Chapter Nineteen
HE WHO PAYS THE PIPER

The low state of medical education in the U.S. prior to 1910; the role of the Flexner Report in dramatizing the need for reform; the role played by the Rockefeller and Carnegie foundations in implementing the Flexner Report; and the use of foundation funding as a means of gaining control over American medical schools.

There is an old saying:

"He who pays the piper calls the tune."

This is one of those eternal truths that exist - and always will exist - in business, in politics, and in education.

We have seen how John D. Rockefeller captured the hearts of Baptist ministers with a mere $600,000 granted to Chicago University. What remains to be demonstrated is that he also captured control of the university.

Within a year after the grant, Rockefeller's personal choice, Dr. William Rainey Harper, was named president of the institution. And within two years, the teaching staff had been successfully purged of all anti-Rockefeller dissidents. A professor of economics and a professor of literature distinguished themselves by proclaiming that Mr. Rockefeller was "superior in creative genius to Shakespeare, Homer, and Dante."(1)

1. Josephson, The Robber Barrons, op. cit., p. 324.

In contrast, a Professor Bemis was expelled from the staff for "incompetence" when he repeatedly criticized the action of the railroads during the Pullman strike of 1894.

A few years later, after the Rockefeller family, through the "philanthropy" of John Archbald, had gained parallel influence at Syracuse University in western New York, an economics instructor by the name of John Cummons was dismissed by the Chancellor for similar reasons.

In 1953, Representative B. Carroll Reece of Tennessee received the authority of Congress to establish a special committee to investigate the power and influence of tax-exempt foundations. The committee never accomplished much due to mounting pressure from multiple sources high within government itself and, eventually, Reece was forced to terminate the committee's work.

During its short period of existence, however, many interesting and highly revealing facts were brought to light.

Norman Dodd, who was the committee's director of research, and probably one of the country's most knowledgeable authorities on foundations, testified during the hearings and told the committee:

The result of the development and operation of the network in which the foundations (by their support and encouragement) have played such a significant role, seems to have provided this country with what is tantamount to a national system of education under the tight control of organizations and persons little known to the American public...

 

The curriculum in this tightly controlled scheme of education is designed to indoctrinate the American student from matriculation to the consummation of his education.(1)

1. As quoted by Weaver, U.S. Philanthropic Foundations, op. cit., pp. 175, 176.

Using the unique talents of Fred Gates, Rockefeller set out consciously and methodically to capture control of American education and particularly of American medical education. The process began in 1901 with the creation of the Rockefeller Institute for Medical Research.

It included on its board such politically oriented "medical" names as Doctors L. Emmett Holt, Christian A. Herter, T. Mitchell Pruden, Hermann M. Briggs, William H. Welch, Theobald Smith, and Simon Flexner. Christian Herter was slated for bigger things, of course, and became Secretary of State under President Eisenhower.

Simon Flexner also was destined for larger success. Although his name never became as well-known as that of Herter, he and his brother, Abraham Flexner, probably influenced the lives of more people and in a more profound way than has any Secretary of State.

Abraham Flexner was on the staff of the Carnegie Foundation for the Advancement of Teaching. As mentioned previously, the Rockefeller and Carnegie foundations traditionally worked together almost as one enterprise in the furtherance of their mutual goals, and this certainly was no exception. The Flexner brothers were the lens that brought the Rockefeller and the Carnegie fortunes into focus on the unsuspecting and vulnerable medical profession.

Prior to 1910, the practice of medicine in the United States left a great deal to be desired. Medical degrees could be purchased through the mail or obtained with marginal training at understaffed and inadequate medical schools. The profession was suffering from a bad public reputation and reform was in the air.

The American Medical Association had begun to take an interest in cleaning its own house.

It created a Council on Medical Education for the express purpose of surveying the status of medical training throughout the country and of making specific recommendations for its improvement. But by 1908 it had run into difficulty as a result of committee differences and insufficient funding. It was into this void that the Rockefeller-Carnegie combine moved with brilliant strategy and perfect timing.

Henry S. Pritchett, the president of the Carnegie Foundation, approached the AMA and simply offered to take over the entire project.

The minutes for the meeting of the AMA's Council on Medical Education held in New York in December of 1908 tell the story:

At one o'clock an informal conference was held with President Pritchett and Mr. Abraham Flexner of the Carnegie Foundation. Mr. Pritchett had already expressed by correspondence the willingness of the Foundation to cooperate with the Council in investigating the medical schools. He now explained that the Foundation was to investigate all the professions: law, medicine, and theology. ...(1)

He agreed with the opinion previously expressed by the members of the Council that while the Foundation would be guided very largely by the Council's investigation, to avoid the usual claims of partiality no more mention should be made in the report of the Council than any other source of information. The report would therefore be, and have the weight of, a disinterested body, which would then be published far and wide.

It would do much to develop public opinion.(2)

1. This is not the subject of the present study, but the reader should not pass over the fact that the same strategy for control over education was being executed in other key areas as well.
2. Morris Fishbein, M.D., A History of the AMA, (Philadelphia & London: W.B. Saunders Co., 1947), pp. 987, 989.

Here was the "philanthropy formula" at work again:

1. have others pay a major portion of the bill (the AMA had already done most of the work; the cost to Carnegie was only $10,000),

2. receive a public-image bonus (Isn't it wonderful that these men are taking an interest in upgrading medical standards!)

3. gain control over a vital sphere of American life. This is how that control came about. The Flexner Report, as it was called, was published in 1910

As anticipated, it was "published far and wide," and it did "do much to develop public opinion."

The report correctly pointed out the inadequacies of medical education at the time. No one could take exception with that. It also proposed a wide range of sweeping changes, most of which were entirely sound. No one could take exception with those, either. The alert observer, however, would note that the recommendations included strengthening courses in pharmacology and the addition of research departments at all "qualified" medical schools.

Taken at face value, the Flexner Report was above reproach and, undoubtedly, it performed a service that was much needed. It is what followed in the wake of the report that reveals its true purpose in the larger plan. Rockefeller and Carnegie began immediately to shower millions of dollars on those medical schools that were susceptible to control.

Those that did not conform were denied the funds and eventually were forced out of business by their well-funded competitors.

A hundred and sixty schools were in operation in 1905. By 1927, the number had dropped to eighty. Most of those that were edged out had been sub-standard, but excellence was not the sole criterion for determining which ones would receive funding. The primary test was the willingness of the school administration and faculty to accept a curricula geared to drug research. That is how the money would come back to the donors - plus a handsome profit. Historian Joseph Goulden describes the process this way:

Flexner had the ideas, Rockefeller and Carnegie had the money, and their marriage was spectacular. The Rockefeller Institute for Medical Research and the General Education Board showered money on tolerably respectable schools and on professors who expressed an interest in research.(1)

1. Goulden, The Money Givers, op. cit., p. 141.

Since 1910, the foundations have "invested" over a billion dollars in the medical schools of America. Nearly half of the faculty members now receive a portion of their income from foundation "research" grants, and over sixteen percent of them are entirely funded this way.

Rockefeller and Carnegie have not been the only source of these funds.

Substantial influence also has been exerted by the Ford Foundation, the Kellogg Foundation, the Commonwealth Fund (a Rockefeller interlock created by Edward Harkness of Standard Oil), the Sloan Foundation, and the Macy Foundation. The Ford Foundation has been extremely active in the field of medical education in recent years, but none of them can compare to the Rockefellers and the Carnegies for sheer money volume and historical continuity.

Joseph C. Hinsey, in his authoritative paper entitled "The Role of Private Foundations in the Development of Modern Medicine," reviews the sequence of this expanding influence:

Starting with Johns Hopkins Medical School in 1913, the General Education Board supported reorganizations which brought about full-time instruction in the clinical as well as the basic science departments of the first two years of medical education at Washington University in St. Louis, at Yale, and at Chicago. In 1923, a grant was made to the University of Iowa in the amount of $2,250,000 by the General Education Board and the Rockefeller Foundation.

 

Similar grants in smaller amounts were made to the following state-supported medical schools: University of Colorado, University of Oregon, University of Virginia, and University of Georgia. An appropriation was made to the University of Cincinnati, an institution which received some of its support from municipal sources. Howard University and the Meharry Medical School were strengthened, the latter by some eight million dollars.

 

The General Education Board and the Rockefeller Foundation later made substantial grants to the medical schools at Harvard, Vanderbilt, Columbia, Cornell, Tulane, Western Reserve, Rochester, Duke, Emory, and the Memorial Hospital in New York affiliated with Cornell.(1)

It is necessary to add to this list the medical schools of Northwestern, Kansas, and Rochester; each heavily endowed, either by Rockefeller money or by the Commonwealth Fund which is closely aligned with Rockefeller interests.(2)

1. Article reprinted in Warren Weaver's U.S. Philanthropic Foundations, op. cit., pp. 264, 265.
2. Ibid., p. 268.

After Abraham Flexner completed his report, he became one of the three most influential men in American medicine. The other two were his brother, Dr. Simon Flexner of the Rockefeller Institute, and Dr. William Welch of Johns Hopkins Medical School and of the Rockefeller Institute.

According to Hinsey, these men, acting as "a triumvirate":

... were not only involved in the awarding of grants for the Rockefeller Foundation, but they were counselors to heads of institutions, to lay board members, to members of staffs of medical schools and universities in the United States and abroad. They served as sounding boards, as stimulators of ideas and programs, as mediators in situations of difficulty.(1)

The Association of American Medical Colleges has been one of the principal vehicles of foundation and cartel control over medical education in the United States and Canada.

Organized in 1876, it serves the function of setting a wide range of standards for all medical schools. It determines the criteria for selecting medical students, for curriculum development, for programs of continuing medical education after graduation, and for communication within the profession as well as to the general public.

The Association of American Medical Colleges, from its inception, has been funded and dominated by the Commonwealth Fund, the China Medical Board (created in 1914 as a division of the Rockefeller Foundation), the Kellogg Foundation, the Macy, Markle, Rockefeller, and Sloan foundations.(2)

By way of analogy, we may say that the foundations captured control of the apex of the pyramid of medical education when they were able to place their own people onto the boards of the various schools and into key administrative positions. The middle of the pyramid was secured by the Association of American Medical Colleges which set standards and unified the curricula.

The base of the pyramid, however, was not consolidated until they finally were able to select the teachers themselves. Consequently, a major portion of foundation activity always has been directed toward what generally is called "academic medicine." Since 1913, the foundations have preempted this field.

The Commonwealth Fund reports a half-million dollars appropriated for this purpose in one year alone, while the Rockefeller Foundation boasts of over twenty-thousand fellowships and scholarships for the training of medical instructors.(3)

1. Ibid., p. 274.
2. Ibid., pp. 267, 268.
3. Ibid., pp. 265, 266.

In The Money Givers, Joseph Goulden touches upon this sensitive nerve when he says:

If the foundations chose to speak, their voice would resound with the solid clang of the cash register. Their expenditures on health and hospitals totaled more than a half-billion dollars between 1964 and 1968, according to a compilation by the American Association of Fund-Raising Counsel. But the foundations' "innovative money" goes for research, not for the production of doctors who treat human beings. Medical schools, realizing this, paint their faces with the hue desired by their customers.(1)

Echoing this same refrain, David Hopgood, writing in the Washington Monthly, says:

The medical school curriculum and its entrance requirements are geared to the highly academic student who is headed for research. In the increasingly desperate struggle for admission, these academically talented students are crowding out those who want to practice medicine.(2)

1. Goulden, op. cit., p. 144.
2. "The Health Professionals: Cure or Cause of the Health Crises?" Washington Monthly, June, 1969.

And so it has come to pass that the teaching staffs of our medical schools are a special breed. In the selection and training process, emphasis has been put on finding individuals who, because of temperament or special interest, have been attracted by the field of research, and especially by research in pharmacology.

This has resulted in loading the staffs of our medical schools with men and women who, by preference and by training, are ideal propagators of the drug-oriented science that has come to dominate American medicine. And the irony of it is that neither they nor their students are even remotely aware that they are products of a selection process geared to hidden commercial objectives.

So thorough is their insulation from this fact that, even when exposed to the obvious truth, few are capable of accepting it, for to do so would be a blow to their professional pride. Generally speaking, the deeper one is drawn into the medical profession and the more years he has been exposed to its regimens, the more difficult it is to break out of its confines.

In practical terms, this simply means that your doctor probably will be the last person on your Christmas card list to accept the facts presented in this study!

Dr. David L. Edsall at one time was the Dean of the Harvard Medical School. The conditions he describes at Harvard are the same as those at every other medical school in America:

I was, for a period, a professor of therapeutics and pharmacology, and I knew from experience that students were obliged then by me and by others to learn about an interminable number of drugs, many of which were valueless, many of them useless, some probably even harmful...

 

Almost all subjects must be taken at exactly the same time, and in almost exactly in the same way by all students, and the amount introduced into each course is such that few students have time or energy to explore any subject in a spirit of independent interest. A little comparison shows that there is less intellectual freedom in the medical course than in almost any other form of professional education in this country.(1)

1. Quoted by Morris A. Bealle, The New Drug Story, (Wash. D.C.: Columbia Publishing Co., 1958), pp. 19, 20.

Yes, he who pays the piper does call the tune. It may not be possible for those who finance the medical schools to dictate what shall be taught in every minute detail.

But such is not necessary to achieve the cartel's goals. It is certain, however, that there is total control over what is not taught, and under no circumstances will one of Rockefeller's shiny dimes ever go to a medical college, to a hospital, to a teaching staff, or to a researcher that holds the unorthodox view that the best medicine is in nature.

Because of its generous patron, orthodoxy always will fiddle a tune of patented drugs. Whatever basic nutrition may be allowed into the melody will be minimal at best, and it will be played over and over again that natural sources of vitamins are in no way superior to those that are synthesized. The day when orthodox medicine embraces nutrition in the treatment of disease will be the day when the cartel behind it has succeeded in also monopolizing the vitamin industry - not one day before.

In the meantime, while medical students are forced to spend years studying the pharmacology of drugs, they are lucky if they receive a single course on basic nutrition. The result is that the average doctor's wife knows more about nutrition than he does.

Returning to the main theme, however, we find that the cartel's influence over the field of orthodox medicine is felt far beyond the medical schools.

After the doctor has struggled his way through ten or twelve years of learning what the cartels have decided is best for him to learn, he then goes out into the world of medical practice and immediately is embraced by the other arm of cartel control - The American Medical Association.

So let us turn, now, to that part of this continuing story.
 

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