The Man Who Invented Medical School

Elsewhere on our site, there's a lively debate raging around David H. Freedman's recent Atlantic magazine story about alternative medicine. Today, we're featuring a response by David Colquhoun, an acerbic British pharmacologist who bemoans the decline of The Atlantic, the folly of his fellow panelists, and the crumbling of the entire U.S. health care system.

Writing about the growing number of American doctors who support alternative medicine, Colquhoun laments:

This is all very sad for a country that realized quite early that the interests of patients were best served by using treatments that had been shown to work. The Flexner report of 1910 led the world in the rational education of physicians. But now even places like Yale and Harvard peddle snake oil to their students.

As it happens, the author of that report, Abraham Flexner, was an Atlantic contributor. In 1910, the magazine published "Medical Education in America," an excerpt from his landmark report on America's 155 medical schools. "Not a few so-called university medical departments are such in name only," Flexner wrote, explaining how a loose apprenticeship system turned into an unregulated industry that churned out "rapidly made doctors."

Flexner himself wasn't a physician, but his critique had a sweeping influence on the way medicine was taught. After his report, about half the medical schools in the United States closed their doors forever. Those that met Flexner's strict empirical standards were rewarded with plentiful foundation money from John D. Rockefeller and Andrew Carnegie.

It's hard to guess what Flexner would have thought of our current article, in which doctors from America's most reputable medical institutions praise alternative therapies they don't fully understand. ("Who cares what the mechanism is?" a Mayo Clinic endocrinologist asks author David H. Freedman. "The patient will be healthier.")

But there's reason to think Flexner would have approved of doctors like Dean Ornish, who, in our debate, argues that inspiring patients to eat vegetables and reduce stress does more to prevent heart attacks than bypasses or angioplasties. As Flexner wrote in his 1910 report:

The physician's function is fast becoming social and preventative, rather than individual and curative. Upon him, society relies to ascertain, and through measures essentially educational to enforce, the conditions that prevent disease and make positively for physical and moral well-being. It goes without saying that this type of doctor is first of all an educated man.