Transcripts For CSPAN2 Licensed To Practice 20170604 : vimar

In this country. Right now average american cant possibly imagine going to a doctor that is a licensed of course doctors have been nice but thats not the case for a lot of u. S. History. Prior to these decisions, prior to this court enabling decision i write about, the practice of medicine was a wideopen occupation, marjorie looked down upon. People with some exceptions did make a very robust living at it. It was not an era that edie would hope your mother and said you wanted to become a doctor, she would not be happy. It was a generally low, dirty, anybody could practice medicine. You could put doctrine front of your name whether you had a degree or not. As long as you get your patience to pay the bills, you could continue doing that. Its that kind of chaotic medical practice that the science oriented ana people want to get rid of and they felt it turns out, they were right. They felt if they could transform the practice of medicine into a sciencebased , state licensed profession, they could make progress. There are largely selfinterested at this point because they cant really demonstrate that a scientific education makes you a better physician at that point. So there are largely motivated by their own occupational wellbeing. But they also have i think a profound faith that science will pay off. That we need to get rid of all these people doing whatever they want to do by the seat of their pants as being ultimately dangerous to the public, but we need is a rigorous scientific approach to medicine. Thats what thereafter, and the law that passed was a board of health law with a licensing plot, the board of Health Begins licensing physicians in the early 1880s in West Virginia. And the challenge takes place in the early 1880s but it takes a long time for this case to go from the county court through the West Virginia Supreme Court. And ultimately to the United States Supreme Court so its not until 1888 that the United States to bring court hears the arguments. And they dont make their decision until the early months of 1889. So its really only at that point that states are fully and constitutionally authorized to begin licensing physicians on whatever grounds they want. Some of the justices made it clear particularly in the West Virginia state level they didnt think this was a very good law, that theres no basis for it but constitutionally, if the state legislature thinks that its in the interest of the public to do this, the state legislature has the constitutional right to do that. The whole practice of medicine in america is transformed dramatically from this wide open, poor paying, anybody can take a shot at it occupation to an elite, welleducated and well paid profession. A profession recognized by the state, the state controls their marketplace for them. By prosecuting able who are practicing medicine without a license but it does not regulate the doctors. The doctors are free to charge whatever they want. They are free to narrow the gate of education. To what we now are accustomed to, by the late 20th and early 21st century with your medical schools that had existed earlier, most schools existing on veryrigorous, lengthy Laboratory Science education. This is all flows from this decision in kent versus West Virginia, the 1889 Supreme Court case. Therewere some notable people who spearheaded the whole activity. The most influential and successful of them was a man named james reed. Reeves was a genuine believer in Public Health. He was also a fanatical believer in science as the future of medicine. But he was so fanatical that he would not allow any of his members of his medical organization to even to talk to physicians. At work medical , that were not ana doctors. For example, he had one man thrown out of the medical society because the man fatherinlaw was a physician of a different sort, a homeopathic physician and reeves felt that at family gatherings you must be talking to your fatherinlaw, you must talk to your wifes father. That means automatically your expelled from our society because youre talking , thats what a fanatic he was. He was also, to give him his credit hewas also genuinely committed to Public Health. One of the founding members of the American Public health association. And very politically astute. And he is the one more than anybody else engineers passage of this law. Hes the one who engineers the alliance with a big railroad siding corporations. Its important to think of this decision as not creating a National Medical profession but instead enabling the separate state legislatures one at a time to license things medical. And americans tend to forget, particularly given the debates over what our health world might looklike , we tend to forget it is still a statebystate practice. Doctors are separately licensed in each separate state and if they go to another state they have to get relicensed or recertified in that state and the requirements forlicensing very from state to state. In some states , they license all levels of medical care. Some license only son. The criteria arestill surprisingly local , at least on a statebystate basis. I like in the law that was passed, i liken it to sort of a faithbased that on the future. That if we allow medicine to transform itself into a profession and base it on science, that you will ultimately help the Public Health of the population. It does but it does much later than most people realize. Theres a great debate among medical historians about what benefit does the average patient of the average illness going to the average doctor. At one point does the patient benefit from that. And there are different answers depending what it is. Insurgency surgery does make an advance as a result of both sides because they discover antisepsis. They have developed anesthesias. Those radically transform surgery by the end of the 19th century so suddenly surgical techniques have really improved. The licensing of doctors is not usually put in the context of the gilded age. Its usually looked at as of course at the progressive staff level, its amazing why did the Country Waste long timeis what most people would think but the fact is , they were licensed before you could demonstrate scientific medicine was the way to go. And their consolidation, their licensing in the 1880s and then continuing into the 1890s parallels perfectly the growth of big corporations and the consolidations taking place in other parts of the american economy. These doctors are reengineering the american medical marketplace just as carnegie was reengineering the steel marketplace and rockefeller was reengineering the oil marketplace. And the Great Pacific and Southern Pacific Railroad corporations were reengineering transportation. These doctors were consolidating a new type of medicine which they control. There are a number of unintended consequences. I think the people passing the law certainly reeves and hisallies , the people passing the law, reeves incidentally got himself, half a dozen of his friends elected to the legislature, they served one term to get this bill passed area. They knew what they were doing and they transformed a medicine in exactly the way it has been transformed. They wanted to limit the educational, they wanted to narrow the gate of education so that only highly educated people could practice medicine. That necessarily limits the number of doctors in the marketplace. That allows them to charge whatever they want and they charge more and more because theres fewer and fewer of them and i think thats a consequence that reeves and his allies were perfectly happy with and consciousness that would happen. And instead of being, thinking of themselves as greedy, i think they thought of themselves as engineering a move in the right direction. I think legislatures who passed it did not fully anticipate the kind of crisis that has now developed by the end of the 20th century and early 21st century in which we are very badly under doctored. We need doctors but by insisting on this lab oriented, high science way of training physicians, it becomes very expensive to transition and we dont train nearly as many as we would like. I think that was an unintended consequence. I dont think the people who voted for these laws also would have wanted the expense of the country on things medical to have risen as quickly and dramatically as it has. But we are fast, we are tremendous outliers now in the world with regard to what we spend on medicine. What we spend, were pushing 20 percent of Gross National product and the next closest developed nation is about half that. And most are about a third of that. And theyre getting according to un statistics, better care for theirpopulations. Spending six percent, seven percent over gnp whereas were pushing 20 percent and not doing any better by un measures, slightly worse. Thats not a partisan issue, thats not a republican issue or democratic issue, thats a question of the structural formation that flows from the decision in denver versus West Virginia and from the particular type of licensing, you need to the United States that was produced by that decision. Thats why i was interested in the case to begin with, it seems to me to be kind of a really important underpinning of the modern system that people seriously looked at their scholars. The cspan city tour and book tvs look at eugene continues. Next, a trip to the university of oregon to learn about the Oregon Rare Books Initiative which is to increase the use of round books and archives in the classroom. The Oregon Rare Books Initiative was done three or four years ago by a couple of colleagues at oregon, derek keller and Mark Schachter so its theme is to increase the use of the rare book and special collections archive among faculty and students and in the classroom here at university of oregon. The Oregon Initiative was founded in 2013. And colleagues including myself have been upstairs in the vault where the