Flexner – THE FATHER OF UNTHINKING MEDICINE – The Philosophy of Medicine

The Flexner Tragedy

Majid Ali, M.D.

A pilot serves his passengers well when he uses a airplane checklist. A cardiologist also serves his extremely ill patient in a coronary care unit. An artist cannot use a checklist to describe his life experiences. A cardiologist in his office does a disservice to his patient when he uses a drug checklist when he tries to prevent heart disease.

Standards are set tp prevent thinking. Standards assure groupthink. When standards are followed by a professionals, none of them thinks. That, of courses, serves well those who profit from unthinking in medicine—drug monsters and their kept useful idiots who push their drugs.

Ask an experienced surgeon what would happen if he always made his decision to operate for suspected appendicitis only by analysis of clinical and laboratory data and exclude intuition. He will tell you that would substantially increase the number of normal appendices removed as well as cases of perforations of appendix with peritonitis due to delay in surgery. I know that. I trained as a surgeon.

The Flexner Tragedy

I believe one can trace the tragedy of excluding intuition and empiricism from American medicine to an amazingly bad judgment of Abraham Flexner, a man engaged to study medical education by Carnegie Foundation on behest of the American Medical Association. I consider him the b”father of unthinkers.”

Flexner evidently was neither a scientist nor a clinician. His 1910 report, the so-called Flexner Report, did more damage to the health of Americans than any other single document. (The only other single report that comes close to its pernicious influence is that of the 1940 Nutrition Board that promulgated the abominable notion of limiting essential nutrients to their putative Required Daily Amounts. None of the persons on that Board was a practicing nutritionist. I discussed that important subject in RDA: Rats, Drugs and Assumptions.)

Flexner undertook a study of 139 allopathic and eight osteopathic medical schools. Much to the liking of those at the helm of the AMA, he pronounced all eight osteopathic schools substandard and unfit to provide medical education. The AMA took full advantage of the report and through a “standardization of hospitals” plan promulgated by the American College of Surgeons in 1918, managed to ban doctors of osteopathy from all American hospitals. Exalting the Flexner report to the status of the bible of “scientific” medicine, the AMA also used that report as a lethal weapon to effectively squelch all other healing arts. As went the United States, so did Europe and the rest of the world.

One of the silly aspects of the Flexner Report that is rarely discussed is that it recommended that the United States allow only thirty four-year medical schools, each enrolling 300 students. That would have reduced by 50% the number of young doctors leaving those schools. For the 1910 American population of 91 million, his plan would have amounted to two physicians per 100,000 persons. But the most pernicious influence of the Flexner Report was not that it secured a lasting medical monopoly for the AMA. For decades, it put a physician’s intuition in servitude of laboratory tests.

Flexner and his disciples essentially trashed all healing arts in the United States. The only model they approved of was that of drug therapies evaluated under what they considered were “controlled” conditions. That model lasted for decades and essentially left no room for a clinician’s intuition in his work. Intuition, they pronounced, was the crutch of the feebleminded, the one who did not have the diligence or discipline to learn their model of drug medicine.

It was in that setting that the “Flexner tragedy” took form. In the past, the atomism-vitalism debate had largely been a matter of amusement for the philosopher and the experimenter. The Flexner tragedy was played on a national scale with real physicians cast in the role of mindless messengers of the science of pharmaceutical companies. (The bag men for drug companies, as one young doctor recently put it.) Flexner declared osteopaths incompetent and pronounced all healing arts “unscientific.” What basis did he have for his pronouncement? Intuition of a homeopath did not fit into his model. Had he studied homeopathy to find whether it works or not? He dismissed a naturopath’s intuition in favor of his own. Had he studied naturopathy before trashing it? He rejected a herbologist’s intuition and experience. Had he evaluated that? And acupuncture? How could a generation of clinicians take that from a non-clinician? How could many more generations of clinicians robotically accept his dogma? And for decades?

Of course, intuition in medicine had been dealt many blows long before Flexner. The old atomism versus vitalism debate—the ancient Greeks thrived on it—was revived during the 1600s. Proponents of vitalism seized the opportunity and laid claim on the former. Life, they pronounced, could only be created and perpetuated by a vital force that governed organic matter in living beings— humans, animals, and plants. Later chemists decided to divide matter into two forms: organic and inorganic.The stage was then set for the proclaimed victory of materialists when, in 1828, Friedrich Wohler claimed that he had synthesized urea, the first organic compound from inorganic raw materials. To many, that put the last nail in the coffin of vitalism. But vitalism persisted. At the turn of the century, it was fashionable among scientists to ridicule vitalism. (Indeed, some even today snicker at it. Consider the following quote from a recent issue of Nature:

Vitalism was an attempt to reconcile rationality with a sense of wonder.5

The author—unwittingly, it seems to me—holds rationality and a sense of wonder to be two discrete elements of the human experience which some lesser souls try to link together. Confusion about what the rational is persists.

It is not surprising that Flexner, a theorist and a non-clinician, mistook a clinician’s intuition as a form of vitalism in 1910. What is surprising is that he failed to realize that his model was inconsistent with great medical arts of the Chinese and Indians. Various healing arts function in their respective cultures. Flexner proposed to destroy all medical cultures except the drug culture. What is astounding is that the main body of physicians of his time failed to see that transparent folly and did not dismiss it outright. Or, perhaps it was merely an economic issue for those at the helm of the AMA who declared Flexner a saviour.

Now consider the following quote from the September 11, 2000, issue of Time:

  • Many patients suffering from high blood pressure were probably surprised last week to hear that one of the most popular classes of drugs for treating their condition—calcium channel blockers—was being blamed for some 85,000 avoidable heart attacks and heart failures a year. Their doctors were less likely to be surprised.

I use this quote to make two points. First, what should be our take on the science of thousands of papers published to show calcium channel blockers were safe? Second, what can be said about the editors who rejected all papers describing clinical outcome of nondrug therapies for controlling hypertension with natural remedies simply because those studies were not blinded and controlled? How can anyone blind treatment plans that include water therapy, meditation, exercise, nutrients, and avoidance of metabolic sugar and insulin roller coasters?

Next time please think of Flexner when your doctor tells you that it a standard of American medicine to prevent heart attacks and strokes with statin drugs—Lipitor, Crsstor, Pravachiol, Vytorin, and others—which lower blood cholesterol levels. Next think of what comes out of an egg’ yellow—a ball of cholesterol—a health chicken. Long live Flexner and his unthinkers!

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