Philanthropy has not been exempt from “cancel culture.” Problematic social entrepreneurs of a century ago have had their names taken off the organizations they founded. William Schambra notes how the decision of Planned Parenthood of Greater New York to remove birth control advocate Margaret Sanger from its headquarters was justified because of Sanger’s advocacy of eugenics. In The Pivot of Civilization, for example, Sanger wrote that “the most serious charge that can be brought against modern ‘benevolence’ is that it encourages the perpetuation of defectives, delinquents, and dependents.”
Now the next Progressive philanthropic icon of a century ago is beginning to topple. As Noam Cohen reports in the Washington Post, the Association of American Medical Colleges decided last November to talk about taking Abraham Flexner’s name off its annual service award (where it had been since 1958). Why? Because of what Dr. David Acosta, the association’s chief diversity and inclusion officer, called Flexner’s “racist and sexist views” and “pejorative language.”
Flexner, as a program officer at the Rockefeller Foundation between 1913-1928, did a great deal to change medical education. These changes did indeed restrict opportunities for women and minorities to get medical degrees.
I devoted a chapter discussing Flexner’s ideas in Great Philanthropic Mistakes. In my view, removing Flexner’s name is justified, but Flexner’s reasons for his beliefs need to be more fully understood in order to determine what to do about his legacy.
Abraham Flexner (1866-1959) discovered medical education because of his first book, The American College, which he sent to Henry S. Pritchett, president of the Carnegie Foundation for the Advancement of Teaching. Pritchett found the book fascinating, in part because Flexner quoted him three times in the book’s first 12 pages. Pritchett offered Flexner a job investigating medical schools.
Flexner, like many Progressives, was someone who believed that society would be best if an elite controlled it. “We have in America no way of achieving rational ends except for voluntary submission to rational ideals,” Flexner wrote in a 1911 article in The Atlantic Monthly. He thought instead of “random and informal discussion” on the topics of the day, society would be better if “ill-informed general gatherings” were replaced by “bodies with separate guidance and advice” that would tell the masses what opinions were permissible.
He was, again like many Progressives, convinced he had the answers to every question. Flexner was the sort of man who, when John D. Rockefeller’s attorney, Starr Murphy, said that Rockefeller was prepared to let him use $20 million to reform medical schools, turned Murphy down and asked for—and received—$50 million.
Dr. Simon Flexner, Abraham Flexner’s brother and the long-time head of the Rockefeller Institute for Medical Research (now Rockefeller University) wrote in an unpublished memoir that Abraham Flexner was “a strong person, very generous, intensely egotistical, with a great capacity for self-deception. My belief is that he readily translates events into harmony with his own point of view and his own cogitations.”
Flexner’s 1910 report, Medical Education in the United States and Canada, did a great deal to reform medical education and close shoddy schools that did a poor job in training doctors. The AAMC’s Dr. Acosta condemns Flexner for three sentences in a 300-page report where he says that women had “obvious limitations” as doctors and it was better if African Americans were “sanitarians” rather than doctors.
Flexner wanted a lot of medical schools that trained women and minorities closed because he wanted most medical schools closed. He knew, somehow, precisely how many medical schools America needed. The U.S. had 131 medical schools in 1910; Flexner thought 31 would be sufficient. Maryland had seven medical schools; Flexner proposed closing six of them.
This mass closure of medical schools meant fewer opportunities for women and minorities because there were fewer opportunities for everyone. But it should also be noted that Flexner supported co-educational medical schools. He also thought that, while the medical schools at George Washington and Georgetown Universities should close, Howard University’s school should remain open because it had “a distinct mission—that of training the Negro physician—as well as an assured future.”
The evidence the AAMC provides saying that the Flexner Report permanently limited the number of Black and female doctors is more limited than they claim. They cite a paper, published in August, in which a research team led by Dr. Kendall M. Campbell of East Carolina University concluded that, as a result of the Flexner Report, five historically Black medical schools might have collectively provided training to an additional 35,315 graduates by 2019.
Dr. Campbell and his associates come up with this number with false precision. Seven medical schools in 1910 were primarily for Blacks; the Flexner Report’s findings closed all of them except for Howard University and Meharry Medical College. Dr. Campbell’s paper then uses statistical handwaving to extrapolate the growth of the closed schools. The paper says that “limited data and incomplete information about the contemporary opportunities and challenges encountered by the schools’ administrations” should be taken into account.
How many students were denied M.D’s by the five closed schools? Rounding off the numbers, we find annual graduation rates of five, three, eleven, four, and seven, for a total of 30 per year. It’s fair to say the Flexner Report denied Blacks opportunities to become doctors they would not have had, but there’s no evidence for Dr. Campbell’s estimator.
The AAMC also cites a 2019 paper by a team led by Rutgers economist Carolyn M. Moehling that notes that only four percent of American doctors in 1940 were female. But Moehling’s piece isn’t about the Flexner Report, but about tightening licensing requirements from 1920-40 that blocked many women from getting M.D.’s. Flexner is barely mentioned in the paper.
Should Abraham Flexner be “cancelled?” If the evidence is three sentences in the Flexner Report, I don’t think he should.
But it is undoubtedly true that the reforms that happened in medical schools as a result of the Flexner Report did reduce opportunities for women and minorities. Historian Kenneth Ludmerer notes that by expediting the closing of most proprietary schools, which would admit anyone, Flexner’s findings forced schools that were more likely to accept women and minorities to close. In addition, many of the surviving schools required a college degree as a prerequisite, which made it harder for poor people who couldn’t afford college to become doctors. Thus, Ludmerer notes, the changes called for by Flexner and his allies (including, during this period, the Association of American Medical Colleges) “did reduce the opportunities for immigrants, blacks, ethnic minorities, and other underprivileged groups to enter medicine.”
So I think removing Flexner’s name from an award is a judgment call. But it’s a call that should be based on accurate evidence and a realization that Flexner’s legacy is more ambiguous than his contemporary foes believe.