Prior To The Flexner Report most American medical universities were trade schools run for profit with low admission standards and an absence of rigorous medical science. The Flexner report in 1910 changed all that. Michael Millenson talks of Flexner’s crusade as a vigorous corrective action campaign against these charlatan medical schools. The
Bill: Part of the problem is that people believe, actually believe, the lies. I went to busines school to earn an MBA at University of Texas, from 1988 to 1990. And I do mean earn. As the only physician in a class full of “executive MBAs” most of whom had over 5 years in real businesses, I was challenged. What I learned was a lot of the language of business, along with accounting, management, quality control, and so on. But what I also learned was the business of business is to make money, nothing else matters. If you don’t help the firm earn higher and higher profits every year, then you’re not going to succeed. And who doesn’t want to succeed? No one. Does such a system (capitalism) require lying? No, it doesn’t. But it doesn’t discourage bending the truth, or exaggerating, and it tolerates a lot of outright lying after a while. For a simple example, how many companies have you seen advertise themselves as “national leaders,” who are neither national in scope or any sort of industry leader? Or, as another example, how often have you been approached by individuals, especially consultants of some sort, who say they are “experienced,” when they are really just fresh out of school? No harm done, right? But people in groups dedicated to a single purpose like making money tend, over time, in my experience, to develop a culture that increasingly justifies whatever it is they do, as long as they are successful monetarily. We all are subject to these pressures. And in medicine, the declaration sometime in the 1970s that “medicine is a business” started that ball rolling and it is now completely out of control. Science, evidence, no longer really matters. So…yes, we do need a new Flexner Study and completely expose the falsehoods and lack of evidence as the basis for modern medicine, hospital care, and pharmaceutical manufacturing and sales. So glad you are tackling these tough issues.
Thanks for that perspective. It is extremely important and so clearly expressed. Medicine is on the same level of need as water and electricity. What if we allowed predatory profiteering in these utilities? This is the same thing.
I think you’re saying that doctors, hospitals, pharmaceutical companies, and other “health care providers” lie to us all the time, and are not to be trusted. It’s not just “bad apples” any more. It’s systemic and industry-wide lying, in order to make money and maintain power. So, what else is new?
I think you are right. I do think that most people involved directly in patient care went into the profession with the best of intentions and the quality that we have exists because of people like you doing the best they could in a broken system. The money people broke it and I think it reflects a much bigger problem. Think about it. Can you think of a single celebrity who is not fabulously wealthy? I can't. There was Mother Teresa, but now she is dead. The American people have lost faith in their institutions including medicine. I think they understand that medicine is no longer doing what is best for them. It is doing what is best for the celebrities in medicine--the CEOs of big hospital systems, drug companies, device companies. and the new big companies that run primary care.
William Osler is probably turning over in his grave. He was part of the Flexner effort and shaped scientific medicine as much as anyone. Now even Johns Hopkins seems to be involved according to this story. "A gastroenterologist, Lee runs the Johns Hopkins Integrative Medicine and Digestive Center, which offers acupuncture, massage therapy, and reiki — a therapy that the center’s website describes as laying on hands “to transmit Universal Life Energy” to the patient." Transmit Universal Life Energy to the patient--Really??? We do need another Flexner effort to return to the science, ethics, and professionalism that attracted me to medicine in the first place https://sciencebasedmedicine.org/why-do-prestigious-hospitals-sell-snake-oil/
Bill: Part of the problem is that people believe, actually believe, the lies. I went to busines school to earn an MBA at University of Texas, from 1988 to 1990. And I do mean earn. As the only physician in a class full of “executive MBAs” most of whom had over 5 years in real businesses, I was challenged. What I learned was a lot of the language of business, along with accounting, management, quality control, and so on. But what I also learned was the business of business is to make money, nothing else matters. If you don’t help the firm earn higher and higher profits every year, then you’re not going to succeed. And who doesn’t want to succeed? No one. Does such a system (capitalism) require lying? No, it doesn’t. But it doesn’t discourage bending the truth, or exaggerating, and it tolerates a lot of outright lying after a while. For a simple example, how many companies have you seen advertise themselves as “national leaders,” who are neither national in scope or any sort of industry leader? Or, as another example, how often have you been approached by individuals, especially consultants of some sort, who say they are “experienced,” when they are really just fresh out of school? No harm done, right? But people in groups dedicated to a single purpose like making money tend, over time, in my experience, to develop a culture that increasingly justifies whatever it is they do, as long as they are successful monetarily. We all are subject to these pressures. And in medicine, the declaration sometime in the 1970s that “medicine is a business” started that ball rolling and it is now completely out of control. Science, evidence, no longer really matters. So…yes, we do need a new Flexner Study and completely expose the falsehoods and lack of evidence as the basis for modern medicine, hospital care, and pharmaceutical manufacturing and sales. So glad you are tackling these tough issues.
Thanks for that perspective. It is extremely important and so clearly expressed. Medicine is on the same level of need as water and electricity. What if we allowed predatory profiteering in these utilities? This is the same thing.
I think you’re saying that doctors, hospitals, pharmaceutical companies, and other “health care providers” lie to us all the time, and are not to be trusted. It’s not just “bad apples” any more. It’s systemic and industry-wide lying, in order to make money and maintain power. So, what else is new?
I think you are right. I do think that most people involved directly in patient care went into the profession with the best of intentions and the quality that we have exists because of people like you doing the best they could in a broken system. The money people broke it and I think it reflects a much bigger problem. Think about it. Can you think of a single celebrity who is not fabulously wealthy? I can't. There was Mother Teresa, but now she is dead. The American people have lost faith in their institutions including medicine. I think they understand that medicine is no longer doing what is best for them. It is doing what is best for the celebrities in medicine--the CEOs of big hospital systems, drug companies, device companies. and the new big companies that run primary care.
William Osler is probably turning over in his grave. He was part of the Flexner effort and shaped scientific medicine as much as anyone. Now even Johns Hopkins seems to be involved according to this story. "A gastroenterologist, Lee runs the Johns Hopkins Integrative Medicine and Digestive Center, which offers acupuncture, massage therapy, and reiki — a therapy that the center’s website describes as laying on hands “to transmit Universal Life Energy” to the patient." Transmit Universal Life Energy to the patient--Really??? We do need another Flexner effort to return to the science, ethics, and professionalism that attracted me to medicine in the first place https://sciencebasedmedicine.org/why-do-prestigious-hospitals-sell-snake-oil/