WEBVTT - How the Flexner Report Changed Medicine 0:00:01.480 --> 0:00:07.720 Welcome to Stuff you should know, a production of iHeartRadio. 0:00:11.160 --> 0:00:13.440 Hey, and welcome to the podcast. I'm Josh, and there's 0:00:13.520 --> 0:00:16.960 Chuck and jar Jar Binks is here too, and this 0:00:17.040 --> 0:00:19.800 is stuff you should know about the Flexner Report. 0:00:20.400 --> 0:00:24.720 That's right. This was a suggestion by my wife. 0:00:25.440 --> 0:00:26.480 Oh, that's a good one. 0:00:26.720 --> 0:00:29.720 Yeah. Emily, of course everyone knows if they listen to 0:00:29.720 --> 0:00:34.600 the show. As an organic gardner and an herbalist, she said, 0:00:34.640 --> 0:00:38.120 has long asked me to do one on the Flexner Report, 0:00:38.159 --> 0:00:43.360 which is a report written in nineteen ten that did 0:00:43.400 --> 0:00:47.000 a lot of things basically kind of revamped how medicine 0:00:47.000 --> 0:00:49.480 worked in the United States, moving forward to medical school 0:00:49.479 --> 0:00:50.120 in particular. 0:00:50.680 --> 0:00:50.880 Right. 0:00:51.080 --> 0:00:54.360 But Emily was interested because another thing it did a 0:00:54.440 --> 0:00:59.200 byproduct was it basically completely squashed what we would now 0:00:59.240 --> 0:01:05.640 call altern medicine homeopathy, basically saying it has zero value 0:01:06.319 --> 0:01:10.520 and we're not doing that anymore. It sure did biff, Yeah, 0:01:10.520 --> 0:01:12.760 and it was also racist and sexist. 0:01:13.959 --> 0:01:16.440 It was definitely of its time. This is a document 0:01:16.440 --> 0:01:19.120 produced in nineteen ten, for sure. Yeah, and it definitely 0:01:19.160 --> 0:01:21.320 stinks of eugenics and all that. 0:01:21.560 --> 0:01:23.920 Yeah. So it's one of those weird things where like 0:01:25.640 --> 0:01:27.760 you can see it from all sides, because it did 0:01:27.800 --> 0:01:30.039 a lot of good and it also maybe didn't do 0:01:30.160 --> 0:01:32.039 some good in certain areas. 0:01:32.400 --> 0:01:35.560 Yeah, for sure. And there's there's not many people who 0:01:35.600 --> 0:01:38.080 are like, no, the Flexner Report sucks. It was all 0:01:38.120 --> 0:01:43.800 bad because it If you enjoy being treated successfully for cancer, 0:01:44.560 --> 0:01:46.959 you can pretty much thank the Flexner Report for that. 0:01:48.480 --> 0:01:50.360 But at the same time, yeah, if you believe that 0:01:50.480 --> 0:01:53.639 there are alternative therapies that are as good or better 0:01:54.120 --> 0:01:58.040 than medications, then yeah, you probably don't like that part 0:01:58.120 --> 0:02:00.000 of the Flexner Report. But I think on the whole 0:02:00.520 --> 0:02:03.920 it was a good thing. There seems to be now 0:02:04.080 --> 0:02:08.280 among you know, thinking people who don't just wait and 0:02:08.400 --> 0:02:12.960 wallow and dogma, saying like, we needed a new Flexner 0:02:12.960 --> 0:02:16.000 Report for the twenty first century because it's basically run 0:02:16.040 --> 0:02:18.280 its course and now again it's become dogma and we 0:02:18.280 --> 0:02:19.400 need to do something about that. 0:02:19.960 --> 0:02:21.920 Right. I think that's a great setup, and maybe we 0:02:21.919 --> 0:02:25.119 should paint a little bit of a picture about what 0:02:25.680 --> 0:02:28.600 medicine and medical school look like in the United States 0:02:28.919 --> 0:02:30.120 pre Flexner Report. 0:02:31.000 --> 0:02:31.799 Who was bad? 0:02:32.120 --> 0:02:34.200 It was bad, I guess quickly we should say that 0:02:34.240 --> 0:02:38.000 Europe was doing it right before we were. In France, 0:02:38.120 --> 0:02:40.799 especially they had some pretty top notch medical schools where 0:02:40.840 --> 0:02:46.960 they embrace real science and we're practicing medicine on people 0:02:47.120 --> 0:02:51.000 like as practice in colleges and stuff like that. But 0:02:51.120 --> 0:02:53.200 in the United States that was around eighteen fifty. In 0:02:53.240 --> 0:02:55.840 the US, in eighteen fifty they had fifty two medical schools. 0:02:56.440 --> 0:02:59.560 This is what fifty sixty years before the Flexner Report, 0:03:00.600 --> 0:03:03.519 and medicine was not you know, to be a doctor 0:03:03.639 --> 0:03:07.639 was not some prestigious thing. Medicine was a trade. If 0:03:07.680 --> 0:03:10.640 you were associated with the university at all. As a 0:03:10.680 --> 0:03:14.679 medical school, it was a two year program. The curriculum 0:03:14.800 --> 0:03:17.800 was very, very broad. They were super underfunded. Even at 0:03:17.800 --> 0:03:20.399 places like Harvard, they had to pay for their own 0:03:20.400 --> 0:03:23.720 teaching supplies. And those were the good ones that were 0:03:23.720 --> 0:03:25.000 attached to universities. 0:03:25.560 --> 0:03:28.360 Yeah, I mean, there were plenty of diploma mills. There 0:03:28.400 --> 0:03:33.120 were a lot of proprietary medical schools where it was 0:03:33.240 --> 0:03:36.240 just some people got together and created a for profit 0:03:36.320 --> 0:03:39.360 school where they would teach you how to become a doctor. 0:03:39.760 --> 0:03:41.840 But they were not doing a very good job of it. 0:03:41.920 --> 0:03:45.839 And your admission requirement was the ability to pay the 0:03:45.880 --> 0:03:47.320 tuition fees. Essentially. 0:03:47.880 --> 0:03:51.840 Yeah, for sure, you might have like redundant classes that 0:03:51.880 --> 0:03:54.200 literally went over the same things. You might not have 0:03:54.280 --> 0:03:57.240 your hands on a scalpel ever, you might not have 0:03:57.280 --> 0:04:04.080 an exam ever, you may not see patience, you might 0:04:04.080 --> 0:04:06.600 not have any contact with another human being at that 0:04:06.640 --> 0:04:07.360 medical school. 0:04:08.160 --> 0:04:10.560 It'd be kind of like if you went to go 0:04:10.640 --> 0:04:14.240 skydive and in the class before you go skydive, they 0:04:14.320 --> 0:04:17.320 just talk about how hard the ground can be if 0:04:17.360 --> 0:04:18.800 you hit it, and then they take you up in 0:04:18.839 --> 0:04:21.480 a plane and push you out. It's similar to something 0:04:21.560 --> 0:04:25.400 like that. That's good, thanks, I like it. 0:04:25.440 --> 0:04:28.520 But then everybody the Civil War came around in the 0:04:28.520 --> 0:04:33.719 eighteen sixties and there was wartime doctoring happening. And after 0:04:33.760 --> 0:04:38.240 the Civil War people came out of that saying we're 0:04:38.240 --> 0:04:41.440 in trouble. Everybody, like the doctoring wasn't so great in 0:04:41.960 --> 0:04:44.120 this war and we need to fix this. 0:04:44.720 --> 0:04:47.159 Well, what I interpreted is that they went out and 0:04:47.320 --> 0:04:50.200 got real world experience and realized, like the stuff they 0:04:50.279 --> 0:04:53.760 learned at school was not preparing them for actual medicine. 0:04:53.839 --> 0:04:55.160 Oh yeah, I mean I think it was a little 0:04:55.200 --> 0:04:57.760 bit of both. I think the person who had their 0:04:57.839 --> 0:05:01.359 leg chopped off unnecessarily complained, and I think the doctor 0:05:01.400 --> 0:05:03.840 who did the chopping might have complained as well. 0:05:03.920 --> 0:05:09.280 Right, they didn't teach me that patient's complain in medical school. Yeah, 0:05:09.320 --> 0:05:13.120 so yes, regardless, by the by the eighteen sixties, like, 0:05:13.200 --> 0:05:17.560 it was quite clear that American medicine was lacking tremendously 0:05:17.720 --> 0:05:20.440 and that the main reason for that was that the 0:05:20.480 --> 0:05:24.800 doctors who were practicing medicine had virtually no actual training 0:05:24.839 --> 0:05:28.719 in medicine. They was lectures, textbooks, That's basically it. So 0:05:29.279 --> 0:05:32.279 there were there was a part of the progressive era, 0:05:33.560 --> 0:05:38.080 this actually this push to create a movement to make 0:05:38.240 --> 0:05:42.760 medicine in America better and by by focusing on the 0:05:42.800 --> 0:05:46.200 medical school education that that came around in about the 0:05:46.320 --> 0:05:49.720 eighteen seventies. It was led by Harvard. Yeah, but really 0:05:49.839 --> 0:05:53.880 Johns Hopkins University was the one that really hopped on it. 0:05:55.400 --> 0:05:58.120 Yeah, for sure, Like Harvard got the ball rolling for 0:05:58.240 --> 0:06:01.160 a couple of decades, and by the time Johns Hopkins 0:06:01.240 --> 0:06:04.279 opened in eighteen ninety three, they became kind of the 0:06:04.320 --> 0:06:08.240 standard for the American model moving forward, which SBC was 0:06:08.240 --> 0:06:11.280 based on the German model. Right, you had to have 0:06:11.320 --> 0:06:13.240 a first of all, you had to have a college 0:06:13.279 --> 0:06:16.120 degree just to get in, and that was previously not 0:06:16.160 --> 0:06:21.480 necessarily the case. Secondly, they had full time faculty. They 0:06:21.480 --> 0:06:24.240 were medical scientists, so they weren't doctors on the side 0:06:24.800 --> 0:06:28.599 as well. They were just fully employed to teach, and 0:06:28.880 --> 0:06:31.520 they had a four year like a full four year 0:06:31.600 --> 0:06:35.040 course of study where it was hands on and a 0:06:35.120 --> 0:06:36.279 lot of laboratory work. 0:06:37.320 --> 0:06:41.000 Yeah, and yes, where they were actually working with patients 0:06:41.080 --> 0:06:44.760 or assisting other actual doctors in working with patients. Like 0:06:44.800 --> 0:06:48.599 it wasn't just like sit there and listen to this lecture. Yeah, 0:06:49.279 --> 0:06:52.919 that was. And that essentially that Johns Hopkins model is 0:06:52.960 --> 0:06:57.479 what became the model for American medical school. And there's 0:06:57.520 --> 0:07:00.840 a lot of there's a lot of talk at parties 0:07:00.880 --> 0:07:02.839 if you stop and listen about whether this would have 0:07:02.839 --> 0:07:06.440 happened on its own or not. And for the most part, 0:07:06.480 --> 0:07:10.280 it seems that, yes, this progressive era movement would have 0:07:10.400 --> 0:07:13.920 gotten there eventually. Yeah, just because it was a good idea. 0:07:13.960 --> 0:07:18.239 The Flexner Report helped it happen on a dime, because 0:07:18.280 --> 0:07:21.080 not only did it show to everybody else this is 0:07:21.120 --> 0:07:23.520 the way to do it, it also said this is 0:07:23.600 --> 0:07:26.040 very expensive, and here's how we need to get the 0:07:26.080 --> 0:07:29.160 money for it. And did get the money for it, 0:07:29.240 --> 0:07:30.680 Like that's how it was implemented. 0:07:30.880 --> 0:07:34.680 Yeah, for sure. The American Medical Association was founded in 0:07:34.720 --> 0:07:39.400 eighteen forty seven. And one of the reasons, and you know, 0:07:39.720 --> 0:07:43.120 again this is stuff that I learned from sort of 0:07:43.120 --> 0:07:47.800 Emily's urgings. One of the reasons the American Medical Association 0:07:47.960 --> 0:07:51.680 was founded to begin with was like on a mission 0:07:51.720 --> 0:07:57.080 to squash homeopathy. It says so in its charter. And 0:07:57.440 --> 0:08:01.400 when the AMA was founded, they discouraged any association or 0:08:01.400 --> 0:08:05.040 communication with those kinds of doctors and had a code 0:08:05.040 --> 0:08:06.680 of ethics that was a clause in there known as 0:08:06.680 --> 0:08:11.400 a consultation clause that said, if you even talk to 0:08:11.600 --> 0:08:14.760 a quote unquote non regular practitioner, then you're going to 0:08:14.840 --> 0:08:18.560 lose your license to practice medicine. They carved out exemptions 0:08:18.600 --> 0:08:23.800 for Massachusetts and New York because it was homeopathy was really, really, 0:08:23.880 --> 0:08:28.120 really popular at the time among the elite, wealthy Americans, 0:08:28.160 --> 0:08:32.679 like the major politicians, the corporate leaders. I think it 0:08:32.720 --> 0:08:36.080 was Rockefeller. I think it was Rockefeller that was under 0:08:36.080 --> 0:08:38.400 the care of a homeopathic doctor for like fifty years. 0:08:38.720 --> 0:08:39.080 Wow. 0:08:39.120 --> 0:08:41.600 So they carved out exceptions for those two states for 0:08:41.640 --> 0:08:44.880 a while until they were able. You know, all those 0:08:44.880 --> 0:08:47.160 people died off basically and they were able to completely 0:08:47.160 --> 0:08:47.640 squash it. 0:08:48.280 --> 0:08:51.720 Right, Rockefeller died, So I guess the homeopathy he didn't work. 0:08:52.559 --> 0:08:55.760 Well. He lived another like forty eight years after being 0:08:55.760 --> 0:08:56.959 told he didn't have long to live. 0:08:57.000 --> 0:09:00.920 I think, oh wow, it's a homeopathy works case closed. 0:09:02.240 --> 0:09:04.559 So yes, I think that you really put your finger 0:09:04.600 --> 0:09:08.720 on that. The AMA became the arbiter of what qualifies 0:09:08.760 --> 0:09:12.839 as medicine in the United States thanks to this Flexner report. 0:09:13.320 --> 0:09:17.720 It basically strengthened all of its position. And yes, they 0:09:17.760 --> 0:09:20.280 were the driving force behind this. Initially they went to 0:09:20.360 --> 0:09:24.600 the Carnegie the Carnegie Foundation, and said, hey, you got 0:09:24.640 --> 0:09:27.360 a lot of money, why don't you help us figure 0:09:27.360 --> 0:09:32.160 out how to change American medical education in the exact 0:09:32.200 --> 0:09:36.280 way we want it, and we'll help you figure out 0:09:36.280 --> 0:09:39.400 who to do that with. We like the Johns Hopkins model. 0:09:39.440 --> 0:09:42.199 We basically want a report that says the Johns Hopkins 0:09:42.240 --> 0:09:45.679 model is great. Let's get an outsider in here. And 0:09:45.720 --> 0:09:49.160 that is how Abraham Flexner enters this story. 0:09:49.440 --> 0:09:51.120 Yeah, and you know this is not to say that 0:09:51.160 --> 0:09:52.920 he was like cooking the books or anything like that, 0:09:53.080 --> 0:09:54.640 and no, this is all a sham, but that was 0:09:54.679 --> 0:09:57.520 just sort of The AMA was definitely after that well. 0:09:57.520 --> 0:09:59.440 One of the reasons he was selected is he was 0:09:59.480 --> 0:10:03.719 already a person, an educator who espoused exactly this kind 0:10:03.760 --> 0:10:07.880 of stuff, just not necessarily as it applied to medical education. 0:10:08.280 --> 0:10:10.800 He just wasn't exposed to medical education at the time. 0:10:10.840 --> 0:10:14.680 But he was an educational philosopher and theorists and he 0:10:14.800 --> 0:10:16.920 was fully on board with that kind of thinking. 0:10:17.240 --> 0:10:19.000 Yeah, I mean he wrote a book. I guess we 0:10:19.000 --> 0:10:22.880 should say he did go to Johns Hopkins, but not 0:10:22.960 --> 0:10:27.760 for medicine. I think he studied classic civilizations and he 0:10:27.840 --> 0:10:31.800 was a teacher in his hometown in Louisville, Kentucky. Eventually 0:10:31.840 --> 0:10:34.720 he was a private school headmaster that he founded the school, 0:10:35.360 --> 0:10:38.520 and after earning a degree in psychology from Harvard, he 0:10:38.559 --> 0:10:41.480 wrote a book called The American College, which was sort 0:10:41.520 --> 0:10:44.520 of the Flexner Report of the university system as a whole. 0:10:45.400 --> 0:10:48.280 And this guy named Henry Pritchett, who was the president 0:10:48.280 --> 0:10:50.720 of the Carnegie Foundation at the time, was like, yeah, 0:10:50.960 --> 0:10:54.560 like Josh Clark of the future will say, this is 0:10:54.600 --> 0:10:56.440 our guy, because did you see the way he came 0:10:56.480 --> 0:10:59.480 at the regular universities, like wayde till he finds out 0:10:59.480 --> 0:11:02.040 what's happening in medical schools exactly. 0:11:02.080 --> 0:11:03.960 And then one of the other reasons that he was 0:11:04.000 --> 0:11:06.880 such a great candidate because he was an outsider and 0:11:06.920 --> 0:11:10.760 a non physician, is that they were quite aware that 0:11:10.800 --> 0:11:12.840 there was going to be a lot of blowback, that 0:11:12.880 --> 0:11:15.240 there was going to be a lot of bruce digos 0:11:15.280 --> 0:11:18.520 and stepped on toes, and that somebody outside of the 0:11:18.520 --> 0:11:21.800 profession would be less likely to suffer, say like a 0:11:21.840 --> 0:11:27.400 professional injury or being ostracized for the rest of their career. Yeah. 0:11:27.440 --> 0:11:30.560 Flexner was like, I don't care what you think of me, doctors. 0:11:30.679 --> 0:11:35.040 That's right. So he started out by researching the European models, 0:11:35.480 --> 0:11:39.280 the American models. Like I said, he was really impressed 0:11:39.280 --> 0:11:42.040 with the German model, and in fact, a couple of 0:11:42.080 --> 0:11:46.200 years after the American and Canadian as we'll see Flexner Report, 0:11:46.600 --> 0:11:51.800 he published a European version which critiqued well Europe basically 0:11:51.800 --> 0:11:56.079 everybody but Germany. He was very uncritical of the German system, 0:11:57.120 --> 0:11:58.920 and we also need to point out some of the 0:11:58.960 --> 0:12:03.880 bad things he said. There were several anti Semitic passages 0:12:04.000 --> 0:12:06.680 in the European version of the Flexner Report because he 0:12:06.720 --> 0:12:09.800 was so enamored of how the Germans did their medicining. 0:12:10.600 --> 0:12:14.160 Yeah, this was Yeah, that German model also inspired the 0:12:14.280 --> 0:12:19.000 guy who founded Johns Hopkins Medical School, William Welch, and 0:12:19.440 --> 0:12:22.520 that was essentially so essentially, the Flexner report said, the 0:12:22.600 --> 0:12:25.240 Johns Hopkins model is what we want. Johns Hopkins said 0:12:25.240 --> 0:12:31.160 the German model is what we want, and the Germans said, yeah, yeah, yeah, 0:12:31.400 --> 0:12:35.600 dah yeah, no, that's Russian, das boot, that's German. 0:12:36.200 --> 0:12:36.920 Nice. What else? 0:12:39.080 --> 0:12:46.280 The heimlich maneuver, Yeah, that's it, brought worst cider. Okay, yeah, 0:12:46.320 --> 0:12:50.599 all that stuff october Fest, but with a k should. 0:12:50.360 --> 0:12:53.599 We take a break? Yeah, all right, you're gonna think 0:12:54.040 --> 0:12:54.480 did you say? 0:12:54.559 --> 0:12:55.079 Yeah? 0:12:55.280 --> 0:12:59.160 Yeah, We're gonna think of some more German words or 0:12:59.400 --> 0:13:03.080 Deutsche words, and we're gonna be back with more on 0:13:03.160 --> 0:13:04.880 what Flexner said right after this. 0:13:28.200 --> 0:13:29.840 Chuck, I could only come up with one more, and 0:13:29.920 --> 0:13:31.800 it was strudal. But it's the best one. 0:13:32.040 --> 0:13:33.160 Mmmm yeah. 0:13:33.200 --> 0:13:37.480 Oh wait Frankenstein, Yeah, that's it. 0:13:37.520 --> 0:13:39.200 Do you see that new Frankenstein movie. 0:13:40.880 --> 0:13:41.439 The Bride? 0:13:41.920 --> 0:13:45.559 No, no, no, the what's his name is new Frankenstein movie? 0:13:46.440 --> 0:13:47.800 I don't, I don't know the rock. 0:13:48.320 --> 0:13:52.320 Now the director Guillermo del Toro's. 0:13:52.160 --> 0:13:54.480 Oh no, what did you think of it? 0:13:54.840 --> 0:13:57.240 That was pretty good? I got a little bored, but 0:13:57.360 --> 0:13:59.559 it was everyone said it was really great. I think 0:13:59.559 --> 0:14:01.439 I was just a maki. 0:14:01.559 --> 0:14:05.040 Jillenhall is redoing the bride in like a really strange, 0:14:05.200 --> 0:14:07.920 like out there kind of fashion that looks interesting. 0:14:08.200 --> 0:14:10.280 Yeah, I saw that. I thought it seemed super interesting, 0:14:10.360 --> 0:14:12.120 and I love Mags, so I'm down. 0:14:13.559 --> 0:14:15.480 Okay, well that's fine, I'll allow it. 0:14:16.720 --> 0:14:19.440 So back to the Flexen report. He started that research 0:14:19.480 --> 0:14:21.440 in nineteen oh eight. I think the thing came out 0:14:21.480 --> 0:14:24.920 in nineteen ten, is like we said. But he went 0:14:24.960 --> 0:14:26.600 around all over the place. He went to one hundred 0:14:26.600 --> 0:14:30.360 and five one hundred and fifty five medical schools, one 0:14:30.440 --> 0:14:32.280 hundred and forty eight of which were in the United States, 0:14:32.760 --> 0:14:35.760 seven were in Canada. Spends a couple of days there 0:14:35.800 --> 0:14:38.880 with his nose turned up, and he did this for 0:14:38.920 --> 0:14:40.200 about eighteen months. 0:14:40.560 --> 0:14:42.760 Yeah, just to be clear here, this guy was not 0:14:42.920 --> 0:14:46.160 phoning this in. He definitely took the assignment and did 0:14:46.200 --> 0:14:49.280 it to like he did it like all of those 0:14:49.360 --> 0:14:51.800 those one hundred and fifty five medical schools in the 0:14:51.920 --> 0:14:55.280 US and Canada. That was every medical school in the 0:14:55.400 --> 0:14:59.800 US and Canada, including ones that taught alternative medicine and 0:15:00.000 --> 0:15:03.240 black medical schools. In the United States. So like, he 0:15:03.800 --> 0:15:06.920 definitely went through the paces. It wasn't just like a, yeah, 0:15:07.080 --> 0:15:09.280 let's look at Johns Hopkins and here's my report. 0:15:09.880 --> 0:15:12.200 Yeah, for sure. And you mentioned the black medical schools 0:15:12.240 --> 0:15:15.960 because they come up pretty front and center here in 0:15:16.000 --> 0:15:21.120 a minute. But Johns Hopkins was like the gold standard, 0:15:21.160 --> 0:15:23.320 so that was his comparison point for all of them. 0:15:23.760 --> 0:15:26.400 He looked at everything. He looked at how they financed 0:15:26.440 --> 0:15:28.720 their school. He looked at how big the classrooms were, 0:15:28.800 --> 0:15:33.000 how many teachers they had per student, like admissions, what 0:15:33.040 --> 0:15:35.440 it took to get in, what they were actually teaching, 0:15:36.880 --> 0:15:40.440 laboratory stuff, facilities kind of everything. And what he came 0:15:40.480 --> 0:15:43.160 out with was one of three determinations in the end 0:15:43.160 --> 0:15:46.560 for each school. The school is good, you can stay, 0:15:46.640 --> 0:15:49.600 you can keep your doors open. Your school is not 0:15:49.640 --> 0:15:53.240 so great, but you show promise, so maybe if you 0:15:53.280 --> 0:15:55.600 have some more funding and you change these things, you 0:15:55.600 --> 0:15:59.000 can be okay, and then I'm sorry, please close your 0:15:59.000 --> 0:15:59.560 doors forever. 0:16:00.440 --> 0:16:02.840 Yeah, there was a lot of them that he categorized 0:16:02.840 --> 0:16:04.600 as hopelessly deficient. 0:16:04.640 --> 0:16:06.400 A lot most in fact. 0:16:06.920 --> 0:16:09.520 Yeah, And it wasn't just like him being a snooty 0:16:09.760 --> 0:16:12.920 butt head like the as we said, like the medical 0:16:12.920 --> 0:16:15.480 schools in the United States were in a lot of 0:16:15.520 --> 0:16:21.200 cases hopelessly deficient, and that's a problem when you're producing doctors, 0:16:21.560 --> 0:16:24.240 you know. So he did make a pretty good case 0:16:24.280 --> 0:16:26.400 that that there were a lot they were hopelessly deficient, 0:16:26.440 --> 0:16:30.720 but the deficient ones they actually had different rankings. For example, 0:16:31.080 --> 0:16:36.640 Iowa State University's medical school. He basically said, they know 0:16:36.760 --> 0:16:39.880 what they're wanting to do, but the hospital associated with 0:16:39.920 --> 0:16:44.400 it is too small. And the your clinical faculty, the 0:16:44.440 --> 0:16:46.800 people who are supposed to be doing research and teaching 0:16:47.240 --> 0:16:49.880 medicine to the students, they all have their own private 0:16:49.920 --> 0:16:54.280 practices because they have to support themselves. So if you 0:16:54.400 --> 0:16:57.560 gave this this group enough funding, they could create a 0:16:57.880 --> 0:17:00.800 top notch medical school. In the Johns Hopkins model that 0:17:00.920 --> 0:17:05.080 was kind of like that deficient category, the varying degrees 0:17:05.160 --> 0:17:08.359 of how much money you would need and whether you 0:17:08.359 --> 0:17:10.160 were you're headed in the right direction. 0:17:10.800 --> 0:17:14.679 Yeah, for sure. The way he wrote in what was 0:17:14.880 --> 0:17:20.280 called Carnegie Foundation Bulletin number four or Medical Education in 0:17:20.320 --> 0:17:23.800 the United States and Canada aka Flexner Report, was that 0:17:25.640 --> 0:17:30.760 very muckbreaking style. It's not the kind of report you 0:17:30.760 --> 0:17:33.280 would people wouldn't write it this way. Today because he 0:17:33.320 --> 0:17:36.400 did get a little It seems like he enjoyed sort 0:17:36.400 --> 0:17:38.200 of the put downs and coming up with new ways 0:17:38.200 --> 0:17:39.720 of saying how bad a school. 0:17:39.560 --> 0:17:43.119 Was, so people would write it that way today and unfortunately. 0:17:42.640 --> 0:17:45.320 Well, you're probably right one of them, he said. Apparently 0:17:45.359 --> 0:17:48.920 the inexcusable degree of ignorance begins just where the ability 0:17:48.960 --> 0:17:50.560 to pay fees leaves off. 0:17:50.840 --> 0:17:54.040 Oh yeah, and so he was basically taking them to 0:17:54.119 --> 0:17:58.040 task over low admission requirements if any. But you didn't 0:17:58.080 --> 0:18:00.880 say low admission requirements. He also used the word reeks, 0:18:01.640 --> 0:18:06.120 which you don't usually see in academic studies. Yeah, he said. 0:18:06.119 --> 0:18:08.960 The osteopathic schools in the United States, there are eight 0:18:08.960 --> 0:18:12.400 of them. That they reek of commercialism, that they attract 0:18:12.480 --> 0:18:16.600 students with a mass of hysterical exaggerations that confidently appeals 0:18:16.600 --> 0:18:19.640 to the crude boys or disappointed men and women whom 0:18:19.720 --> 0:18:26.680 it successfully exploits. We should say osteopathy isn't accepted form 0:18:26.800 --> 0:18:29.560 medicine in the United States now, but a lot of 0:18:29.600 --> 0:18:35.840 people still view it as a pseudo scientific alternative medicine. Yeah. 0:18:35.880 --> 0:18:39.560 I mean, he had a site set on them, on chiropractors, 0:18:39.200 --> 0:18:42.520 on all kinds of things that a lot of people 0:18:43.359 --> 0:18:45.919 put a lot of great value in today. So he 0:18:46.040 --> 0:18:48.400 was off based on some stuff for sure. But again 0:18:48.440 --> 0:18:49.520 this was nineteen ten. 0:18:50.119 --> 0:18:53.320 So of the underfunded medical schools and this was a 0:18:53.359 --> 0:18:56.719 problem too. This is actually one of the things that 0:18:56.760 --> 0:18:59.440 befell black medical schools is we'll see in a minute. 0:19:00.320 --> 0:19:03.320 If you were underfunded, that was it. Sorry, no amount 0:19:03.359 --> 0:19:05.879 of funding is going to bring you up. Well, maybe 0:19:05.920 --> 0:19:07.879 some amount of funding is going to bring you up 0:19:07.880 --> 0:19:10.800 to speed, but we need that money to bring other 0:19:11.160 --> 0:19:14.440 medical schools that are closer up because we can bring 0:19:14.480 --> 0:19:16.880 more of them up to snuff, or we can bring 0:19:16.920 --> 0:19:19.480 fewer up to snuff and basically get the ones that 0:19:19.520 --> 0:19:22.719 are at least funded. His whole premise was just close 0:19:22.800 --> 0:19:25.240 those poorly funded ones because they're just not going to 0:19:25.280 --> 0:19:26.080 be able to do this. 0:19:26.440 --> 0:19:28.760 Yeah, and you know he was probably onto something there 0:19:28.760 --> 0:19:30.959 because there was a glut of bad schools. And his 0:19:31.080 --> 0:19:34.720 quote was the curse of medical education is the excessive 0:19:34.760 --> 0:19:38.520 number of schools. This situation can improve only as weaker 0:19:38.560 --> 0:19:42.399 and superfluous schools are extinguished. Right, Like I said, it 0:19:42.440 --> 0:19:46.239 was Canada and the US. Canada fared much better our 0:19:46.280 --> 0:19:49.560 northern friends up there. Of the seven Canadian medical schools. 0:19:49.960 --> 0:19:52.320 He only recommended one for closure. 0:19:52.320 --> 0:19:54.119 So one seventh of them, that's. 0:19:54.040 --> 0:19:57.320 Right, the one hundred and forty eight medical schools in 0:19:57.359 --> 0:20:02.760 the United States, more than half of them he recommended closing. 0:20:02.880 --> 0:20:04.880 And I think it ended up being more than that even, right. 0:20:06.640 --> 0:20:10.440 Yeah, he actually recommended reducing the full number of schools 0:20:10.480 --> 0:20:14.119 in the US and Canada from one hundred and fifty 0:20:14.119 --> 0:20:20.840 five down to thirty one. Yeah, that's four fifths. So yeah, 0:20:20.880 --> 0:20:23.160 I mean, like he was basically a hatchet man. They 0:20:23.160 --> 0:20:26.680 brought him in to basically get rid of competing, poorly funded, 0:20:27.040 --> 0:20:30.520 poorly run medical schools. He said, if you're a proprietary 0:20:30.600 --> 0:20:33.640 medical school, it doesn't matter what you're doing, you're closed. 0:20:34.000 --> 0:20:38.800 He saw med school as a public trust, that it 0:20:38.800 --> 0:20:42.280 should be publicly funded. Ergo, they should be associated or 0:20:42.280 --> 0:20:46.640 attached to public universities, and that the reason that doctors 0:20:46.640 --> 0:20:49.879 were being produced was to help society along. That you 0:20:49.920 --> 0:20:53.399 should not have a board or stockholders to whom you 0:20:53.400 --> 0:20:55.800 were really kind of beholden to so they would affect 0:20:55.840 --> 0:20:58.800 your decision making. No, you needed to be beholden to 0:20:58.880 --> 0:21:03.640 science right ideally to patients, although he didn't put much 0:21:03.680 --> 0:21:04.879 emphasis on that part. 0:21:05.320 --> 0:21:07.840 Yeah, and we'll talk about that at the end. So 0:21:08.280 --> 0:21:11.720 every single proprietary school was immediately on the list, basically 0:21:11.760 --> 0:21:14.960 from the jump, like, if you weren't affiliated with the university, 0:21:14.960 --> 0:21:19.000 you had no hope for surviving this. All the holistic 0:21:19.160 --> 0:21:23.120 or what we call alternative medical systems were completely shut down. 0:21:24.760 --> 0:21:29.360 Five of the seven black medical schools were recommended for closure. 0:21:30.119 --> 0:21:33.680 I think Howard University in DC and Mahari Medical College 0:21:33.760 --> 0:21:37.439 right here in Georgia he thought might be salvageable. But 0:21:37.640 --> 0:21:42.359 there are a couple of chapters in there. Chapter fourteen, specifically, 0:21:42.400 --> 0:21:44.879 the Medical Education of the Negro was the title of 0:21:44.920 --> 0:21:48.639 that chapter, where he shows a real disdain for black 0:21:48.680 --> 0:21:52.879 medical schools. He said they were wasting money, small sums 0:21:52.880 --> 0:21:56.120 of money annually, that undisciplined men whose lack of real 0:21:56.160 --> 0:22:00.560 training is covered up by imposing MD degrees. And he 0:22:00.640 --> 0:22:04.520 basically ended up saying, like close most of these, and 0:22:04.840 --> 0:22:08.240 my suggestion is just to make black medical schools to 0:22:08.320 --> 0:22:11.479 train black doctors to treat black patients only, and they 0:22:11.480 --> 0:22:13.879 should really just concentrate on hygiene. 0:22:14.359 --> 0:22:17.720 Yeah, they should focus on public health in order to 0:22:17.840 --> 0:22:20.960 keep black people from spreading disease to white people. That 0:22:21.119 --> 0:22:25.480 was essentially his take on the purpose for the existence 0:22:25.520 --> 0:22:28.880 of black doctors. Out of three hundred and forty six 0:22:28.920 --> 0:22:32.520 pages in the initial version of the report, two chapter 0:22:32.560 --> 0:22:36.480 fourteen was two pages long, and that is shocking in 0:22:36.520 --> 0:22:40.639 and of itself. But the Flexner Report was essentially the 0:22:40.680 --> 0:22:45.800 first document about medicine and medical school that even acknowledged 0:22:45.800 --> 0:22:48.560 the existence of black medical schools. Up to this point, 0:22:48.560 --> 0:22:53.919 they were totally invisible, completely ignored. So the fact in 0:22:54.000 --> 0:22:57.720