 00:24:28,280 --> 00:24:31,800 Speaker 2: of doctor. So that meant you had to have money 429 00:24:32,320 --> 00:24:35,760 Speaker 2: to even get started because this new model was so 430 00:24:36,000 --> 00:24:39,920 Speaker 2: much more expensive than the old model. Three to tuition 431 00:24:40,040 --> 00:24:43,680 Speaker 2: I think need to do increase three to four times 432 00:24:43,760 --> 00:24:46,000 Speaker 2: just to start to meet the funding for this. So 433 00:24:46,520 --> 00:24:48,679 Speaker 2: you're like you just out of the gate, had to 434 00:24:48,680 --> 00:24:51,159 Speaker 2: have money to even try to apply to medical school. 435 00:24:51,560 --> 00:24:55,960 Speaker 2: And then the academic requirements meant that even if you 436 00:24:56,000 --> 00:24:58,600 Speaker 2: had money, if you didn't have what it took to 437 00:24:58,720 --> 00:25:01,959 Speaker 2: like really dedicate yourself to learning this stuff, you were 438 00:25:02,000 --> 00:25:05,560 Speaker 2: going to fail. Out too. So in that sense, it 439 00:25:05,600 --> 00:25:09,680 Speaker 2: took doctors from being just ordinary trades people and said, 440 00:25:09,720 --> 00:25:13,720 Speaker 2: these people are responsible for keeping the population of the 441 00:25:13,840 --> 00:25:16,679 Speaker 2: United States healthy and we're making sure that they are 442 00:25:16,800 --> 00:25:21,160 Speaker 2: up to the task. In return, they're rich. 443 00:25:21,240 --> 00:25:25,560 Speaker 1: Now it's right, And you know, you know, part of 444 00:25:25,600 --> 00:25:29,000 Speaker 1: it was says medical school was expensive was because or 445 00:25:29,119 --> 00:25:32,760 Speaker 1: ended up being more expensive, is because they needed better facilities, 446 00:25:32,800 --> 00:25:35,840 Speaker 1: they needed better equipment. I know, we already mentioned that 447 00:25:35,920 --> 00:25:38,720 Speaker 1: teachers were working part time as doctors just because they 448 00:25:38,720 --> 00:25:40,880 Speaker 1: had to make a living. But one of his big 449 00:25:40,960 --> 00:25:43,240 Speaker 1: key recommendations was you have to have a full time 450 00:25:43,280 --> 00:25:46,800 Speaker 1: faculty that is just doing biomedical research, like they're not 451 00:25:46,920 --> 00:25:49,800 Speaker 1: doctoring on the side. And in order to come up 452 00:25:49,840 --> 00:25:53,399 Speaker 1: with this kind of money, it was expensive. The idea 453 00:25:53,400 --> 00:25:56,960 Speaker 1: of medical philanthropy really really took off because you know, 454 00:25:57,040 --> 00:25:59,439 Speaker 1: Johns Hopkins was one thing, but if you wanted to 455 00:25:59,440 --> 00:26:02,359 Speaker 1: have more than one Johns Hopkins like model out there, 456 00:26:03,080 --> 00:26:06,159 Speaker 1: you had to lay out this roadmap of basically you know, 457 00:26:06,280 --> 00:26:09,560 Speaker 1: starting in nineteen ten and over the next few decades 458 00:26:09,560 --> 00:26:14,040 Speaker 1: and continuing today, these huge foundations were created and also 459 00:26:14,080 --> 00:26:18,800 Speaker 1: local groups just donating money to make sure The Flexner 460 00:26:18,840 --> 00:26:23,119 Speaker 1: Report was enacted, like the Rockefeller Foundation, they gave hundreds 461 00:26:23,119 --> 00:26:26,399 Speaker 1: of millions of dollars to get these programs going across 462 00:26:26,400 --> 00:26:26,840 Speaker 1: the country. 463 00:26:27,480 --> 00:26:30,720 Speaker 2: Yeah, and it worked, but again it took hundreds of 464 00:26:30,720 --> 00:26:33,040 Speaker 2: millions of dollars in I think nineteen ten money too. 465 00:26:33,600 --> 00:26:36,000 Speaker 1: Should we take a break. Let's take a break, all right, 466 00:26:36,040 --> 00:26:38,280 Speaker 1: We'll be right back with the closing act of the 467 00:26:38,280 --> 00:27:05,600 Speaker 1: Flexner Report. So we're back. One of the results we 468 00:27:05,640 --> 00:27:07,600 Speaker 1: talked about was all these schools shutting down, I think 469 00:27:07,680 --> 00:27:10,919 Speaker 1: more within ten years, I'm sorry, Within five years of 470 00:27:10,960 --> 00:27:14,640 Speaker 1: the report's release, more than fifty of the medical schools 471 00:27:14,640 --> 00:27:18,280 Speaker 1: in the United States shut down, and twenty years on, 472 00:27:18,280 --> 00:27:20,720 Speaker 1: only seventy six of the original one hundred and forty 473 00:27:20,760 --> 00:27:24,320 Speaker 1: eight in the United States remained. Like you said, five 474 00:27:24,359 --> 00:27:28,399 Speaker 1: of the seven black medical schools, eighty percent of the 475 00:27:28,560 --> 00:27:33,280 Speaker 1: alternative medicine programs were shut down, and the handful of 476 00:27:33,560 --> 00:27:37,080 Speaker 1: schools that had admitted women were either shut down or 477 00:27:37,119 --> 00:27:39,040 Speaker 1: not admitting women anymore for a while. 478 00:27:39,440 --> 00:27:44,639 Speaker 2: Right, So, like this was a huge impact on the 479 00:27:44,680 --> 00:27:48,440 Speaker 2: way that doctors were created in the United States and 480 00:27:48,520 --> 00:27:52,000 Speaker 2: again the profession of doctoring in the first place. And 481 00:27:52,080 --> 00:27:55,560 Speaker 2: it happened very quickly, as you just mentioned, and there 482 00:27:55,600 --> 00:27:57,400 Speaker 2: are a lot of positives to it, but there are 483 00:27:57,440 --> 00:28:00,399 Speaker 2: a lot of criticisms to the outcomes too. One of 484 00:28:00,480 --> 00:28:03,480 Speaker 2: the big ones is the impact that the flexner had 485 00:28:03,800 --> 00:28:07,560 Speaker 2: on producing black doctors in the United States. I saw 486 00:28:07,600 --> 00:28:11,360 Speaker 2: an estimate that had all seven of the black medical 487 00:28:11,400 --> 00:28:13,880 Speaker 2: schools stayed open and been funded so that they could 488 00:28:13,960 --> 00:28:19,480 Speaker 2: follow this model, another thirty thousand doctors Black doctors would 489 00:28:19,520 --> 00:28:22,720 Speaker 2: have been produced to the United States between nineteen ten 490 00:28:22,800 --> 00:28:26,160 Speaker 2: and twenty twelve, I think, which is a big deal 491 00:28:26,320 --> 00:28:29,800 Speaker 2: because apparently right now two percent of American doctors are black, 492 00:28:30,160 --> 00:28:35,080 Speaker 2: but the percentage of the Black population in the American 493 00:28:35,119 --> 00:28:39,640 Speaker 2: population overall is thirteen percent, so they're grossly underrepresented, which 494 00:28:39,680 --> 00:28:42,840 Speaker 2: is another problem in and of itself, because studies show 495 00:28:42,920 --> 00:28:46,440 Speaker 2: that black patients are likelier to follow the orders and 496 00:28:46,520 --> 00:28:50,120 Speaker 2: instructions of black doctors than they are of doctors of 497 00:28:50,160 --> 00:28:53,240 Speaker 2: other races. They just it's just a question of. 498 00:28:53,320 --> 00:28:56,520 Speaker 1: Comfort, yeah, for sure. And you could also make an 499 00:28:56,600 --> 00:28:59,320 Speaker 1: argument that that gave rise to things like the Tuskegee 500 00:28:59,320 --> 00:29:03,760 Speaker 1: experiments and other like awful experiments carried out by white 501 00:29:03,800 --> 00:29:06,760 Speaker 1: doctors on black patients that led to the cycle of 502 00:29:06,920 --> 00:29:10,240 Speaker 1: mistrust of the you know, the medical profession as a whole. 503 00:29:10,720 --> 00:29:12,920 Speaker 2: Yeah, there was a whole like part of this, this 504 00:29:13,040 --> 00:29:17,040 Speaker 2: emphasis on science. And because Flexner was not a physician, 505 00:29:17,320 --> 00:29:21,440 Speaker 2: he really ignored the idea of the physician as a healer. 506 00:29:21,800 --> 00:29:24,200 Speaker 2: The physician is somebody who was meant to see their 507 00:29:24,240 --> 00:29:28,120 Speaker 2: patients as human and instead, because of this focus on 508 00:29:28,240 --> 00:29:32,560 Speaker 2: rationalism over humanism, the patient became essentially just a walking 509 00:29:32,640 --> 00:29:36,200 Speaker 2: bag of medical issues that needed to be diagnosed and treated. 510 00:29:36,400 --> 00:29:39,560 Speaker 2: They weren't a person. That stuff didn't matter. The point 511 00:29:39,560 --> 00:29:42,720 Speaker 2: of the doctor was to treat their illnesses and make 512 00:29:42,760 --> 00:29:46,200 Speaker 2: them better, not to be their friend. And in doing that, 513 00:29:46,320 --> 00:29:50,280 Speaker 2: like the medical profession lost a lot of I guess 514 00:29:50,320 --> 00:29:52,920 Speaker 2: connection with the rest of us, where you know, doctors 515 00:29:52,960 --> 00:29:57,320 Speaker 2: are kind of looked at is looking at the rest 516 00:29:57,320 --> 00:29:59,960 Speaker 2: of us is not fully human and that doesn't really 517 00:30:00,400 --> 00:30:03,160 Speaker 2: jibe and feel good, you know when you're a patient. 518 00:30:03,480 --> 00:30:06,160 Speaker 1: Yeah, for sure, I think I can't find it. It's 519 00:30:06,200 --> 00:30:07,400 Speaker 1: not in front of me now. But I sent you 520 00:30:07,440 --> 00:30:10,720 Speaker 1: one study from a few years ago where I think 521 00:30:10,760 --> 00:30:12,800 Speaker 1: the long and shortage it was they were surveying people 522 00:30:12,880 --> 00:30:15,600 Speaker 1: that how happy they were with like the end of 523 00:30:15,760 --> 00:30:21,719 Speaker 1: care care for relatives, and I think only forty percent 524 00:30:21,880 --> 00:30:25,479 Speaker 1: of the people were satisfied with like how their the 525 00:30:25,560 --> 00:30:28,000 Speaker 1: end of the lives of their relatives went. And a 526 00:30:28,000 --> 00:30:29,920 Speaker 1: lot of that had to do with pain management, and 527 00:30:29,960 --> 00:30:31,840 Speaker 1: that sort of ties back to what you were saying 528 00:30:31,880 --> 00:30:37,840 Speaker 1: about just sort of the rigorous you know, eyeballs on 529 00:30:37,880 --> 00:30:42,960 Speaker 1: a microscope and not like eyeballs on a human. You know, 530 00:30:43,000 --> 00:30:45,080 Speaker 1: it's all sort of tied in together, I think. 531 00:30:45,520 --> 00:30:48,280 Speaker 2: Yeah, And the other way that that manifested itself was 532 00:30:48,320 --> 00:30:54,360 Speaker 2: a huge emphasis on separating academic physicians from practicing physicians 533 00:30:54,400 --> 00:30:57,960 Speaker 2: so that academics could just focus on research. And then 534 00:30:58,000 --> 00:31:01,240 Speaker 2: they emphasized the research that the act academics we're producing, 535 00:31:01,280 --> 00:31:04,560 Speaker 2: like that's the most important thing. You clinicians, listen to 536 00:31:04,600 --> 00:31:07,040 Speaker 2: the research doctors and what they're finding, and then you 537 00:31:07,080 --> 00:31:09,480 Speaker 2: can go apply it to your practice. And so they 538 00:31:09,480 --> 00:31:13,040 Speaker 2: were like, well, you've taken these people away from patients 539 00:31:13,680 --> 00:31:18,040 Speaker 2: and they're just using like this this scientific mentality and 540 00:31:18,280 --> 00:31:21,280 Speaker 2: there's no humanism to it. And they critics say that 541 00:31:21,440 --> 00:31:23,880 Speaker 2: was one of the ways that this whole idea of 542 00:31:24,200 --> 00:31:27,520 Speaker 2: science losing its humanity or medicine losing part of its 543 00:31:27,600 --> 00:31:29,520 Speaker 2: humanity or soul came about. 544 00:31:29,960 --> 00:31:32,720 Speaker 1: Yeah, for sure, you know, I know, I've already mentioned 545 00:31:32,760 --> 00:31:35,640 Speaker 1: a little bit about eliminating sort of all kinds of 546 00:31:35,720 --> 00:31:40,960 Speaker 1: alternative medicines, and that homeopathy was homeopathy homeopathy, what do 547 00:31:41,000 --> 00:31:45,000 Speaker 1: you say, I've heard both, Okay, both at the same time. 548 00:31:45,760 --> 00:31:47,640 Speaker 1: Was very popular at the time. I mean, there are 549 00:31:47,680 --> 00:31:51,959 Speaker 1: people that think that they were doing pretty well with 550 00:31:52,280 --> 00:31:57,640 Speaker 1: homeopathy and curing disease with natural remedies. Other people will say, no, 551 00:31:57,840 --> 00:32:00,600 Speaker 1: you've got your tinfoil hat on, and that's not the case. 552 00:32:00,640 --> 00:32:03,400 Speaker 1: They just didn't know real science at the time. So 553 00:32:03,440 --> 00:32:05,640 Speaker 1: there's a lot of raging debate online about that kind 554 00:32:05,680 --> 00:32:08,560 Speaker 1: of stuff. But another point of this all is that 555 00:32:09,200 --> 00:32:15,040 Speaker 1: psychiatric medicine lost a lot of I guess curricular elements 556 00:32:15,160 --> 00:32:18,200 Speaker 1: that were very beneficial at the time for mental health treatment. 557 00:32:18,400 --> 00:32:20,720 Speaker 1: They were making a lot of strides at the time 558 00:32:20,800 --> 00:32:25,440 Speaker 1: with things like meditation and like how nutrition food can 559 00:32:25,600 --> 00:32:29,280 Speaker 1: alter like a person's or lifestyle can alter a person's 560 00:32:29,320 --> 00:32:31,960 Speaker 1: mental health. And that was all just sort of flushed 561 00:32:31,960 --> 00:32:35,680 Speaker 1: down the toilet because of this, and the neurochemical model 562 00:32:35,720 --> 00:32:38,920 Speaker 1: came out of mental illness, and the same people that 563 00:32:39,040 --> 00:32:43,600 Speaker 1: were arguing for homeopathy basically said, you know what, the 564 00:32:43,600 --> 00:32:47,320 Speaker 1: flex and report really did was, among other things, was 565 00:32:48,040 --> 00:32:50,800 Speaker 1: let us down the path of people like the Rockefeller 566 00:32:50,880 --> 00:32:57,080 Speaker 1: Foundation creating big pharma essentially and getting people on endless 567 00:32:57,120 --> 00:33:00,520 Speaker 1: amounts of medicine that just don't heal you. They're just 568 00:33:00,640 --> 00:33:02,600 Speaker 1: never ending and make big, farmer, bigger. 569 00:33:03,120 --> 00:33:06,080 Speaker 2: Yeah, psychiatric medicine is a good example of that. They 570 00:33:06,160 --> 00:33:09,640 Speaker 2: just took the neurochemical model of mental illness and that 571 00:33:09,640 --> 00:33:10,280 Speaker 2: that was that. 572 00:33:10,680 --> 00:33:12,320 Speaker 1: I mean, I think a lot of that stuff has 573 00:33:12,360 --> 00:33:15,800 Speaker 1: come back now. Yeah, it's just not super funded and 574 00:33:16,600 --> 00:33:21,040 Speaker 1: you're not going to find any like huge medical schools 575 00:33:21,040 --> 00:33:26,280 Speaker 1: that tout their homeopathy departments or anything like that. But 576 00:33:26,840 --> 00:33:30,840 Speaker 1: I think there's underground movements for all that stuff, like hey, 577 00:33:31,320 --> 00:33:34,760 Speaker 1: meditation can help your mental health, and maybe these herbs 578 00:33:34,800 --> 00:33:36,800 Speaker 1: can make you feel better, or this honey that you 579 00:33:36,880 --> 00:33:40,840 Speaker 1: rub on your cut is better than vactine or whatever. 580 00:33:40,720 --> 00:33:44,920 Speaker 2: It really is. If you see a good psychiatrist, especially 581 00:33:44,960 --> 00:33:47,880 Speaker 2: probably a younger one these days, one of the first 582 00:33:47,920 --> 00:33:49,960 Speaker 2: things they're going to ask you is how are you sleeping, 583 00:33:50,040 --> 00:33:53,360 Speaker 2: are you exercising? What your diet? Like, yeah, totally, And 584 00:33:53,400 --> 00:33:55,440 Speaker 2: then they'll start to go into meds. But like they're 585 00:33:55,480 --> 00:33:57,720 Speaker 2: gonna say, like, you need to really pay attention to 586 00:33:57,760 --> 00:33:59,880 Speaker 2: these three things, and if you still need meds, it'll 587 00:34:00,080 --> 00:34:04,520 Speaker 2: still drastically reduced the kind or amount of meds you'll 588 00:34:04,520 --> 00:34:05,520 Speaker 2: probably need. 589 00:34:05,760 --> 00:34:08,080 Speaker 1: Right if you're taking care of yourself in the other. 590 00:34:07,920 --> 00:34:10,960 Speaker 2: Ways exactly, So that has definitely come back in psychiatry. 591 00:34:11,000 --> 00:34:12,920 Speaker 2: And that's a really good example of what a lot 592 00:34:12,960 --> 00:34:16,120 Speaker 2: of people point to. The Flexner Report suppressed that for 593 00:34:16,160 --> 00:34:21,160 Speaker 2: one hundred years, it derailed black doctors, it derailed women doctors, 594 00:34:21,160 --> 00:34:25,279 Speaker 2: it derailed alternative medicines. It even took the stuff that 595 00:34:25,560 --> 00:34:28,400 Speaker 2: was part of the medical establishment and twisted it around, 596 00:34:28,840 --> 00:34:32,000 Speaker 2: and it took a full century for things to start 597 00:34:32,080 --> 00:34:34,920 Speaker 2: to even come back, And that again is a really 598 00:34:35,000 --> 00:34:38,719 Speaker 2: big criticism of the whole thing. But overall, you can 599 00:34:38,760 --> 00:34:41,160 Speaker 2: point to a lot of stuff, a lot of lives 600 00:34:41,160 --> 00:34:43,320 Speaker 2: that were saved, a lot of lives that were improved, 601 00:34:43,320 --> 00:34:46,839 Speaker 2: a lot of life spans that were extended because of 602 00:34:46,880 --> 00:34:51,480 Speaker 2: this Johns Hopkins German model that the Flexner Report essentially 603 00:34:52,080 --> 00:34:57,400 Speaker 2: with the AMA, got the Rockefeller Foundation to fund and 604 00:34:57,440 --> 00:34:59,920 Speaker 2: create this new model for America. 605 00:35:00,120 --> 00:35:03,040 Speaker 1: This is one of those rare episodes where there's truly 606 00:35:03,120 --> 00:35:06,319 Speaker 1: like two ways to look at it. I mean, he 607 00:35:06,360 --> 00:35:08,319 Speaker 1: definitely threw the baby out with the bathwater. In a 608 00:35:08,360 --> 00:35:11,440 Speaker 1: lot of cases, oh well put. But you could also 609 00:35:11,560 --> 00:35:15,120 Speaker 1: argue that, like it was such a mess that like 610 00:35:15,320 --> 00:35:20,040 Speaker 1: something drastic had to happen or else. You know, who 611 00:35:20,040 --> 00:35:22,040 Speaker 1: knows how many more decades it would have taken. I mean, 612 00:35:22,080 --> 00:35:23,920 Speaker 1: I definitely agree with you that like it would have 613 00:35:23,920 --> 00:35:25,719 Speaker 1: happened at some point. I doubt if we'd still be 614 00:35:25,760 --> 00:35:28,800 Speaker 1: sitting here today had the Flexner Report and not been written, 615 00:35:28,960 --> 00:35:30,920 Speaker 1: and like I'm sitting here with like a leech on 616 00:35:30,920 --> 00:35:32,080 Speaker 1: my forehead. 617 00:35:31,800 --> 00:35:36,120 Speaker 2: Right or I have typhus Yeah exactly. Yeah, I agree 618 00:35:36,120 --> 00:35:41,239 Speaker 2: with you, Chuck. This is a good one. Thank you 619 00:35:41,400 --> 00:35:42,440 Speaker 2: Emily for it. 620 00:35:43,160 --> 00:35:44,440 Speaker 1: Thanks, Josh, You're welcome. 621 00:35:44,920 --> 00:35:45,800 Speaker 2: That was a great Emily. 622 00:35:45,840 --> 00:35:47,759 Speaker 1: I seen you in San Francisco, buddy. 623 00:35:47,640 --> 00:35:49,359 Speaker 2: Yeah, it was great to see you too. I don't 624 00:35:49,400 --> 00:35:52,799 Speaker 2: know why I'm talking like you, but I am. If 625 00:35:52,880 --> 00:35:54,840 Speaker 2: you want to know more about the flex And Report, 626 00:35:54,880 --> 00:35:56,839 Speaker 2: go out and read it. Three hundred and forty six 627 00:35:56,880 --> 00:35:59,960 Speaker 2: pages of muck raking gold. And since I just wrapped 628 00:36:00,120 --> 00:36:02,640 Speaker 2: up this episode as if it were from twenty ten, 629 00:36:03,239 --> 00:36:05,279 Speaker 2: I think it's Chuck time for listener mail. 630 00:36:07,520 --> 00:36:10,359 Speaker 1: That's right, This is from Kyle. Hey, guys, I'm sure 631 00:36:10,360 --> 00:36:14,120 Speaker 1: you've heard this over the years, maybe receive snarky emails 632 00:36:14,680 --> 00:36:17,160 Speaker 1: from people saying, what do you mean I should know this? 633 00:36:17,880 --> 00:36:19,120 Speaker 2: Oh yeah, I like this email. 634 00:36:19,160 --> 00:36:21,279 Speaker 1: Thanks for picking it in a way it makes it 635 00:36:21,280 --> 00:36:24,000 Speaker 1: seem like they interpret it as stuff you should already know. 636 00:36:24,160 --> 00:36:27,000 Speaker 1: But I always took the approach that a Quintessential SYSK 637 00:36:27,120 --> 00:36:30,040 Speaker 1: episode sheds light on something that a person should know 638 00:36:30,160 --> 00:36:34,000 Speaker 1: in order to give voice two situations, regions, historical events, 639 00:36:34,080 --> 00:36:36,759 Speaker 1: things like that, something we should know today to help 640 00:36:36,840 --> 00:36:40,800 Speaker 1: learn and grow. Kyle, That's of course always been the case. 641 00:36:41,120 --> 00:36:43,879 Speaker 2: Yeah, it's stuff that we think you should know, which 642 00:36:43,880 --> 00:36:44,880 Speaker 2: we want to share with you. 643 00:36:45,440 --> 00:36:47,000 Speaker 1: But it is interesting to learn how the son of 644 00:36:47,040 --> 00:36:50,000 Speaker 1: the Jackamer works. I found I see what you're doing there, Kyle. 645 00:36:50,640 --> 00:36:52,920 Speaker 1: I found that the Helen Keller and a Sullivan episode 646 00:36:53,000 --> 00:36:54,719 Speaker 1: was exactly what I think of as a great stuff 647 00:36:54,760 --> 00:36:57,600 Speaker 1: you should know episode. My only knowledge of Helen Keller 648 00:36:58,239 --> 00:37:00,640 Speaker 1: was what I had learned from the late nineties and 649 00:37:00,760 --> 00:37:03,280 Speaker 1: aughts media and pop culture. So thank you for showing 650 00:37:03,280 --> 00:37:06,840 Speaker 1: me how amazing both of them were as people, activist advocates, 651 00:37:06,840 --> 00:37:10,680 Speaker 1: and his friends. The lives of Keller and Suliman is 652 00:37:10,719 --> 00:37:14,080 Speaker 1: something everyone should know. Thank you. That is from Kyle. 653 00:37:14,600 --> 00:37:18,080 Speaker 2: Thank you right back. Kyle. That was a world class email, don't. 654 00:37:17,880 --> 00:37:20,800 Speaker 1: You think, Chuck, Yes, Kyle, that was wonderful. 655 00:37:21,200 --> 00:37:23,120 Speaker 2: Yeah. So, if you want to knock it out of 656 00:37:23,160 --> 00:37:26,160 Speaker 2: the park with an email like Kyle did, wrap it up, 657 00:37:26,360 --> 00:37:28,680 Speaker 2: spank it on the bottom, and send it off to 658 00:37:28,880 --> 00:37:34,560 Speaker 2: Stuff podcast at iHeartRadio dot com. 659 00:37:34,680 --> 00:37:37,560 Speaker 1: Stuff you Should Know is a production of iHeartRadio. For 660 00:37:37,640 --> 00:37:39,560 Speaker 1: more podcasts my heart Radio, visit 661 00:37:39,600 --> 00:37:42,800 Speaker 2: The iHeartRadio app, Apple Podcasts, or wherever you listen to 662 00:37:42,880 --> 00:37:43,760 Speaker 2: your favorite shows.