Americans traveling through the northeast in the 19th century would have encountered medical institutions practicing an extinct craft: homeopathy. Rooted in the principle of “like cures like,” the system contends (115) that diluted doses of substances that cause symptoms in a healthy person can be administered to sick individuals to produce a similar effect. Medical centers familiar to contemporary Americans—including Boston University’s School of Medicine and Drexel University College of Medicine—once had large sections of their curricula dedicated (116) to homeopathy.
In 1910, one report upended the practice that stood at the core of the overwhelming majority of America’s medical centers. Funded by the Carnegie Foundation for the Advancement of Teaching, Abraham Flexner, a politician who studied natural sciences at Johns Hopkins University, drafted “Medical Education in the United States and Canada” with the aim (117) of eradicating complementary and alternative medicine. The most direct way of doing so was to target local centers that embraced non-traditional healing methods, in contrast to the rigid, laboratory-based methods promoted by universities like Johns Hopkins.
The report thus starkly stated (118) that it was necessary to “destroy schools and restrict output,” hire “fewer and better doctors,” and form “a more uniformly arduous and expensive medical education” so that the sick could “reap the full benefit of recent progress in medicine” (pages 13, 16-17). Flexner’s impact was immediate. A 2003 article determined (119) that between seven to 22 percent of the 168 schools mentioned in the report closed or merged due to the report, while nearly 60 schools closed for unclear reasons in the decades following its publication.
Flexner was not exclusively interested in homeopathy. Naturopathy (relying on natural processes rather than established medicine), eclectic therapy (psychotherapy that combines multiple techniques tailored to the patient), physical therapy, osteopathy (moving bones and muscle tissue to address bodily conditions), and chiropractic were all denounced. Accordingly, 80 percent of programs in these disciplines shut down (120) after the report was distributed across the country.
How is it that a single document had such an outsized influence on consolidating medical institutions into one homogeneous administrative entity? It had one important supporter: John D. Rockefeller, founder of the Standard Oil Company. Frederick Gates, one of the magnate’s advisors and managers of his philanthropic fund, became convinced (121) that the germ theory of disease was one of the most pressing issues of his day and that humanity had failed to find cures for the majority of the diseases it had discovered. He wrote a detailed memorandum that emphasized (121) to Rockefeller the necessity of turning his attention to medical research.
Rockefeller did not need much persuasion. Medical research was already one of the tycoon’s interests. Leading the nation’s largest oil monopoly, Rockefeller was at the heart of new discoveries (122) relating to petrochemicals, synthetic plastics, and essential vitamins. Rockefeller would obtain even greater profits in the corporate world if he could be at the forefront of new scientific revelations regarding the minerals and chemicals linked to oil extraction. Thus, his foundation helped execute (123) the Flexner report’s recommendations, and Flexner himself joined the Rockefeller-funded General Education Board two years after its publication.
Flexner's vision saw the light of day with the Carnegie Foundation’s endorsement and Rockefeller’s financial backing. Collaborating with fellow philanthropist Edward Harkness—who focused specifically on hospitals and universities—Rockefeller and Flexner donated buildings to universities that hired (124) full-time, salaried physician faculty members. This replaced the patchwork, local approach from previous decades. Johns Hopkins, Washington University, and the University of Chicago became the model for medical schools nationwide.
Flexner and Rockefeller’s worldview (125), which is that rational organization, rigorous scientific training, and experimental laboratories should advance medical progress, is difficult to rebuke. However, the implications of their decision to shuttle medical schools and standardize medical education have been considerable.
The first is that holistic medical treatments that consider multiple variables across the human body rather than assigning a specific drug to an illness have been negatively portrayed (126) for the past few decades. In Flexner’s model—whereby a small, select quantity of highly qualified physicians diagnose (127) patients based on findings made in a laboratory rather than working with a patient on a personal level—the same treatments are applied to people who may have varying health conditions. Enormous pharmaceutical companies produce (128) drugs that crowd out the market and that patients are forced to buy even if the drug is not tailored to their specific needs. Parenthetically, it should be noted (129) that 99 percent of pharmaceutical raw materials and reagents come from natural gas or other petrochemicals.
As hinted above, another consequence of the reduction in the number of local medical institutions is that there will be an insufficient number of doctors for average Americans. The percentage of U.S. doctors in adult primary care has decreased (130) to around 25 percent, leaving more than 100 million Americans without access to primary care. McKinsey estimated (131) that by the end of 2024, the United States would have a shortage of approximately 64,000 physicians. The allopathic (or conventional, Western medical system defined (132) by medical experts and healthcare professionals treating patients through surgeries, therapies, and medications) model espoused by Flexner and Rockefeller fails to explain how hospital consolidation (133) will help a growing number of patients seeking treatment.
Indeed, from 2013 to 2020, around 4 percent of America’s rural hospitals closed (134). Furthermore, between 1998 and 2021, 1,887 hospital mergers were executed (135). This makes emergency medical care much more difficult to access in rural communities. People living in these cities cannot necessarily turn to local clinics for help, though, since the physicians who once worked in these clinics are either leaving or moving to established institutions. This is exemplified (136) by the 60 to 47 percent drop in the share of physicians working in private practices from 2012 to 2022.
Flexner’s wish for more “expensive medical education” has also been fulfilled. Today, the average medical school student graduates with roughly $200,000 in debt (137). Medical school education costs have increased (138) by around 2.5 percent each year. This disincentivizes aspiring physicians from going to medical school in the first place, which has likely contributed to hospital mergers and closures across the country.
The reduction in the number of doctors and the decline of holistic health may be what has led patients to seek out complementary and alternative treatments. Practitioners specializing in holistic care often dedicate (139) more time to their patients, offer recommendations instead of immediately prescribing drugs, and focus on cultivating a strong patient-practitioner relationship absent in bureaucratic health centers. Before the Flexner report, nutrition, community care, and mind-body practices were much more common (140), and these solutions have now been labeled as “alternative” or even “pseudoscientific.” Big Pharma’s cures have been dubbed the “norm,” even though antidepressants, for instance, have been shown to have a negligible (141) impact on patients’ behavior.
A growing recognition of the benefits of holistic health treatments and the downsides of catch-all pharmaceutical cures may explain the recent surge in complementary medicine. The National Institutes of Health’s National Center for Complementary and Integrative Health conducted a survey that found that the percentage of individuals using “yoga, meditation, massage therapy, chiropractic care, acupuncture, naturopathy, or guided imagery/progressive muscle relaxation” rose (142) from 19.2 percent to 36.7 percent from 2002 to 2022.
Thus, the system that Flexner and Rockefeller sought to dismantle is making a comeback. After shuttering medical centers, raising medical school prices, consolidating hospitals, driving out physicians from local practices, and standardizing medical curricula, the Flexner-Rockefeller model has not prevented dissatisfied patients from seeking complementary medical treatments. In fact, data from recent years shows the opposite trend.
As mental health disorders soared (143) in the 2010s and anxiety levels skyrocketed (144) during the COVID-19 pandemic, tablets, antidepressants, and prescription drugs are being swiftly distributed to affected patients. However, one recent study found (145) that 10 percent of patients diagnosed with schizophrenia and 30 percent of those with an affective disorder (which includes depression, anxiety, and bipolar disorder) consulted an alternative care practitioner for either physical or psychiatric symptoms. This aligns with a 2000 Yale School of Medicine study, which determined (146) that people with psychiatric illnesses, including depression, schizophrenia, and anxiety disorders, are 25 percent more likely to turn to complementary treatments than those not suffering from these disorders.
Americans should work to make healthcare local again. Physicians diagnosing a smaller number of patients with whom they have a personal relationship can develop tailored recommendations that include holistic treatments—including changes to one’s diet, physical activity, and everyday lifestyle—adapted to the patient’s circumstances. This would also increase job opportunities for physicians, open up more clinics for citizens in rural neighborhoods, and chip at the monopoly that Big Pharma and large healthcare providers maintain.
The current allopathic healthcare system is largely founded on Flexner’s report and Rockefeller’s backing and serves corporate interests rather than the average patient. Americans are starting to reverse this system by considering alternatives to pharmaceutical treatments for physical and psychiatric health issues.
Axel de Vernou is a graduating senior at Yale University majoring in Global Affairs and History with a Russian Certificate. You can find him on LinkedIn here.
Article FAQs:
Q: How is our current allopathic healthcare system set up?
A: It is based on surgeries, therapies, and drug prescriptions administered by doctors and other healthcare professionals. Rather than seeking a holistic approach to an issue, it prioritizes intervention to target a specific problem.
Q: What was Rockefeller’s role in promoting today’s healthcare system?
A: Rockefeller funded the Flexner report, which advocated for the closure of local medical centers practicing homeopathy and other forms of unconventional medicine. This empowered the rise of pharmaceutical companies and the consolidation of hospitals and medical institutions.
Q: Why is it more difficult for rural Americans to access healthcare?
A: Hospitals in rural areas have more difficulty operating due to shortages of physicists and the pressure exerted by larger healthcare companies that have monopolies over the market. This leads hospitals to consolidate or move to more urban areas.
Q: What do holistic health treatments entail?
A: The term is quite general, so it can entail a variety of treatments. However, it usually prioritizes nutrition, physical exercise, personal lifestyle, and other comprehensive variables instead of focusing on the specific pharmaceutical treatment for an illness.
Q: Are complementary health treatments making a comeback?
A: Following the Flexner report, which caused a significant drop in complementary and alternative healthcare treatments in the 20th century, there appears to be a renewed interest among Americans in embracing a more holistic form of healthcare. This could be because they hope for more personal time with a practitioner, are dissatisfied with the current system, or want to align their treatments with their personal lifestyle.
