evidence based medicine and the flexner report

THE FLEXNER REPORT
AND
EVIDENCE-BASED MEDICINE

Flexner Report

Mohamed Hassan – Giza/Egypt – Pixabay

“Truth is stranger than fiction.”  Mark Twain
“He who pays the piper, calls the tune.”  Old English Proverb
The only place that the old idiom, “he who pays the piper calls the tune,” could possibly be more true than in the field of medicine is in the field of politics.  Today we will deal with both.  But wait, you say.   Don’t we now live in the UTOPIAN WORLD of EVIDENCE- BASED MEDICINE?  Isn’t everything in medicine ‘scientific‘ now?  Haven’t bias, prejudice, and simply doing things for financial gain all been eliminated?  Suuuuure they have.  And I have this bridge in Brooklyn that I would just looooove to make you a great deal on.  But first things first.   Allow me take you on a short journey back in time.  I want you to meet John D. Rockefeller — a man who, when inflation is accounted for, is widely considered the richest self-made man who ever lived. 

John David Rockefeller was born in 1839 in New York to a mother who was a devout Baptist, and a father who wore many hats including that of the traveling huxter; a snake oil salesman whose specialty was selling quack medicine to anyone gullible to fork over the bucks (he fancied himself a “botanical physician” and was known locally as “Devil Bill“).   Since Bill was rarely home and did not play a large role in the day-to-day raising of his six children (including John David), things were tough and the family tended to move around.  Shortly after moving to the Cleveland area when Rockefeller was 14, JD got a job as a bookkeeper in a produce business. Considered bright, articulate, highly religious (he tithed 10% to the Baptist church throughout his lifetime), and exceptional at verbally expressing himself and his opinions, he had, by age 20, learned enough of the trade to go into business on his own. 

Rockefeller worked hard and was extremely successful.  With his knack for business, it did not take long for him to find his way into the budding oil industry.  In fact, you may have heard of his company; Standard Oil.  By the time he was a middle aged man; between oil, railroads, and shipping, he was literally making money hand over fist (he was the world’s first billionaire).   Because Standard Oil refined between 80 and 90% of the world’s crude during most of his lifetime, he was accused of and eventually convicted of holding a monopoly under the Sherman Anti-trust Act of 1890.  By this time, he was also butting heads with the steel magnate, Andrew Carnegie.  And although he lived to be nearly 100 years old, he was retired by the time he reached his early 60’s, earning tens of millions of dollars a year on his investments, and becoming well known for giving away his money to causes that he not only believed in, but would sooner or later provide a substantial ROI.

ANOTHER MONOPOLY

By the mid 1800’s, a form of natural healing called “Homeopathy” (developed by German physician Christian Samuel Hahnemann), had become a huge player in American medicine, with some sources claiming that Homeopathic Doctors outnumbered Allopathic Doctors nearly 2:1.  Homeopathy, founded on the “like cures like” principle, was in direct opposition to Allopathic Medicine — the form of medicine practiced today which is said to be the only “scientific” form of medicine, and based largely on drugs and surgery.  Homeopathy found itself increasingly in the cross hairs of the Allopath’s national organization; the AMA (American Medical Association), which had been formed in 1847 largely as the result of Allopathic Medicine’s perceived need to squelch the gains made by the Homeopaths. 

Although not nearly as common today, we still see this “homeopathic” thought process in play today with things like allergy shots, and even on some level, vaccines (although the homeopathic remedies were far more diluted than vaccines).  Rockefeller was not only a proponent of Homeopathy (he is said to have actually preferred it), but also an owner / developer of early biotech companies that among other things, created medicine and vaccines. 

The brilliant Rockefeller who never missed a trick when it came to seizing the chance to make money, saw an opportunity and took full advantage of it.  Which brings us to his plan to commandeer modern medicine.  Rockefeller began to realize that just like other industries he was deeply involved in (oil, railroads, shipping, steel, etc), the whole of medicine had the potential to be controlled as well —- at a handsome profit.  This was particularly convenient considering he suspected he was about to get busted for monopolizing the oil industry.   If his plan could come to fruition, there would be no more wandering “Devils” hawking coal tar from the back of their wagons.  The pharmaceutical industry would become mainstream and scientific, with its wares (drugs and surgery) being promoted, prescribed, and sold by educated and respectable people wearing white jackets.  

ROCKEFELLER’S CONNECTION TO EUGENICS

THE PERFECT STORM

Eugenics Rockefeller

Bundesarchiv, Bild 119-5592-14A / CC-BY-SA

Rockefeller, via his investment manager Frederick T. Gates (a highly motivated ex-Baptist pastor, who had become secretary of the American Baptist Education Society before coming to work for Rockefeller), was making an increasingly concerted effort to subdue and control the field of medicine.  Lest you think that this is nothing more than the titillating stuff of conspiracy theories, just remember that over the course of three years at the turn of the century, Rockefeller established his Medical Research Institute, built the EUGENICS LABORATORY on Long Island (a think tank to some of Adolph Hitler’s “master race” theories, and currently home of the Human Genome Project), and worked to see that laws for mandatory vaccination were passed (by 1905, 11 states had them).  The “Philanthropy Roundtable” website says this about Rockefeller, “within his lifetime, Rockefeller helped launch the field of biomedical research, funding scientific investigations that resulted in vaccines…….“.   Think about it for a moment, if you have the power and means to both manufacture the product and see that the government mandates its use in the general population, you will make money.

In the early 1900’s, this battle between Allopathic Medicine and the several competing forms of “Alternative Medicine” (often referred to back then as “Eclectic Medicine”) came to a head.  Rockefeller had previously used one Simon Flexner, a physician and researcher on staff at the brand new Johns Hopkins University, to organize his Rockefeller Institute for Medical Research just after the turn of the century (it eventually became Rockefeller University).   In 1907, Rockefeller hired Simon’s brother, Abraham; a ‘cutting edge’ school principal from Louisville, Kentucky who had modeled his private school on the teachings of John Dewey, America’s “Father of Modern Education“, and original author / signer of the First Humanist Manifesto

Before taking on this endeavor, Abraham did research on medical education and practice.  The European method resonated with his love for science, and he soon become enamored with the German system in particular — the system that Johns Hopkins was based on (and his brother just happened to work for).  The results of the book-length “Flexner Report” of 1910 led to sweeping reforms in American medical education and practice.  For better or worse, within a matter of years, the number of medical schools had decreased by 80% (from 150 to 30) and in less than a generation, the Homeopathic Schools were totally gone. 

Dr. Bill Bowman (M.D.) —- in an article making the point that the Flexner Report was particularly bad for rural America — put it this way.  “He began his visits in January of 1909 and finished April 1910. His aggressive schedule barely allowed him a whole day each for the evaluation of some schools. His efforts were closely linked with the American Medical Association, who provided resources. An AMA official accompanied Flexner throughout most of this period. Some feel that Flexner had inadequate time to do the visits including one stretch of 90 days where he visited 69 schools.

A popular online encyclopedia had this to say about the work he was doing.  “Flexner clearly doubted the scientific validity of all forms of medicine other than that based on scientific research, deeming any approach to medicine that did not advocate the use of treatments such as vaccines to prevent and cure illness as tantamount to quackery and charlatanism. Medical schools that offered training in various disciplines including eclectic medicine, physiomedicalism, naturopathy, and homeopathy, were told either to drop these courses from their curriculum or lose their accreditation and underwriting support. A few schools resisted for a time, but eventually all complied with the Report or shut their doors.

As I write this, we are being pounded by ice, snow, and the 20 below wind chills of winter storm “Titan”.  Everything came together to create the perfect conditions to leave us in a real mess.  Rockefeller was taking full advantage of a different kind of “perfect storm”.   When you add together the appalling state of facilities in most of the nation’s medical schools, the heavy backing of the AMA for Flexner’s work, and Flexner’s infatuation with the Germanic system of medicine (i.e. Johns Hopkins University in Baltimore, founded in 1893 was the school that all others were measured against), it created the perfect environment for Rockefeller to begin working his magical Midas touch in the field of medicine.  

Rockefeller and the Carnegie Foundation (an organization which as near as I can tell is now under the umbrella of and controlled by the Rockefeller Foundation) published their study on the state of the various medical schools in the United States and, along with the full backing and financial support of the AMA, began a massive advertising campaign to let the public know what constituted “good” medicine, and what constituted quackery.  You either got on board or got out.

As an important side note to this issue, a decade earlier Carnegie had written a series of articles called The Gospel of Wealth.  His premise was that since he and Rockefeller now owned everything of any real value (including the government), the American system of free enterprise (capitalism) was dead.  There would be no competing businesses unless allowed.   Furthermore, Carnegie wrote that every aspect of life and business would be regulated through various forms of licenses, which, only the highly educated (i.e. wealthy) would be able to obtain.  The stated reason?  Carnegie said the the goal was to be able to control all facets of day-to-day life, including education and economics by social engineers like himself, Rockefeller, and a few select others.  Quite interesting in light of what is currently going on with government-backed educational programs such as Common Core.

Today you can get on the internet and read about a jillion articles on “The Illuminati”, Rosicrucians, Freemasons, the Knights Templar, and who-knows-what other “Skull & Bones” types of organizations these folks (Rockefeller, Carnegie, Ford, and others) were supposedly involved with.  I have no real interest in this, and frankly think that most of it is poppycock.  What I do know is that Rockefeller and his fellow philanthropists realized early on that the practice of medicine could be shaped and molded by donating huge sums of money (hundreds of millions of dollars) to follow the European model as recommended by Abraham Flexner.   Instead of allowing individuals, towns,and communities to make their own decisions concerning the various aspects of healthcare, the AMA stepped in with their Council on Medical Education and lobbied the government to begin heavily regulating both medical practice and medical education. 

Although this was not necessarily all bad (there were plenty of quacks, and many of these schools were nothing less than diploma mills that needed to be shut down), it led to a great number of problems including much higher costs for education, fewer rural doctors, fewer female doctors, fewer minority doctors, dramatically higher costs for medical care, and much more governmental control.  And that’s just for starters.  Instead of the free market taking care of itself, medicine became a system propped up and dependent on massive infusions of tax dollars and private grants from the various Foundations.  Fail to follow the new paradigm and you were left out in the cold.  Oh; and don’t forget who “owned” the government at this time.   Rockefeller, and numerous others who held the purse strings in those days had a vision.  They realized that they could change the system and get rich in the process.  Let me show you a tiny example of what I am talking about.

TAKING OVER

Flexner Report

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The first two schools that Rockefeller essentially commandeered for his purposes were Syracuse and the University of Chicago (Wash U in St. Louis, Yale, Harvard, Vanderbilt, Colombia, Tulane, Georgia, Virgina, Colorado, Oregon, Emory, Duke, Kansas, Cornell, Howard, Northwestern, and Rochester, were soon to follow).  Significant donations would be made, and almost immediately, individuals who were critical of the Foundations (or the powers behind the Foundations) and their various endeavors were replaced with people who were sympathetic to his causes (KIND OF LIKE THIS). 

Let me ask you a question.  If your medical school is home to the PFIZER Research Center, the GLAXOSMITHKLINE Genetics Lab, or the Rockefeller Biotechnical Consortium, Do you think that there might be a potential conflict of interest?  Who do you think is funding most of the building occurring on the campuses of our nation’s medical schools?  This one’s a no-brainer.  BIG PHARMA and the Foundations controlled by those who own or have huge financial interest in Big Pharma.   And because the FDA simply “monitors” the research done in these facilities, there is virtually no such thing as 3rd party, independent research in America anymore (HERE). 

Wouldn’t it be interesting to know how much money we are talking about here?  Suffice it to say that over the course of time, there have been tens of billions spent.  According to the American Association of Fund-Raising Council, between the years 1964 and 1968, Foundations funded healthcare (including medical education, capital projects, hospitals, and others) to the tune of 500 billion dollars — dollars which went a lot farther then than they do now.  The problem of Foundational giving got to be so blatant that congressional hearings were convened in the early 1950’s to look into the matter. 

Yale-educated banker and expert on Foundational spending had this to say, “The result of the development and operation of the network in which the foundations (by their support and encouragement) have played such a significant role, seems to have provided this country with what is tantamount to a national system of education under the tight control of organizations and persons little known to the American public . . . . The curriculum in this tightly controlled scheme of education is designed to indoctrinate the American student from matriculation to the consummation of his education.”   Of course, this begs the question of how much is being spent today. 

Although hard numbers are sketchy to say the least, I would guess that about 50% of the researchers at our nation’s medical research facilities are getting at least a portion of their salaries paid for by Foundations (many of which are funded directly by Big Pharma), with probably about one in five receiving their entire salary in this manner.  And this is only salaries.  Don’t forget all the other aspects of the giving.  Thus; how likely is it that the bastions of science — our medical institutions —- are going to bite the hands that feed them?  Doubtful.  HISTORY HAS REPEATEDLY SHOWN US that this industry is not doing a great job of policing itself.  And let’s be honest.  The greater the amount of money involved, the greater the temptation to cheat.

Furthermore, if you study the FDA ITSELF, what you find is that there is incredible turnover at the top of the organization.  In a day and age where people clamor for the security, benefits, and retirement associated with government jobs, why would this be?  Easy.  These folks get to the top echelon of the FDA, make ‘friends’ within Big Pharma, create policy, and then leave to go make 10, 30, or even 100 times more money in the Pharmaceutical Industry than they could by staying where they are at (HERE).  But this is probably another story for another day. 

With virtually all of the financial and media support swung in favor of Allopathic Medicine, some might say it’s a wonder that Alternative Medicine has survived at all.  The thing you have to grasp is that Alternative Medicine has not only survived, it has thrived.  Twenty year old statistics showed us that millions of more visits were made to the Alternative Practitioners than to Allopths.  And the most recent statistics on the subject (2009) said that most of this was paid for in an out-of-pocket fashion (sans insurance dollars). 

In fact, the July 31, 2009 issue of Time Magazine stated that, “In some 300 million annual visits to chiropractors, massage therapists and other non-physician caregivers, we spend $11.9 billion, about a quarter of out-of-pocket spending for traditional doctor’s visits.”  The total spending on alternatives in 2009 was 34 billion.  What do statistics like this really mean?  Plainly stated; alternatives are valued!  They are valued so highly because they work.  To suggest otherwise would be suggesting that the whole of the American public is just plain gullible and stupid.  But, even though things are slowly improving, much of the medical community continues to take pot shots at the alternatives.  Lest you think I am being overly-critical, take a look at a few recent comments.

“The AMA The AMA did some very regrettable things. They used inappropriate language, referring to chiropractors as rabid dogs. They attacked chiropractors as killers without any supporting evidence. Their intent was to destroy chiropractic. They tried to conceal what they were doing. Their biggest mistake was to prohibit MDs from associating with chiropractors.  The AMA distributed “Quack Packs” and 10,000 copies of an anti-chiropractic book, Ralph Lee Smith’s At Your Own Risk: The Case Against Chiropractic.”  Outspoken critic of Chiropractic, Dr. Harriet Hall from a book review on early Chiropractors.

“I am a family physician from a tradition of scientific allopathic medicine and rational skepticism. I think much of what is today called “alternative medicine” is, at best, effective placebo, and, at worst, fraud. This is an unpopular position in our era of cultural relativism, and it is not often heard. The popular press, the fashionable elite, and many physicians, have embraced herbal remedies and homeopathic medicines. Nonetheless, I feel a professional and cultural obligation to speak out, even if I run the risk of being unfashionable.”  Dr.  John G. Faughnan from Alternative Medicine, A Critique from Scientific Medicine

“The impending national discussion about broadening access to health care, improving medical practice and saving money is giving a group of scientists an opening to make a once-unthinkable proposal: Shut down the National Center for Complementary and Alternative Medicine at the National Institutes of Health.”  From an article by David Brown (Scientists Speak Out Against Federal Funds for Research on Alternative Medicine) in the March 17, 2009 issue of the Washington Post.

“There’s nothing inherently wrong with choosing alternative meds, ‘natural’ meds, and supplements if you find that for you there’s a benefit, and particularly if you can find evidence-based information about what they do. But it’s important to know that if they are having an effect, when it comes to your body, they’re no different from industrial pharmaceuticals.”  Emily Willingham from the February 27, 2013 issue of Forbes (There’s Nothing Special About Alternative Medicine).  Are you joking me?  Natural products like WHOLE FOOD SUPPLEMENTS are not any different than “industrial pharmaceuticals”?  I could debate the merits of this argument with one hemisphere of my brain tied behind my back.

“…there is no evidence that chiropractic treatment has any benefit beyond massage therapy.  In almost every state, there are boards to regulate homeopathic practice as well as, chiropractic boards, naturopathic boards.  They are state sanctioned and licensed treatments that have little or no proven efficacy.”   – Dr. Terry Simpson (Arizona WEIGHT LOSS SURGEON) from an online article on the Flexner Report called Unethical Medicine Sanctioned

THE TIDES ARE TURNING

Let me go on record to say that number one, I could publish several volumes of similar quotes from today’s (as well as yesterday’s) experts on what constitutes ‘scientific‘ medicine.  Secondly, Flexner’s work was not all bad.  Did he throw the baby out with the bathwater?   Unfortunately, I would have to argue that he did.  One thing that would be difficult to argue, however, is that his employer’s agenda coupled with his laser like focus on the “science” of doctoring (to the all-but-complete exclusion of the “art” of doctoring), inadvertently created a vacuum in the field of medicine — a vacuum that people continue to fill with alternatives.   On top of this, current polls tell us that doctors are fried.  They dislike their jobs, and the majority would love to leave the profession they have dedicated their lives to if they were financially able to do so (HERE). 

The truth is, physicians are being overwhelmed by government programs, governmental control, political agendas, bureaucracy, paper work, and outright stupidity.   This might leave some of us wondering what the ultimate legacy of the Flexner Report will be?  Sort of like the famous movie / play “Twelve Angry Men“, the jury is still out, and the jurors are changing their minds in droves.  Listen to what a Yale professor of Internal Medicine and Hematology with over 50 years experience, Dr. Thomas P Duffy, had to say on this particular subject a few short years ago.

Did the Flexner Report overlook the ethos of medicine in its blind passion for science and education?  What was the cost of our success, and who has borne that burden?  Review of medical care in the last century documents that the trust and respect that were extended to the profession 50 years ago have been substantially eroded. There has been a fall from grace of our vaunted profession. Physicians have lost their authenticity as trusted healers. The discontent with doctor’s errors, doctor’s silence, doctor’s experimentation, and the crass monetary orientation of the profession is legion. The profession appears to be losing its soul at the same time its body is clothed in a luminous garment of scientific knowledge.  As it was, the science of medicine eclipsed the active witnessing of our patients.

Edmund Pellegrino’s lament was proven true that doctors had become neutered technicians with patients in the service of science rather than science in the service of patients. How else to explain the seemingly unexplainable Tuskegee experiments, the Henrietta Lacks tissue culture tragedy, the many occurrences in which the physician as scientist has taken precedence over the physician as healer. But this lesion is not restricted to situations in which patients are used as experimental subjects ― it pervades the fashion in which so much of medicine was taught and practiced in the last century. From a 2011 article in the September issue of the Yale Journal of Biology and Medicine (The Flexner Report 100 Years Later). 

WHERE IS ALL OF THIS LEADING US?

Flexner ReportJgaray

Where has all of this taken us, and where are we going to eventually end up?  Considering what we know about disease today, it amazes me that doctors who spend hundreds upon hundreds of hours learning about which drugs should be given for what diseases; there is almost zero time spent studying NUTRITION or simple matters such as GUT HEALTH.  What is the unspoken implication of this thought process?  Natural things are inferior, unscientific, and don’t really matter. 

And although this emphasis on drugs and surgery to the near total exclusion of natural methods of healing has made a lot of doctors a lot of money, I am not sure it is leaving them fulfilled or happy.  What would possibly lead me to make such a bold statement?  Besides the link I left you a few paragraphs ago, let’s look at a few statistics from the most recent survey (2012) of the Physicians Foundation (over 13,500 doctors were included in this poll).

  • When asked about their feeling concerning the current state of the medical field, nearly 70% checked, “negative or somewhat negative“.
  • When asked about their thoughts concerning the future of the medical field, nearly 80% were on the “negative / pessimistic” side of the fence.
  • Over 80% of the doctors polled checked “Somewhat Negative or Very Negative” when asked about physician morale (less than 2% checked “Very Positive”).
  • 85% of those surveyed believe that the practice of medicine is in decline.
  • One third of these physicians said that if they had to do it all over again, they would choose a different profession, and nearly 60% said they would not recommend entering the profession to their children.
  • Over 60% revealed that if they could, they would retire today.
  • Not surprisingly, some of the main reasons given for the low morale and pessimism within the profession include “Too much regulation and paperwork” (99%), “Loss of clinical autonomy” (over 95%), “Erosion of the patient / doctor relationship” (over 90%), “Money trumps patient care” (over 85%), Physicians not compensated for quality” (over 90%).

Statistics like this lead me to believe that many doctors are waking up to the fact that Allopathic Medicine, while providing its share of successes, has in many arenas, been an abject failure.  To begin understanding some of the underlying reasons, one need look no further than the 2007 study on “Clinical Evidence” from the British Medical Journal.  After reviewing nearly 2,500 of the most common medical treatments, they found that only 13 percent were PROVEN to be beneficial.  Twenty years earlier, Duke University’s DR. DAVID EDDY told us that only 15% of medical treatments had any evidence for their use.   Our own government had told us the same thing ten years prior to that — the Office of Technology Assessment’s 1978 study on the same topic found that, “only 10 percent to 20 percent of medical treatment had evidence of efficacy“. 

The pharmaceutical industry cannot continue to demand impossibly high standards of evidence from the Alternative Community, when they cannot attain those standards for themselves.  Face it.  Until we reign in Big Pharma’s stranglehold over medicine (whether directly, through political lobbying, payoffs, and OUTRIGHT FRAUD; or by contributions from “Foundations”), things will never change.  Science will continue be whatever the person or group with the most money says it is, and alternatives will continue to be squelched to the degree that Big Pharma is able to do so. 


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