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Important Milestones in the History of Medicine in the United States Essay (Critical Writing)

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Updated: Jun 23rd, 2022

The history of American medicine dates back to the Colonial era when traditional medicines and cures were the preeminent methods of treatment. After the American Revolution, the medical system was disjointed, dysfunctional, and slow to adopt scientific advances and innovations originating from the Old World. One of the particular weaknesses of the healthcare system was medical education, as the majority of educational facilities were nothing more than “diploma mills,” offering certifications for a fee. The book-length report by Abraham Flexner criticized the lack of standards for medical training and offered fundamental principles for managing public health. This paper argues that Flexner’s report set the trend for subsequent milestones, including life extension efforts and infant mortality reduction.

Milestone Description

Today, the US science administrator and political activist Abraham Flexner is recognized as a critical figure behind US medical education reforms that have shaped the modern education system. The best-known milestone associated with Flexner is dated 1910 when he presented the report under the title Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (Stahnisch & Verhoef, 2012). Trained in natural sciences at the preeminent Johns Hopkins University in Baltimore, Abraham Flexner was well-aware of the pace that scientific development in medicine had taken. For this reason, he passionately advocated for making the best scientific practices and clinical experiences become the basis of medical education.

The Flexner report addressed the evolving role of the physician, suggesting that scientific progress had had a profound impact on medical ethics and social responsibility (Maeshiro et al., 2010). The author explained that previously, the focus of therapy was an individual patient. However, as of 1910, the United States population required that the physician’s scope of work went beyond family medicine and became “social and preventive, rather than individual and curative” (Maeshiro et al., 2010, p. 211). In his report, Flexner did not use the term “public health,” though it is quite clear that he concerned himself with matters of this very concept. The report contained three public-health-oriented principles that remain relevant to this day (Maeshiro et al., 2010). Firstly, Flexner argued that the contents and quality of medical training should be in line with the health needs of the public. Thus, medical education should be ever-evolving to broaden medical professional’s knowledge and prepare them for disease prevention and health promotion. Lastly, Flexner was a strong believer in the value of collaboration between academic medicine and public health communities.

As for the context in which Flexner’sFlexner’s report emerged, it should be noted that at the turn of the century, the state increased funding for medical research, welfare insurance, new hospitals, and asylums. A number of philanthropists, such as the Rockefeller Foundation and the Carnegie Foundation for the Advancement of Teaching in New York City, were making great contributions to public health causes. However, it was not only evidence-based medicine that flourished during the “American progressive era” but also its alternative forms. Stahnisch and Verhoef (2012) explain that competing approaches, such as naturopathy and homeopathy, had their share in the medical marketplace. Flexner was adamant in fighting against what he saw as “charlatanism,” “quackery,” and “medical sects” (Stahnisch & Verhoef, 2012). Therefore, with his report, the author wanted to refine medical standards and protect populations against unreliable forms of treatment.

Flexner’s report was revolutionary, and even 110 years later, it does not lose its relevance. Evidence-based practice has become standard for medical education and the medical profession (Maeshiro et al., 2010). Doctors and nurses are trained in conducting research and drawing on the latest scientific findings to guide their decision-making in the workplace. Public health strategies shifted from reactive to proactive, as in preventing disease outbreaks and health crises rather than dealing with the consequences. Statistically, during the last one hundred years, there has been an improvement in key health determinants. The life expectancy in the US has risen by 25 years, and infectious diseases, such as diarrhea, tuberculosis, and pneumonia, ceased to be leading causes of death (Maeshiro et al., 2010). Yet, social inequality with regard to access to healthcare and the presence of underserved communities persist.

Other Milestones

Around the same time that Flexner’s report appeared, the American health system passed two more important milestones. In 1913, the Life Extension Institute was founded by the celebrity philanthropist Irving Fischer and tasked with addressing the public health issues of the American population. In the Report on National Vitality, the Life Extension Institute referred to the conservation of health as part of natural resources conservation in the whole. It was pointed out that protection against natural and manmade disasters should pursue not only the prevention of property damage but also life loss (Kneese, 2019). The strategy of the organization was largely influenced by the philosophy of the Progressive Era. The concept of economic efficiency was central to the Institute’sInstitute’s goals and seen as the end result of health maintenance efforts (Kneese, 2019). Though controversial in many aspects and blamed for eugenics, the Life Extension Institute set an important precedent for making preventive exams part of medical insurance plans as well as promoting preventive medicine.

In terms of public health, the year 1913 was marked with the publication of a pamphlet on prenatal care by the United States Children’s Bureau. The rationale for publication was the lack of information about pregnancy and childbirth among American women, which caused high infant mortality rates (West, 1915). A college-educated writer and a mother of five children, Mary Mills West, wrote the booklet that covered the most important topics regarding pregnancy, childbirth, and nursing (West, 1915). What made the pamphlet stand out is the clear language and practical recommendations to expecting and new mothers, as well as the focus on preventing complications through healthier lifestyle choices, such as light exercise and dieting. Apart from that, West gave information on signs of pregnancy and taught her audience to calculate terms and due dates. The publication became widely popular and requested by millions of women across the country.

Milestones Comparison

Today’s US healthcare system draws on principles established more than a century ago by Abraham Flexner, who was a prolific scientist and a public health advocate. His report not only criticized the existing medical education system but also drafted a trajectory for further development. In particular, Flexner prioritized the social responsibility of medical workers and proactive approaches toward public health. This philosophy is reflected in the Life Extension Institute’s activities that were aimed at making Americans more socially and economically efficient through health maintenance and disease prevention. Further, the preventive approach translated into women’s education on the issues of pregnancy, childbirth, and nursing, thus, helping to tackle the longstanding infant mortality problem.

References

Kneese, T. (2019). Death, disrupted. continent., 8(1), 70-75.

Maeshiro, R., Johnson, I., Koo, D., Parboosingh, J., Carney, J. K., Gesundheit, N.,… & Cohen, L. (2010). Medical education for a healthier population: Reflections on the Flexner Report from a public health perspective. Academic Medicine, 85(2), 211-219.

Stahnisch, F. W., & Verhoef, M. (2012). The Flexner report of 1910 and its impact on complementary and alternative medicine and psychiatry in North America in the 20th century. Evidence-Based Complementary and Alternative Medicine: eCAM, 2012, 647896.

West, M.M. (1915). Prenatal care. Washington Government Printing Office.

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