1. For most of the history of
medicine, its professional
education has been proprietary. The
apprenticeship engaged a
novice in the service of a seasoned veteran
physician, for a set
term of years, during which he "read medicine,"
i.e. memorized
anatomy and other texts, learned how to suture
wounds, deliver
babies, and the like.
2. In addition to this traditional one-on-one
method, there
developed from time to time what amounted
to medical schools,
where groups of doctors might practice their
art at a temple
complex dedicated to healing, as came to
be the case in ancient
Greece. It is often forgotten now,
but during the Middle Ages,
medical education and practice in many Islamic
countries was far
in advance of that in Europe. But eventually,
in the
Renaissance, medical schools were founded
in university towns,
such as Padua and Oxford, thus establishing
a paradigm for
linking medicine to higher learning in general.
In other
European cities, especially the large metropolitan
ones like
Paris and London, those who aspired to become
doctors went to the
charity hospitals, where there were abundant
desperately ill poor
people.
3. When the University of Kansas was established
just after the
Civil War, the old traditional apprenticeship
method of medical
education still prevailed, though private
proprietary schools in
cities like Topeka and Kansas City soon attracted
students. But
there was no publicly-supported Medical School
in the State.
4. By the mid-1890s, KU leaders began to argue
that the
University and the State needed its own medical
school. One
problem was that the University was in Lawrence,
a small
community, which, it was argued, could not
support a full-scale
clinical enterprise. However, Kansas
City was nearby, and like
medieval London or Paris, furnished a large
supply of "clinical
material," i.e. numerous poor people who
were sick. Venereal
diseases, tuberculosis, and so forth were
common there, along
with gunshot and knife trauma, and thus students
would be able to
learn their trade.
5. Notably, one of Kansas' most eminent and
energetic physicians,
the Halstead surgeon, Arthur Hertzler, had
himself experienced
the apprenticeship by "reading medicine"
under a rural preceptor,
but had gone on to earn a formal M.D. degree
at Northwestern
University. That was followed by advanced
post-graduate
education in Berlin, under the famous Virchow.
Hertzler became
Professor of Surgery at the new University
of Kansas School of
Medicine after it was founded in 1905.
Curiously, Hertzler
maintained his growing clinic in Halstead,
taking a Pullman car
to and from Kansas City, where he taught
for nearly forty years.
6. Other Kansas City physicians, in private
practice, became
professors at KU, more or less on a volunteer
basis. But a small
nucleus of full-time faculty was formed as
well. The growth of
KU's medical school was given a powerful
impetus by the Flexner
Report of 1910, which argued that all medical
education should
become university-based. In part, the
argument was that such a
basis would ensure that medicine would become
firmly scientific.
Soon afterwards, in Kansas City as elsewhere
around the United
States, the small proprietary schools closed
up shop.
Henceforward, while a few private schools
continued to exist,
most young doctors got their training at
the new university
schools.
7. However, even in the political discussions
leading up to the
founding of KU's medical school, there was
vocal concern in the
state legislature that the school's proximity
to Kansas City
would mean that it would in fact serve and
be controlled by
Kansas City, Missouri physicians. How,
it was demanded, would
the need for physicians in the many small
towns of Kansas be
met? This was an important question,
because rural communities
were being asked to support the school (always
an expensive
proposition, then as now), without receiving
any clear benefit.
That is, the "split" of interests between
"Eastern" and "Western"
Kansas was operative in those days, just
as it is in our own
time.
8. The system that prevailed up into the early
1960s was that the
basic sciences such as anatomy, physiology
and so forth, would be
taught on the main campus in Lawrence, and
the clinical years
would be in Kansas City. Eventually,
under the leadership of Dr.
Franklin Murphy, the whole enterprise was
consolidated on the
Kansas City campus. Perhaps symbolically,
that campus was
located right on the border with Missouri,
on State Line Road; it
could not have been more "eastern" in its
placement.
9. Murphy is regarded as a legendary leader
of the University of
Kansas, first as Dean of the Medical School,
and then as
Chancellor. Certainly he was one of
the rare persons who served
in either position whose credentials as an
intellectual were not
in doubt. Murphy strongly supported
the growth of the KU
libraries on both campuses, and was himself
something of a
bibliophile and art connoisseur. Coinciding
with his own
expansive vision for the University and its
medical school were
two trends. First, the G.I. Bill enabled
hundreds of young
people in Kansas who had served in World
War II to secure
advanced education. During the War,
many older physicians in
rural communities had been prevailed upon
to remain in practice.
When the War ended, there was a wave of retirements,
and the
"Murphy Plan" aimed to meet the needs of
these small towns by
introducing young doctors to opportunities
there. The second
trend was the huge flow of federal money
into hospitals for
clinical education and for research.
The funding rationale was
that basic scientific research and education
of young people,
especially for underserved rural communities,
justified the
commitment. There were also significantly
increased State
expenditures as well.
10. One of the unusual features of the KU
Medical School was its
Clendening Library, which focused on the
History of Medicine.
Before joining the KU faculty, Logan Clendening
had been a Kansas
City, Missouri physician, with a successful
private practice in
Internal Medicine. He was also a Freethinker
(so defining
himself in Who's Who), a friend of the iconoclastic
novelist
Sinclair Lewis (who did the "research" for
Elmer
Gantry from
his suite in the Ambassador Hotel on Broadway
in Kansas City,
Missouri), and a popular author of newspaper
medical advice
columns. An enthusiastic bibliophile,
he began amassing a
substantial collection, which included first
editions of
Vesalius, Harvey, and other great pioneers
of medicine. Today
the Clendening Library is among the top ten
Medical History
libraries in the United States. Clendening
published numerous
books, both popular clinical "guides," and
medical history. His
successors, Drs. Ralph Major and Robert Hudson,
insured that
through their own teaching and through invited
lectures by
distinguished scholars, KU's medical education
would be strongly
founded in the classic medical humanities.
11. During Hudson's decades of leadership,
every freshman medical
student attended a required course, which
was called The Clinical
Process. This course aimed to introduce
students to social and
ethical issues, such as sexual identity,
abortion, health care
economics, death and dying, etc. In
addition, Hudson annually
gave a popular elective course on the History
of Medicine. I
served as a discussion leader for The Clinical
Process, and
because of my additional reputation as a
humanities scholar, I
received a joint appointment as a faculty
member in that
Department.
12. The University of Kansas has a long
and perhaps rather
romanticized connection to New England and
its tradition of
distinguished colleges. KU's Crimson
and Blue colors are those
of Harvard, and indeed, KU is colloquially
known as "Harvard on
the Kaw." But institutions like the
Clendening Library and its
affiliated History and Philosophy of Medicine
Department in part
justified the comparison.
13. My own connection to the University of
Kansas began when I
enrolled as a freshman in 1962, just in time
for the Cuban
Missile Crisis. Every visitor to the
Lawrence campus is
impressed by its dramatic natural setting.
Situated along the
crest of Mount Oread, KU has a panoramic
view of the Kansas River
valley. Coming as I and many others
did from provincial Kansas
towns, the University provided both an Enlightenment
and a
Liberation. By 1978, after I completed
my Ph.D. at Columbia
University, more or less by accident I was
informed of a position
at the Medical School, as Assistant Director
of the Preceptorship
Program, which sent senior students to work
with physicians in
rural Kansas. The Director was Dr.
Ralph Reed, like Murphy, a
well-read physician and humanist, who volunteered
as an
instructor in KU's Western Civilization course.
Reed was active
in Republican party politics, but was a civilized
man, i.e. he
did not automatically recoil at radical ideas,
though he rarely
found them believable. While we were
very different in
temperament, he and I enjoyed our work for
the Preceptorship,
especially the long expeditions through Kansas
to meet doctors
and their students. I think he hired
me because he wanted to
have someone he could talk with about books
and ideas on these
trips.
14. Not all KU administrators were as enlightened
as Reed. For
some years in the 1980s, the Preceptorship
was in the Department
of Family Medicine, under the Chairmanship
of James Price. I had
gotten interested in writing a book about
Mad Scientists, and
therefore had my office shelves filled with
books on science
fiction, Nazi history, medical experiments
gone wrong, and the
like. Price had a habit of abusing
his staff, and one day he
called me into his office and demanded: "Why
do you have all
those books in your office?!" Amazed,
I could only reply: "Jim,
I'm writing a book; I thought universities
liked people who had
books, and write books." Price later
became Dean of the Medical
School.
15. Not long after that, with a small but
enthusiastic group of
professors and community physicians, I co-founded
the da Vinci
Society, which provided a monthly forum for
topics combining
themes in science, medicine, and the humanities.
This was
outside the formal curriculum, but again,
was in the spirit of
advanced Higher Education. At places
like Harvard, Berkeley or
Stanford, such a Society would be supported
and encouraged. At
KU it was tolerated at best.
16. By 1991, the Preceptorship Program was
under the leadership
of Dr. Jane Murray, a newly appointed Chair
of Family Medicine.
Murray was a graduate of the UCLA Medical
School, where she had
earlier majored in the History of Science.
She strongly believed
that medicine should not be reductive, that
it had to become
personal, emotional, and spiritual.
She readily agreed to a
proposal I made, to commence a monthly Humanities
Conference,
based in our Department, but open to all
faculty, students and
staff at the Medical Center. In the
course of the next several
years, I organized some 80 of these sessions,
which took the form
of lunch-time seminars. Topics ranged
widely, from the history
of various diseases, to the lives and works
of graphic artists,
and poetry readings. According to Murray,
KU's Department of
Family Medicine was unique in the United
States for its
sponsorship of a regular Humanities event.
17. Under Murray's leadership, KU obtained
a $15 million grant
from the Kansas Health Foundation, to support
Primary Care
Physician Education. Awarded in 1995,
the grant was for a term
of five years, and at the time was one of
the largest ever given
to an American medical school. This
project was intended to
support revision of the curriculum and expansion
of medical
education into the "real world" community
outside the walls of
the campus on State Line. Like Franklin
Murphy before her,
Murray was a young, optimistic and progressive
physician who
believed that the University should serve
the State and its
people. The goal was that KU's medical
school should become the
top national model for producing primary
care doctors.
18. Beginning in 1995 the University itself
had new leadership in
the person of Chancellor Robert Hemenway,
who had a scholarly
record of achievement, especially in the
field of African-
American literature. Also soon coming
on board was Dr.
Donald Hagen, who had recently retired after
a long career in the
Navy, where he had become Surgeon General.
While not an
academic, Hagen quickly sized up KU Medical
Center as a hotbed of conflicting fiefdoms. With weekly messages
via e-mail, Hagen
proclaimed a day of renewal was at hand for
KU. He even put his
top leadership through a course of Covey
training, which aims at
developing cooperative ways of functioning
in large
organizations.
19. For a variety of reasons, these efforts
at renewal failed.
One reason was the arrival of a new Dean
of the Medical School,
Dr. Deborah Powell. A graduate of Radcliffe
and of Tufts, she
had the requisite New England pedigree traditionally
esteemed at
KU. However, because she was a Pathologist,
there was some
concern whether she understood or supported
the Primary Care
Physician Education project and its ambitious
goals. We were all
assured that, though she was not in a "people-oriented"
specialty, she did support P.C.P.E.
As it turned out, Powell was
urged by none other than Hagen himself to
begin cutting the
budget of the Family Medicine Department,
which was supposed
to be the linchpin of the whole Primary Care
project. In
frustration Murray resigned as Chair, though
she continued to
teach residents in Family Medicine on a part-time
basis. Dr.
Cynda Johnson, who then became Interim Chair,
supported the
continuation of the Humanities Conferences,
and otherwise was a
dedicated and progressive educator.
20. By the Summer of 1999, various candidates
for permanent Chair
of Family Medicine had been interviewed,
and the consensus of the
faculty was that Johnson should be appointed
to the post.
Powell, however, refused to do so, saying
"the chemistry is not
right." Exasperated, Johnson announced
she was leaving KU, where
she had spent twenty years, to take the position
of Chair of
Family Medicine at the University of Iowa
Medical School. The
Dean was developing an alarming penchant
for authoritative but
mysterious statements such as her judgment
about "the chemistry."
21. On October 6, 1999 I was summoned to Dr.
Powell's office and
given a letter stating that my contract would
not be renewed
after June 30, 2000. In a brief discussion,
she stated: (1) "Your Department is in a budget deficit, and I have to
make
cuts," and (2) "Your research does not fit
the mission of the
Medical School." The latter statement
was especially amazing,
since I had just recently earned promotion,
via rigorous peer
review, to Associate Professor, a senior
faculty rank, effective
July 1, 1999. Subsequently, I learned
that Powell told the new
Interim Co-Chairs of Family Medicine: "I
cannot justify having an
English major in a Family Medicine Department."
Powell's
statement about my research dismissed in
one sentence my record
of 80 scholarly publications, plus 100 lectures
and seminars I
had given all around the United States and
in Europe, on topics
of medical, intellectual and cultural history.
22. Naive people customarily take such things
personally. Some
even come to agree with those who dismiss
them, that their work
is insignificant. However, I resolved
at once to contest this
dismissal. Some 400 letters and messages
from around the United
States and from several other nations went
to Dr. Hagen. The
American Association of University Professors
conducted an
investigation of my case and of others on
the main campus in
Lawrence. Their investigating committee
prepared a report, which
however, had no effect on the administration.
After a
perfunctory exchange of letters with a KU
attorney, Robert
Kreiser of the AAUP's national office said
there was nothing more
they could do. Proceeding to a formal
censure of KU would not be
possible, Kreiser said, for reasons that
remain obscure.
23. A bizarre atmosphere began to develop
on the State Line
campus. In August 1999, a majority
of the Kansas State Board of
Education voted to remove key concepts of
the theory of evolution
from tests given to high school students
in the state. This
prompted intense international publicity,
projecting an image of
Kansas in 1999 as backward as Tennessee in
1925. In response, I
personally agreed to sponsor a scholarly
conference, "Monkey
Business in Kansas," to be held at the Medical
Center November
5-6, 1999. Two days before the conference,
Linda Davies,
Director of Academic Support, telephoned
me and directly charged
me with falsely representing that the Department
of Family
Medicine had sponsored the event. I
replied that I was
personally sponsoring it as a faculty member.
The next day, Ed
Phillips, Vice Chancellor for Administration,
telephoned and
similarly berated me: "You have been," he
charged, "less than
forthcoming about the sponsorship of this
event." He added: "The
University cannot support events like this."
When I demanded
that he put his objections in writing, Phillips
perhaps realized
that his bullying tactics would not prevail
with me and refused
to do so. The conference took place
as planned. Phillips,
recently hired by Hagen, was a pal from Navy
days, and obviously
knew nothing of the concept of academic freedom.
Phillips' next
move was to proclaim a new policy at the
Medical Center, that
faculty had to obtain the approval of their
Department Chairs
before scheduling any space for "outside
events." I protested
this to Dr. Robert Trueworthy, chair of the
Faculty Council, but
he never replied, nor did the AAUP take any
action on this clear
abrogation of traditional faculty rights
and privileges.
24. I filed a formal complaint against Dr.
Powell, for violating
my academic freedom when she made the statement
dismissing me
because of my research. On June 27,
2000, four days before my
dismissal took effect, the mandated hearing
finally was held.
The faculty member I originally wanted to
represent me was not
allowed to serve on the committee.
Dr. Mark Fey, a professor of
hearing and speech, chaired the hearing,
and among other
irregularities, attempted to prevent my son
from making a
tape-recording of the hearing. Fey
even attempted to prevent my
citation of Sir William Osler, the distinguished
Professor at
Hopkins, concerning the importance of the
humanities in medical
education and practice. I persisted,
and got into the record
Osler's denunciation of those whose only
standard of value was
"the tape-measure of utility." At the
hearing, Dean Powell
testified she could not remember making the
statement about my
research. Dr. Dolores Furtado, a long-time
AAUP officer at KU
Medical School and the head of the AAUP's
Task Force on Medical
Schools, "represented" me on the Committee,
but as I learned only
much later, did not support me in the decision
that was made in
favor of the Dean. The Committee made
no finding of facts, nor
did it issue any kind of explanation for
its decision, nor did it
actually have a formal vote. In short,
the whole hearing took on
the character of a Star Chamber proceeding
such as occurred in
17th Century England. To this day,
Furtado has never explained
to me her strange role in this proceeding.
25. My dismissal occurred as the Dean ordered,
on June 30, 2000.
The University refused to pay me several
thousands of dollars for
unused sick leave accrued, on the grounds
that I had been
terminated, and had not retired. I
did not even receive any
formal written notice of the Committee's
adverse decision until
the middle of July.
26. There are other aspects of this case too
complicated to enter
into here. It must, however, be said,
that other faculty were
told the same thing, that their research
did not fit the mission
of the School, and were dismissed.
In the summer of 2000, after
I had been forced out, Dr. Jane Murray, my
former Chair and
supporter of the Humanities Conferences,
learned that her
part-time appointment as a Professor of Family
Medicine had been
terminated when her paychecks simply stopped
coming. Justifiably
infuriated at this treatment, Murray reported
these attacks on
Family Medicine to the press, resulting in
several articles.
27. Difficult as it is to retain one's perspective
during such
disturbing events, it is important to try
to grasp trends which
underly what might otherwise be considered
personality disputes.
I had often remarked to Murray that KU's
departments resembled
the atavistic combatants of the Balkans,
who glare out from their
battlements, prepared to pour boiling tar
on all who approach.
These are people, I said, who are not educated
or civilized, but
are content to remain mercantilists of the
provincial sort.
28. The reason Family Medicine found itself
in "deficits" was
that the other "rich" departments starved
it for resources.
Faculty salaries in Surgery or Anesthesiology,
for example, were
often several multiples of those for Family
doctors on the
faculty. Similarly, administrative
expenses grew out of
control. Powell herself made a salary
of $270,000 the year she
dismissed me (while I made $37,000).
Her husband, also a
pathologist, made a salary almost as much
as the Dean: hence,
these two exacted a sum in the neighborhood
of Half a Million a
year. For the sake of comparison, we
may note that United States
Senators make $140,000 per year, and United
States Supreme Court
Justices make $170,000. Furthermore,
through the Kansas Open
Records Act, I obtained records that showed
the Dean's office
spent $190,000 in one year for "social activities,"
such as
receptions and dinners. Almost $300,000
was spent for
consultants on a project to collect information
on the kinds of
work done by the faculty, at the same time
faculty with a proven
record of scholarly research and publication
were being harassed,
driven out, and dismissed.
29. Aside from this gross waste of money,
which alone gives the
lie to "deficit" claims of any kind, the
entire context became
clearer in the summer of 2000, when suddenly
a Life Sciences
Initiative was announced in the Kansas City
media. An ambitious
and complex project, this scheme joined the
University of Kansas,
the University of Missouri-Kansas City, and
the newly established
Stowers Institute in Kansas City, Missouri
in a plan to make
Kansas City one of the largest national centers
for basic
biomedical research. Hundreds of millions
of dollars were to be
sought from a combination of public and private
sources, for an
initiative which proclaimed as its goal "an
aggressive and
comprehensive commercialization system."
In his annual
Convocation address in September 2000, Chancellor
Hemenway, a
member of the Board of Directors of the Life
Sciences Initiative,
supported this effort, saying almost incidentally
that
"reallocations" at the Medical Center would
have to be made.
Thus, without any faculty advice or consent,
it was revealed
exactly how "the mission" had changed.
If you did not bring in
big federal or private dollars, you were
dispensable.
30. At KU Medical Center, the Department of
Family Medicine was
dislodged from its easily accessible position
at the entrance to
the Hospital, to make room for a large group
of cardiologists
from St. Luke's Hospital in Kansas City,
Missouri. Just as
legislators a hundred years ago had feared,
Kansas City, Missouri
interests were taking over the KU Medical
School. This
transition was facilitated by the newly privatized
KU Hospital
Authority, created by act of the State Legislature.
For the
first year or two, a community and legislative-based
oversight
committee was required by law, but that was
soon quietly
eliminated. Food and custodial services
were privatized, with
more long-term employees terminated.
The administration's
"reallocation" became the workers' unemployment.
31. One thing that is common to Powell, Hagen
and Hemenway is
that none of them are native Kansans.
Conversely, many of those
they have attacked and fired were either
born in Kansas or have
long years of service to the state and to
the university. The
approach of this troika is quite clearly
to support outsiders
whose objective is to make as much money
as possible from us.
They also support high rollers within Kansas
who have the same
objective.
32. One might have expected Chancellor Hemenway
to make a stand in defense of the humanities in medical education, such
as he did on November 14, 1997, when he gave a seminar in our Family Medicine
Humanities Conference series, and publicly stated: "I'm really glad that
Fred Whitehead is drawing together the humanities and medicine."
By 1999, he and others had determined that mere English majors were an
impediment to the Life Sciences. KU would go backward in time, to
become a proprietary trade school like those which vanished ninety years
before. As Osler foresaw, its standard of value would be, indeed,
"the tape-measure of utility."
Fred Whitehead (fredwh@swbell.net)
is former Associate Professor
of Family Medicine, University of Kansas
School of Medicine.
This article is a chapter from his new book,
KU
Confidential,
which is available free via e-mail from the
author as an attached
MS Word document, or in printed form postpaid
for $15 (PO Box
5224, Kansas City, KS 66119). |
|
