How the Flexner Report Changed Medicine

The Flexner Report shook up medicine in the United States when it was released in 1910 and it's never been the same since. For better or worse. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 1:03Speaker 03

  Welcome to Stuff You Should Know, a production of iHeart Radio.

• 1:13Josh Clark?

  Hey, and welcome to the podcast. I'm Josh, and there's Chuck, and Jer Jer Binks is here, too. And this is Stuff You Should Know about the Flexner Report.

• 1:22Speaker 02

  That's right. This was a suggestion by my wife.

• 1:27Josh Clark?

  Oh, that's a good one.

• 1:28Speaker 02

  Yeah, Emily, of course, everyone knows if they listen to the show, is an organic gardener and an herbalist. She said, "Has long asked me to do one on the Flexner Report," which is a report written in 1910 that did a lot of things, basically kind of revamped how medicine worked in the United States moving forward, in medical school in particular.

• 1:52Josh Clark?

  Right.

• 1:53Speaker 02

  But Emily was interested because another thing it did, a byproduct, was it basically completely squashed what we would now call alternative medicine, homeopathy, basically saying it has zero value and we're not doing that anymore.

• 2:10Josh Clark?

  It sure did, Biff.

• 2:12Speaker 02

  Yeah, and it was also racist and sexist.

• 2:15Josh Clark?

  It was definitely of its time. This is a document produced in 1910 for sure. And it definitely stinks of eugenics and all that.

• 2:23Speaker 02

  Yeah, so it's one of those weird things where like, you can see it from all sides because it did a lot of good and it also maybe didn't do some good in certain areas.

• 2:34Josh Clark?

  Yeah, for sure. And there's, there's not many people who are like, no, the Flexner Report sucks. It was all bad because it, if you enjoy being treated successfully for cancer, you can pretty much thank the Flexner Report for that. But at the same time, yeah, if you believe that there are alternative therapies that are as good or better than medications, then yeah, you probably don't like that part of the Flexner Report. But I think on the whole, it was, it was a good thing. There seems to be now among, you know, thinking people who don't just wade and wallow in dogma,

• 3:12Josh Clark?

  saying like, we need a new Flexner Report for the 21st century because it's basically run its course. And now, again, it's become dogma and we need to do something about that.

• 3:21Speaker 02

  Right. I think that's a great setup and maybe we should paint a little bit of a picture about what medicine and medical school looked like in the United States pre-Flexner Report.

• 3:33Josh Clark?

  It was bad.

• 3:34Speaker 02

  It was bad. I guess quickly, we should say that Europe was doing it right before we were.

• 3:38Josh Clark?

  Yeah.

• 3:39Speaker 02

  And France especially, they had some pretty top notch medical schools where they embrace real science and were practicing medicine on people like as practice in colleges and stuff like that. But in the United States, that was around 1850. In the US in 1850, they had 52 medical schools. This is what 50, 60 years before the Flexner Report. And medicine was not, you know, to be a doctor was not some prestigious thing. Medicine was a trade. If you were associated with the university at all as a medical school, it was a two-year program. The curriculum was very, very broad. They were super underfunded. Even at places like Harvard, they had to pay for their own teaching supplies.

• 4:23Speaker 02

  And those were the good ones that were attached to universities.

• 4:27Josh Clark?

  Yeah, I mean, there were plenty of diploma mills. They were a lot of proprietary medical schools where it was just some people got together and created a for-profit school where they would teach you how to become a doctor, but they were not doing a very good job of it. And your admission requirement was the ability to pay the tuition fees, essentially.

• 4:49Speaker 02

  Yeah, for sure. You might have like redundant classes that literally went over the same things. You might not have your hands on a scalpel ever. You might not have an exam ever. You may not see patients. You might not have any contact with another human being at that medical school.

• 5:10Josh Clark?

  It'd be kind of like if you went to go skydive. And in the class before you go skydive, they just talk about how hard the ground can be if you hit it. And then they take you up in a plane and push you out. It's similar to something like that.

• 5:24Speaker 02

  That's good.

• 5:26Josh Clark?

  Thanks.

• 5:27Speaker 02

  I like it. But then, everybody, the Civil War came around in the 1860s. And there was wartime doctoring happening. And after the Civil War, people came out of that saying, we're in trouble, everybody. Like, the doctoring wasn't so great in this war, and we need to fix this.

• 5:46Josh Clark?

  Well, what I interpreted is that they went out and got real-world experience and realized like the stuff they learned at school was not preparing them for actual medicine.

• 5:55Speaker 02

  Oh, yeah. I mean, I think it was a little bit of both. I think the person who had their leg chopped off unnecessarily complained. And I think the doctor who did the chopping might have complained as well.

• 6:05Josh Clark?

  Right. They didn't teach me that patients complained in medical school.

• 6:09Speaker 02

  Yeah.

• 6:10Josh Clark?

  So yes, regardless by the by the 1860s, like it was quite clear that American medicine was lacking tremendously and that the main reason for that was that the doctors who were practicing medicine had virtually no actual training in medicine. They were lectures, textbooks, that's basically it. So there were, there was a part of the progressive era, this actually, this push to create a movement to make medicine in America better and by, by focusing on the medical school education, that that came around in about the 1870s. It was led by Harvard.

• 6:50Speaker 02

  Yeah.

• 6:51Josh Clark?

  But really Johns Hopkins University was the one that really hopped on it.

• 6:57Speaker 02

  Yeah, for sure. Like Harvard got the ball rolling for a couple of decades and by the time Johns Hopkins opened in 1893, they became kind of the standard for the American model moving forward, which as we'll see was based on the German model.

• 7:11Josh Clark?

  Right.

• 7:12Speaker 02

  You had to have a, first of all, you had to have a college degree just to get in and that was previously not necessarily the case.

• 7:19Josh Clark?

  No.

• 7:20Speaker 02

  Secondly, they had full-time faculty. They were medical scientists, so they weren't doctors on the side as well. They were just fully employed to teach and they had a four year, like a full four-year course of study where it was hands-on and a lot of laboratory work.

• 7:39Josh Clark?

  Yeah. And yes, where they were actually working with patients or assisting other actual doctors in working with patients. Like it wasn't just like, sit there and listen to this lecture.

• 7:50Speaker 02

  Yeah.

• 7:51Josh Clark?

  That was, and that essentially that Johns Hopkins model is what became the model for American medical school. And there's a lot of,

• 8:01Josh Clark?

  There's a lot of talk at parties, if you stop and listen, about whether this would have happened on its own or not.

• 8:07Speaker 02

  Yeah.

• 8:07Josh Clark?

  And for the most part, it seems that, yes, this progressive era movement would have gotten there eventually.

• 8:13Speaker 02

  Yeah.

• 8:14Josh Clark?

  Just because it was a good idea.

• 8:15Speaker 02

  Yeah.

• 8:16Josh Clark?

  The Flexner Report helped it happen on a dime because not only did it show to everybody else, this is the way to do it, it also said, this is very expensive and here's how we need to get the money for it and did get the money for it. Like, that's how it was implemented.

• 8:32Speaker 02

  Yeah, for sure. The American Medical Association was founded in 1847. And one of the reasons, and, you know, again, this is, this is stuff that I learned from sort of Emily's urgings. One of the reasons the American Medical Association was founded to begin with was like on a mission to squash homeopathy. It says so in its charter. And when the AMA was founded, they discouraged any association or communication with those kinds of doctors and had a code of ethics. There was a clause in there known as a consultation clause that said, if you even talk to a quote

• 9:14Speaker 02

  unquote, "non-regular practitioner," then you're going to lose your license to practice medicine. They carved out exemptions for Massachusetts and New York because it was, homeopathy was really, really, really popular at the time among the elite wealthy Americans, like the major politicians, the corporate leaders. I think it was Rockefeller, I think it was Rockefeller that was under the care of a homeopathic doctor for like 50 years.

• 9:40Josh Clark?

  Wow.

• 9:41Speaker 02

  So they carved out exceptions for those two states for a while until they were able, you know, all those people died off basically, and they were able to completely squash it.

• 9:50Josh Clark?

  Right. Rockefeller died, so I guess the homeopathy didn't work.

• 9:54Speaker 02

  Uh, well, he, he lived another like 48 years after being told he didn't have long to live, I think.

• 9:59Josh Clark?

  Oh, wow. So homeopathy works. Case closed.

• 10:04Josh Clark?

  So yes, I think that you've really put your finger on it. The AMA became the arbiter of what qualifies as medicine in the United States, thanks to this Flexner report. It basically strengthened all of its position. And, um, and yes, they were the driving force behind this initially. They went to the Carnegie, um, the Carnegie Foundation and said, hey, you got a lot of money. Why don't you help us figure out how to change American medical education in the exact way we want it? And, uh, we'll help you figure out who to, who to do that with. We like the Johns Hopkins model. We basically want a report that says the Johns Hopkins model is great. Let's get an outsider in here. And that is how Abraham

• 10:48Josh Clark?

  Flexner enters this story.

• 10:51Speaker 02

  Yeah. And, you know, this is not to say that he was like cooking the books or anything like that. And this is all a sham. But that was just sort of, the AMA was definitely after that.

• 10:59Josh Clark?

  Well, one of the reasons he was selected is he was already a person and educator who espoused exactly this kind of stuff, just not necessarily had, as it applied to medical education. He just wasn't exposed to medical education at the time, but he was an educational philosopher and theorist, and he was fully on board with that kind of thinking.

• 11:19Speaker 02

  Yeah. I mean, he wrote a book. I guess we should say he, um, he, he did go to Johns Hopkins, but not for medicine. Uh, I think he studied, uh, classic civilizations. And he was a teacher in his hometown in Louisville, Kentucky. Eventually he was a private school headmaster that he founded the school. And after earning a degree in psychology from Harvard, he wrote a book called The American College, which was sort of the Flexner Report of the university system as a whole. And this guy named Henry Pritchett, who was the president of the Carnegie Foundation at the time, was like, yeah, like Josh Clark of the future will say. This is, this is our guy. Cause did you see the way he came at the regular universities? Like wait till he finds out what's happening in medical schools.

• 12:03Josh Clark?

  Exactly. And then one of the other reasons that he was such a great candidate because he was an outsider and a non-physician is that they were quite aware that there was going to be a lot of blowback, that there were going to be a lot of bruised egos and stepped on toes. And that somebody outside of the profession would be less likely to suffer, say like a professional injury.

• 12:25Speaker 02

  Right.

• 12:25Josh Clark?

  Or being ostracized for the rest of their career. Um, yeah. Flexner was like, I don't care what you think of me, doctors.

• 12:32Speaker 02

  That's right. Uh, so he started out by researching, uh, the European models, the American models. Uh, like I said, he, they, he was really impressed with the German model.

• 12:42Josh Clark?

  Yeah.

• 12:42Speaker 02

  Uh, and in fact, a couple of years after the American, uh, and Canadian, as we'll see Flexner report, he published a European version, which critiqued, um, well, Europe, basically everybody but Germany. He was.

• 12:55Josh Clark?

  Right.

• 12:55Speaker 02

  He was very uncritical of the German system. Uh, and, uh, we also need to point out some of the bad things he said. Uh, there were several anti-Semitic passages in the European version of the Flexner report because he was so enamored of how the Germans did their medicining.

• 13:12Josh Clark?

  Yeah, this was, um, yeah, that German model also inspired the guy who founded Johns Hopkins Medical School, William Welch. Um, and that was essentially, so essentially the Flexner report said the Johns Hopkins model is what we want. Johns Hopkins said the German model is what we want. And the Germans said, yeah.

• 13:31Speaker 02

  Uh, ja.

• 13:32Josh Clark?

  Ja, da.

• 13:33Speaker 02

  Yeah.

• 13:34Josh Clark?

  No, that's Russian. Das boot. That's German.

• 13:37Speaker 02

  Yeah. Nice. What else?

• 13:39Josh Clark?

  Um, the Heimlich maneuver.

• 13:42Speaker 02

  Yeah. That's it. Brotwurst?

• 13:45Josh Clark?

  Cider.

• 13:46Speaker 02

  Okay.

• 13:48Josh Clark?

  Yeah. All that stuff. Oktoberfest, but with a K.

• 13:52Speaker 02

  Should we take a break?

• 13:53Josh Clark?

  Yeah.

• 13:54Speaker 02

  All right. You're gonna think, did you say ja?

• 13:57Josh Clark?

  Yeah.

• 13:58Speaker 02

  We're gonna think of some more German words or Deutsche words, and we're gonna be back with more on what Flexner said, right after this.

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• 17:30Josh Clark?

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• 17:34Speaker 02

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• 17:35Josh Clark?

  Oh, wait. Frankenstein?

• 17:38Speaker 02

  Yeah.

• 17:39Josh Clark?

  That's it.

• 17:40Speaker 02

  Did you see that new Frankenstein movie?

• 17:43Josh Clark?

  Uh, The Bride?

• 17:44Speaker 02

  No, no, no. The, uh, what's his name's new Frankenstein movie?

• 17:48Josh Clark?

  I don't, I don't know. The Rock?

• 17:50Speaker 02

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• 17:54Josh Clark?

  Oh, no.

• 17:55Speaker 02

  Frankenstein.

• 17:56Josh Clark?

  What'd you think of it?

• 17:57Speaker 02

  It was pretty good. I, I got a little bored, but it was, everyone said it was really great. I think I was distracted.

• 18:03Josh Clark?

  Maggie Gyllenhaal is redoing The Bride in like a really strange, like out there kind of fashion that looks interesting.

• 18:10Speaker 02

  Yeah, I saw that. I thought it seemed super interesting and I love mags, so I'm down.

• 18:16Josh Clark?

  Uh, okay. Well, that's fine. I'll allow it.

• 18:19Speaker 02

  Uh, so back to the flexing report. Uh, he started that research in 1908. I think the thing came out in nine, 1910 is like we said. But he went around all over the place. He went to 105, 155 medical schools.

• 18:33Speaker 02

  148 of which were in the United States, seven were in Canada, spends a couple of days there with his nose turned up. And he did this for about 18 months.

• 18:43Josh Clark?

  Yeah. Just to be clear here, this guy was not phoning this in. He definitely took the assignment and did it to, uh, like he did it. Like all of those, those 155 medical schools in the US and Canada, that was every medical school in the US and Canada, including ones that taught alternative medicine and black medical schools in the United States. So like he, he definitely went through the paces. It wasn't just like a, yeah, let's look at Johns Hopkins and here's my report.

• 19:12Speaker 02

  Yeah, for sure. And you mentioned the black medical schools because they, they come up pretty, uh, uh, front and center here in a minute.

• 19:19Josh Clark?

  Yeah.

• 19:19Speaker 02

  But, uh, Johns Hopkins was the, like the gold standard. So that was his comparison point for all of them. He looked at everything. He looked at how they financed their school. He looked at how big the classrooms were, how many teachers they had per student. What like admissions, what it took to get in, what they were actually teaching, um, laboratory stuff, facilities, kind of everything. And what he came out with was one of three determinations in the end for each school. The school is good. You can stay, you can keep your doors open. Um, your school is not so great, but you show promise. So maybe if you have some more funding and you change these things, you, you can be okay. And then I'm sorry, please close your doors forever.

• 20:03Josh Clark?

  Yeah, there was a lot of them that he categorizes hopelessly deficient.

• 20:07Speaker 02

  A lot, most in fact.

• 20:09Josh Clark?

  Yeah. And it wasn't just like him being a snooty butt head. Like the, as we said, like the medical schools in the United States were in a lot of cases, hopelessly deficient. And that's a problem when you're producing doctors, you know?

• 20:25Josh Clark?

  So he did make a pretty good case that that there were a lot that were hopelessly deficient, but the deficient ones, they actually had different rankings. For example, Iowa State University's medical school. He basically said, they're, they know what they're wanting to do, but the hospital associated with it is too small. And that the your clinical faculty, the people who are supposed to be doing research and teaching medicine to the students, they all have their own private practices because they have to support themselves. So if, if you gave this, this group enough funding, they could create a top notch medical school in the Johns Hopkins model. That was kind of like that deficient category.

• 21:06Josh Clark?

  The varying degrees of how much money you would need and whether you were, you're headed in the right direction.

• 21:13Speaker 02

  Yeah, for sure. The way he wrote in what was called Carnegie Foundation Bulletin Number Four, or Medical Education in the United States and Canada, AKA Flexner Report, was that,

• 21:28Speaker 02

  very muckraking style. It's not the kind of report you would, people wouldn't write it this way today because he did get a little, it seems like he enjoyed sort of the put downs and coming up with new ways of saying how bad a school was.

• 21:42Josh Clark?

  So people would write it that way today, unfortunately.

• 21:45Speaker 02

  Well, you're probably right. One of them, he said, apparently the inexcusable degree of ignorance begins just where the ability to pay fees leaves off.

• 21:53Josh Clark?

  Oh, yeah. And so he was basically taking them to task over low admission requirements, if any. But he didn't say low admission requirements. He also used the word reeks, which you don't usually see in academic studies.

• 22:07Speaker 02

  Yeah.

• 22:08Josh Clark?

  He said that the osteopathic schools in the United States, there are eight of them, that they reek of commercialism, that they attract students with a mass of hysterical exaggerations that confidently appeals to the crude boys or disappointed men and women whom it successfully exploits.

• 22:24Speaker 02

  Yeah.

• 22:25Josh Clark?

  We should, we should say osteopathy is an accepted form of medicine in the United States now, but a lot of people still view it as a pseudo-scientific alternative medicine.

• 22:38Speaker 02

  Yeah, I mean, he had a site set on them, on chiropractors, on, on all kinds of things that a lot of people put a lot of great value in today. So he was off base on some stuff for sure. But again, this was 1910.

• 22:52Josh Clark?

  So of the underfunded medical schools, and this was a problem too. This is actually what one of the things that befell black medical schools is we'll see in a minute. If you were underfunded, that was it. Sorry.

• 23:05Speaker 02

  Yeah.

• 23:05Josh Clark?

  No amount of funding is going to bring you up. Well, maybe some amount of funding is going to bring you up to speed, but we need that money to bring other medical schools that are closer up. Because we can bring more of them up to snuff, or we can bring fewer up to snuff and basically get the ones that are the least funded. His whole premise was just close those poorly funded ones because they're just not going to be able to do this.

• 23:29Speaker 02

  Yeah, and you know, he was probably on to something there because there was a glut of bad schools. And his quote was, "The curse of medical education is the excessive number of schools. The situation can improve only as weaker and superfluous schools are extinguished."

• 23:43Josh Clark?

  Right.

• 23:44Speaker 02

  Like I said, it was Canada and the US. Canada fared much better. Our northern friends up there of the seven Canadian medical schools, he only recommended one for closure.

• 23:55Josh Clark?

  So one seventh of them.

• 23:56Speaker 02

  That's right. Of the 148 medical schools in the United States, more than half of them, he recommended closing, and I think it ended up being more than that even, right?

• 24:09Josh Clark?

  Yeah, he actually recommended reducing the full number of schools in the US and Canada from 155 down to 31.

• 24:18Speaker 02

  Yeah.

• 24:19Josh Clark?

  That's four fifths.

• 24:23Josh Clark?

  So, yeah, I mean, like, he was basically a hatchet man. They brought him in to basically get rid of competing, poorly funded, poorly run medical schools. He said, "If you're a proprietary medical school, it doesn't matter what you're doing, you're closed." He saw med school as a public trust, that it should be publicly funded, ergo, they should be associated or attached to public universities, and that the reason that doctors were being produced was to help society along, that you should not have a board or stockholders to whom you were really kind of beholden to, so they would affect your decision making. No, you needed to be beholden to science.

• 25:02Speaker 02

  Right.

• 25:02Josh Clark?

  And ideally to patients, although he didn't put much emphasis on that part.

• 25:07Speaker 02

  Yeah, and we'll, we'll talk about that at the end. So every single proprietary school was immediately on the list, basically, from the jump. Like, if you weren't affiliated with the university, you had no hope for surviving this. All the holistic or what we call alternative medical systems were completely shut down.

• 25:27Speaker 02

  Five of the seven black medical schools were recommended for closure. I think Howard University in DC and Mahary Medical College, right here in Georgia, he thought might be salvageable. But there are a couple of chapters in there. Chapter 14 specifically, "The Medical Education of the Negro" was the title of that chapter, where he shows a real disdain for black medical schools. He said they were wasting money, small sums of money annually, that undisciplined men, whose lack of real training is covered up by imposing MD degrees. And he basically ended up saying like, "Close most of these, and my suggestion is just to make black medical schools to train black doctors,

• 26:12Speaker 02

  to treat black patients only, and they should really just concentrate on hygiene."

• 26:17Josh Clark?

  Yeah, they should, they should focus on public health in order to keep black people from spreading disease to white people. That was essentially his take on the purpose and for the existence of black doctors. Out of 346 pages in the initial version of the report, two, chapter 14, was two pages long. And that is shocking in and of itself. But the Flexner Report was essentially the first like document about medicine and medical school that even acknowledged the existence of black medical schools. Up to this point, they were totally invisible, completely ignored. So the fact, in a really silver lining to the cloud way of looking at this,

• 27:00Josh Clark?

  the fact that Howard University and Mahary Medical College in Georgia made the cut

• 27:07Speaker 02

  Yeah.

• 27:07Josh Clark?

  was really substantial. Like that was a, that was sadly a really big positive for black medical schools, unfortunately.

• 27:16Speaker 02

  Yeah, for sure. You know, I mentioned Texas into the AMA and the Carnegie Foundation were also not too hot on the idea of the three women's medical college, colleges even existing. And Flexner himself basically came out and said, "I don't think women can withstand the mental rigors of being a doctor."

• 27:38Josh Clark?

  He never met Elizabeth Blackwell.

• 27:40Speaker 02

  Yeah, no kidding. And he, he literally said, "You know, women make better patients than doctors."

• 27:48Josh Clark?

  This is the 1910s.

• 27:50Speaker 02

  Yeah, it's not like 1810.

• 27:53Josh Clark?

  So, um, yeah, so this was, I mean, I guess on the other way of approaching this too. So we've talked about everything that he was giving the hatchet to. He had a version of what made an idea, ideal medical education. And again, it was based on the German model, which the Johns Hopkins model was based on. And he essentially said, so you need to have rigorous instruction.

• 28:16Speaker 02

  Yeah.

• 28:16Josh Clark?

  You need to have rigorous admissions requirements and you have to enforce them too. And in doing so, he basically said, you're going to, you're going to weed out candidates who aren't, they don't have, they can't make the cut for this new kind of doctor. So that meant you had to have money to even get started because this new model was so much more expensive than the old model, three to like tuition, I think, needed to increase three to four times just to start to meet the funding for this. So you're like, you just out of the gate had to have money to even try to apply to medical school. And then the, the academic requirements meant that even if you had money,

• 28:59Josh Clark?

  if you didn't have what it took to like really dedicate yourself to learning this stuff, you were going to fail out too. So in that sense, it, it took doctors from being just ordinary tradespeople and said, these people are responsible for keeping the, the population of the United States healthy. And we're making sure that they are up to the task. In return, they're rich now.

• 29:24Speaker 02

  That's right. And, you know, you know, part of it was as medical school was expensive was because, or ended up being more expensive is because they needed better facilities. They needed better equipment. Uh, I know we already mentioned that teachers were working part-time as doctors just because they had to make a living. But one of his big key recommendations was you have to have a full-time faculty that is just doing biomedical research, like they're not doctoring on the side. And in order to come up with this kind of money, it was expensive. The idea of medical philanthropy really, really took off because, you know, Johns Hopkins was one thing, but if you wanted to have more than one Johns Hopkins-like model out

• 30:04Speaker 02

  there, you had to lay out this roadmap of basically, you know, starting in 1910 and over the next like few decades and continuing today, these huge foundations were created. And also local groups just donating money to make sure the Flexner Report was enacted, like the Rockefeller Foundation, they gave hundreds of millions of dollars to get these programs going across the country.

• 30:30Josh Clark?

  Yeah, and it worked. But again, it took hundreds of millions of dollars and I think 1910 money, too.

• 30:36Speaker 02

  Should we take a break?

• 30:37Josh Clark?

  Let's take a break.

• 30:38Speaker 02

  All right, we'll be right back with the closing act of the Flexner Report.

• 30:59Josh Clark?

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• 31:21Josh Clark?

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• 32:02Josh Clark?

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• 32:25Speaker 02

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• 32:38Josh Clark?

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• 33:31Speaker 02

  So, we're back. One of the results we talked about was all these schools shutting down. I think more within 10 years, I'm sorry, within five years of the report's release, more than 50 of the medical schools in the United States shut down. And 20 years on, only 76 of the original 148 in the United States remain. Like you said, five of the seven black medical schools. 80% of the alternative medicine programs were shut down. And the handful of schools that had admitted women were either shut down or not admitting women anymore for a while.

• 34:07Josh Clark?

  Right. So like this was a huge impact on the way that doctors were created in the United States. And again, the profession of doctoring in the first place. And it happened very quickly, as you just mentioned. And there are a lot of positives to it, but there are a lot of criticisms to the outcomes, too. One of the big ones is the impact that the Flexner had on producing black doctors in the United States. I saw an estimate that had all seven of the black medical schools stayed open and been funded so that they could follow this model.

• 34:44Josh Clark?

  Another 30,000 doctors, black doctors, would have been produced in the United States between 1910 and 2012, I think. Which is a big deal, because apparently right now, 2% of American doctors are black. But the the percentage of the black population in the American population overall is 13%. So they're grossly underrepresented, which is another problem in and of itself, because studies show that black patients are likelier to follow the orders and instructions of black doctors than they are of doctors of other races. They just, it's just a question of comfort.

• 35:22Speaker 02

  Yeah, for sure. And you could also make an argument that that gave rise to things like the Tuskegee experiments and other like awful experiments carried out by white doctors on black patients that led to this cycle of mistrust of the, you know, the medical profession as a whole.

• 35:39Josh Clark?

  Yeah, there was a whole, like, part of this, this emphasis on science. And because Flexner was not a physician, he really ignored the idea of the physician as a healer. The physician is somebody who was meant to see their patients as human. And instead, because of this focus on rationalism over humanism, the patient became essentially just a walking bag of medical issues that needed to be diagnosed and treated. They weren't a person. That stuff didn't matter. The point of the doctor was to treat their illnesses and make them better, not to be their friend. And in doing that, like, the medical profession lost a lot of, I guess, connection with the rest of us, where, you know, doctors are kind of looked at as...

• 36:24Josh Clark?

  Looking at the rest of us is not fully human and that doesn't really jibe and feel good, you know, when you're a patient.

• 36:31Speaker 02

  Yeah, for sure. I think, I can't find it, it's not in front of me now, but I sent you one study from a few years ago where I think the long and short of it was they were surveying people that, how happy they were with like the end of care, care for relatives. And I think only 40% of the people were satisfied with like how their, the end of the lives of their relatives went. And a lot of that had to do with pain management. And that sort of ties back to what you were saying about just sort of the rigorous, you know, eyeballs on a microscope and not like eyeballs on a human. You know, it's all sort of tied in together, I think.

• 37:14Josh Clark?

  Yeah. And the other way that that manifested itself was a huge emphasis on separating academic physicians from practicing physicians so that academics could just focus on research. And then they emphasized the research that the academics were producing, like that's the most important thing. You clinicians, listen to the research doctors and what they're finding and then you can go apply it to your practice. And so they were like, well, you've taken these people away from patients and they're just using like this, the scientific mentality and there's no humanism to it. And the critics say that was one of the ways that this whole idea of science losing its humanity or medicine losing part of its humanity or soul came about.

• 37:58Speaker 02

  Yeah, for sure. You know, I know I've already mentioned a little bit about eliminating sort of all kinds of alternative medicines and that homeopathy was, homeopathy, homeopathy? What do you say?

• 38:10Josh Clark?

  I've heard both.

• 38:11Speaker 02

  Okay.

• 38:12Josh Clark?

  I say both at the same time.

• 38:14Speaker 02

  Was very popular at the time. I mean, there are people that think that they were doing pretty well with homeopathy and curing disease with natural remedies. Other people will say, no, you've got your tinfoil hat on, and that's not the case. They just didn't know real science at the time. So there's a lot of raging debate online about that kind of stuff. But another point of this all is that psychiatric medicine lost a lot of, I guess, curricular elements that were very beneficial at the time for mental health treatment. Like, they were making a lot of strides at the time with things like meditation and like how nutrition, like food can can alter like a person's or lifestyle can alter a person's mental health.

• 38:58Speaker 02

  And that was all just sort of flushed down the toilet because of this. And the neurochemical model came out of mental illness. And the same people that were arguing for homeopathy basically said, you know, what the Flexner Report really did was, among other things, was led us down the path of people like the Rockefeller Foundation creating Big Pharma, essentially, and getting people on endless amounts of medicine that just don't heal you, and they're just never ending and make Big Pharma bigger.

• 39:31Josh Clark?

  Yeah, psychiatric medicine is a good example of that. They just took the the neurochemical model of mental illness and that that was that.

• 39:39Speaker 02

  I mean, I think a lot of that stuff has come back now.

• 39:41Josh Clark?

  Yeah, for sure.

• 39:42Speaker 02

  It's just not super funded and you're not going to find any like huge, you know, medical schools that that tout their homeopathy departments or anything like that. But I think the there's underground movements for all that stuff like, hey, meditation can help your mental health. And maybe these herbs can make you feel better, or this honey that you rub on your cut. Is better than Bactine or whatever.

• 40:09Josh Clark?

  It really is. If you see a good psychiatrist, especially probably a younger one these days, one of the first things they're going to ask you is how are you sleeping? Are you exercising? What's your diet like?

• 40:20Speaker 02

  Yeah, totally.

• 40:21Josh Clark?

  And then they'll start to go into meds, but like they're going to say like, you need to really pay attention to these three things. And if you still need meds, it'll still drastically reduce the kind or amount of meds you'll probably need.

• 40:34Speaker 02

  Right. If you're taking care of yourself in the other ways.

• 40:36Josh Clark?

  Exactly. So that has definitely come back in psychiatry. And that's a really good example of what a lot of people point to. The Flexner Report suppressed that for a hundred years. It derailed black doctors, it derailed women doctors, it derailed alternative medicines. It even took the stuff that was part of the medical establishment and twisted it around. And it took a full century for things to start to even come back. And that again, is a really big criticism of the whole thing. But overall, you can point to a lot of stuff, a lot of lives that were saved, a lot of lives that were improved, a lot of lifespans that were extended because of this Johns Hopkins German model that the Flexner Report essentially,

• 41:20Josh Clark?

  with the AMA, got the Rockefeller Foundation to fund. And create this new model for America.

• 41:28Speaker 02

  Yeah, this is one of those rare episodes where there's truly like two ways to look at it. I mean, he definitely threw the baby out with the bathwater in a lot of cases.

• 41:37Josh Clark?

  Oh, well put.

• 41:39Speaker 02

  But you could also argue that like it was such a mess that like something drastic had to happen.

• 41:47Speaker 02

  Or else, you know, who knows how many more decades it would have taken. I mean, I definitely agree with you that like it would have happened at some point. I doubt if we'd still be sitting here today had the Flexner Report not been written and like I'm sitting here with like a leech on my forehead.

• 42:00Josh Clark?

  Right, or I have typhus.

• 42:01Speaker 02

  Yeah, exactly.

• 42:03Josh Clark?

  Yeah, I agree with you.

• 42:06Josh Clark?

  Chuck, this is a good one.

• 42:09Josh Clark?

  Thank you, Emily, for it. Thanks, John.

• 42:12Speaker 02

  You're welcome.

• 42:13Josh Clark?

  That was a great Emily.

• 42:14Speaker 02

  Nice seeing you in San Francisco, buddy.

• 42:16Josh Clark?

  Yeah, it was great to see you, too. I don't know why I'm talking like you, but I am. If you want to know more about the Flexion Report, go out and read it. It's 346 pages of muckraking gold. And since I just wrapped up this episode as if it were from 2010, I think it's Chuck time for listener mail.

• 42:36Speaker 02

  That's right. This is from Kyle. Hey, guys, I'm sure you've heard this over the years. Maybe you receive snarky emails from people saying, what do you mean, I should know this?

• 42:46Josh Clark?

  Oh, yeah, I like this email. Thanks for picking it.

• 42:48Speaker 02

  In a way, it makes it seem like they interpret it as stuff you should already know. But I always took the approach that a quintessential SYSK episode sheds light on something that a person should know in order to give voice to situations, regions, historical events, things like that. Something we should know today to help learn and grow. And Kyle, that's, of course, always been the case.

• 43:09Josh Clark?

  Yeah, it's stuff that we think you should know, which we want to share with you.

• 43:14Speaker 02

  It is interesting to learn how the son of the jackhammer works. I found, I see what you're doing there, Kyle. I found that the Helen Keller and Ann Sullivan episode was exactly what I think of as a great Stuff You Should Know episode. My only knowledge of Helen Keller was what I had learned from the late 90s in aughts media and pop culture. So thank you for showing me how amazing both of them were as people, activists, advocates, and as friends. The lives of Keller and Sullivan is something everyone should know. Thank you. That is from Kyle.

• 43:43Josh Clark?

  Thank you right back, Kyle. That was a world-class email, don't you think, Chuck?

• 43:47Speaker 02

  Yes, Kyle, that was wonderful.

• 43:49Josh Clark?

  Yeah. So if you want to knock it out of the park with an email like Kyle did, wrap it up, spank it on the bottom, and send it off to [email protected].

• 44:03Speaker 03

  Stuff You Should Know is a production of iHeartRadio. For more podcasts, iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

• 44:18Josh Clark?

  Buy smart, drive for less and trade for more. That's Toyota affordability and it starts with a great deal on an off-road ready Tacoma or half-ton Tundra, two of Toyota's longest lasting trucks, combining power for work, tech for adventures and style in between. And they're built on a reputation for quality and reliability, which is why Toyota trucks are known for holding their value, which could mean big savings when it's time for your next Toyota. So get a great deal today and a great value tomorrow. Shop toyota.com for more. Toyota, let's go places. Introducing Voices of Vivgard. Vivgard is also known as its generic name, Fgard Tigamod Alpha F-Cab. And this new show features firsthand stories from people living with a rare disease.

• 45:00Josh Clark?

  Hosted by Andrew Stratton, these perspectives highlight that life is more than a moment, a condition, or a tough day. Living with a rare disease can be challenging, but it does not define the Voices of Vivgard. In these episodes, they share their stories, from diagnosis to working with their care team on their treatment plan. Listen to Voices of Vivgard on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Hey everybody, I am here to talk to you about Dude Wipes, who offer fragrance-free wipes that are made with 99% water and plant-based ingredients. So they're gentle enough for sensitive skin, but they're tough enough for even the worst messes. Weather cleans better and Dude Wipes flushable wipes deliver textbook freshness and ultimate clean.

• 45:41Josh Clark?

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