Bio and Background ~ Abraham Flexner 1866-1959 [complied from various sources]

Abraham Flexner was born in Louisville, Kentucky, the child of German immigrants. He spoke German, and as an adult studied and traveled in Europe. His brother, Simon Flexner, was an MD employed by the Rockefeller Foundation.

Abraham Flexner graduated from Johns Hopkins University in 1886 as a teacher. He taught school for four years and then opened a preparatory school in Louisville in 1889 that he owned and operated for 15 years. In 1905 he began his post-graduate studies in professional education at Harvard and the University of Berlin, specializing in developing and administrating graduate schools education and professional training programs.

To research professional educational systems in other countries, he traveled extensively in England, Germany, France, and Canada. He was well aware that in continental Europe, an extensive and specialized university education was required before anyone could practice medicine. He saw universities not as popular institutions reflecting the desires and whims of society but as intellectual leaders. “Universities must at times give society not what society wants, but what it needs”.

As research fellow in 1908 at the Carnegie Foundation for the Advancement of Teaching in New York City, Flexner’s first impact on American education took the form of “Germanizing” American medical education. In effect, Flexner believed that medical education in the US should be based on the model and practices of continental Europe, which is to say a university-degree-based education in basic and advanced sciences, with an extensive clinical training element in diagnosis and performance of medical and surgical procedures.

Flexner rejected the scientific validity of all healing arts other than western or ‘biomedicine’. Any practice of medicine that did not advocate the use of ‘chemical’ treatments such as vaccines to prevent and cure illness were quackery in his opinion. His policy recommendation reflected in a quote by him in his final report: “If the sick are to reap the full benefit of recent progress in medicine, a more uniformly arduous and expensive medical education is demanded.” 1

After finishing his landmark study of medical education in 1910, Flexner investigated prostitution in Europe. He was also known as an ‘able fund raiser’. Thru his personal and professional relationships with philanthropists he secured a $1.5 million gift from the Rockefeller Foundation’s General Education Board to his alma mater — the German-oriented Johns Hopkins University.

In 1913 he left the Carnegie Foundation and joined the educational board of the Rockefeller Foundation General Education Board (GEB) as its assistant secretary. After four years, he was promoted to principal executive officer and ran the operations of the Board for eight years in partnership with its president, Wallace Buttrick. As the resident intellectual and educator on the Board, Flexner’s directed  the dispersal of millions of dollars of medical education endowment funds to institution that promoted ‘chemical’ (pharmaceutical medicines) and surgically-oriented medicine in the United States.

Over the next 47 years, the Rockefeller Foundation’s GEB contributed $96 million to medical schools to Johns Hopkins and other university medical schools that disregarded naturopathy, homeopathy and all other forms of ‘alternative’ or non-MD practice of healthcare disciplines (such as midwifery), favoring only those that taught its practitioners to depend exclusively on the use of prescription drugs and surgery.

In the 1930s, Flexner served as first director of the Institute for Advanced Study at Princeton.

Overview & History: Flexner and the Carnegie Foundation for the Advancement of Teaching’ report on Medical Education in the United States and Canada

In 1904 the American Medical Association created an in-house committee known as the “Council on Medical Education”. This later became a stand-alone organization known as the Association of American Medical Colleges. The AMA-CME developed more restrictive standards for medical education that required additional years of didactic and clinical training. The Council also called for ‘irregular’ medical schools to be closed down, a recommendation that was an extension of the efforts going back to the 1820s to make it illegal to practice of any non-allopathic form of medicine.

In 1908 the AMA asked the president of the Carnegie Foundation, Henry Pritchett, to underwrite a major study of medical schools in the United States and Canada (see link to Pritchett’s ‘Introduction’ to the original Carnegie report (bulletin #4). Pritchett was a staunch advocate of medical school reform and chose Flexner, a researcher at the Carnegie Foundation for the Advancement of Teaching, to conduct the survey.

Excerpt of Correspondance from Henry S. Prichett,  April 16,1910: 

“The Foundation is under the greatest obligation in the preparation of this report to leading representatives of medicine and surgery in this country for their cooperation and advice. The officers of the various medical associations and of the Association of American Medical Colleges have furnished information which was invaluable and have given aid in the most cordial way. We are particularly indebted for constant and generous assistance to 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. In addition, our acknowledgments are due to Dr. N. P. Col well, secretary of the Council on Education of the American Medical Association, and to Dr. F. C. Zapffe, secretary of the Association of American Medical Colleges, for most helpful cooperation. I wish to acknowledge also our indebtedness to a number of eminent men connected with various schools of medicine who have been kind enough to read the proof of this report and to give us the benefit of their comment and criticism.”

From January 1909 to April 1910, Flexner visited 167 medical colleges and post-graduate programs in the U.S. and Canada seeking data on five points for each school:

(1) entrance requirements and adherence to them

(2) size and training of the faculty

(3) amount of tuition, endowments and fees to support the institution

(4) quality of the laboratories and qualifications of the laboratory instructors

(5) relationships between the school and hospitals used as sites for clinical training

By his own admission, Flexner had “no fixed method or procedure” and used no standard questionnaire. As a layman, he had never: “[set] foot inside a medical school” and “knew neither anatomy, physiology, nor psychology enough to warrant embarking on a highly specialized bit of experimentation.” Although this obviously conflicted with the scientific medicine Flexner claimed to promote, he himself admitted that it’s “inconsistency never bothered me.”

The plan called for Flexner to travel to and comprehensively evaluate each campus of 167 geographically dispersed institutions scattered over the entire North American continent. The actual number of site visits was even greater (175), since some schools maintained separate campuses in different cities. According to the itinerary in his footnotes [see addendum] he would have had only a fraction of a day to travel and evaluate each of the 167 institutions. Although 16 months were allotted to the fieldwork, the majority of the visits occurred in only in eight months.

He made 157 or 90 % of his site visits in approximately 240 days. His pace was even more amazing in April 1909, when he investigated 31 schools in 30 days in six western states (Colorado, Illinois, Iowa, Missouri, Nebraska, and Utah). Flexner often visited schools when they were not in session and toured some institutions unaccompanied by school officials. On one occasion bribed the janitor to open the laboratories; when he didn’t see any microscopes or other apparatus, he concluded that the school had no laboratory equipment. He never checked with the director or considered other possibilities, such as locking up valuable equipment.

The logistical challenge of visiting multiple schools in such a limited period of time was complicated by frequently returning to his home base in New York, where he stayed for many months at a time. Train travel was fastest, but still took one to three days in each direction. Excluding weekends, the train-dependent Flexner would have had only 0.71 of a 12-hour day per school.

Flexner readily admitted that his tour of medical schools was “swift,” and that he finished his inspections “within less than a year.” His explanation of these methods was his personal maxim of Ambulando discimus  or “we learn by going about“.

His strong negative report on American medical education was quickly picked up by the Hurst and other publishing empire and syndicated all across the country as a front-page story. As a result, about half of the medical schools in the United States were forced to close. This included all that taught non-AMA approved methods and nearly all that accepted women and minorities.

As of 2010, the recommendations in the Carnegie Foundation’s “Medical Education in the United States and Canada” will have defined both medical education and medical practice as an intensely hierarchical product under their exclusive control for 300 million people for an entire century.

However, the underlying research for this power-broker document was undertaken at the request of the AMA and all the parameters were established by the AMA’s Council of Medical Educationand the AMA’s sister organization the Association of American Medical Colleges. Unfortunately for us all, its conclusions have never been questioned by the public, or exposed to review by an unbiased scientific community or reexamined by other health professionals or policy-makers.

It was not until 1975 that anyone publicly questioned society’s blanket acceptance and dependence on AMA defined, drug and surgery centric healthcare. When someone finally did,it came from an unlikely source — a Catholic social theorist by the name of Ivan Illich. His book Medical Nemesis subjected the allopathic practice of medicine in the US to detailed scrutiny. Illich was the first to introduce the concept of iatrogenic disease to the public. He argued against the routine medicalization of life.

In this context, medicalization is usually defined as “the process by which health or behavioral conditions come to be defined and treated as medical issues. The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat.” [Wikipedia: definition of ‘medicalization]

Since 1910 many aspects of normal biology, including normal childbirth and anticipated natural death (example: elderly or persons known to have a terminal illness) have become intensely medicalization. Ivan Illich was convinced this caused more harm than good and had turned the entire population of the United States into lifelong patients.

Mortality and morbidity statistics in his book also showed the ‘shadow side’ of medicalization, in the shocking extent of post-operative side-effects and drug-induced illness in now rampant in advanced industrial societies that depend solely on drugs and surgery for all their healthcare needs.