Straight Talking Doc Unhinged

The first half of American Medical History ends at the Flexner Report, which entirely morphed American Healthcare into a monolithic corporate entity under the complete control of the AMA.  Every aspect of healthcare transformed, from education, to payment, to philosophy, to licensing, to dogma.  The Medical Racial Script, long unspoken and oft ignored, became the law of the land.  What are the repercussions of Flexner today?  We will discuss some of the ramifications of the AMA's cooptation, and the corporate ownership of, healthcare before moving on two the second part of the course.

Dementia tells us a great deal about our healthcare system.  Not even noted to be a disease at the time of Medicare's birth in 1965 it is now one of the most onerous and common diseases of the elderly.  Why?  And why is the incidence so much higher in the United States than the rest of the world?  We have tried to medicalize dementia and memory loss and created a multi-billion dollar industry around it including useless drugs, unhelpful tests, and far too many specialist visits.  But we've missed the point.  Dementia can't be prevented or treated by throwing money and drugs at it.  It is a disease of lifestyle, and only by improving inflammation through diet, exercise, and other lifestyle changes can we seek to prevent and mitigate it.  We'll discuss all of this in our podcast.

Two pages of the Flexner Report condemned African American medial providers, hospitals, and patients to decades of struggle.  Relying on the AMA's medical-racial script, and playing into the atmosphere of Progressive eugenics, Flexner's chapter devoted to the African American medical situation flowed from what united white orthodox providers and fed the corporate impetus that would finance the new health care system.  Essentially, Flexner sought to close all but two African American medical schools, condemn graduates from those schools to being sanitation workers who would assure that African Americans don't spread disease to whites, and deflect corporate funding elsewhere.  The results were disastrous.

As the medical community scripts new cholesterol guidelines, the media has compliantly announced that our nation's top scientists, most respected medical agencies, and academic centers want to prevent heart disease by screening for high cholesterol more aggressively and treating cholesterol more aggressively.  The geniuses who created the guidelines want screening and treatment to start even in 10-year-olds!  But there are flaws.  First, no new science is incorporated into the guidelines, and other than drug-company designed observational studies all randomized trials show no value to measuring and fixing cholesterol.  In fact, not only is cholesterol not a prognostic risk factor for heart disease, not only does lowering it not help heart disease, but in people over 60 and in kids/young adults high cholesterol portends better outcomes.  Second, the organizations that printed these guidelines are tainted and self-serving, seeking to push lower cholesterol levels not based on any likelihood of helping people, but solely to sell more drugs, create more office visits, and justify more testing.  The American Heart Association (AHA) is funded and led by drug companies; the American College of Cardiology also has strong ties to drug companies and has as its main objective increasing salaries of cardiologists.  Third, the academic doctors who put their name on these guidelines are a who's who of docs who conduct drug company research, research that pays their institutions.  We know that cholesterol is not worth measuring, especially in kids and elders.  We know that statins come with risks and should be reserved for people with high risk of heart attack and stroke who are over 25 and under 80, but are not helpful in people with high cholesterol.  And we know that pushing LDL cholesterol under 70 is frankly dangerous and medically negligent.  We will explain!

Once the AMA and William Welch orchestrated an alliance of Progressive reformers, corporate interests, and state medical licensing agencies, it was time to sanctify the cogs of a new medical system.  That is what the Flexner Report is all about, a survey of US medical schools largely scripted by the AMA, conducted by a little known educator working for the Carnegie Corporation named Abraham Flexner, and financed by complicit corporations.  The Report entirely transformed the American healthcare system into one that focused on lab rats over clinicians, number measurement over patient-centered care, and a dogmatic top-down system run entirely by the AMA and financed by corporations.  The report closed most medical schools and required the surviving one to use corporate funds to transform into lab-based institutions.  Students would now be taken out of the clinical realm and be placed in the classroom and lab where they would learn about tests and drugs and German medicine, transforming healthcare into more of a technical field than one of critical thinking, humanism, and dynamic science.  Those who complied received higher salaries and status.  Those who did not were excluded from the healthcare landscape.  Poor William Osler protested from England, but his vision for medical care evaporated once the report's findings became the new norm.

Depression is a very vague concept.  How do we determine if someone is depressed?  What does depression even mean, and how is it best prevented and treated?  The realities of depression veer sharply from how the medical industrial complex would like you to think about it.  They have designed screening tools and have incorporated them into the quality indicators required for all doctors to complete.  Then, of course, we have to treat those who test positive, typically with drugs.  And is that not the point of screening, to medicalize what is often normal emotional fluctuations in our lives, and then to sell people medicine?  We will discuss why such screening is flawed, why treatment is dangerous, and how we have all been sold yet another medical myth that profits many and harms many more.

Two of American medicine's pioneers, and co-founders of Johns Hopkins Medical School, represented a fork in the road.  William Osler, whose scientific humanism pushed back against a healthcare system teetering between commercialism and quackery, created a solution at Hopkins: clinical care, doctors as teachers, patients as teachers, an end to protocols and dogma.  He believed in patient centric care: "If you want to know the diagnosis, ask the patient," he said.  He believed that America was becoming a society of drugging rather than healing.  He believed that nuance and uncertainty were inherent to healthcare, and that there could never be one right answer.  His colleague, William Welch, was a pathologist, a eugenicist, a believer in German medicine, an AMA president.  He did not believe in the importance of patient centered care, rather advocating laboratory medicine that trumped the patient.  He believed in drugs and one-right-answer thinking and he rejected the value of clinical care in education.  He wanted a medical education system run only by full time laboratory faculty, not practicing physicians as Osler had set up at Hopkins.  Welch, in the end, won the day.  Once Osler retired, Welch fired all clinical staff, and imprinted the AMA model upon all of healthcare.  He is indeed the father of American healthcare, but of a healthcare system that embraced eugenics and the medical racial script, that marginalized patients, that created diseases out of numerical norms, and that worked with corporations and drug companies.  If you want to know where our system came from, you only have to understand Welch's victory over Osler.  And if you want to know how to fix the system, you only have to understand and revive Olser.

Alan and Andy discuss why they are dinosaurs, why primary care is becoming extinct and why its disappearance will instigate harm to the health care system, to patients, to our national debt, and to reason and sanity in health care.  Talking about changes within the medical environment, they show not only why primary care is being left to die, but also the measures needed to revive it.  It's not hard, but any reasonable measures we as a society institute will run into the wall of profits derived from keeping the system dysfunctional.  

The AMA grew up in a libertarian America, but chose to change its nature during a top-down Progressive America, where experts and scientifically based rules were determined to be crucial to any viable reforms.  Working with corporate foundations, Progressive reformers, and German-inspired Progressive academic doctors, the AMA shifted course and transformed into a top-down organization that sought to control all aspects of American medicine, including education.  It changed its structure to rely on a very narrow board of "experts," it adapted a German ideology of care, it worked with corporations and drug companies to increase its base of money and power, and it started to survey medical schools and determine which ones were capable of surviving in a new Progressive age.  All of this foreshadowed the Flexner Report, which would vault the AMA into total domination over the medical landscape, normalize German medical thinking, and create a formulaic dogmatic medical script that would be templated upon all medical schools and all licensing requirements.

In the 1980's dermatologists were somewhere in the basement of the doctor world in terms of reputation and reimbursement.  It was always felt to be an easy job--not too much thinking, a limited scope of care, no after hours calls--but did not pay well  So the American Dermatology Association hired a publicist and some lobbyists in Congress and created a generalized fear of skin cancer, stating there was an epidemic, that annual skin screens would save lives, and that aggressively removing both cancers and precancers is necessary.  All the sudden it became difficult to even become a dermatologist and their incomes and reputations skyrocketed, with many earning $500,000 to $1,000,000 a year and still working less than virtually every doctor according to statistics.  Yes, despite all this surveying and slicing, skin cancer deaths have not dropped at all.  This has occurred simultaneously with the sunscreen craze, and now we are blocking our skin with substances that have not reduced skin cancer deaths but have likely increased sickness, including cancer, since sun hitting the skin is necessary for our immune system, and we are blocking that with all this toxic cream.  We will dissect the truth of skin cancer and the role of dermatologists, and tell you how you can best protect yourself not from the sun but from snake oil salesmen who have abused your trust.