Living life day to day it is easy to forget that ideas can change the world sometimes much faster and more profoundly than we expect. Before the Civil War, for example, John D. Rockefeller was just a boy and his father “Big Bill” Rockefeller was a quack physician selling bottles of creosote to cancer patients for 25 dollars apiece. The family, as might be expected, moved frequently.
After the war, while John D. was getting started in the oil business, a large and growing Jewish-German immigrant family was struggling to get along in Louisville, Kentucky. Two of Mr. And Mrs. Flexner’s seven children would ultimately partner with Rockefeller to revolutionize medical education and practice in America. Simon, the older of the pair, was a renowned pathologist and bacteriologist. Recruited from the medical faculty at Johns Hopkins University in 1903, he organized the Rockefeller Institute for Medical Research (now Rockefeller University). Where he later pioneered a technique for isolating the polio virus. This work contributed directly to the later development of a vaccine for this dread disease.
His younger brother Abraham initially settled on a career in education. He spent 19 years as a secondary school teacher of Latin and Greek before leaving to do graduate work at Harvard and the University of Berlin. Everything changed when the Carnegie Foundation for the Advancement of Teaching tapped him to carry out a comprehensive study of medical education in America. He visited all 155 medical schools in operation at that time. In 1910, the findings were published in a report opaquely titled “Bulletin Number Four” but always referred to as the “Flexner Report.” Twenty years later, Flexner became the director of the Institute for Advanced Study at Princeton. It was there that he became known as “the man who brought Einstein to America.”
The Flexner report presented a scathing critique of the state of medical education at the time. It concluded that 120 of the weaker American medical schools in should be merged or closed leaving just 32 in operation. It is hard to argue with this stern prescription given the President of Harvard’s view that “The ignorance and general incompetency of the average graduate of American Medical Schools, at the time when he receives the degree which turns him loose on the community is something horrible to contemplate.”
The collision of a very real need for fundamental reform in medical education, the Flexner’s avowed belief in the superiority of the Johns Hopkins model of medical training and Rockefeller’s philanthropic ambitions created something like a perfect storm. With the hundreds of millions of dollars he poured into the new, standardized approach to medical education John D. could drive confusion and “sinful” competition out of American medicine just as he had done with the oil business. A quack cancer doctor brought into the world a son who, with the Flexner brothers at his side, would standardize American medicine. The boy ensured that there would be no place for an itinerant cancer-doctor to sell his snake oil and then slip out of town never to be seen again.
The One True and Only Doctor
Before it was standardized, American medicine was home to a half a dozen competing philosophies and approaches. They were in open conflict with each other their practitioners routinely savaged others for their bungling and mistakes. Critics of “regular” physicians continue to cite the ill-treatment of “the Father of our Nation” as a reason to fear conventional medicine. “When George Washington lay dying, the country’s best physicians, from Harvard and Yale, proceeded to kill him by draining 3 QUARTS of blood, giving him several doses of Calomel (mercury sub-chloride) and covering his body with blisters.” Despite their obvious, and fearsome, ineffectiveness, the practice of the “regular” physician was the foundation upon which Rockefeller decided to build a new American medicine would be the foundation on which the standard medical practice would be built.
The approach favored at Hopkins and thus chosen to be elevated, permanently above all others was called “allopathy.” Initially used as a slur against medical doctors, the term actually refers to the practice of healing through opposites. If the patient is retaining water, then a drug that promotes urination is the answer. If a persistent cough is the problem then a cough suppressant is the answer. I am an allopath and I think that allopathy has much to offer all of us. All prescription drugs are allopathic medicines.
Once relieved of its formerly beloved purgatives, leeches and lances, allopathy proved itself to be quite effective in addressing illnesses and injuries. It has given us laser eye surgery, titanium prosthetic hips, Viagra, heart transplants, cancer chemotherapy, Vioxx, insulin, the polio vaccine, Rogaine, coronary artery bypass surgery, MRIs and Thalidomide. Allopathy has proven both its power and the damage it can do when used less than skillfully. It deserves the central role it now plays in our health care system but, in 1910, it was just one of many different approaches to health and healing.
Thomsonian Medicine was founded by Samuel Thomson (1769-1843) a farmer and self proclaimed “root doctor.” His approach relied heavily on Native American herbal remedies and sweat baths. Thomson embraced a Jeffersonian belief in “every man as his own doctor” and was relentlessly critical of the medical establishment of his time. Most of his criticisms were merited but they enraged the regular doctors who opposed Thomasonian Medicine at every turn. Unable to survive in America, the system was exported to England where it flourished and was taught at the four-year College of Herbal Medicine until the 1970s.
Originally known as the American System of Medicine, Eclecticism encouraged the selection of therapies from a range of medical approaches including Allopathy, Homeopathy, Naturopathy and Hydrotherapy. At its peak in the late 19th Century there were 10,000 Eclectic physicians practicing throughout the United States. With eight legitimate eclectic medical schools its place seemed secure. It turned out that the eclectic were no match for the enduring enmity of the American Medical Association combined impact of Rockefeller foundation money and the Flexnor Report weighed heavily on the movement. The Eclectic Medical College, the last school of Eclectic Medicine, closed its doors in 1939. The health care system we have today would be radically different if Rockefeller had opened his purse to the Eclectics. Alas, it was not to be.
Homeopathy was the creation of Samuel Hahnemann (1755-1843), a German physician who developed the “law of similars” into a practical medical philosophy. The word “homeopathy” is derived from the Greek “homoios” which means “similar” and “pathos”— suffering. Unlike allopaths who believed that opposites should form the basis of therapy, homeopaths held that “like cures like.” This idea can be turned back to the doctrine of signs. The quaky aspen leaf is similar to the tremor of the human hand and thus might be used as a treatment for that tremor. The impetus for the formation of the AMA came largely from the desire to turn back the gains made by homeopathic doctors.. One Connecticut physician was expelled from his local medical society for consulting with a homeopath–his wife. Apothecaries didn’t like homeopathy either, because its practitioners insisted upon using tiny “homeopathic” doses, and their prescriptions could rarely be filled at a profit.
Even Mark Twain felt compelled to weigh in on the issue of Homeopathy. Quoted in Harpers Magazine in 1890, he vouched for homeopathy and tweaked the nose of the medical establishment. “The introduction of homeopathy forced the old school doctor to stir around and learn something of a rational nature about his business.” Despite a concerted (many would call it vengeful) campaign to destroy homeopathy, it continued to grow. By 1900 there were 22 homeopathic medical schools giving this discipline a respectable share of all the medical colleges operating at that time. Then came Flexner. In 1923 only two of these schools remained in operation. By 1950 no homeopathic colleges remained in the U.S.
The battle had been joined, a standard imposed and medical education in America was, on the whole, vastly improved. Even though much was gained we should not lose sight of what was lost. Alternative and, potentially, complementary systems of medical thought are important to our health care system in the same way that a diversity of species strengthens an ecosystem. The extinction of a bird or mammal is a loss, profound and enduring. The approaches that were eliminated during the rise of allopathy (and others that have developed since then) can, as Twain pointed out, make the existing system better.
It is time to let Doc Rockefeller rest in peace and begin exploring a new broader scope of health and healing. There are and always have been multiple legitimate approaches to the problem of alleviating human suffering.
Monopoly is bad Medicine.