How the Flexner Report Changed Medicine

Summary

Stuff You Should Know

Episode Summary: How the Flexner Report Changed Medicine

Podcast: Stuff You Should Know
Hosts: Josh Clark, Chuck Bryant
Release Date: February 19, 2026

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Episode Overview

In this episode, Josh and Chuck dive into the history and lasting impact of the 1910 Flexner Report—a document that overhauled the American medical education system. They unpack how the report modernized medicine, wiped out many "alternative" medical practices, and discuss its more problematic aspects, including its role in entrenching racism, sexism, and medical elitism. Throughout, they weigh the balance of positive outcomes with lasting negative effects, posing the question: was the Flexner Report a necessary revolution, or did it throw out too much with the bathwater?

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Key Discussion Points & Insights

1. Setting the Stage: Medicine in America Pre-Flexner

• (03:24) Medical education in mid-1800s America was chaotic, underfunded, and often lacking practical experience. Doctors could graduate without ever touching a patient or taking an exam.
  • Josh Clark: “Medicine was a trade...Even at places like Harvard, they had to pay for their own teaching supplies. And those were the good ones…” (04:06)
• (04:30) Diploma mills proliferated, with admittance based mainly on the ability to pay tuition.
  • Chuck Bryant: “Your admission requirement was the ability to pay the tuition fees essentially.” (04:30)
• The Civil War exposed glaring inadequacies in doctor training, sparking calls for reform.
  • Josh Clark: "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." (05:58)

2. The Progressive Push for Reform

• By late 1800s, leading universities like Harvard and then Johns Hopkins pushed for rigorous, science-based, hands-on medical education, inspired by the German model.
  • Josh Clark: "Johns Hopkins was the one that really hopped on it." (06:53)
  • Entry prerequisites and length/difficulty of curriculum greatly increased.
• (08:35) The American Medical Association (AMA) formed to professionalize and to combat alternative medicine/homeopathy. Their charter even openly targeted homeopathy as something to eliminate.

3. The Flexner Report: How It Happened

• (10:54) The AMA, wanting to solidify the Johns Hopkins model, partnered with the wealthy Carnegie Foundation to commission a study. They selected Abraham Flexner, an education reformer and outsider—not a physician.
  • Josh Clark: “This is not to say he was cooking the books…that was just sort of—the AMA was definitely after that.” (10:54)
  • Flexner was already known for his critique of higher education.
• Flexner studied all 155 North American medical schools, judging them against the rigorous Hopkins/German model (and, in Europe, displaying uncritical admiration for German institutions).

4. Flexner’s Findings & Judgments

• Flexner toured 155 schools (18 months), classifying each as:
  1. Good (keep open)
  2. Promising but needing upgrades/funding
  3. Hopelessly deficient (recommend closure)
  • Josh Clark: “The school is good…show promise…or, I’m sorry, please close your doors forever.” (17:44)
• His reporting was notably harsh, even “muckraking.”
  • “Apparently the inexcusable degree of ignorance begins just where the ability to pay fees leaves off.” (Flexner, via Josh, 20:25)
  • On osteopathic schools: they “reek of commercialism…exploit crude boys or disappointed men and women." (Chuck Bryant, 20:52)
• Proprietary (for-profit) schools, black medical schools, and women's colleges were especially targeted. Alternative medicine (homeopathy, osteopathy, etc.) was summarily dismissed.
• (24:49) Flexner suggested black doctors should be trained “to treat black patients only” and focus on hygiene to prevent disease from spreading to whites—a profoundly racist stance.
  • Chuck: "The medical Education of the Negro...he shows a real disdain for black medical schools." (24:49)
• Women’s colleges were minimized: “I don’t think women can withstand the mental rigors of being a doctor.” (25:49)

5. Implementation & Philanthropy

• Flexner’s recommendations were enacted via vast philanthropy (e.g., Rockefeller Foundation), allowing university-affiliated, research-based schools to thrive and others to shutter.
• (30:23) Within five years, over 50 U.S. med schools closed; after 20 years, only 76 remained from the original 148.
  • “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.” (30:23)
• The reformed system further increased expense and exclusivity—now, only those with means and strong academic credentials could hope to attend.

6. Lasting Impact: The Good and the Bad

• Positives:
  • Standardized, scientifically rigorous, and effective medical care in the U.S.
  • Acceleration of medical advances (e.g., successful cancer treatment, overall improved public health).
  • Elevated medicine from trade to respected profession; doctors’ autonomy and societal influence increased.
  • Chuck Bryant: “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…" (38:20)
• Negatives:
  • Disproportionately harmed black and women physicians—only 2% of American doctors are Black, though 13% of population is Black. Estimated 30,000 Black doctors weren’t produced due to med school closures. (31:00)
  • Racist and sexist attitudes institutionalized.
  • Dismissal of alternative/holistic traditions, some of which are seeing renewed interest (meditation, nutrition in mental health).
    • Josh Clark: “He definitely threw the baby out with the bathwater in a lot of cases.” (38:29)
  • Over-emphasis on science/rationalism led to a depersonalized medical system; doctors seen as detached from patient humanity. Research prioritized over clinical relations.
    • “Because Flexner was not a physician, he really ignored the idea of the physician as a healer. The patient became… a walking bag of medical issues.” (32:31, Chuck)
  • Helped set the stage for “Big Pharma.”

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Notable Quotes & Memorable Moments

• “If you enjoy being treated successfully for cancer, you can pretty much thank the Flexner Report for that. But at the same time...if you believe there are alternative therapies...then yeah, you probably don’t like that part.” – Chuck Bryant, 02:37
• “The inexcusable degree of ignorance begins just where the ability to pay fees leaves off.” – Josh Clark quoting Flexner, 20:25
• “Five of the seven black medical schools were recommended for closure...” – Josh Clark, 23:40
• “I don’t think women can withstand the mental rigors of being a doctor...women make better patients than doctors.” – Josh Clark recounting Flexner’s sexism, 25:49
• “The curse of medical education is the excessive number of schools. The situation can improve only as weaker and superfluous schools are extinguished.” – Josh Clark quoting Flexner, 22:01
• “The medical profession lost a lot of, I guess, connection with the rest of us...doctors are kind of looked at as looking at the rest of us as not fully human.” – Chuck Bryant, 32:31
• “He had his sights 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 base on some stuff for sure. But again, this was 1910.” – Josh Clark, 21:10
• “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.” – Chuck Bryant, 37:28
• “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.” – Josh Clark, 38:31

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Timestamps for Key Segments

• 01:15 – Episode intro; why the Flexner Report matters
• 03:35 – State of medicine in America before Flexner
• 06:53 – The rising influence of Harvard, then Johns Hopkins
• 08:35 – AMA’s anti-homeopathy crusade
• 10:54 – Why and how Flexner was chosen
• 16:51 – How Flexner conducted his study
• 17:44 – Flexner’s three-way classification: Good, Needs Improvement, Close
• 20:25 – Scathing language, criticism of for-profits and alternative medicine
• 22:01 – Call for mass closures
• 24:49 – Racist prescriptions for black medical schools
• 25:49 – Sexism: On women in medicine
• 27:57 – Medical philanthropy and new school standards
• 30:23 – Closures and impact in the following decades
• 31:00 – The impact on black doctors and representation today
• 32:31 – Loss of patient focus in medicine
• 35:01 – Erasure and slow return of non-allopathic modalities
• 37:26 – The century-long backlash and recovery
• 38:20 – Balancing the positive and negative legacy

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Tone and Style

True to SYSK form, Josh and Chuck maintain their conversational, witty, and thoughtful tone, balancing serious critique with humor and approachability. They cite personal anecdotes, throw in historical side notes, and make the story accessible—while occasionally riffing with pop culture asides and gentle sarcasm.

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Conclusion

This episode delivers a rich, nuanced exploration of a complex event in medical history, inviting listeners to consider both the necessity and cost of reform—and suggesting (as modern critics do) that medicine may be overdue for a new kind of Flexner Report oriented toward inclusion, humility, and rediscovered humanity.

Transcript

[Josh Clark]

This is an iHeart podcast. Guaranteed Human.

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[Josh Clark]

Welcome to Stuff youf Should Know, a production of iHeartradio.

[Chuck Bryant]

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.

[Josh Clark]

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

[Chuck Bryant]

Oh, that's a good one.

[Josh Clark]

Yeah. Emily, of course, everyone knows if they listen to the show, is an organic gardener and an herbalist. And 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. 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.

[Chuck Bryant]

It sure did, Biff.

[Josh Clark]

Yeah. And it was also racist and sexist.

[Chuck Bryant]

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

[Josh Clark]

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.

[Chuck Bryant]

Yeah, for sure. And there's not many people who are like, no, the Flexner Report sucks. It was all bad. Because 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's. It was a, it was a good thing. There seems to be now among, you know, thinking people who don't just wade and wallow and dogma 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.

[Josh Clark]

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.

[Chuck Bryant]

Oh, it's bad.

[Josh Clark]

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 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 curricula 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.

[Chuck Bryant]

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.

[Josh Clark]

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.

[Chuck Bryant]

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.

[Josh Clark]

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.

[Chuck Bryant]

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.

[Josh Clark]

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.

[Chuck Bryant]

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

[Josh Clark]

Yeah.

[Chuck Bryant]

So, yes, Regardless, by the 1860s, 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. It was lectures, textbooks. That's basically it. So 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.

[Josh Clark]

Yeah.

[Chuck Bryant]

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

[Josh Clark]

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 see, was based on the German model.

[Chuck Bryant]

Right.

[Josh Clark]

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.

[Chuck Bryant]

No.

[Josh Clark]

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.

[Chuck Bryant]

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.

[Josh Clark]

Yeah.

[Chuck Bryant]

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

[Josh Clark]

Yeah.

[Chuck Bryant]

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, 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.

[Josh Clark]

Yeah, for sure. The American Medical association was founded in 1847. And one of the reasons, and 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. There 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 50 years.

[Chuck Bryant]

Wow.

[Josh Clark]

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.

[Chuck Bryant]

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

[Josh Clark]

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

[Chuck Bryant]

Oh, wow. So homeopathy works. Case closed. So, yes, I think that you've really put your finger on it. The AMA became the arbiter of what quantum qualifies as medicine in the United States thanks to this Flexner report. It basically strengthened all of its position. And, 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. 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.

[Josh Clark]

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

[Chuck Bryant]

Well, one of the reasons he was selected is he was already a. 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 theorist. And he was fully on board with that kind of thinking.

[Josh Clark]

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, wait till he finds out what's happening in medical schools.

[Chuck Bryant]

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 was. 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.

[Josh Clark]

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, flexing a 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.

[Chuck Bryant]

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 Flexman 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, ja, ya, da.

[Josh Clark]

Yeah.

[Chuck Bryant]

No, that's Russian. Das Boot. That's German. Nice.

[Josh Clark]

What else?

[Chuck Bryant]

The Heimlich maneuver.

[Josh Clark]

Yeah, that's it.

[Chuck Bryant]

Bratwurst, cider.

[Josh Clark]

Okay.

[Chuck Bryant]

Yeah, all that stuff. Oktoberfest, but with a K. Should we take a break? Yeah.

[Josh Clark]

All right. You're gonna think. Did you say Ja? 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.

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[Chuck Bryant]

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[Chuck Bryant]

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

[Josh Clark]

Mm, yeah.

[Chuck Bryant]

Oh, wait. Frankenstein. Yeah, that's it.

[Josh Clark]

Do you see that new Frankenstein movie, the Bride? No, no, no. The. What's his name? It's a new Frankenstein movie.

[Chuck Bryant]

I don't know. The Rock. Who?

[Josh Clark]

No, the director. Guillermo del Toro's.

[Chuck Bryant]

Oh, no. Frankenstein. What'd you think of it?

[Josh Clark]

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

[Chuck Bryant]

Mikey Gyllenhaal is redoing the Bride in like a really strange, like out there kind of fashion. That looks interesting.

[Josh Clark]

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

[Chuck Bryant]

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

[Josh Clark]

So back to the Flexner Report. He started that research in 1908. I think the thing came out in 1910 like we said. But he went around all over the place. He went to 155 medical schools, 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.

[Chuck Bryant]

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 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.

[Josh Clark]

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

[Chuck Bryant]

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

[Josh Clark]

A lot. Most, in fact.

[Chuck Bryant]

Yeah. And it wasn't just like him being a snooty butthead. As we said, 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 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 know what they're wanting to do, but the hospital associated with it is too small. And 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. The varying degrees of how much money you would need and whether you were. You're headed in the right direction.

[Josh Clark]

Yeah, for sure. The way he wrote in what was called Carnegie Foundation Bulletin Number 4 or Medical Education in the United States and Canada, aka Flexner Report was that 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.

[Chuck Bryant]

So people would write it that way today, unfortunately.

[Josh Clark]

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.

[Chuck Bryant]

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

[Josh Clark]

Yeah, I mean, he had a sightset 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.

[Chuck Bryant]

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, as we'll see in a minute, if you were underfunded, that was it. Sorry.

[Josh Clark]

Yeah.

[Chuck Bryant]

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 you 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.

[Josh Clark]

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. The situation can improve only as weaker and superfluous schools are extinguished.

[Chuck Bryant]

Right.

[Josh Clark]

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

[Chuck Bryant]

So one seventh of them.

[Josh Clark]

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?

[Chuck Bryant]

Yeah. He actually recommended reducing the full number of schools in the US and Canada from 155 down to 31. 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. 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 and ideally to patients, although he didn't put much emphasis on that part.

[Josh Clark]

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 D.C. and Meharry 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 to treat black patients only. And they should really just concentrate on hygiene.

[Chuck Bryant]

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 document about medicine in 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 University and Meharry Medical College in Georgia made the cut was really substantial. Like that was sadly a really big positive for black medical schools, unfortunately.

[Josh Clark]

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 3 Women's Medical College colleges even existing. And Plexner himself basically came out and said, I don't think women can withstand the mental rigors of being a doctor.

[Chuck Bryant]

He never met Elizabeth Blackwell.

[Josh Clark]

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

[Chuck Bryant]

This is the 1910s.

[Josh Clark]

Yeah, it's not like 1810.

[Chuck Bryant]

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 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. Yeah, 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, like, you just out of the gate had to have money to even try to apply to medical school. And, and then the, 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 tradespeople 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 now.

[Josh Clark]

That's right. And part of it 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 1910 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.

[Chuck Bryant]

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

[Josh Clark]

Should we take a break?

[Chuck Bryant]

Let's take a break.

[Josh Clark]

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

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[Josh Clark]

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 reports released, 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 remained. 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.

[Chuck Bryant]

Right. So 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 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 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.

[Josh Clark]

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.

[Chuck Bryant]

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 doctors are kind of looked at as 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.

[Josh Clark]

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 how 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 eyeballs on a microscope and not like eyeballs on a human. It's all sort of tied in together, I think.

[Chuck Bryant]

Yeah. And the other way that that manifested itself was a huge emphasis on separating academic physicians from practicing physicians so the 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.

[Josh Clark]

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?

[Chuck Bryant]

I've heard both.

[Josh Clark]

Okay.

[Chuck Bryant]

I say them both at the same.

[Josh Clark]

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 how nutrition, food can alter 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 flexion 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.

[Chuck Bryant]

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

[Josh Clark]

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

[Chuck Bryant]

Yeah, for sure.

[Josh Clark]

It's just not super funded and you're not going to find any, like, huge, you know, 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 Bactine or Whatever it really is.

[Chuck Bryant]

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

[Josh Clark]

Yeah, totally.

[Chuck Bryant]

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' will drastically reduce the kind or amount of meds you'll probably need.

[Josh Clark]

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

[Chuck Bryant]

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, with the ama, got the Rockefeller foundation to fund and create this new model for America.

[Josh Clark]

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.

[Chuck Bryant]

Oh, well put.

[Josh Clark]

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 not been written. And, like, I'm sitting here with, like, a leech on my forehead.

[Chuck Bryant]

Right. Or I have typhus.

[Josh Clark]

Yeah, exactly.

[Chuck Bryant]

Yeah, I agree with you, Chuck. This is a good one. Thank you, Emily, for it. Thanks, Josh.

[Josh Clark]

You're welcome.

[Chuck Bryant]

That was a great Emily.

[Josh Clark]

Nice seeing you in San Francisco, buddy.

[Chuck Bryant]

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.

[Josh Clark]

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?

[Chuck Bryant]

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

[Josh Clark]

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.

[Chuck Bryant]

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

[Josh Clark]

It is interesting to learn how the sun or 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.

[Chuck Bryant]

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

[Josh Clark]

Yes, Kyle, that was wonderful.

[Chuck Bryant]

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 podcastheartradio.com.

[Josh Clark]

Stuffy sh should know is a production of iHeartRadio. For more podcasts my heart radio, visit the iHeartRadio app. Apple Podcasts are wherever you listen to your favorite shows. This is an iHeart podcast. Guaranteed Human.