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How the Flexner Report Changed Medicine

Feb 19, 202638 min
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Summary

The 1910 Flexner Report fundamentally transformed medical education in the U.S., establishing rigorous standards and a scientific, hospital-based model inspired by Johns Hopkins. While it dramatically improved the quality of medical care and contributed to longer lifespans, the report also led to the closure of over half of existing medical schools, including most Black and women's institutions, and effectively eliminated alternative and holistic medical practices for decades. Its legacy is a complex mix of progress and controversial social consequences.

Episode description

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.

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Transcript

Intro / Opening

Speaker 1

Welcome to Stuff you should know, a production of iHeartRadio.

Introduction to the Flexner Report

Speaker 2

Hey, and welcome to the podcast. I'm Josh, and there's Chuck and jar Jar Binks is here too, and this is stuff you should know about the Flexner Report.

Speaker 1

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

Speaker 2

Oh, that's a good one.

Speaker 1

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

Speaker 2

Right.

Speaker 1

But Emily was interested because another thing it did a byproduct was it basically completely squashed what we would now call altern medicine homeopathy, basically saying it has zero value and we're not doing that anymore. It sure did biff, Yeah, and it was also racist and sexist.

Speaker 2

It was definitely of its time. This is a document produced in nineteen ten, for sure. Yeah, and it definitely stinks of eugenics and all that.

Speaker 1

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.

Speaker 2

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 a good thing. There seems to be now among you know, thinking people who don't just wait and wallow and dogma, saying like, we needed a new Flexner Report for the twenty first century because it's basically run its course and now again it's become dogma and we need to do something about that.

US Medical Education Before 1910

Speaker 1

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 look like in the United States pre Flexner Report.

Speaker 2

Who was bad?

Speaker 1

It was bad, I guess quickly we should say that Europe was doing it right before we were. In France, especially they had some pretty top notch medical schools where they embrace real science and we're practicing medicine on people like as practice in colleges and stuff like that. But in the United States that was around eighteen fifty. In the US, in eighteen fifty they had fifty two medical schools.

This is what fifty sixty 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. And those were the good ones that were attached to universities.

Speaker 2

Yeah, I mean, there were plenty of diploma mills. There 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.

Speaker 1

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 patience, you might not have any contact with another human being at that medical school.

Speaker 2

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. That's good, thanks, I like it.

Speaker 1

But then everybody the Civil War came around in the eighteen sixties 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.

Speaker 2

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.

Speaker 1

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.

Speaker 2

Right, they didn't teach me that patient's complain in medical school. Yeah, so yes, regardless, by the by the eighteen sixties, 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 was 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

The Rise of Modern Medical Standards

eighteen seventies. It was led by Harvard. Yeah, but really Johns Hopkins University was the one that really hopped on it.

Speaker 1

Yeah, for sure, Like Harvard got the ball rolling for a couple of decades, and by the time Johns Hopkins opened in eighteen ninety three, they became kind of the standard for the American model moving forward, which SBC was based on the German model. Right, 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. 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.

Speaker 2

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. Yeah, that was. And that essentially that Johns Hopkins model is what became the model for American medical school. And there's a lot of there's a lot of talk at parties if you stop and listen about whether this would have

happened on its own or not. And for the most part, it seems that, yes, this progressive era movement would have gotten there eventually. Yeah, just because it was a good idea. 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.

AMA's Influence and Flexner's Appointment

Speaker 1

Yeah, for sure. The American Medical Association was founded in eighteen forty seven. And one of the reasons, and you know, again 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 that was a clause in there known as a consultation clause that said, if you even talk to a quote 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 fifty years.

Speaker 2

Wow.

Speaker 1

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.

Speaker 2

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

Speaker 1

Well. He lived another like forty eight years after being told he didn't have long to live.

Speaker 2

I think, oh wow, it's a homeopathy works case closed. So yes, I think that you really put your finger on that. 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 yes, they

were the driving force behind this. Initially they went to the Carnegie 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 we'll help you figure out 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 Flexner enters this story.

Abraham Flexner's Background and Biases

Speaker 1

Yeah, and you know this is not to say that he was like cooking the books or anything like that, and no, this is all a sham, but that was just sort of The AMA was definitely after that well.

Speaker 2

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

Speaker 1

Yeah, I mean he wrote a book. I guess we should say he did go to Johns Hopkins, but not for medicine. I think he studied 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 our guy, because did you see the way he came at the regular universities, like wayde till he finds out what's happening in medical schools exactly.

Speaker 2

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 was going to be a lot of bruce digos and stepped on toes, and that somebody outside of the profession would be less likely to suffer, say like a professional injury or being ostracized for the rest of their career. Yeah. Flexner was like, I don't care what you think of me, doctors.

Speaker 1

That's right. So he started out by researching the European models, the American models. Like I said, he was really impressed with the German model, and in fact, a couple of years after the American and Canadian as we'll see Flexner Report, he published a European version which critiqued well Europe basically everybody but Germany. He was very uncritical of the German system, and we also need to point out some of the

bad things he said. 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.

Speaker 2

Yeah, this was Yeah, that German model also inspired the guy who founded Johns Hopkins Medical School, William Welch, 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, yeah, yeah, dah yeah, no, that's Russian, das boot, that's German.

Speaker 1

Nice. What else?

Speaker 2

The heimlich maneuver, Yeah, that's it, brought worst cider. Okay, yeah, all that stuff october Fest, but with a k should.

Speaker 1

We take a break? Yeah, all right, you're gonna think did you say?

Speaker 2

Yeah?

Speaker 1

Yeah, 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.

Speaker 2

Chuck, I could only come up with one more, and it was strudal. But it's the best one.

Speaker 1

Mmmm yeah.

Speaker 2

Oh wait Frankenstein, Yeah, that's it.

Speaker 1

Do you see that new Frankenstein movie.

Speaker 2

The Bride?

Speaker 1

No, no, no, the what's his name is new Frankenstein movie?

Speaker 2

I don't, I don't know the rock.

Speaker 1

Now the director Guillermo del Toro's.

Speaker 2

Oh no, what did you think of it?

Speaker 1

That was pretty good? I got a little bored, but it was everyone said it was really great. I think I was just a maki.

Speaker 2

Jillenhall is redoing the bride in like a really strange, like out there kind of fashion that looks interesting.

Speaker 1

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

Speaker 2

Okay, well that's fine, I'll allow it.

Flexner's Comprehensive School Evaluation

Speaker 1

So back to the Flexen report. He started that research in nineteen oh eight. I think the thing came out in nineteen ten, is like we said. But he went around all over the place. He went to one hundred and five one hundred and fifty five medical schools, one hundred and forty eight 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 eighteen months.

Speaker 2

Yeah, just to be clear here, this guy was not phoning this in. He definitely took the assignment and did it to like he did it like all of those those one hundred and fifty five 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 definitely went through the paces. It wasn't just like a, yeah, let's look at Johns Hopkins and here's my report.

Speaker 1

Yeah, for sure. And you mentioned the black medical schools because they come up pretty front and center here in a minute. But Johns Hopkins was 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, like admissions, what it took to get in, what they were actually teaching,

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. Your school is not so great, but you show promise, so maybe if you have some more funding and you change these things, you can be okay, and then I'm sorry, please close your doors forever.

Speaker 2

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

Speaker 1

A lot most in fact.

Speaker 2

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. So he did make a pretty good case that that there were a lot they were hopelessly deficient, but the deficient ones they actually had different rankings. For example,

Iowa State University's medical school. He basically said, they know what they're wanting to do, but the hospital associated with it is too small. And 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 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, the varying degrees of how much money you would need and whether you were you're headed in the right direction.

Damning Critiques and School Closures

Speaker 1

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 very muckbreaking 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.

Speaker 2

Was, so people would write it that way today and unfortunately.

Speaker 1

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.

Speaker 2

Oh yeah, and so he was basically taking them to task over low admission requirements if any. But you didn't say low admission requirements. He also used the word reeks, which you don't usually see in academic studies. Yeah, he said. 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. We should say osteopathy isn't accepted form medicine in the United States now, but a lot of people still view it as a pseudo scientific alternative medicine. Yeah.

Speaker 1

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

Speaker 2

So of the underfunded medical schools and this was a problem too. This is actually one of the things that befell black medical schools is we'll see in a minute. If you were underfunded, that was it. Sorry, 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 at least funded. His whole premise was just close those poorly funded ones because they're just not going to be able to do this.

Speaker 1

Yeah, and you know he was probably onto 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. This situation can improve only as weaker and superfluous schools are extinguished. Right, 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.

Speaker 2

So one seventh of them, that's.

Speaker 1

Right, the one hundred and forty eight 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.

Speaker 2

Yeah, he actually recommended reducing the full number of schools in the US and Canada from one hundred and fifty five down to thirty one. Yeah, that's four fifths. 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.

Impact on Black and Women's Medical Schools

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

Speaker 1

Yeah, and 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. Five of the seven black medical schools were recommended for closure. I think Howard University in DC and Mahari Medical College right here in Georgia he thought might be salvageable. But

there are a couple of chapters in there. Chapter fourteen, 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 to treat black patients only, and they should really just concentrate on hygiene.

Speaker 2

Yeah, 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 for the existence of black doctors. Out of three hundred and forty six pages in the initial version of the report, two chapter fourteen was two pages long, and that is shocking in and of itself. But the Flexner Report was essentially the first 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, the fact that Howard Universe and Mahari Medical College in Georgia made the cut, Yeah, was really substantial, Like that was a that was sadly a really big positive for black medical schools. Unfortunately.

Speaker 1

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

Speaker 2

You never met Elizabeth Blackwell.

Speaker 1

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

Speaker 2

This is the nineteen tens.

Speaker 1

Yeah, it's not like eighteen ten.

The New Model and Philanthropic Funding

Speaker 2

So 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 too. 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, 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 tuition I think need to do 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 academic requirements meant that even if you had money, 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 took doctors from being just ordinary trades people and said, these people are responsible for keeping the population of the United States healthy and we're making sure that they are up to the task. In return, they're rich.

Speaker 1

Now it's right, And you know, you know, part of it was says medical school was expensive was because or ended up being more expensive, is because they needed better facilities, they needed better equipment. 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 there, you had to lay out this roadmap of basically you know, starting in nineteen ten and over the next 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.

Speaker 2

Yeah, and it worked, but again it took hundreds of millions of dollars in I think nineteen ten money too.

Consequences and Criticisms of the Report

Speaker 1

Should we take a break. Let's take a break, all right, We'll be right back with the closing act of the Flexner Report. So we're back. One of the results we talked about was all these schools shutting down, I think more within ten years, I'm sorry, Within five years of the report's release, more than fifty of the medical schools in the United States shut down, and twenty years on, only seventy six of the original one hundred and forty

eight in the United States remained. Like you said, five of the seven black medical schools, eighty percent 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.

Speaker 2

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, another thirty thousand doctors Black doctors would have been produced to the United States between nineteen ten and twenty twelve, I think, which is a big deal because apparently right now two percent of American doctors are black, but the percentage of the Black population in the American

population overall is thirteen percent, 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.

Speaker 1

Comfort, 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 the cycle of mistrust of the you know, the medical profession as a whole.

Speaker 2

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 is 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.

Speaker 1

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 shortage it was they were surveying people that how happy they were with like the end of care care for relatives, and I think only forty percent 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.

Speaker 2

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 act academics we're 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 this scientific mentality and there's no humanism to it. And they 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.

Suppression of Alternative and Holistic Medicine

Speaker 1

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, I've heard both, Okay, both at the same time. 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. They were making a lot of strides at the time with things like meditation and like how nutrition food can alter like a person's or lifestyle can alter a person's

mental health. 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 flex and report really did was, among other things, was let 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. They're just never ending and make big, farmer, bigger.

Speaker 2

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

Speaker 1

I mean, I think a lot of that stuff has come back now. Yeah, it's just not super funded and you're not going to find any like huge medical schools that tout their homeopathy departments or anything like that. But I think 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 vactine or whatever.

Speaker 2

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 your diet? Like, yeah, totally, And then they'll start to go into meds. But like they're gonna say, like, you need to really pay attention to these three things, and if you still need meds, it'll still drastically reduced the kind or amount of meds you'll probably need.

Speaker 1

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

Flexner Report's Mixed Legacy

Speaker 2

Ways 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 one 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 life spans that were extended because of this Johns Hopkins German model that the Flexner Report essentially with the AMA, got the Rockefeller Foundation to fund and create this new model for America.

Speaker 1

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, oh well put. But you could also argue that, like it was such a mess that like something drastic had to happen 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 and not been written, and like I'm sitting here with like a leech on my forehead.

Speaker 2

Right or I have typhus Yeah exactly. Yeah, I agree with you, Chuck. This is a good one. Thank you Emily for it.

Speaker 1

Thanks, Josh, You're welcome.

Speaker 2

That was a great Emily.

Speaker 1

I seen you in San Francisco, buddy.

Speaker 2

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 flex And Report, go out and read it. Three hundred and forty six pages of muck raking gold. And since I just wrapped up this episode as if it were from twenty ten, I think it's Chuck time for listener mail.

Speaker 1

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

Speaker 2

Oh yeah, I like this email.

Speaker 1

Thanks for picking it 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 two situations, regions, historical events, things like that, something we should know today to help learn and grow. Kyle, That's of course always been the case.

Speaker 2

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

Speaker 1

But it is interesting to learn how the son of the Jackamer works. I found I see what you're doing there, Kyle. I found that the Helen Keller and a 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 nineties and aughts media and pop culture. So thank you for showing me how amazing both of them were as people, activist advocates, and his friends. The lives of Keller and Suliman is

something everyone should know. Thank you. That is from Kyle.

Speaker 2

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

Speaker 1

You think, Chuck, Yes, Kyle, that was wonderful.

Speaker 2

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 Stuff podcast at iHeartRadio dot com.

Speaker 1

Stuff you Should Know is a production of iHeartRadio. For more podcasts my heart Radio, visit

Speaker 2

The iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

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