ficial schools. The AMA claimed that the public did notrnknow what was good for it and that the medical establishmentrnmust hac total control.rnThe organization knew it needed more than persuasion tornsecure a monopoly, so it also called for a national bureaurnof medicine to oversee state licensing and other regulations, hirnthose limited-government days, howeer, the idea wentrnnowhere. But in the statist Progressive Era after the turn of therncenturv, anticompetitive measures became respectable, and thernAMA renewed its drive for a cartel, spurred on by the popularityrnof self-nicdication and the increasing number of medicalrnschools and doctors, (hi 1902, an AMA stud’ decried the competitionrnthat had lowered physicians’ incomes.)rnThe number of medical schools had increased from 90 inrn1880 to 154 in 1903. As an ofheial AMA history by James GordonrnBurrow ])uts it, the “frightening competition” showed arnneed for “education reform,” i.e., earteli/.ation. The state legislaturesrnshowed little interest in more restrictionist laws, so thernAMA appointed the secretary of the Kentucky State Board ofrnI Icaltli to rouse the profession to lobby.rnJoseph N. McCormack spent a decade in agitprop amongrnthe doctors of more than 2,000 cities and towns, inspiringrnthem w ith such speeches as “The Danger to the Public Fromrnan Unorganized and Underpaid Medical I’rofcssion.” Likernmedical cthieists before and since, he denounced advertisingrn(letting customers know services and prices in advance) andrnquackcv (unapproved competition). Join our union, lie said,rnand we will raise vour pay. By 1910, about 70,000 doctors belongedrnto the AMA, an eight-fold increase over the previousrndecade.rnlb help bring about a higher-paid profession, the AMArnin 1904 created the Council on Medical Education, whichrnsought to shut down more than half the existing medicalrnschools by rating them on a scale of A to C. hi cooperationrnwith state medical boards composed of what Arthur Dean Boran,rnhead of the council, called the “right sort of men,” thernAMA succeeded in cutting the number of schools to 131 byrn1910, from a high of 166.rnThen the council’s secretary N.P. Colwell helped plan (andrnsome sa write) the famous 1910 report b Abraham Flexner.rnElexner. the owner of a bankrupt prep school, had the goodrnfortune to have a brother, Simon, who was director of thernRockefeller histitutc for Medical Research. At his brother’srnsuggestion, Abraham Hcxncr was hired b the RockefelleralliedrnCarnegie Eoundation so that the report would not bernseen as a Rockefeller initiative. And Carnegie, whose main goalrnwas to “rationalize” higher education, that is, replace religionrnwith science, saw the A M A cartelization drive as useful. Claimingrnto hac investigated nearh’ every school in the country,rnFlexner rated them on suitability. Schools he praised receivedrnlush grants from the Rockefeller and associated foundations,rnand almost all tlie medical schools he condemned were .shutrndown, espccialK- the “commercial” institutions. AMA-domiiiatedrnstate medical boards ruled that in order to practicernmedicine, a doctor had to graduate from an approved school.rnPost-Flexncr, a school could not be appro ed if it taught alternatirne therapies, didn’t restrict the number of students, orrnmade profits based on student fees.rn ‘ l i flic opposition to for-profit schools? If an institutionrnwere supported bv student fees rather than philanthropic donations,rnit could be independent of the foundations. ThernRockefeller family had invested heavily in allopathic drug companiesrnand wanted doctors to use their products.rnThe Flexner Report was more than an attack on free competitionrnfunded by special interests. It was also a fraud. For example,rnFlexner claimed to have thoroughly investigated 69rnschools in 90 days, and he sent prepublication copies of his reportrnto the favored schools for their revisions. Homeopathsrnnoted that his authority derived solely “from an unlimited accessrnto the poeketbook of a millionaire.” Homeopaths did notrnuse synthetic drugs, of course. John E. Churchill, president ofrnthe Board of Education of New York, called the report a “menacernto the freedom of teaching.” Years later, Flexner admittedrnthat he knew nothing about medical education. But he did notrnneed to in order to serve his employers’ purposes.rnFlexncr’s attack, stepped up by the AMA’s Council on MedicalrnEducation and its state medical boards, closed 25 schoolsrnin three vears, with more over the years to come, and cut thernnumber of students attending the remaining schools in half.rnAll nonmainstream practitioners were targeted. Â¥OT example,rnfrom the ead part of the century, consumers preferred optometristsrnto ophthalmologists on grounds of both service andrnprice. Yet the AMA derided the optometrists as quacks, and inrnevery state, the AMA-dominated medical boards imposed restrictionsrnon these and other “sectarian” practitioners whenrnthey could not outlaw them entirely.rnHoiiieopath still had a remnant of about 13,000 practitioners,rnsupported by a fiercely loal customer base, butrndecades of well-financed attacks had taken their toll. Thernbattle-weary homeopaths eventually gave in, conceding majorrnparts of their doctrine, but the AMA was not satisfied with anythingrnless than total victory, and today, American homeopathsrnpractice mostly underground.rnWith its monopoly, the AMA sought to fix prices. Early on,rnthe AMA had come to the conclusion that it was “unethical”rnfor the consumer to have any say over what he paid. Commonrnprices were transmuted into professional “fees,” and the AMArnsought to make them uniform across the profession. Loweringrnfees and advertising them were the worst violations of medicalrnethics and were made illegal. When fees were raised across thernboard, as the’ frequently could be yvith decreased competition,rnit yyas done in secret.rnBut organized medicine still feared reporters. In Illinois inrn1906, the publication of secret fee increases nearly incitedrnpublic violence. The secretary of the Illinois Medical Society,rnN.L. Barker, admonished his fellow physicians to keep theirrnhigher “fee-bills” secret, “for the people will not appreciaternwhat was intended for kindness and justice.” To collect thernhigher fees, the AMA recommended that state-level medicalrnsocieties develop formal systems. If a patient had not paid thernfull amount, especially out of dissatisfaction with the treatment,rnhis name would go on a blacklist and he would be forbiddenrnall future treatment by doctors until he had paid up andrnshut up.rnThe AMA, in its constant quest for higher incomes throughrnlower competition, also battled churches and other charitiesrnthat gave free medical care to the poor. Through lobbying, itrnattempted to stamp out what it called “indiscriminate medicalrncharity.” A model 1899 law in New York put the control of allrnfree health care under a State Board of Charities dominated byrnthe AMA. To diminish the amount of free care, the board imposedrnfines and even jail terms on anyone giving treatmentrnlUNE 1994/19rnrnrn