We have already heard how the Flexner Report in 1911 reduced doctors to robotic drones, beholden to corporate America, under the strict rule of AMA policies and dictates, who were taught that patients are nothing more than a series of numbers to be measured and fixed. The blueprint of Flexner--drawn up by corporate tycoons, eugenic doctors, and the AMA brass--sought to homogenize American medicine, make it subservient to corporate America, and reduce it to a one-right-answer "science" in which human nuance, individual choice, and the breath of scientific knowledge is bulldozed by dogmatic absolutism, much as we are seeing with COVID but which has been present since 1911 when the report was published. The critical thinking and humanistic patient-centered gaze advocated by William Osler collapsed in the face of what we have today: doctors following protocols, treating numbers, and acting as unwitting pimps of the pharmaceutical industry, all while touting that they are scientific and patient-oriented. Sadly, Flexner did to our doctors what the German educational system--upon which the Flexner Report was based--did to its doctors, the majority of whom became enthusiastic Nazi's. Really, there is little difference between us and them.
One lost legacy of Flexner is how the report essentially--and intentionally--decimated the black physician professional class and relegated all black Americans to potential spreaders of disease to whites whose contagion had to be contained. The Report--which is still the foundation of our health care system today and how medical students are trained--devoted several pages to describing its anti-black position, claiming it to be necessary, and which the AMA had been already practicing for decades. The Report's recommendations closed all but two black medical schools, depriving them of funding and seeking to transform them into institutions to train black health-workers whose sole job was to keep black Americans from spreading disease to whites.
As the decades progressed, the exclusion and marginalization of blacks within our health care system only worsened, and black physicians had to fund their own schools and create their own medical organization--the NMA--merely to survive. Black Americans have suffered the consequences of this horrific policy. Only recently did the AMA apologize for its racist past, but the gears of that racism inscribed into the Flexner Report still drive our entire medical-industrial complex today.
Part 3 of our Flexner podcast mini-series is a bit long and taken from the final project I completed as a student at University of Maryland last year, where I am working toward a Masters of History. While this is a bit of a detour from the theme of the podcast, it's crucial to know just how deeply racism is embedded in our health care system even today, and understand the roots of its perfidy, the very roots that drive the cogs of the doctors who you trust so much but who remain shackled by the handcuffs of Flexner.