Medical Education—A Racket

The caliber of medical services rendered to the community is largely dependent upon the quality of the basic training which the physician receives in the course of his education, and upon the facilities which the graduate physician has for keeping abreast of medicine and its advances. It is unfortunate for the community that both of these processes are so highly commercialized that they deserve no better designation than rackets.

In past centuries, a medical student, after receiving fundamental scientific instruction, received his training as an assistant to a practicing physician. Inasmuch as the practice of medicine is an art which involves flexible application of medical and other sciences, such preceptor training in medicine is the only form that is safe or proper. The student receives individual training and instruction; and the application of his knowledge is watched closely in order to safeguard the lives of patients entrusted to his care.

The origin of the modern medical school can be traced to the commercial ambition of medical leaders of the past century. Their incomes from teaching were often larger than from practice. Thus Dr. David Hosack of New York City, reported that in the years 1826 to 1829 he made fourteen hundred dollars from his private students and assistants.

An idea of the relative magnitude of such an income can be sensed from the fact that with it Dr. Hosack was able to indulge in the luxury of a botanical garden on the site of the New York City Public Library.

Teaching physicians also observed that their assistants, when launched into independent medical practice, continued to call them out on well-paid consultations. It dawned upon some of them that if one assistant or student would call them on five consultations per year, one hundred medical students probably would call them on 500 consultations per year; and their incomes and practice would thus be multiplied. The entire history of medicine in the U.S. has been characterized by a mad scramble for the commercial profits of teaching medicine. This is illustrated by the history of the College of Physicians and Surgeons of Columbia University.

HISTORY OF THE COLLEGE OF PHYSICIANS AND SURGEONS—COLUMBIA UNIVERSITY

The first medical school in New York was that of King's College (now Columbia University) founded in 1768. It was short-lived, because of factional strife in medicine in New York City.

When Dr. Nicholas Romayne, in 1791, requested the Regents of the University of the State of New York to supervise his private medical school, Columbia University blocked the organization of the school by politics until 1807. Organized as the College of Physicians and Surgeons, Dr. Romayne's School merged with Columbia University in 1813. Between 1809 and 1814, the state approved lotteries for the medical schools. From the lottery of 1809, the College of Physicians and Surgeons received five thousand dollars which constituted the chief lure for the belated merger.

Universities have regarded medical schools as good businesses because they could be made to pay. But the College of Physicians and Surgeons was not much of a financial success for Columbia University. For the cream of the profits was drawn off by the professors who collected their tuition fees directly from the students. So lucrative was the college to the "professors" that they were willing to lend it twenty thousand dollars out of their own purses. Some professors earned as much as $8,000 a year from their jobs.

The large income derived from medical schools by the professors, and their unfair competition made possible by the advertising of the school, aroused the jealousy of the trustees of the College and of the medical profession. Jealous commercial quarrels raged continually between the competing professors over sharing of the money and business, and became public scandals.

THE WAR OF THE MEDICAL SCHOOLS

These jealous bickerings reached a climax in 1826. Envy of the large professional income of Dr. David Hosack who represented the socially elite element in the community, and of his income from private instruction started a war between factions on the faculty of the College of Physicians and Surgeons. Charges were brought against him and other professors by the trustees of the College which alleged favoritism, misappropriation of funds and oppression. It is interesting to note that several years prior, in 1819, the College was charged by the New York City Medical Society with falsification of records of students, failure to hold public examinations and favoritism in granting degrees to unqualified students. This last charge is interesting because the practice still continues.

As a result of this disreputable conduct the charter of the College was amended. The charter originally granted the College made the profession and the entire medical society of the city and county of New York the board of trustees. In 1816, the number was cut to twenty-one. In 1826, so well had the physicians discredited themselves with their bickering that the law was amended to require that ten of the trustees be laymen. The appointment of these trustees rested with the Regents of the University of the State of New York, who negotiated between the College and legislature. The balance of power was given by this act to the laymen.

As remonstrance against the legislation which ousted them from the control of the business of the Physicians and Surgeons, Dr. Hosack and his professors resigned. With a charter secured from Rutgers University, they proceeded to establish a rival medical school. This was an eloquent commentary on the political power of Dr. Hosack and his clique. For in earlier years they had always succeeded in blocking the establishment of a medical school under the Rutgers' University charter by their rivals.

The attitude of the "professors" is revealed by the Regents' report to the legislature on the condition of the school in 1827, which is quoted from the report of the Trustees of the College, as follows:

"The unfortunate state of the College during the last winter, with the circumstance of another medical school having been established in this city, under the patronage of a College in a neighboring state, has had an effect which is to be regretted. To these causes may be ascribed the diminished number of students attending the College at this time."

"The College since its re-organization, has gone into operation with brighter prospects of success in many respects, than have been witnessed in many years. The Professors being now confined to their proper sphere of teaching, have no longer the power nor the disposition to interfere with the government of the College. Thus discord, suspicion and strife have given way to harmony, confidence and good feeling."

In the following years, 1828 and 1829, the College of Physicians and Surgeons found itself in dire straits. It was indebted to its former professors to the extent of twenty thousand dollars. It called upon the New York State Legislature to aid by paying off the debt and by denying a charter to the competitive Rutgers Medical College. The professors alleged that the rival professors would use the money paid them to drive the Physicians and Surgeons out of business. The Hosack group replied that it was the superiority of their medical school that was driving the Physicians and Surgeons out of business. By 1830, the Rutgers Medical College closed its doors.

During all this passage-at-arms and "conflict of ideals" of these merchants-in-medicine, never once were the interests of the public or of the students considered. Instead, a higher income was assured to the professors from the tuition fees of fifteen dollars per course, by increasing the length of attendance required to two years. During both years the students were compelled to attend the same course of lectures.

DIPLOMA MILLS MULTIPLY

The situation in medical education in New York was characteristic of the situation in other sections of the country. The large incomes of "professors" tempted doctors to start new medical schools to amplify their otherwise meagre incomes. Those physicians who succeeded in getting into the medical "education" racket sought to make a monopoly of the business and to keep out rivals.

The dawn of the era of "big business" discovered medical leaders launching upon "big business" in medicine. In the last decades of the nineteenth century and in the early decades of the present century, medical schools grew like mushrooms, overnight, in all sections of the country. In these schools, classes containing as high as 200 to 300, or more, students were not at all unusual. Teaching was conducted on a lecture and quiz basis. The vogue was then established which still persists in medical education.

The art of medicine, upon which human lives depend, is made the subject of rote learning and dependent upon the chances of examination. There was no valid effort to make sure that these future practitioners had mastered the skill and the knowledge necessary for the protection of the lives of their patients. These schools were highly successful, however, in building up enormous practices and incomes for their medical bosses.

A further step in the development of the medical education racket was the "diploma mill." These institutions gave concrete expression to the obvious fact that attendance in crowded classes to hear lectures on diseases and their remedies is of no value in the learning of the art of the practice of medicine. Facing the situation with greater candor than their competitors, the schools issued medical diplomas to applicants who were willing to pay the price, without requiring that the applicant even attend the school.

It is seriously to be questioned whether these diploma mills did not turn out greater physicians than did their competitors. Thus the Rush Medical College of Chicago gave a degree to George H. Simmons while he was practicing as an advertising quack many miles away in Lincoln, Nebraska. It thus supplied the medical profession with the man who revitalized its august and authoritative A.M.A.

MEDICAL EDUCATION AND THE ROCKEFELLERS

Competition became extremely keen in this medical school business. As a consequence the overlords of medicine found that they were not gaining the full advantage which they had hoped from their medical schools. They thereupon set about establishing a monopoly of the medical school business and wiping out their competitors.

The merchants-in-medicine, organized in the A.M.A., found allies in their fellow merchants in industry at the beginning of this century. It is peculiarly fitting that the agency that enabled them to monopolize the field of medicine and its education should be the General Education Board, an outgrowth of Doc William Rockefeller's quack cancer cure and medicine show.

A joint investigation into the medical schools of the country by Abraham Flexner was instituted about 1910. There ensued a publicity campaign of calumny and slander directed against medical schools in which the socially elect political bosses of medicine had no interests. The competing schools were represented as low grade and inferior. While it is true that the Standards of some of them were low, few were lower in caliber than many of the schools which were sponsored by the bosses and investigators and approved for that reason. Over half of the 165 medical schools of the country were forced to close their doors. The balance of the medical schools were left in monopolistic control of medical education.

This maneuver left the remaining schools under heavy debt to the Rockefeller group and their General Education Board. By judicious subsidy, this debt has been converted to a highly profitable, dictatorial control of the medical schools of the country by the Rockefellers and allied financial interests, and by subsidiary social service groups.

MEDICAL EDUCATION PERVERTED TO PROPAGANDA

This control of medical education and research has brought large dividends for the relatively minor funds invested. Among these dividends are the intangible items: allaying of public resentment and antagonism, and public good-will gained through proper publicizing of these virtuous activities; the earning of good-will through provision of comfortable berths, professorships, research positions, and others, for dependents of folks of influence or of associates; quite as important, if not more so, the power to eliminate individuals or groups of individuals, who insist upon telling the truth as they see it and thereby jeopardize the monetary interests of these powers. By alliance with religious institutions and missions abroad, they were enabled to penetrate and gain the good-will of foreign lands for the furtherance of trade, commerce and oil.

Some of the dividends, however, were more tangible and far exceeded the value of the supposed philanthropies. Among these were: the control and manipulation of the vast funds and endowments of the schools and universities; profits derived from licit and illicit enterprises, such as the milk racket, the drug monopoly and oil concessions, which were given prestige bv the support of the prostituted institutions and their professors; and a very profitable control of medical and allied businesses.

It has also enabled the group who control the Foundation and other Rockefeller agencies to plant in universities as professors, propagandists who serve their interests. Thus the Foundation has endowed the Institute of the History of Medicine of Johns Hopkins University at the head of which has been placed the German propagandist of the Bismarxian program of Socialized Medicine and Compulsory Health Insurance, Professor Henry E. Sigerist. With Professor C.E.A. Winslow he has been one of the most active agitators for the program which is so eagerly desired by the German Dye Trust and their Rockefeller allies.

From the subsidized group of professors there was recruited the "Committee of 430." It is not a matter of chance that some of the professors are leaders of Communist propaganda. Thus Dr. A.E. Blumberg of Johns Hopkins University has been cited by the Dies Committee as the secretary of the District of Columbia-Maryland branch of the Communist Party. Professor Franz D. Boas of Columbia University is reported by Walter Winchell to be the head of the Communist cabal organized to discredit J. Edgar Hoover and the F.B.I. His son, Dr. Ernest Boas, assistant professor of clinical medicine of the College of Physicians and Surgeons, Columbia University, leads the pseudo-liberal element in the medical profession of New York in its campaign for the adoption of Socialized Medicine, and is a Prominent leader in Organized Social Service.

These professors have organized an intensive campaign of propaganda which follows closely the party-line of the Bismarxian or Communazi dogma. They do this with the support of Organized Social Service and with the aid of subsidies from pseudo-philanthropies and of associated commercial interests Under the auspices of an advisory board consisting of members of the Committee of 430, there is issued, as a vehicle of propaganda among medical students, a monthly magazine, The Journal of the Association of Medical Students, which is distributed free of charge to the students. On the advisory board of the Journal are the following:

Charles Sumner Bacon, M.D., University of Illinois; Emmet Bay, M.D., Rush Medical College; Hugh Cabot, M.D., University of Minnesota; Walter B. Cannon, M.D., Harvard University; A.J. Carlson, M.D., Rush Medical College; Lewis A. Conner, M.D., American Heart Journal; David J. Davis, M.D., University of Illinois; Reginald Fitz, M.D., Boston University; J.F. Fulton, M.D., Yale University; Harold Edward MacMahon, M.D., Tufts College; James H. Means, M.D., Harvard University; Adolf Meyer, M.D., Johns Hopkins University; Joseph Earle Moore, M,D., Johns Hopkins University; Harry S. Mustard, M,D,, New York University; Thomas Parran, M.D., U.S. Public Health Service; John P. Peters, M.D., Yale University; G. Canby Robinson, M.D., Johns Hopkins University; Martha Tracy, M.D., Womans Medical College of Penn.; Maurice B. Visscher, M.D., University of Minnesota; C.E.A. Winslow, D.P.H., Yale University; George B. Wislocki, M.D., Harvard University.

"ENDOWMENTS" AND MEDICAL EDUCATION COSTS

The medical school business under such control has become a highly lucrative business in more than one way. The greater the investments, or "endowments," of the medical schools have become, the higher are the tuition fees demanded of the individual medical students. Tuition fees in medicine range as high as seven hundred dollars. The greater the sums contributed for "the improvement of medical education," the higher has become its cost to the student. There is about the highly endowed medical schools, little of the altruism which they demand of their students—they are becoming increasingly, purely commercial institutions bent on charging all that the traffic will bear.

MONOPOLY OF MEDICAL EDUCATION AND OF THE PRACTICE OF MEDICINE IS NOW, AS IT ALWAYS HAS BEEN, THE GOAL OF THESE ORGANIZATIONS AND THEIR CLIQUES.

The number of students admitted to the medical schools has been steadily reduced and restricted to the men whom these cliques choose to admit. They pretend to desire students who will not follow the example of intensive commercialism given them by the schools, and improvement of the caliber of the medical graduate. This is belied by the basis of choice of students. Two of the most important considerations are wealth and social position, and Aryanism. The non-Aryan quota system has rapidly degenerated into a method of blackmailing the Jewish applicants to the average tune of one thousand dollars for admission in many institutions; and in due time, this easy money racket has been extended to all applicants for admission. The restriction of medical education to rich "gentlemen of leisure" usually spells no good for the average public.

THE LAW AND MEDICAL EDUCATION

The bosses of medicine collaborated with the A.M.A. and established minimum standards and requirements for medical schools which were successively incorporated into the law of the various states. Under these laws, they appointed themselves, or had themselves appointed, the dictators of medical education and licensure in their respective states. They invariably arranged to have the medical schools in which they had vested interests included in the list of legitimate institutions. But this does not mean to say that their schools made any attempt to comply with the minimum requirements which they set up in the law.

Thus, as late as 1917, the College of Physicians and Surgeons, Columbia University, a school rated high in the Flexner report, failed utterly to teach at least two subjects required by the Medical Practice Act of the State of New York. But its Dean, Dr. Samuel Lambert, was a member of the Medical Board of Regents, who controlled medical education in the State of New York.

I recall, with excellent reason, the caliber of instruction which students received in that school. The most illustrative incident occurred in my senior year at the school. My section of the class was assigned for "instruction" in surgery to the Presbyterian Hospital. Our instructor was a Fellow of the American College of Surgeons, a man more distinguished for his social and financial affiliations than for his competence as a surgeon. Without the former, he would have been quickly denied the opportunity to operate, as an incompetent. He has his incompetence and his social and financial position to thank for the fact that he was "kicked upstairs" and made the executive head of a surgical department.

Our instruction consisted in watching him operate. It was barbarous. Three patients died on the operating table under his knife in one session because of egregious blunders and gross carelessness. I dreaded to think that life could be sacrificed so cold-bloodedly to such absolute and unbelievable incompetence.

Reassigned to the same instructor on the following day, I sat with fellow members of the section in a room reserved for students, that was separated by a partition from the hospital library. We guardedly voiced our opinions and our horror at the deaths we had witnessed on the previous day; and speculated on the possibility of a repetition of the incident. Before long, a patient passed on the way to the operating room, the first victim of the day. When he had passed I remarked to my fellow students—"More sheep to the slaughter." Much to our embarrassment, the instructor in question bounded out of the adjoining library room and disappeared.

A few minutes later, I was summoned to the office of the Superintendent of the Hospital. The instructor had accused me of making the above-stated remark to the patient. I was suspended and ordered to report to Dean Lambert. This was within two weeks of graduation.

On reporting to the Dean, he informed me that I was suspended, and would not be permitted to take the examinations or to graduate. I heatedly challenged his statement. He thereupon pronounced me to be mad. Fearing little whatever truth there may have been to his remark, I offered to submit that question to a competent psychiatrist of his own choosing.

Fortunately, the psychiatrist let me off. I passed my examinations with flying colors, and even received an offer of an appointment in the department of neurology and psychiatry. Thus ended my first tilt with organized medicine and the hospital system.

Upon passing my State Board examinations, I bethought myself of the deficiencies of the medical education which I had survived. I notified the State Board of Medical Regents of the failure of my alma mater to comply with the Medical Education Act. Shortly thereafter Dr. Lambert was no longer Dean or Regent.

The caliber of the control of medical education is made even more apparent by a recent incident also involving the New York State Board of Medical Regents. Its secretary, Dr. Harold Rypins was named in connection with "fixing" for a highly organized abortion racket. He died of angina pectoris in the home of an Assistant Attorney-General assigned to the Board who was also accused. In the hands of men of this type lies the control of medical education, licensing and "ethics" in all sections of the country.

"RISING" STANDARDS OF MEDICAL EDUCATION

The monopoly of medical education has not resulted in any material improvement in caliber or mode of instruction. It is motivated by the same objective, the building up of large teaching incomes and lucrative consultant practices for the professors and instructors. It is unfortunate that the privileges and advantages of teaching medicine in the medical schools and universities is, as frequently as not, a matter of nepotism or of outright purchase. And it is relatively seldom dependent upon superior ability or superior knowledge of the subject taught. The subdivision of medical and surgical teaching into narrow specialties facilitates the distribution of the personal advantages which might be derived from the medical schools among a larger group of favored sons.

The caliber of teachers in some phases of medicine is inconceivably low. Some subjects, such as otology, the study of diseases of the ear, require knowledge of the sciences. It is doubtful if there are more than a half dozen professors of otology in the universities of the country who have sufficient basic training in the physical sciences to understand the subjects which they are supposed to teach.

The present-day medical school differs little from the proprietary and commercial medical school of the earlier days. Nowadays there is a bit more individual instruction and practical experience in diagnosing and treating of patients.

There has recently been added to the medical course, in most States, a fifth year devoted to internship. Internship in a large hospital does not imply effective instruction in the art of medicine. The greater part of the intern year is spent by the student in the mechanical routine of a large hospital. The larger the hospital, the more effectively is the intern reduced to the role of a cog in a machine. For the privilege of doing the servile tasks of the hospitals interns are now compelled to pay high tuition fees into the coffers of medical schools.

OBJECTIVES OF MODERN MEDICAL EDUCATION

The prime objectives of medical education and the mode of instruction in the present-day monopolistic medical schools remain essentially the same as they were in the days when the schools were frankly commercial.

The student is not taught so much that he will not be forced to call his instructor into consultation when he graduates and enters practice.

Mass classroom instruction, which must be set at the pace of the mediocre student, helps to insure against effective instruction.

The subdivision of medicine into specialties involves the endless repetition of elementary and readily learned ideas, and consumes the time which might be spent in acquiring a rounded knowledge.

Lectures by the hour are given by professors and instructors who are too busy with their medical practices to keep abreast of advances in medicine. These lectures are often of very low quality, and are generally extremely fragmentary. They merely rob the student of the time that might be devoted to mastering his subject and to acquiring skill in its application.

Many essential phases of medicine, consigned to the realm of specialties and post-graduate instruction, are glossed over and neglected in the training of the medical student. But neglect of these subjects insures that the medical graduate will be compelled to refer cases of the diseases which have not been taught him to the specialist professor or instructor.

This was stressed by Dr. James Rowland Angell, President of Yale University, in a recent address made at the installation of President Dr. Frank C. Babbott, of the Long Island College of Medicine. He said:

"I am convinced that the present curriculum of many of our medical schools is staggering under a useless legacy of traditional subject-matter, which could be curtailed to a great extent. Reorganization of medical courses would be a great improvement, and would result in the saving of time and energy of the student, and would materially increase his actual mastery of the practical problems with which he is later to be confronted. It might be necessary to establish a few new chairs; but the results would be worth the cost and trouble.*

NOTABLE ADVANCE— WISCONSIN PRECEPTOR SYSTEM

There is one notable exception, in this country, to the low caliber of medical undergraduate instruction. At the University of Wisconsin, Dean Bardeen has honestly and intelligently acknowledged the inadequacy of classroom medical instruction, and has restored the "old-fashioned" preceptor system. Early in the course of medical training, the students at the University are sent out to work as assistants to practicing physicians to acquire skill in the art of medicine. Dean Bardeen deserves the thanks of the nation if this precedent will lead to a break-down of the medical school teaching rackets and to the institution of adequate training for the medical students.

Glenn Frank, as president of the University of Wisconsin, wrote an enthusiastic report of this improvement in medical education for a 1931 issue of the Wisconsin Alumni Magazine. He related that students of medicine of the University were sent as far afield as Chicago to work directly under the supervision of practicing physicians. He stated:

"Students are receiving, in the opinion of many competent observers, more careful personal instruction in clinical medicine than is provided in any other medical school."

NEPOTISM AND FAVORITISM IN MEDICAL EDUCATION

Within the last several decades, in increasing degree, intelligence and aptitude are being eliminated even in the requisites for admission to medical schools. Students are selected primarily for religion, wealth, submissiveness, subservience, and docility, to insure that they will fit into the corrupt system.

In some of the medical schools that are more completely controlled by the foundations and the Bismarxian propagandists, adherence to Marxian doctrines is an important consideration for admission. Thus the profession is becoming filled with Communazi propagandists and agents.

To cap the climax of inadequacy of university medical training, nepotism and dishonest practices are still as widespread as they were in the early days, in aiding inadequately trained and incompetent students to obtain medical degrees. Promotion and graduation are rarely dependent upon a thorough knowledge of the subject. They are dependent upon cramming and passing examinations. The dishonest practice of giving the favored few, or even the favored fraternity, a list of examination questions in advance of the examination is not unknown in the medical schools of the country.

In my last year at the College of Physicians and Surgeons, Dean Lambert undertook to question the ten highest students in the class, who had been included in the honor-roll just read by him, on an elementary subject in medicine. The honor-roll students failed ignominiously. They made a disgraceful exhibition from which they were belatedly rescued by loud promptings by less favored members of the class. This was condoned and overlooked by the Dean, to save his face.

POST-GRADUATE MEDICAL EDUCATION RACKETS

Racketeering in medical training does not cease with the undergraduate medical school. Although, in theory, graduate medical training might supplement and correct the inadequacies of undergraduate medical training, this is precluded in practice by the intensity of racketeering in the graduate medical schools.

Most of the graduate medical schools are proprietary institutions. In many of them, professorships and instructorships in the various subjects have been sold to the highest bidder. In some of them, such as College of Physicians and Surgeons (which was subsequently merged with the University of Illinois), the sale of a job was disguised by the sale of stock in the institution. Dr. G. Frank Lydston in his booklet entitled "Why the American Medical Association Is Going Backward (a Critique of the Medical Trust )" mentions his holdings of the College of Physicians and Surgeons stock. It readily can be understood that those who purchase professorships and instructorships hope to make handsome returns on their investments through consultations and through the reference to themselves of cases and operations. If the subject matter of the specialty should become too widely known among practicing physicians, or if the post-graduate students learned too much, the chances of a return on the investment would be minimized. Therefore, the opportunities offered to physicians for post-graduate and special instructions are highly restricted.

For purposes of restriction and monopoly of the specialties, the cost of graduate instruction is made high in time and money as compared with the means and earnings of the members of the profession. In the graduate schools, the bulk of the instruction even in the surgical specialties, which especially require actual technical training, practice and experience, is almost entirely by lecture and rote. To acquire even this special instruction, a physician must give up as much as three years of his time for a single subject, and expend thousands of dollars.

Medical education does not terminate with schooling. Throughout his life as a practitioner, a physician must continue his education. Each day adds a new bit to the meagre stock of medical science. Medical journals, scientific journals, newspapers, books and libraries are essential to the physician and to the welfare of the patients who entrust their lives to his care. All of these have been converted into rackets by organized medicine.

ABUSE OF LICENSING POWERS

For the purpose of holding down competition, the number of students admitted to medical training is being severely restricted by organized medicine. Only a small percent of the total number of acceptable applicants is being admitted each year to the medical schools in this country.

For a time it was pretended that the reason for restriction was the limited capacities of the schools. The sham of this pretense became clear when the A.M.A. and the licensing boards of the various States that it controls, reached overseas and intimidated foreign universities from accepting American students. The foreign universities were threatened with removal from the list of those which are recognized as giving a course acceptable for American licensure. It was a neat bit of international blackmail that was made possible by the gang's control of the boards that license medical practice, Medical licensing powers are as often misused by organized medicine today as they were a century ago. History repeats itself.