By November 1908 the American Medical Association‘s Council on Medical Education (CME) (est 1902) were noted as experiencing “committee differences and insufficient funding”, so the president of the Carnegie Foundation, Henry S. Pritchett, stepped in and offered to simply take over the entire medical education reform project. The AMA Council minutes for December of 1908 stated: [4]
[Pritchett] agreed with the opinion previously expressed by the members of the Council that while the Foundation would be guided very largely by the Council’s investigation, to avoid the usual claims of partiality no more mention should be made in the report of the Council than any other source of information. The report would therefore be, and have the weight of, a disinterested body, which would then be published far and wide. It would do much to develop public opinion.”
Leading up to this point, in early 1907 The Carnegie foundation for the advancement of teaching had already began defining education standards when they issued a bulletin “defining the preliminary educational requirements necessary for a high-grade college” this send a “shudder” through the AMA institutions. [9, 10]
In June 1908 Abraham Flexner, who worked for the Carnegie Foundation published a little book The American College, A Criticism. Highlights the education of students, comparing the American student at 23 year old to be equivalent to the German at 20 year old in “scholarship and trained capacity”. His colleague Henry Pritchett was referenced,. Flexner proposed “The Way Out” plan, noting a “splendid opportunity thus awaits a school outside the present system”. [8]
The Carnegie Foundations appointed Abraham Flexner to undertake the reform project and by April 16, 1910 the report was released, titled “Medical Education in the United States and Canada“, which became known as The Flexner Report [PDF]. It is stated “the purpose of the Foundation to proceed at once with a similar study of medical education in Great Britain, Germany, and France.” Published reviews of the report were mixed.
In the report’s forward by the Foundation’s president Henry Pritchett, he acknowledged the particular assistance from “Dr. William H. Welch of Johns Hopkins University, Dr. Simon Flexner of the Rockefeller Institute, and Dr. Arthur D. Bevan, chairman of the Council on Education of the American Medical Association.”
The Foundation president highlighted that medical schools are no longer profitable due to the recent “need for laboratories …the expenses of an efficient medical school have been greatly increased….Colleges and universities have in large measure failed in the past twenty-five years to appreciate the great advance in medical education and the increased cost of teaching it along modern lines.” It also stated a “hospital under complete educational control is as necessary to a medical school as is a laboratory of chemistry or pathology.” They had a desire that “fewer physicians graduated each year, but that these should be better educated and better trained.” [6]
The Flexner Report was the catalyst that “created and enabled the terms of a centralised medical system and pharma industry to take over control”. It “established guidelines meant to sanction orthodox medical schools and condemn homeopathic” and other “cults” practices which were popular at the time and competition for “regular” physicians.
In JAMA 1911 it was stated “this report was not a mere criticism of existing conditions. It aimed to point out accurately and frankly the present status of medical education ; but it did much more than this. It attempted a thorough -going study of the medical curriculum and it suggested certain broad lines on which the medical curriculum might fairly be expected to develop in the immediate future.” Flexner is praised for “spotting the commercial diploma mills”.
By 1912 Abraham Flexner was lecturing to professional audiences in Britain and Europe the new “hands on” American model of training physicians. In 1913 he left the Carnegie Foundation and went to work for the Rockefeller founded, General Education Board, headed by Fredrick Taylor Gates, a trusted advisor of John D. Rockefeller Sr. Gates encouraged Flexner to steer Rockefeller’s millions into the “development of chemically oriented medicine” or the diagnose and treat “Principles and Practice of Medicine”. [1, 2, 3, 4, 5, 7]
Through time, medical institutes directed their focus and resources to teaching patentable solutions. Since you can’t patent nature, solutions were skewed to man-made synthetic drugs and surgery and away from nature, this was more profitable than cures. Pharmaceutical companies benefited greatly. Medical journals receive their greatest funding from pharmaceutical companies, which in turn, skews their articles away from cheap solutions which would dilute the profits of patented drugs. Pharma has great influence over physicians, medical researchers, regulators and policy makers.
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