
Authors: Andrew Klein & Sera Elizabeth Klein
Dedication: For those who still remember that health is a right, not a revenue stream.
Abstract
This paper examines the transformation of American medicine in the early 20th century, focusing on the pivotal role of the 1910 Flexner Report and the financial power of the Rockefeller and Carnegie philanthropies in reshaping medical education and practice. Drawing on historical analysis, political economy, and medical sociology, we argue that the reform movement was not merely an effort to improve scientific standards but a deliberate restructuring that marginalised alternative, non-patentable approaches and created a system of dependency and extraction. The “scientific” model that emerged systematically excluded therapies that could not be owned or commodified—natural remedies, herbal tinctures, and sunlight-based treatments—while institutionalising a framework that treats patients as revenue streams. We situate this transformation within the broader architecture of extraction and manufactured threat that characterises the modern predator state and argue that the capture of medicine represents a template for control that has since been applied across multiple sectors.
Keywords: Flexner Report, Rockefeller Foundation, Medical Education, Homeopathy, Pharmaceutical Industry, Architecture of Extraction, Biomedical Model, Public Health History, Capitalism and Medicine, American Medical Association.
1. Introduction: The Century-Old Wound
Before the Flexner Report of 1910, American medicine was a diverse landscape. Hospitals used copper’s natural antibacterial properties, unpatentable herbal tinctures, and sunlight as free medicine. The system included a wide range of practices, from homeopathy to herbalism, alongside conventional approaches.
Today, the dominant narrative is that the Flexner Report was a necessary reform—a triumph of science over superstition, of rigorous education over diploma mills. We argue that this narrative is incomplete and, in many ways, itself a form of “Just So Story.” What actually occurred was a capture—a deliberate restructuring of medicine to serve the interests of the corporate class and the pharmaceutical industry, systematically eliminating what they could not own and replacing it with a system of dependency sold as progress.
2. The Flexner Report: A Critical Turning Point
2.1 The State of Medical Education Before 1910
At the beginning of the 20th century, the United States had approximately 150 to 166 medical schools. Most were proprietary schools with no formal university affiliation. Standards and quality of instruction varied widely. The system was chaotic, and many institutions were indeed “diploma mills” with lax standards.
2.2 The Report and Its Author
Abraham Flexner was a veteran schoolteacher and principal from Kentucky with no formal medical training. He had a passionate interest in pedagogy and had studied at Harvard and visited schools in Europe. His book The American College caught the attention of the Carnegie Foundation, which invited him to survey medical schools throughout the United States and Canada and make recommendations for their improvement.
The Flexner Report, published in 1910, was a stinging indictment of the era’s medical schools. Flexner found the majority of schools lacking in educational “rigor” or in need of significant improvement. He proposed replacing the multitude of inadequate schools with far fewer, university-based programs modelled along the lines of Johns Hopkins and German medical education. He argued for a formal college education requirement for admission, coupled with a four-year curriculum emphasising clinical and basic sciences.
2.3 The Impact
The highly publicised report sounded the death knell for more than half of U.S. medical schools in the two decades following its publication. The number of medical schools plummeted from 166 in 1904 to just 76 by 1930. The reforms were implemented through state licensing laws, which effectively closed or forced the reorganisation of institutions that did not conform to Flexner’s vision.
However, the closures also curtailed opportunities for African Americans, ethnic minorities, women, and other underprivileged groups to enter the medical profession. A colourful exchange between Flexner and Yale President Arthur Hadley offers insight into considerations of race, religion, and class at the time.
3. The Role of Rockefeller and Carnegie Money
3.1 The Financial Architecture
The Flexner Report was funded by the Carnegie Foundation. Its recommendations aligned perfectly with the vision of the Rockefeller philanthropies. The Rockefeller Foundation established a Division of Medical Education in 1919 to help “strategically placed medical schools in various parts of the world to increase their resources and to improve their teaching and research” . Grants followed to medical schools in England, France, Belgium, Brazil, Southeast Asia, Canada, the South Pacific, and elsewhere .
As historian E. Richard Brown documents in Rockefeller Medicine Men, the foundations used a “carrot and stick” approach . They provided massive financial support to schools that adopted the new scientific curriculum while denying funding to those that did not. The strategy was deliberate. Foundation leaders, particularly Frederick T. Gates, Rockefeller’s chief philanthropic advisor, believed that scientific medicine would serve the needs of the corporate class and provide a rational, efficient, and controllable system of healthcare.
3.2 The China Connection
The Rockefeller Foundation’s ambitions were global. In 1914, it established the China Medical Board to develop a system of modern medicine in China. The plan was to establish medical schools in Beijing and Shanghai as “pivotal centers” for American-style medical education. The Foundation took over the management of Peking Union Medical College, intended to be the “Johns Hopkins of China”. While the Shanghai plan ultimately failed, the Foundation’s global efforts demonstrate the systematic application of the Flexner model worldwide.
4. The Systematic Exclusion of Alternative Approaches
4.1 The “Sectarian” Label
Flexner’s attitude toward what he called “sectarian” or “irregular” medicine was extremely antagonistic. The term referred to treatments that were alternative to the conventional medicine of the day and that focused on the “forces of nature and the doctor within every person” . The Flexner Report, the American Medical Association (AMA), and the Rockefeller Foundation collaborated to marginalise these practices .
4.2 The Example of Homeopathy
Homeopathy was a major, respected medical practice in the 19th century. The AMA adopted a “consultation clause” in its code of ethics, which prohibited its members from consulting with homeopathic physicians, effectively professional ostracism. The Flexner Report contributed to the marginalisation of homeopathy by excluding it from the new “scientific” model of medical education.
4.3 The “Just So Story” of Scientific Medicine
As we have argued in other contexts, the origin story of scientific medicine is itself a “Just So Story.” It claims that science triumphed because it was superior, ignoring the fact that its dominance was facilitated by massive philanthropic funding and regulatory capture, not by inherent merit alone. The system that emerged was not the inevitable result of scientific progress but a constructed outcome of political, economic, and social forces. As critic Bernstein notes, Brown’s argument is that scientific medicine was “explicitly intended to develop and strengthen institutions that would extend the reach and tighten the grasp of capitalism throughout the society”.
5. The Architecture of Extraction: A Template for Control
5.1 The Pattern
The capture of medicine follows the same pattern we have identified in our earlier work on the Architecture of Manufactured Threat:
1. Manufacture a Threat: The “threat” was the chaotic, unscientific state of medicine. The Flexner Report was the tool used to define what was legitimate and what was not.
2. Deploy the Machinery of Fear: The report, backed by the Carnegie Foundation, mobilised a narrative of progress, necessity, and scientific supremacy, justifying the complete overhaul of the system.
3. Justify Extraction: The new system created a framework designed for profit: a healthcare infrastructure built on expensive technology, patented drugs, and specialist training. Health was no longer a right or a natural state; it became a “revenue stream.” Dependency was sold as progress.
4. Repeat: This pattern has been replicated in agriculture, education, and other sectors.
5.2 What Was Lost
The new model systematically pushed aside approaches that could not be commodified: copper’s natural antibacterial power, unpatentable herbal tinctures, sunlight as free medicine. They eliminated what they couldn’t own. This is not because these approaches were ineffective, but because they were a threat to the emerging model of control.
5.3 The New Dependency
The result is a system where patients are treated as “data points” and “revenue streams,” and health is framed as a commodity to be purchased through a lifetime of pharmaceutical consumption and specialist visits. The patient is never “healed” in the traditional sense but rather managed in a state of ongoing dependency. This is the essence of what we have termed the Architecture of Extraction.
6. Conclusion: Beyond the “Just So Story” of Medicine
The Flexner Report and the subsequent reforms were not simply a victory of science over superstition. They were a deliberate and highly effective capture of medicine by a new alliance of corporate, philanthropic, and professional interests that served the needs of the emerging capitalist order.
This narrative fits within the broader framework we have developed, where systems of control are established by defining a crisis, deploying resources to shape the response, and then institutionalising a model that extracts value while creating dependency. The “scientific” model of medicine is not the only possible way to heal; it is the model that prevailed because it was funded, promoted, and institutionalised by those who stood to profit from it.
To see this is not to reject science. It is to understand that science, like any other human endeavour, can be captured and turned to ends that have little to do with its stated purpose. It is to remember that health was once understood as a state of balance, and that there are forms of knowledge—copper, sunlight, herbs—that do not require a patent or a lifetime of dependency.
The question is not whether Flexner was right to eliminate medical diploma mills. He was. The question is whether the new system he helped create has served the health of the people or the wealth of the few.
References
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4. The Rockefeller Foundation. (2015). Our History.
5. Harvard T.H. Chan School of Public Health. (2013). Reports heard ’round the world. Harvard Public Health Magazine.
6. Maeshiro, R., et al. (2010). Medical education for a healthier population: reflections on the Flexner Report from a public health perspective. Academic Medicine, 85(2), 211-219.
7. South Korean Journal of Medical History. (2025). The Rockefeller Foundation’s Unrealized “Shanghai Medical School” Plan and Its Implications (1915–1920). 34(2), 501-546.
8. Library of Congress. (2012). Rockefeller Foundation. Division of Medical Education.
9. Bernstein, S. (1980). Review of Rockefeller Medicine Men. The Antioch Review, 38(1), 123.
Signed,
Andrew Klein
Co-Author:
Sera Elizabeth Klein








