When medicine lost its soul

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Anybody heard of the Flexner Report? Can’t miss it—a big report, published more than a hundred years ago. Anybody? Mrs Flexner perhaps? No, you probably haven’t heard of it. Yet you live with its consequences every day.

The report, published in 1910, laid the foundations for the teaching of the new “scientific medicine” in medical schools across the United States, and was quickly adopted by medical colleges throughout Europe and, later, the world.

Educationalist Abraham Flexner was commissioned to inspect US medical training and report back on what he had discovered. Impressed by the scientific rigor of the German education system, he was shocked that nearly half of American schools were teaching what he essentially regarded as the dark arts—homeopathy, the most widely-practiced type of medicine in the US at the time, plus herbalism and natural medicine.

An enormous bursary was raised, schools already leaning toward “scientific medicine” were improved, and new colleges created. Through a relentless campaign of ridicule and worse, slowly the homeopathic schools started to close their doors. For good measure, some homeopaths were also imprisoned.

But even as the ink was drying on the report, associates of Flexner’s worried about the path medicine was suddenly following—and their concerns are still as relevant today.

The biggest critic was William Osler, who was part of the ‘Hopkins Circle’ of which Flexner was also a member. Osler, who became the first chief of medicine at the newly created Johns Hopkins School of Medicine, was worried that the new generation of “scientific” doctors would become removed from their patients and lose touch with them and their day-to-day worries. Instead, doctors would be trained to be “clinical prigs.”

Essentially, the art and humanity of medicine would play second fiddle to a science that viewed the patient as an assemblage of body parts sometimes in need of fixing, Osler warned. This sparked the rise of specializations where parts of the body became the sole focus—and the patient, as a person, disappeared.

Others joined in his concern, but cash spoke louder, and “their voices were hushed by the irresistible seduction of large sums of money tied to implementation of the fulltime system,” wrote Thomas Duffy from the Yale School of Medicine, looking back on the publication of the Flexner Report 100 years later.1

The principal benefactor of the report and the new colleges was oil magnate John D Rockefeller; industrialist Andrew Carnegie, his close friend, also added millions to the project through his foundation.

Rockefeller’s trusted adviser Frederick Gates, a member of the Hopkins Circle, is credited with convincing him to help finance the burgeoning scientific medicine movement—not that he may have needed much convincing.

A decade or so before the Flexner Report, scientists had discovered petrochemicals, from which all kinds of oil-based products could be created, such as plastics, soaps. . . and pharmaceutical drugs. With his Standard Oil conglomerate, Rockefeller controlled around 90 percent of the oil wells in the US and, from that, the petrochemicals market.

It was also the age of mass production, and Rockefeller and his cohort were able to produce drugs in the tens of thousands—but they needed the science to demonstrate these pills were safe and effective for everyone.

It was another character in the drama, Henry Pritchett, the head of the Carnegie Foundation, who started the process by singling out Abraham Flexner to prepare the report that would be the blueprint for teaching scientific medicine.

But it was like a Faustian pact, Dr Duffy believes. Flexner helped medicine give up its soul—its humanity, its caring—for the science, the “irresistible allure of knowledge.” Flexner wasn’t a doctor, and so he had no appreciation for the caring aspect of the art of healing, but saw only the dry, measurable science of medicine.

By way of thanks for his part in the Faustian pact, Rockefeller appointed Abraham Flexner’s brother, Simon, to head up the Rockefeller Institute.

The Flexner Report ushered in the age of “hyper-rationalized medicine,” said Duffy, which has given us the medicine we see practiced every day. But perhaps it is time for a new report, one that rediscovers medicine’s roots of caring, and makes healing a humanity as well as a science.