The only problem with Abraham Flexner's legacy is how it is being rewritten today – mainly by the AAMC in order to signal its commitment to becoming "anti-racist" which includes lowering standards, but alas, also by Graboyes for his own reasons.
Flexner was no racist or sexist, and that fact is not "ambiguous." Flexner worked for decades to advance educational conditions for Blacks and women. Nor is there any evidence that Flexner had any interest in eugenics or social engineering – other than working to establish public K-12 schools for Black children in the South.
On Graboyes' personal Substack site, this article attracted much criticism for being historically revisionist:
Even better is the biography written by the late by Thomas Neville Bonner: "Iconoclast: Abraham Flexner and a Life in Learning."
A couple of points by the way...
In Flexner's day, "allopaths" diagnosed and treated patient according to the theory of Four Humors, which is why they were held in such contempt by all of science-based medicine at the time. Because of all the horrific diseases rampant in the early 20th century – small pox, TB, typhoid, cholera, plague, etc – public health medicine was emphasized and much respected. And along with scientific rigor, Flexner also promoted physician bedside care, so laying the ills of modern day medicine at his door seems hardly fair.
Linda, Your argument that my article “attracted much criticism for being historically revisionist” is, well, … a tad revisionist.
The “much criticism” that you refer to is your own criticism (and that of one other commenter) over my use of the word “allopath.” I used the word in its contemporary sense. For example, a Columbia University webpage says: “Allopathic medicine refers to a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called biomedicine, conventional medicine, mainstream medicine, orthodox medicine, and Western medicine. Allopathic physicians receive an MD.” You and the other commenter correctly informed me that in the 19th century, “allopath” originated as an insult given by a prominent homeopath. That is a fascinating etymological tidbit, but utterly irrelevant to my thesis. By your argument, it would “revisionist” to describe Monet, Renoir, Pissarro, and Degas as “impressionists” because that term originated in the 19th century as an insult. Likewise with Tories, Whigs, Cubists, Quakers, Puritans, Yankee Doodles, or the Wrecking Crew.
My concerns with Flexner are quite legitimate--and they concern his institutional structures, not his inner motivations. He did see the physician as a "social instrument... whose function is fast becoming social and preventive, rather than individual and curative." He did advocate rigid standardization of medical education and practice, with centralized, monopolized control over those standards. And he did place enormous trust and faith in scientific authority. My argument is not that he had ill intent, but rather that his framework presumed that medical educators, regulators, and researchers would always be honest, objective, competent, and selfless. Such naïveté was typical of Progressive Era schemes. Eugenicists took advantage of this framework in Flexner’s time. In our own time, Flexnerian standardization, centralization, and deference to scientific authority are enabling ideologues to squelch scientific dissent, impose ideological litmus tests, and engage in indoctrination and intimidation. I suspect that Flexner would be appalled by 21st century developments, but they are greatly aided by the institutional arrangements that he pioneered.
I agree that the AAMC, AMA, and others presume that they can look into the mind of Flexner, where they find a racist and sexist. But in certifying Flexner as unambiguously devoid of such prejudice, you, too, are unjustifiably asserting intimate knowledge of his soul. I’m simply agnostic on his inner motivations. I suspect strongly that he was NOT a racist or sexist—at least by the standards of his time. But the fact that he “worked for decades to advance educational conditions for Blacks and women” gives us no certainty regarding his intentions and prejudices. I grew up in the Jim Crow South, and I personally knew politicians who made substantial contributions to African American education but who were, behind closed doors, racist as hell.
Flexner and his legacy are complex, and I strive to avoid the angel-or-devil controversies over that legacy.
Sabrina String's "Fearing the Black Body" discussed a lot of related medical and cultural history relative to the current narrative on "obesity". Interesting stuff.
Not sure if your comment is aimed at me or to another commenter. I "made it"--but as an economist, not an MD. Sounds as if someone in admissions made a mistake with respect to you. Thanks for the message.
For 30 years I worked as a surgeon and never did I treat any patient differently based upon their race or gender. Now we are all suffering from unconscious bias, and overt racism. We are accused of having micro aggressions and anger issues. DEI and CRT are making people with no micro aggressions exhibit macro aggressions and that is when the system puts them down like a rabid dog and says “see?” This has been by design. The health care system has been emasculated over the past 20 years, and I mean that for female and as well as male HCWs. The quickness within which the DEI racism movement and action took hold is staggering to me. As a lifelong democrat who is now an independent I just think this is emotion driven “progressive” craziness. Where is the evidence based medicine?
Mar 11, 2023·edited Mar 11, 2023Liked by Adam Cifu, MD, Robert F. Graboyes
Another development that fits the historical pattern described in this article: What about the big global push to reduce antibiotic usage? Real quantifiable harms of undertreatment are never weighed against vague, hubristic theories of antibiotic resistance. Which MD doesn't want to see herself as a good steward of vital resources? Apparently, less is known about the evolution of these bacteria than commonly thought. https://www.nature.com/articles/s41586-021-04265-w
"Discussion
This research shows that hedgehogs are a natural reservoir of zoonotic mecC-MRSA lineages that predate the antibiotic era, which is inconsistent with the commonly accepted view that widespread resistance in clinical pathogens is a modern phenomenon that is driven by our use of antibiotics in human and veterinary medicine."
Mar 11, 2023Liked by Adam Cifu, MD, Robert F. Graboyes
Loved the article. Having been born in the mid 1960’s with myelomeningocele, I remember the stories my parents shared when the L5/S1 lesion was discovered. My folks were encouraged to either euthanize or institutionalize me. I’m glad my old man was an Irish Catholic Marine; I’ve had an amazing life. I wonder what people centuries from now (assuming humanity makes it that far) will really think of western medicine? I’m glad I was born when I was; however these days I’m also very glad that the majority of my difficult surgeries are behind me. My trust in medicine in general has waned since leaving the field; my trust in public health was already gone by the time I left.
I just Googled you and listened to some of your tunes. Impressive! Your story is inspiring. For writing, I'd suggest that you simply tell your stories from the heart. Your bio and what it says about the world will provide more stories than you'll ever have time to write. My musical accomplishments are much more modest than yours, but my compositions are at https://YouTube.com/@RFGraboyes/videos. I'd like to speak offline. If you're interested, drop an email to rfg.counterpoint@gmail.com.
Mar 11, 2023Liked by Adam Cifu, MD, Robert F. Graboyes
I thoroughly enjoyed this article. The ACP joins the growing list of medical organizations hellbent on making physicians kowtow to party-line demands. There is little tolerance for dissenting physicians who say white people aren't inherently racist, not everyone needs a vaccination, public health dropped the COVID ball, a single-payer system would be disastrous, etc. I've even seen the ACP come out in full, unmitigated support of abortion with a zero-tolerance policy for those of us who hold it as a ghastly practice. Their pursuit of "diversity, equity, and inclusion" is leading to the opposite effect: a group of physicians who think and act the same way, too afraid to say what they really think...a group thoroughly steeped in secularized morality and weakened intestinal fortitude.
The only problem with Abraham Flexner's legacy is how it is being rewritten today – mainly by the AAMC in order to signal its commitment to becoming "anti-racist" which includes lowering standards, but alas, also by Graboyes for his own reasons.
Flexner was no racist or sexist, and that fact is not "ambiguous." Flexner worked for decades to advance educational conditions for Blacks and women. Nor is there any evidence that Flexner had any interest in eugenics or social engineering – other than working to establish public K-12 schools for Black children in the South.
On Graboyes' personal Substack site, this article attracted much criticism for being historically revisionist:
https://graboyes.substack.com/p/the-foibles-of-flexner/comments#comment-13993425
For a more accurate accounting of Flexner, I recommend my article published by "Physician Outlook":
"Abraham Flexner: Academic Medicine's Favorite Scapegoat"
https://www.physicianoutlook.com/articles/abraham-flexner-academic-medicines-favorite-scapeg
Even better is the biography written by the late by Thomas Neville Bonner: "Iconoclast: Abraham Flexner and a Life in Learning."
A couple of points by the way...
In Flexner's day, "allopaths" diagnosed and treated patient according to the theory of Four Humors, which is why they were held in such contempt by all of science-based medicine at the time. Because of all the horrific diseases rampant in the early 20th century – small pox, TB, typhoid, cholera, plague, etc – public health medicine was emphasized and much respected. And along with scientific rigor, Flexner also promoted physician bedside care, so laying the ills of modern day medicine at his door seems hardly fair.
Linda, Your argument that my article “attracted much criticism for being historically revisionist” is, well, … a tad revisionist.
The “much criticism” that you refer to is your own criticism (and that of one other commenter) over my use of the word “allopath.” I used the word in its contemporary sense. For example, a Columbia University webpage says: “Allopathic medicine refers to a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called biomedicine, conventional medicine, mainstream medicine, orthodox medicine, and Western medicine. Allopathic physicians receive an MD.” You and the other commenter correctly informed me that in the 19th century, “allopath” originated as an insult given by a prominent homeopath. That is a fascinating etymological tidbit, but utterly irrelevant to my thesis. By your argument, it would “revisionist” to describe Monet, Renoir, Pissarro, and Degas as “impressionists” because that term originated in the 19th century as an insult. Likewise with Tories, Whigs, Cubists, Quakers, Puritans, Yankee Doodles, or the Wrecking Crew.
My concerns with Flexner are quite legitimate--and they concern his institutional structures, not his inner motivations. He did see the physician as a "social instrument... whose function is fast becoming social and preventive, rather than individual and curative." He did advocate rigid standardization of medical education and practice, with centralized, monopolized control over those standards. And he did place enormous trust and faith in scientific authority. My argument is not that he had ill intent, but rather that his framework presumed that medical educators, regulators, and researchers would always be honest, objective, competent, and selfless. Such naïveté was typical of Progressive Era schemes. Eugenicists took advantage of this framework in Flexner’s time. In our own time, Flexnerian standardization, centralization, and deference to scientific authority are enabling ideologues to squelch scientific dissent, impose ideological litmus tests, and engage in indoctrination and intimidation. I suspect that Flexner would be appalled by 21st century developments, but they are greatly aided by the institutional arrangements that he pioneered.
I agree that the AAMC, AMA, and others presume that they can look into the mind of Flexner, where they find a racist and sexist. But in certifying Flexner as unambiguously devoid of such prejudice, you, too, are unjustifiably asserting intimate knowledge of his soul. I’m simply agnostic on his inner motivations. I suspect strongly that he was NOT a racist or sexist—at least by the standards of his time. But the fact that he “worked for decades to advance educational conditions for Blacks and women” gives us no certainty regarding his intentions and prejudices. I grew up in the Jim Crow South, and I personally knew politicians who made substantial contributions to African American education but who were, behind closed doors, racist as hell.
Flexner and his legacy are complex, and I strive to avoid the angel-or-devil controversies over that legacy.
Sabrina String's "Fearing the Black Body" discussed a lot of related medical and cultural history relative to the current narrative on "obesity". Interesting stuff.
Will look into it. Thanks.
I was rejected in the late 60s...class acceptance in CA was 5 10 percent.. I was honors grad UC Berkeley. I'm glad you made it !
Not sure if your comment is aimed at me or to another commenter. I "made it"--but as an economist, not an MD. Sounds as if someone in admissions made a mistake with respect to you. Thanks for the message.
For 30 years I worked as a surgeon and never did I treat any patient differently based upon their race or gender. Now we are all suffering from unconscious bias, and overt racism. We are accused of having micro aggressions and anger issues. DEI and CRT are making people with no micro aggressions exhibit macro aggressions and that is when the system puts them down like a rabid dog and says “see?” This has been by design. The health care system has been emasculated over the past 20 years, and I mean that for female and as well as male HCWs. The quickness within which the DEI racism movement and action took hold is staggering to me. As a lifelong democrat who is now an independent I just think this is emotion driven “progressive” craziness. Where is the evidence based medicine?
Big problem, isn't it?
Another development that fits the historical pattern described in this article: What about the big global push to reduce antibiotic usage? Real quantifiable harms of undertreatment are never weighed against vague, hubristic theories of antibiotic resistance. Which MD doesn't want to see herself as a good steward of vital resources? Apparently, less is known about the evolution of these bacteria than commonly thought. https://www.nature.com/articles/s41586-021-04265-w
"Discussion
This research shows that hedgehogs are a natural reservoir of zoonotic mecC-MRSA lineages that predate the antibiotic era, which is inconsistent with the commonly accepted view that widespread resistance in clinical pathogens is a modern phenomenon that is driven by our use of antibiotics in human and veterinary medicine."
Great stuff. Thanks.
Loved the article. Having been born in the mid 1960’s with myelomeningocele, I remember the stories my parents shared when the L5/S1 lesion was discovered. My folks were encouraged to either euthanize or institutionalize me. I’m glad my old man was an Irish Catholic Marine; I’ve had an amazing life. I wonder what people centuries from now (assuming humanity makes it that far) will really think of western medicine? I’m glad I was born when I was; however these days I’m also very glad that the majority of my difficult surgeries are behind me. My trust in medicine in general has waned since leaving the field; my trust in public health was already gone by the time I left.
Brilliant. Thanks so much for sharing--on so many levels.
Thanks Robert - I’m new at this substack but plan to write as much as I can!
I just Googled you and listened to some of your tunes. Impressive! Your story is inspiring. For writing, I'd suggest that you simply tell your stories from the heart. Your bio and what it says about the world will provide more stories than you'll ever have time to write. My musical accomplishments are much more modest than yours, but my compositions are at https://YouTube.com/@RFGraboyes/videos. I'd like to speak offline. If you're interested, drop an email to rfg.counterpoint@gmail.com.
PS looking forward to listening to your stuff!
Awesome! I’m jryser@msn.com.
I'll drop a note!
I thoroughly enjoyed this article. The ACP joins the growing list of medical organizations hellbent on making physicians kowtow to party-line demands. There is little tolerance for dissenting physicians who say white people aren't inherently racist, not everyone needs a vaccination, public health dropped the COVID ball, a single-payer system would be disastrous, etc. I've even seen the ACP come out in full, unmitigated support of abortion with a zero-tolerance policy for those of us who hold it as a ghastly practice. Their pursuit of "diversity, equity, and inclusion" is leading to the opposite effect: a group of physicians who think and act the same way, too afraid to say what they really think...a group thoroughly steeped in secularized morality and weakened intestinal fortitude.
Thanks! Glad you enjoyed it!