By Michael Barker

“In view of the emerging demands for revision of the social contract, a passive response on the part of the business community could be dangerous. … So it is up to businessmen to make common cause with other reformers — whether in government or on the campus or wherever — to prevent the unwise adoption of extreme and emotional remedies, but on the contrary to initiate necessary reforms that will make it possible for business to continue to function in a new climate.” David Rockefeller.

“The Crisis in today’s health care system is deeply rooted in the interwoven history of modern medicine and corporate capitalism. The major groups and forces that shaped the medical system sowed the seeds of the crisis we now face.” E. Richard Brown, 1979.[1]

The backbone of capitalist social engineering is liberal philanthropy. Elite “aid” and “charity” for the poor serves a critical function in legitimating imperial domination and the exploitation of the majority of the world’s citizens. Through such philanthropic endeavors, liberal elites and their associated foundations have thus acted in the service of capital to maintain an unjust — although somewhat flexible — status quo. Seen in this light, understanding the role that such elites have fulfilled in promoting modern-day medicine and the medical-industrial complex is critical for citizens to make informed decisions about health care plans.

Consequently we ought to be thankful for E. Richard Brown’s much needed historical intervention, Rockefeller Medicine Men: Medicine and Capitalism in America (University of California Press, 1979). In this book, Brown — who is the founder and current director of the Center for Health Policy Research at the University of California, Los Angeles — examined how liberal foundations, most notably those associated with the Rockefeller oil dynasty, shaped a medical system that conformed to the needs of capitalism.

As scant attention has been given to such analyzes of soft power, this article will review Brown’s seminal contribution in the hope of facilitating a more informed debate about health systems and the role of liberal philanthropy in the world today.

By way of an introduction, Brown writes:

In the United States medicine came of age during the same period that corporations grew to dominate the larger economy. As corporate capitalism developed, it altered many institutions in the society, medicine among them. Its influence was created not simply through cultural assimilation or the demands of industrial organization but by persons who acted in its behalf. This interpretation does not suggest that history is made by dark conspiracies. Rather, it argues that the class that disproportionately owns, directs, and profits from the dominant economic system will disproportionately influence other spheres of social relations as well. (p.4)

In stark contrast to the present, Brown notes how in the late nineteenth century medicine “was pluralistic in its theories of disease, technically ineffective in preventing or curing sickness, and divided into several warring sects.” Power was far from centralized in the hands of corporate elites, a situation that had changed by the 1930s: by which time medicine “was firmly in the hands of an organized profession that controlled entry into the field through licensure and accreditation of medical schools and teaching hospitals.”[2]

As Brown continues:

“Medicine” had come to mean the field of clinical practice by graduates of schools that followed the scientific, clinical, and research orientations laid down by the American Medical Association (AMA) and by Abraham Flexner in a famous report for the Carnegie Foundation. All other healers were being excluded from practice. (p.5)

During this time of exclusion the corporate class were striving to implement ameliorative changes (often symbolic) to prevent capitalisms collapse — hence the misnamed Progressive Era. But at the same time, more farsighted members of this elite worked to provide the backbone for a technical and “preventive” project which required the “training of personnel needed by industrial capitalism if it was to survive and grow.”

These rationalizing reforms in medical care did not happen by osmosis, and through the power of the “purse” foundations acted as “the major external influence on American medicine in its formative period from 1900 to 1930.”That said, foundations could not, and did not act alone, and they allied their philanthropic work with those members of the medical community who were committed to professionalization — enabling these medical practitioners to attain the political power necessary to “assure high incomes, social status, and continued prosperity for the profession.”[3]

Thus towards the end of the nineteenth century:

It became clear to increasing numbers of physicians that the complete professionalization of medicine could come only when they developed an ideology and a practice that was consistent with the ideas and interests of socially and politically dominant groups in the society. It was desirable that everyone in society recognize their technical effectiveness, but it was essential that the classes and groups associated with the ascending social order believe in their efficacy.

The development and increasing dominance of scientific medicine within the profession provided the virtually perfect material and ideological basis for an alliance of the medical profession with other professionals (mainly engineers and lawyers), corporate managers, and all ranks of the capitalist class. The medical profession discovered an ideology that was compatible with the world view of, and politically and economically useful to, the capitalist class and the emerging managerial and professional stratum. (p.71)

Much like the rising popularity of “scientific management” of labor (to maximize sustainable exploitation), “scientific medicine” was totally compatible with capitalist growth priorities, as it “analyzed the body into its parts, subjected the parts to the control of scientific doctors, and thereby kept the bodies healthier and more efficient.” It should come as no surprise that “Rockefeller money did not support medical research that investigated the relationship of social factors to health and disease.”[4]

Fortuitously for corporate elites, the rise and rise of scientific medicine was aided by a small but significant number of breakthroughs in medical science, “mostly in bacteriology,” which helped boost public confidence in the medical profession. However, it is important to recognize that the industrious amounts of propaganda immortalizing the “slight increase in the effectiveness of the new medicine” played a critical role in manufacturing both public and elite consent for these advances.[5]

As Brown points out:

The actual impact of progress against infectious disease was not nearly so great as its proponents claimed. The arsenal of effective weapons against diseases did not increase spectacularly, but its limited advances did provide the basis for persuading the public that scientific medicine reflected on all members of the profession — practitioners as well as researchers — who had been trained in the theory and methods of scientific medical research.[6]

William H. Welch for one, came to play a key role in propelling scientific medicine forward, and in 1901 his expertise “came to the attention of Frederick T. Gates, the grand master of the Rockefeller philanthropies” (since 1891) who asked him “to help organize” the Rockefeller Institute for Medical Research (which was created in 1901). Thereafter, Welch became chief adviser to the Rockefeller foundations medical projects; which is significant given that Rockefeller wealth presented “the largest single source of capital for the development of medical science in the United States”.[7]

The Rockefeller Institute for Medical Research began its work with $20,000 a year for grants to medical researchers and soon thereafter a $1 million gift from Rockefeller, a board of directors composed of physicians — including [Emmett] Holt and Welch — with training in pathology and a commitment to bacteriological research, and Dr. Simon Flexner as the executive director.[8]

Hookworm infestations in the southern U.S. states were famously targeted by Rockefeller largess, for ostensibly humanitarian reasons (which no doubt was a motivating factor in some states): but as Brown points out “their primary incentive was clearly the increased productivity of workers freed of the endemic parasite.” This boost to economic productivity did not however directly correlate to personal profit, as the “Rockefellers did not have any significant investment in Southern textile mills. Rather their extensive and widespread investments gave them a concern for the productivity of the entire economy.”

This leads Brown to suggest that the 1909 Rockefeller Sanitary Commission — which sought to eradicate the hookworm — “was a logical extension of their educational programs in the South [coordinated by the General Education Board], all directed ultimately to integrating the Southern economy into the national dominion of Northern capitalists.”[9]

Here one should note that the Rockefellers chief philanthropic advisor, Frederick T. Gates — who in earlier years had served as the executive secretary of the American Baptist Education Society — took to his medical task with a true missionaries zeal, realizing how “Medicine can be used to convert and colonize the heathen.” In 1909, public health programs were integrated into international projects, and “In China, Gates switched from supporting religious missionaries to building a Western medical system.”

“As J. A. Hobson, an English economist, noted at the time, ‘Imperialism in the Far East is stripped nearly bare of all motives and methods save those of distinctively commercial origin.’” Ironically, Gate’s promoted imperialism via medicine not religion, and soon after joining the Rockefellers his “views on religion began to change” such that “Gates found himself converted from Baptism to capitalism and scientism!”[10]

“Medicine was a fundamental part of his new ‘religion,’” and Brown writes that “it seems clear” that Gates “viewed medicine as industrial society’s counterpart to religion, carrying moral precepts, ‘new duties,’ and the values of science to all people through its universal appeal and irresistible intimacy.”[11]  Yet the massive institutional power wielded by Gates and the General Education Board (GEB) meant that even by 1929 (when Gates died), although together they “did not achieve everything they sought… they had firmly established three important strategies in the development of medicine in the United States.”

First, Gates and the GEB created an important role for foundations — to give direction to the development of American health care. They assumed the right to define what kind of health care their society needed, and they used their tremendous corporate wealth to realize that vision. In its early years, the GEB provided a leadership that was widely followed by other foundations and by wealthy individuals. Gates and his associates achieved power over American medicine partly because of the wealth they wielded but, more fundamentally, because they articulated the interests of the corporate class in a strategy that won sufficient support to succeed. (p.194)

This does not mean that foundations and their supporters were not motivated by some good intentions, but the fact of the matter is that their philanthropic work was only ever intended to make “capitalist society work better.” Brown adds: “Sometimes they tried to make it work more justly, but even then it was because gross injustice leads to movements for radical change.”[12]

Such forward-thinking was of course nothing new, as:

From Bismarck to the Conservative party in England to the American Association for Labor Legislation and the National Civic Federation, the far-sighted leaders of corporate capitalism believed that government-sponsored sickness insurance, workers’ compensation, and other social security measures would reduce the appeal of radical labor and socialist movements. Hoping to depoliticize workers’ unhappiness with their lot, corporate leaders joined reformers in calling for such moderate reforms.[13]

Needless to say the mass of humanity has always had different goals than Gate’s and his fellow corporate plutocrats, thus many useful lessons can be learned from Richard Brown’s oft-neglected history of medicine in the United States. This will enable the politicization of unhappiness and the instigation of the type of radical reforms that will be necessary to create a just and egalitarian medical system which can replace the current medical-industrial complex.

Michael Barker is a researcher and activist.

His ‘On Corporate Power’ column appears monthly.

REFERENCES:

[1]    Cited in E. Richard Brown, Rockefeller Medicine Men: Medicine and Capitalism in America (University of California Press, 1979), p.187., p.1

[2]    Brown, Rockefeller Medicine Men, p.5.

[3]    Brown, Rockefeller Medicine Men, p.28, p.23, p.8, p.69. After World War II, the foundations’ position of funding dominance was replaced by the government. “The enormous sums they expended — from foundations some $300 million from 1910 through the 1930s and from the federal government many billions of dollars since World War II, for medical research and education alone — have not been for their own financial enrichment.” (p.8) “For the most part, social transformations were led by the same ‘unseen hand’ that guided the market forces of capitalism; this self-interest provided a limited perspective for social change.” (p.14)

[4]  Brown, Rockefeller Medicine Men, p.75, p.129. “The germ theory of disease was especially attractive to both the regular profession and these new industrial and corporate elites. The germ theory emphasized discrete, specific, and external causal agents of disease. It gave encouragement to the idea of specific therapies to cure specific pathological conditions. … Disease was thus seen as an engineering problem, surmountable with sufficient talent and resources.” (p.75)

“Old-time homeopaths and eclectics, of course, fell by the wayside, and proprietors of crassly commercial medical schools lost their lucrative businesses. But most physicians could relate to the purposes of the reform campaign — more respect for their skills, higher social status, more money — and to the necessary means of achieving them. Undoubtedly conspiracies and conscious deceptions occurred along the way (we will see some examples in Chapter 4), but even the reform leaders believed their mission would benefit society as well as the medical profession. Nevertheless, it strains the imagination to conclude that the complete professionalization of medicine served the interests of more than a small minority of the population.” (p.97)

Here it is interesting to note that John D. Rockefeller Senior was a strong proponent of homeopathy, which resulting in various conflicts for some years  and “suggests an ideological difference between the robber barons like Senior who built up huge industrial empires and the next generation of corporate capitalists who ran the operations.” (p.109) However, Senior’s support of homeopathy is more understandable when one realizes that: “From the mid-nineteenth century on, homeopathy in the United States appealed primarily to the upper classes. It was safer than the heroics of regular medicine, and it was a sign of affluence and taste since it was very fashionable among the European nobility and upper class, who were aped in many ways by wealthy Americans.” (p.115)

[5]    Brown, Rockefeller Medicine Men, p.77, p.79. For more on the Rockefeller Foundation’s involvement with refining the means to manufacture consent, see Michael Barker, “The Liberal Foundations of Media Reform? Creating Sustainable Funding Opportunities for Radical Media Reform,” Global Media Journal, 1 (2), June 2, 2008.

[6]    Brown, Rockefeller Medicine Men, p.77. “In reality the number of medically effective therapies had not increased significantly in the first few years of this century, the period when sectarianism declined in medicine.” (p.91) “Rene Dubos, the microbiologist formerly with the Rockefeller Institute, succinctly summed up the historical record. ‘The tide of infectious and nutritional diseases was rapidly receding when the laboratory scientist moved into action at the end of the past century,’ Dubos wrote in Mirage of Health. ‘In reality,’ he observed, ‘the monstrous specter of infection had become but an enfeebled shadow of its former self by the time serums, vaccines, and drugs became available to combat microbes.’” (p.220)

[7]    Brown, Rockefeller Medicine Men, p.103, p.104.

[8]    Brown, Rockefeller Medicine Men, p.108.  In 1908, Dr. Simon Flexner’s brother Abraham began research for the Carnegie Foundation for the Advancement of Teaching on a review of medical teaching in the United States. “Not coincidentally, Flexner’s criticisms of American medical schools and his recommendations for reform [which were published in 1910] were perfectly consistent with those of the leading medical profession reformers.” (pp.146-7) “In fact, it was explicitly understood from the beginnings that the Carnegie study would be part of the [Council for Medical Education’s] campaign, lending credibility to the council’s plans for reforms.” (p.151) Thus Flexner’s important report “helped ‘educate’ the public to accept scientific medicine, and, most important, it ‘educated’ wealthy men and women to channel their philanthropy to support research-orientated scientific medical education.” (p.155)

[9]  Brown, Rockefeller Medicine Men, p.116. “Through the International Health Commission — the first program of the Rockefeller Foundation established in 1913 — the hookworm and other public health programs were extended worldwide. None of these programs was intended to prop up specific Rockefeller investments abroad. They were directed more generally at improving the health of each country’s work force to facilitate sufficient economic development to provide the United States with needed raw materials and an adequate market for this country’s manufactured goods.” (p.116)

The similarly named U.S. Sanitary Commission was “organized in 1861 to provide medical relief to Union Soldiers on Southern battlefields” to enhance the economic utility of the wounded. In the commissions own words “its ultimate end” was to “economize for the National service the life and strength of the National Soldier.” (p.114)

[10]    Brown, Rockefeller Medicine Men, p.122, p.123, p.125.

[11]    Brown, Rockefeller Medicine Men, p.125.

[12]    Brown, Rockefeller Medicine Men, p.187.

[13]    Brown, Rockefeller Medicine Men, pp.177-8. “In 1883 Bismarck established the Sickness Insurance Act to help stem the growing support for socialism among the German working class. In England Lloyd George and the Liberal party enacted the National Health Insurance Act in 1911 to win the workingmen’s swing vote away from the socialistic Labor party. When the Labor party finally came to power after the Second World War, it nationalized the hospitals and the insurance system in the National Health Service Act.” Brown, Rockefeller Medicine Men, p.201.