The Beginning of the Pharmaceutical Takeover in the US: The Flexner Report

Have you ever wondered why herbs are deeply woven into medical institutions in many places including China, India, Germany and Japan, but often dismissed as ineffective in North America, where taking a pill is suggested at every turn? Or if you do mention an herbal adjunct therapy to your doctor, you are met with dismissal or even belittling comments?

The disregard for integrative medicine is one hundred years in the making and we are still suffering the effects of a medical school review published more than a century ago.

Enter… the Flexner Report.

Have you heard of the Flexner Report? Read on, because being empowered with this piece of history that helped gut our medical choices, is part of how we bring balance back into what is considered “medicine” in the United States.

We have to know where we come from to change where we are going. What was the intention behind limiting the medical choices we have available in US mainstream medicine?

Holistic models of medical treatment can be found all over the world and the Flexner Report is key to understanding how we in the United States lost access to holistic medical options.

Here is a story of the efforts of a few players who drastically altered the path of medicine in North America based on personal gain and profit.

What is the Flexner Report?

The Flexner Report – actual title “Medical Education in the United States and Canada” but nicknamed for its author, Abraham Flexner – was an in-depth assessment of 155 medical schools in the US and Canada. It was commissioned by the American Medical Association, funded by the Carnegie Foundation, and penned by Flexner, who visited each of the schools.

Published in 1910, the Flexner Report would redefine medical education in North America, putting a stranglehold on what could be taught in medical schools. With the stated goal of creating more uniform standards in North American medicine, it established the biomedical model as the sole legitimate form of medicine and contributed to the eventual closure of schools that did not meet its standards.

“Being empowered with this piece of history that helped gut our medical choices, is part of how we bring balance back into what is considered ‘medicine’ in the United States.”

Even if you’ve never heard of the biomedical model, it has almost certainly influenced the way you think about health and medicine. The biomedical model seeks to understand disease at the microscopic level, centralizing the body’s structure and the impact of pathogens.

Under the biomedical model, drugs are often designed to suppress symptoms through molecular interactions. You attack the specific symptom without regard for affect on the rest of the body. Thus, the current rampant statistics of iatrogenic disease. Iatrogenic disease is an ill effect that is caused by a medical procedure or substance used to treat symptoms but causes a secondary illness. (Side-effects anyone?)

Flexner Report bottom line, if your medical school was focused on teaching pharmaceuticals and surgery, you were in. Herbs, nutrition, water cures, thousands of years of empirical evidence about which food and herbs to use when… nope, not good enough, time to close the doors and suppress all knowledge not in line with the narrative.

Before the Flexner Report

Prior to the 1910 report, medical colleges that focused on herbalism and holistic health flourished in the United States, although they wouldn’t have used the words “herbalism” or “holistic health.”

Doctors practicing in what was called the “Eclectic” tradition used knowledge of plants drawn from various sources, including European and Native American folk medicine, to help patients. There were schools of hydrotherapy using ancient knowledge of how to heal with water along with homeopathic colleges using plants and minerals to activate the body’s innate healing power.

Eclectic medicine, which continues to influence North American herbalism, was popular in the late 1800s and early 1900s. The name comes from the Greek eklego, “to choose from,” because these doctors drew on plants, physical therapy, and other remedies to bring their patients into a state of health.

Eclectic medicine was focused on strengthening the whole person with natural means instead of using drugs to kill a pathogen without regard for its effect on the overall health of the person.

Think of the drug commercials on T.V. Sunshine and rainbows are how you feel while suppressing a certain symptom with a new drug. And then at the end you hear the litany of possible side effects that include even death.

One of the Eclectic movement’s leaders was John Uri Lloyd, a pharmacist whose practice was infused with ethnobotany and herbalism. His extensive research into the medical use of plants shows how vastly the pharmaceutical industry has changed since the early 1900s. His name will come up again in this post – he helped fund the Lloyd Library and Museum, which houses publications of the Eclectic physicians and medical schools.

My beloved teacher and Herbalist Michael Moore credits the American School of Medicine for training Eclectic physicians in the US The Ohio-based Eclectic Medical Institute graduated its first class in 1833 and its last in 1939.

It’s hard to imagine that a century ago, those looking to become doctors could choose from an array of medical philosophies: Eclecticism, homeopathy, hydrotherapy, osteopathy, and more.

I often wonder where we would be today if we would have allowed the Eclectic’s approach to health to continue alongside the surgery and pharmaceuticals?

The Making of the Flexner Report: Follow the Money

So, who was at the helm of this report that revamped the trajectory of medical education? Steel tycoon Andrew Carnegie’s name was prominently attached to the project, but he wasn’t the only business magnate to fund it.

Rockefeller had already realized the oil industry was poised to make fortunes through pharmaceuticals and undermining trust in plant-based medicines was part of the plan.

The drug-making process uses petrochemicals for 99% of its raw materials and chemical reagents. If they were going to spin oil into gold, it follows that the general public – or at the very least, doctors – would have to be convinced that isolated chemicals in standardized pills were superior to plant-based medicines.

“Here is a story of the efforts of a few players who drastically altered the path of medicine in North America based on personal gain and profit.”

Rockefeller and Carnegie – the project was funded. The search was on for someone to author the as-yet-unwritten report. Who caught the committee’s eye but Abraham Flexner, who had recently published an influential critique of the American educational system.

It’s important to note that Flexner’s background was in teaching rather than medicine. According to a history published in the Yale Journal of Biology and Medicine, the selection team at the Carnegie Foundation intentionally chose someone from outside the medical field to write the report:

“They perceived the problem of medical education as a problem of education and believed a professional educator was better qualified to address this dimension of the problem. They also had preconceived ideas concerning what changes needed to be made in medical schools to allow these ideas to be introduced.”

Uncontestedly, it was a small group of well-resourced individuals who came up with a set of ideas to spread and found someone to do the research and writing. Keep that in mind as we explore the report itself and its effects.

The Flexner Report and Standardized Medicine

Flexner’s report described homeopathic, Eclectic, and osteopathic medicine as primitive precursors to evidence-based medicine, saying their practices were based on “dogma” and “magic” rather than evidence (Flexner Report pp. 156-166).

Although Flexner acknowledged that Eclectic schools were committed to the scientific method, teaching anatomy, pathology, and bacteriology, his generally dismissive attitude lingers in mainstream ideas about herbalism today, especially the idea that there’s not enough scientific evidence to support plants’ medicinal uses.

The Flexner Report led to the eventual closure of many medical schools, including all but two African-American medical colleges in the US.

And within 30 years of the report’s publication, all of the Eclectic schools had closed. Generations’ worth of observations about real-world use of plants were left to disintegrate in a basement, as the herbalist Michael Moore recounted:

“In 1990 I visited the Lloyd Library in Cincinnati, Ohio, where, in the basement, I found the accumulated libraries of ALL the Eclectic medical schools, shipped off to the Eclectic Medical College (the “Mother School”) as, one by one, they died. Finally, even the E. M.C. died (1939) and there they all were, holding on by the slimmest thread, the writings of a discipline of medicine that survived for a century, was famous (or infamous) for its vast plant materia medica, treated the patient and NOT the pathology, a sophisticated model of vitalist healing every bit as usable as Traditional Chinese Medicine and Ayurvedic medicine…and molding in front of my eyes.”

Within a few decades of the report’s publication, the general population had begun to turn away from plants and toward isolated extracts that could be measured and standardized – the beginning of the pharmaceutical takeover. Rockefeller continued to fund biomedical research long after the Flexner Report was published, and went on to become one of the field’s most significant sources of philanthropic funding to date.

With the foundation laid in medical schools and then decades of relentless pharmaceutical advertisement focused on symptom suppression; regardless of side-effects, even with not fully tested products… And then add in two pharmaceutical lobbyists per congress person, well, you know the rest of the story. Check out my most commented on in the past ten years blog post about real life medication side-effects.

A Century Later, Americans’ Health is Worse Than Ever

The Flexner Report is still generally treated with reverence by the Western medical community. Although they acknowledge that its findings were racist and sexist by today’s standards, there is little reflection on whether the shift to the biomedical model has benefited health overall.

Now, in a medical landscape saturated with pharmaceutical drugs, many people are realizing that symptom free is not the same as healthy. In fact, suppressing symptoms may allow a condition to worsen while exposing the patient to drugs’ side effects.

Meanwhile, we are sicker than ever, and the cost of health care continues to increase. Chronic diseases are now the most common health conditions in the United States. According to the National Association of Chronic Disease Directors, nearly 60% of the nation’s population have at least one chronic disease – up from 45% in the early 2000s.

In terms of cost, the CDC estimates that 90% of the $4.1 trillion that Americans spend per year on healthcare is used to treat (largely preventable) chronic diseases.

This is a direct result of a medical model that prioritizes molecular-level understanding over observing the whole being. Doctors’ nutritional education is superficial at best, and they are taught nothing about herbs. We have a medical system that’s great at saving lives in an emergency but does little to proactively build the kind of good health that would prevent diseases that eventually become emergencies.

Hope for the Future

In spite of a century of setbacks for herbalism and the health of the average person, I’m filled with hope for the future.

After decades of suppression and disregard in standard North American medicine, grassroots interest in herbalism began to grow again – slowly at first and then exponentially. People want to be active stewards of their health. They are craving a form of medicine that looks at them as a whole being and seeks to balance root causes rather than suppress symptoms.

If you or a loved one is ill, don’t you want access to it all? Drugs, surgery, AND herbs and holistic modalities for healing? Have you suffered a medication side-effect? In fact, that is what got me on the herbal path in the first place. I developed a brain tumor that was a medication side effect!

“The knowledge of how to work with the plants and care for ourselves is an oral tradition passed from one generation to the next in the home. This stream of knowledge needs to be fortified in every community.”

It isn’t that I think the pharmaceutical campaigns will lighten up any time soon. They are masters at the psychology of selling drugs. What I do find hope in is the stream of health and herbal awareness that is gaining traction IN THE HOME, IN THE KITCHEN.

The knowledge of how to work with the plants and care for ourselves is an oral tradition passed from one generation to the next in the home. This stream of knowledge needs to be fortified in every community and that is happening. If you are reading this, you are probably one who is revitalizing and reclaiming the art of home herbal care for your people. Good. We need you.

Yes, there is hope – that hope is you, me, and the ever-growing herbal community. The more we understand our bodies and how to work with healing plants, the more literate we are with what we ask for from health care institutions.

Needless to say, we desperately need a new medical model, one allows for drugs, surgery, AND herbs, hydrotherapy and the vast array of healing arts that can help us all.

What do you think? Where are we at today? Are we moving toward change or are the pharmaceutical companies in control more than ever? I’d love to hear your insights and reactions in the comments!