While healthcare philanthropy is recognized as a worthy cause, the grand scope Rockefeller applied to every challenge from curing hookworm around the world to cerebrospinal meningitis remains elusive, as well as the sheer willpower required to achieve such scale. Mr. Musk has both, and he should set his mind to doing something purely to help others, for which he has no financial incentive.
As impossible as it might seem, there were no medical research institutes or accredited medical universities in the United States at the end of the 19th and the beginning of the 20th centuries, even as the industrial age was in full swing producing marvel after marvel from the car to the telephone. The medical field, meanwhile, was defined primarily by a lack of objective analysis, consistency, rigor, or standards of any kind. Medical schools, such as they were, trained doctors based on the whims and fancies of a generation that came of age before the germ theory of disease was fully accepted with devastating consequences to public health including a life expectancy well under 50 years old, more than thirty years less than today. Schools in general were underfunded and staffed with doctors moonlighting as professors for extra money, following no real curriculum, no agreed up methodologies, and with no research to guide them. In 1910, Abe Flexner, an educator and professor, was commissioned by the Carnegie Foundation for the Advancement of Teaching to conduct a comprehensive survey of the 155 medical schools operating in the United States and Canada, visiting each and everyone and issuing a detailed report on his findings. To say they were lacking by modern standards barely begins to describe it. As a whole, they were lacking just about everything. In Washington, the “dean” of a medical school was asked if he had a physiology lab. “Surely,” he responded. “I have it upstairs and will bring it to you,” he joked, presenting a single device to measure the pulse. An osteopathic school in Iowa, didn’t have charts or scientific equipment of any kind, merely desks and blackboards. In Chicago, the home of fourteen schools, Flexner described “a disgrace to the State whose laws permit its existence . . . indescribably foul . . . the plague spot of the nation.” Only 23 of the schools in total required students to have a high school diploma, and the coursework was unimpressive with almost no hands-on training in all about a handful. As Flexner saw it, “Each day students were subjected to interminable lectures and recitations. After a long morning of dissection or a series of quiz sections, they might sit wearily in the afternoon through three or four or even five lectures delivered in methodical fashion by part-time teachers. Evenings were given over to reading and preparation for recitations. If fortunate enough to gain entrance to a hospital, they observed more than participated.”
Johns Hopkins, however, Flexner’s alma mater (he majored in the classics) was among only a handful singled out for praise, a “small but ideal medical school, embodying in a novel way, adapted to American conditions, the best features of medical education in England, France, and Germany.” Ultimately, Flexner recommended seven key reforms, reduce the number of schools from 155 to 31 along with the number of poorly trained physicians, increase the prerequisites to enter medical training, train physicians in a scientific manner and engage medical faculty in research, give medical schools control of clinical instruction in hospitals, hire trained, full-time staff, increase funding, and require state regulation to receive a medical license. The question, of course, was how to achieve these goals and in that regard, it was John D. Rockefeller, the notorious oil baron and richest man in the world, rather than Andrew Carnegie who seized on the report. Over the next two decades, he invested close to five billion dollars in today’s money to reform medical education throughout North America, an effort described by the head of Johns Hopkins itself as the “the first large public recognition of medical education and medical research as a rewarding subject of philanthropy.”
Rockefeller’s interest in medical philanthropy actually began some years earlier. In 1897, the head of Rockefeller’s charitable efforts, Frederick T. Gates, a former Baptist clergyman, chose Principles and Practices of Medicine, a monstrous tome by another Johns Hopkins physician, William Osler, for some “light” reading while on vacation with his family in the Catskills. Having recently suffered a serious medical condition himself, Gates was appalled that the sum total of our healthcare knowledge as represented by the book appeared to be the compilation of long lists of symptoms for diseases, rather than actual causes or treatments of any kind. Rarely could anyone in the profession say for sure what germ was responsible for a disease, much less recommend a workable cure, resulting in only four to five in the entire book, but Gates wasn’t the sort of man to be daunted by a problem of this scale. After all, he had access to a benefactor with an equally expansive vision and the funding to make close to anything happen. Almost immediately, he recommended that Rockefeller fund the first medical research institute in the United States, following the model of Pasteur Institute in Paris and the Koch Institute for Infectious Diseases in Berlin, though neither had been in existence for more than a decade at that point. Rockefeller himself was also keenly interested in medicine, believing he might live for a hundred years with the right diet and exercise, and he was, rather ignominiously and notoriously, the son of a man who pretended to be a doctor, but was really a con artist, offering an opportunity to right some past wrongs. He wasn’t known for moving fast, however, and no one was surprised when he demurred for a few years before founding the Rockefeller Institute for Medical Research, the only one of his projects or companies to bear his name, in 1903 on the East River between 64th and 69th Streets in New York City.
Initially, the Institute faced widespread skepticism, both from the experts and the media. The idea of research in general in any field was relatively new, and the thought that top flight minds would spend their time daydreaming rather than practically applying their knowledge was radical, but Rockefeller was armed with more than a big checkbook. In all his endeavors, he had a talent for finding the right talent and convincing them to his cause. The combination of the two lured Simon Flexner, Abe’s brother and another Johns Hopkins graduate (this time in pathology), to lead the fledgling project, and as serendipity would have it, an initial opportunity to prove the Institute’s worth arose sooner than expected. In the winter of 1904, three thousand New Yorkers died from an epidemic of cerebrospinal meningitis, but within four years, Flexner and his team crafted a simple yet revolutionary serum to defeat the disease and were treating patients free of charge. By 1911, the New York City Board of Health began distributing the serum and Flexner along with the institute were considered miracle workers. Rockefeller, as always, preferred to remain behind the scenes, while closely following each and every detail. He was, in fact, one of the first to be notified that the serum was a success by the doctor testing it in Germany.
Perhaps Rockefeller’s greatest single public health achievement occurred around the same time. Dr. Charles Wardell Stiles had spent a long period working in Southern states as part of the US Public Health Service in 1902. At the time, there was a prevailing notion that Southerners, both white and black, were lazy, shiftless, and inferior by birth, if not entirely irredeemable, but Dr. Stiles believed there could be a medical cause for this condition, lurking beneath the surface. Inspired by the discovery that many poor islanders in Puerto Rico were suffering from hookworm instead of malaria, he thought the same might be true of the American South and it wasn’t long before he found hookworm eggs in almost every Southern state using just a simple microscope, studying samples culled from human feces. From there, it wasn’t difficult to figure out how the epidemic spread so widely when many poor Southerners didn’t so much as wear shoes, making the disease easily preventable with a little precaution. As an added bonus, any existing cases were easy to cure with about $.50 worth of salts and thymol. It seemed a problem that would be easy enough to solve with a little concerted effort. Nonetheless, the medical powers that be in Washington, DC were less than impressed, openly mocking his findings. The New York Sun, typical of the reaction, characterized the entire notion with the headline, “Germ of Laziness Found?” Even some physicians who should surely have known better insisted hookworm simply didn’t exist in America for whatever reason. Dr. Stiles, however, was dogged and would not be so easily ignored. He continued on the crusade against hookworm for six years, when President Teddy Roosevelt appointed him to a commission to study country life in another moment of serendipity. There, he met a North Carolina native, Walter Hines Page, who was receptive to the hookworm theory and happened to be on the board of the Rockefeller Institute. Within a couple of months, he introduced Dr. Styles to both Gates and Flexner, who almost immediately saw this as another opportunity for a large scale public health initiative.
Fortuitously, Rockefeller had already developed a keen interest in Southern welfare – as shocking as it might sound, the deeply religious Rockefeller frequented relatively poor black Southern churches whenever he traveled there – and son, John D. Rockefeller, Jr. participated on a tour of the Southern states in 1901 which prompted millions of dollars of investment in education and farming reform. Suddenly, there was a new opportunity to extend these efforts to healthcare, using the talent and resources Institute, combining two of Rockefeller’s charitable passions into one. By 1910, he funded programs on perhaps the scale that only the founder of Standard Oil could. While in his professional career, he integrated every aspect of the oil business, from drilling to distribution, he proceed to deploy a team that would address every aspect of the infestation – where it was concentrated, what means there were to reduce the spread through better sanitation, education on how it could be prevented, and of course curing those that were afflicted. While Southerners themselves were resistant at first, believing it an affront to their pride, a mere two dispensaries for the cure in 1910 exploded to almost 210 by 1913. The dispensaries themselves attracted attention in the community with an almost carnival atmosphere, daring visitors to “See the hookworms and the various intestinal parasites that man is heir to.” Because the cure was quick, people could see for themselves that it worked, resulting in surging interest. During the first year, 102,000 people were examined and 43,000 were cured, a number that rose to half a million over five years. “Hookworm has not only been recognized, bounded, and limited,” Gates wrote to Rockefeller himself, “it has been reduced to one of the minor infections of the south, perhaps the most easily and universally recognized and cured of all.” As a result of this success, states and local governments continued supporting these initiatives on their own, allowing Rockefeller to extend the campaign globally, across fifty two countries on six continents, curing millions of people. It’s no surprise that Charles W. Eliot, the longest serving president of Harvard University from 1869 to 1909, described what was officially known as The Rockefeller Sanitary Commission as “the most effective campaign against a widespread disabling disease which medical science and philanthropy have ever combined to conduct.” None other than Winston Churchill described Rockefeller’s overall impact on public health shortly before his death at 97, “When history passes its final verdict on John D. Rockefeller, it may well be that his endowment of research will be recognized as a milestone in the progress of the race. For the first time, science was given its head; longer term experiment on a large scale has been made practicable, and those who undertake it are freed from the shadow of financial disaster. Science today owes as much to the rich men of generosity and discernment as the art of the Renaissance owes to the patronage of Popes and Prices. Of these rich men, John D. Rockefeller is the supreme type.”
Far be it from me to make suggestions to or demands of Elon Musk, a man who has already revolutionized payments across the internet, cars around the world, and space exploration beyond the reach of the planet, and has now set his sights on Mars and is set to spearhead a generational transformation in government efficiency at the same time. A man with his kind of means, however, especially one who thinks as big or perhaps even bigger than Rockefeller himself, can change the world for the better even when he’s not directly involved, doing great things by backing the right causes, headed by the right people. In that regard, Rockefeller created a strategy that can still be put to ready use though it was clearly languished in recent decades, leveraging his vast wealth to initiate a massive change in thinking and subsequent action, then engaging governments and other groups to drive it forward, building public and private partnerships of such size and scope they reached around the entire world. Sadly, the world today still has no shortage of healthcare challenges, from malaria and yellow fever in the hotter parts of still developing countries, to heart disease and cancer everywhere, to Alzheimer’s increasingly afflicting the elderly, and more. While healthcare philanthropy is now recognized as a worthy cause and billions are raised every year, the sort of grand scope Rockefeller applied to every challenge remains elusive, as well as the sheer willpower required to achieve such scale. It seems to me Mr. Musk has both, and he should set his mind to doing something purely to help others, for which he has no financial incentive. The world will be better off for it, and considering the battering Mr. Musk’s personal reputation has taken in recent years, he too could benefit. Mr. Musk certainly isn’t the first extremely rich person accused of insane greed and manipulating politics for his own ends. If anything, Rockefeller was even more stridently abused, but perhaps Mr. Musk can hope the next Winston Churchill will write him such an epitaph.
Confessions of a Conservative Atheist 