Good Rockefeller Medicine Men: Book Review Example

Medicine and Capitalism in America

Rockefeller Medicine Men: Medicine and Capitalism in America
E. Richard Brown published Rockefeller Medicine Men in 1979. Since then, the book has been the topic of controversy. Moreover, it is among the most provocative medical texts written during the second half of the 20st century. Today, as we move into the 21st century, the debates concerning Rockefeller Medicine Men continue from both historical and practical standpoints. These controversies include social and historical approaches to medicine in the United States. In the introduction to the text, Brown points out that during the 1970s the "great physician ideology" (Brown, 1979) had fallen by the wayside. Furthermore, the system that had once underlined medical practice was transitioning into a newly revised approach to medical care. This new approach included an analysis of the political, economic, and social aspects of medicine, with respect to health services and medicine. While Brown agreed that the accomplishments of the great physicians of the past were not to be disregarded, they were in fact just an aspect of the larger realm marked by political, economic, and social factors. E. Richard Brown’s work focuses on how these forces developed in a manner that served to shape and redefine them. Brown explains the relationship between the Rockefeller patterns of foundation giving (Dooley, 1987) and the corporate class, as medicine moved into a new era.
While critics, such as Paul Starr, questioned the publication (Starr, 1982) stating that cultural and political influences served to shape the institution, Brown contends that the greatest influence on contemporary medical practice came through the embracement of science. Through technological and scientific advancements, the field of medicine not only gained effective skills, it also managed to gain global credibility. Accountability was possible because medical practice in the United States was better equipped to keep up with a worldwide trend toward knowledge-based industrialization. In order for medicine in the western world to keep pace, it was necessary for the practice to move beyond the humiliating reputation that Brown felt it acquired during the 19th century. Brown’s position was that in spite of the fact that economic, political and cultural factors played a major role in medical reform, the emphasis on scientific medicine and technology supplied the major thrust behind the transformation. He states that the deliberate decision of leaders, to emphasize medical legitimacy through scientific and technological advancement, helped in acquiring national and global respect.
Brown contends that while the field of medicine was acquiring increased credibility within the general society, some of the most influential support was coming from major institutions within the influential corporations of the day. Moreover, in spite of the fact that wealthy donors were making substantial contributions, many of the leading corporations were contributing to the development of medical research laboratories, medical colleges, and training hospitals. The author points out that the Rockefeller patronages contributed immeasurably to the reforms in medical education, advancement of medical science, and toward improvements in public health. Brown also credits Reverend Frederick T. Gates, who was Rockefeller’s chief primary advisor, as the impetus behind the development of the strategic decisions that helped form the foundations medical endeavors. Initially, around the turn of the 20th century, Gates was driven by a desire to improve health and humanitarian resources. This desired helped to fuel the formation of the Rockefeller Institute for Medical Research. While E. Richard Brown recognized Gates for his leading role in this transition, he also mentions reforms by Charles W. Eliot, the president of Harvard University in 1870. Eliot helped facilitate the opening of the Johns Hopkins medical school in 1893, and continued to extend reforms into the new century.
The problem Brown states in Rockefeller Medicine Men, was that by the 1900s, health care reforms had focused on the interplay between historical medical practices, modern medicine, and corporate capitalism. The same powers that helped to create the current medical structure had been invested in trying to organize a system that served their own special interests, primarily motivated by monetary gain. Due to an emphasis on self-serving practices, Brown believed a system had developed that inadequately served the health needs of the nation. The most obvious downfalls were related to healthcare cost, inaccessibility of appropriate and adequate care, and inflation. He believed that medical expenses had filtered into inflated health insurance costs, taxes, and out-of-the-pocket expenses. The other problem that Brown discusses is that in spite of the emphasis on scientific breakthroughs and advanced technologies, the nation as a whole was not the picture of health. Brown comments that although it seemed natural that modern medical practice should have alleviated many conditions and diseases, quite the opposite was true. In fact, if anything, individuals within the society were less healthy and more dependent on medications and treatments than in the past. Furthermore, in the text, Brown questions why treatment has become increasingly costly why if it is so bountiful it is ‘so inaccessible?’
Why, when modern medical practices appear to be so scientifically advanced, should they remain detached from the best interests of society as a whole? Brown answers the question by presenting a cursory argument that industrialization and technology can limit social organization thereby producing reciprocal problems and solutions. According to Brown, this type of situation overlooks practical historical and societal technological interactions. From a Marxist vantage point, the groups and individuals owning the resources control the production while potentially neglecting the greater good. Rockefeller Medicine Men further discusses private fortunes and social discontent, medicine, and the ideological professional ‘uplift,’ preservation of capital, medical education reform, and technological medicine.
Brown successfully delineates the interplay between private fortunes and social discontent in the first chapter of the book. The author begins by explaining that 19th century presented many difficulties. As the country developed, Americans who owned and operated the dominant industries had to shuffle complex duties. Systems had not yet been established for tiered responsibilities, and the bulk of management tasks occurred without existing protocols. Not only that, Brown points out that corporate leaders found themselves within a preexisting political structure that had become outdated. Since the existing medical, educational, religious, and cultural institutions carried over practices based on an outdated agricultural structure, it needed to adapt to the new industrial age. Through such groundbreaking works as “Carnegie’s Gospel of Wealth,” Andrew Carnegie explained in The North American Review (1889, 29-30) that the wealthy had a duty to consider the needs of the community at large. Likewise, along with Reverend Gate’s concept of “Wholesale Philanthropy” the tides began to turn. This was particularly true in the arena of a medical reform equipped to meet the needs of the growing society. While the intention of the philanthropists was notable, the application required assistance from professional managers.
Within this context, the author explains medicine and the ideological professional ‘uplift.’ During the 1880s, Brown points out that there was a pervasive lack of interest in medical reform as an aspect of American medical history. However, in the later part of the century, when scientific breakthroughs began to capture the interest of the public, attention to medical advancements began to take hold. While most physicians had been learning their trade through apprenticeships with doctors and relying on herbal remedies, by the turn of the century “Scientific medicine” was gaining universal acknowledgment and political support. Licensing measures were developed to avoid “herbal healers” (Brown, 63), and legal reforms were paving the way to lawsuits. In 1847, the American Medical Association (AMA) was formed. Initially, the AMA sought to restrict the ways in which medicine was taught in university settings. Most significantly, a scientific approach to medicine was taking place in other countries. Germany, France, and researchers in the United States were establishing a standard that was raising the bar around the world. The public was gaining an appreciation for the study and practice of medicine. As training became compulsory, there were fewer doctors, however these new physicians were equipped to specialize. Specialization provided less competition for an elite group, thereby creating another problem, as medical limitations were replaced by professional elitism.
Along with the professional elitism, another situation was developing. This concern had to do with “preservation of capital.” With this newfound appreciation came the need for advanced technology and research and equipment required capital. The need for advanced equipment was coupled with the development of 20th-century hospitals, by the late 1890s. Prior to that time, most doctors worked out of small clinics or offices in their own home. By the turn of the century, however, many doctors had become dependent on hospital settings. As Brown points out, many of the most prominent American hospitals came into existence during this period. The scope of the expenses far exceeded the funds available within the profession. The gifts of the philanthropists became a fundamental turning point for the modern day medical institution, and one of the first significant ‘Rockefeller medicine men’ was William H. Welch (Brown, 102). Welch’s generous contributions to the field of medicine soon caught the attention of Reverend Frederick T. Gates. With Gates encouragement, Rockefeller and Carnegie became competitors as they both endeavored to move forward with scientific and technology backed medical research. The efforts of these ‘medicine men’ paved the way, initiating the preservation of capital that would further serve international medical reform for individuals within society, as well as the workforce.
These reforms continued to influence medical education reforms, and E. Brown provides an insightful look into the events that led up to instructional reform. Brown explains the role of technological medicine based on the question of who was to govern this reform. The AMA had already made its mark. In the early 1900s, it wagered it stakes on medicinal training. Around the same time, the Carnegie Foundation pledged to upgrade the status and qualifications of medical university professors, by providing a uniform system. A man by the name of Abraham Flexner wrote a report, around 1908, that explained his findings in the 155 medical schools he visited in North America. Coupled with the efforts of leading philanthropists, Flexner’s Report (Brown, 144) eventually helped prompt educational reform. Gates, supported by the Rockefeller Foundation, helped appropriate almost 80-million dollars to medical schools and implement strategies designed to support the cause.
Rockefeller Medicine Men goes on to delineate the next half-century of “medicine in corporate capitalist society” (Brown, 192), as well as the role of technology. Brown wrote the book with the intention of portraying scientific medicine as a tool developed by institutions and medical professionals to further their perceived cause, rather than as a decisive influence designed to develop and improve medical practice. The “Rockefeller men,” with their necessary funds, applied resources designed to improve various technological medicinal innovations as they pleased, thereby furthering the cause and serving social and economic needs in order to achieve their goal.
Although the text was written almost forty years ago, the point conveyed by Brown is still worth consideration. As the author successfully illustrates, the policies of large institutions, both private and governmental, are designed to assist medical groups in meeting the needs of corporate business and political groups. In the medical field, the primary incentive is to create a medical system that can be applied within a capitalistic society. Further, the system serves to justify the medical institution by making it available to members using the least amount of fiscal resources. Brown points out, throughout the book, that while these goals seem to complement each other, they also carry unique contradictions. While larger foundations, such as Carnegie and Rockefeller, associated with the goals set out by medical practitioners, they quickly began to scorn the restrictive nature of special interest groups. They motioned to support the cause of hospitals, medical schools and medical care as a whole. A precedent was established, during the first half of the 20th century, until after World War II. Following the Second World War, according to Brown, the United States became fully recognized as a capitalist country and the federal government procured the role of organizing medicine within the country. The precedent established by the “Rockefeller” foundations was clearly defined, allowing the government to take over where the leading philanthropists left off. At this point, the government was in a financial position to provide the capital necessary to leverage and impose medical policy.
In conclusion, E. Richard Brown successfully proved his thesis. Brown brought up several key points about the transitions in the medical field brought about through the involvement of the Rockefeller medicine men. My primary reaction, after reading the book, is an increased awareness of what a strong role politics and finance play in medical reform. At no other time in history has technology and scientific research reached such heights, yet we are left with the question of why the United States is falling behind. With such great potential, why is it that the US is falling short? The answer could very well be found in Brown’s conclusion that the struggle lies not only in healthcare reform, but also in a need for social, political, and economic reform.

References

Berliner, H. S. (1985).A System of Scientific Medicine: Philanthropic Foundations in the
Flexner Era. New York: Tavistock. Retrieved from http://www.jstor.org/discover/10.2307/3342493?sid=
Brown, E. R. (1979). Rockefeller medicine men: medicine and capitalism in America.
Berkley: University of California Press. Retrieved from Retrieved from https://openlibrary.org/books/OL4747269M/Rockefeller_medicine_men
Carnegie, A. (1901) The Gospel of Wealth, and Other Timely Essays. Century,
Dooley, B. L. (1987). Patterns in Foundation Health Giving. Health Affairs. 6. 144-56.
Numbers, J. L. (1982) History of American Medicine. John Hopkins University Press. 245-246
Retrieved from http://www.columbia.edu/itc/hs/pubhealth/rosner/g8965/client_edit/readings/week_1/numbers.pdf
Starr, P. (1982) The Social Transformation of American Medicine. New York: Basic Books.
227-29. Retrieved from http://faculty.washington.edu/jwilker/382/starr.pdf>