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tv   Licensed to Practice  CSPAN  June 3, 2017 12:31pm-12:45pm EDT

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really setting down a legacy, of african-american service, useful for later generations, in some ways we didn't want to sugarcoat the disappointments which happened in the war but nonetheless they wanted to take forward pride, and education for being involved, for the next generation. >> in eugene we caught up with james moore, licensed to practice which chronicles how easy it was to practice medicine in the 19th century and how in 1889, us supreme court decision changed all of that by turning on unregulated occupation to a recognized profession.
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>> licensed to practice addresses supreme court decision made in 1889. enabled the state to begin licensing positions. doctors have been licensed in this, average american can't imagine going to a doctor who isn't licensed. that was not the case. prior to these decisions, enabling a decision i write about, a wide open occupation largely looked down upon people with some exceptions didn't make a robust living at it. if you wanted to become a doctor, she would not be happy, it was a generally low -- you put doctor in front of your name
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whether you have a degree or not, patients to pay the bills you could continue doing that. people practice medicine all kinds of bases. the practice of medicine as i indicate was wide open, people used various forms of hearing, what might work. something their grandmother use forever and set themselves up as the county doctor and somebody else uses herbs and somebody else uses alcohol and somebody else uses hot water and somebody else uses whatever is at hand. that kind of chaotic medical practice that the science oriented 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 science-based state licensed profession they
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could make progress. their motives are largely self-interested because they can't demonstrate that a scientific education makes you a better physician at this point, largely motivated by their own occupational well-being but they also have i think a profound faith that science will pay off. we need to get rid of all these people doing whatever they want to do by the seat of their pants, ultimately dangerous to the public. what we need is a rigorous approach to medicine. that is what they are after. the law that passed a board of health law, with a licensing clause, the board of health begins licensing a physician in the 1880s and the challenge takes place in the early 1880s but it takes a long time for the
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case to go from the county court through the west virginia supreme court and ultimately to the united states supreme court so it is not until 1888 that the united states supreme court hears the arguments and they don't make their decision until the early months of 1889. at that point, states are fully and constitutionally authorized to begin licensing physician on whatever grounds they once. some of the justices made clear in the state level that they didn't think this was a good law. there is no basis for it but constitutionally at the state legislature, thinks in the interest of the public to do this the state legislature has the constitutional right to do that. the practice of medicine is transformed dramatically from this poor paying, anybody can take a shot at it occupation to an elite, well-educated and
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well-paid profession recognized by the states. the state patrols the marketplace for them by prosecuting people 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 are accustomed to by blake 20th, early 21st-century with fewer medical school than existed earlier. those goals existing on very rigorous, lengthy laboratory science education. this flows from this decision, the 1889 supreme court case, there were some notable people who spearheaded the whole activity, the most influential and successful was a man named
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james reeves, reeves was a genuine believer in public health and a fanatical believer in science as the future of medicine. so fanatical that he would not allow any of his members of his medical organizations that were not medical, for example he had one man thrown out of the medical society because the man's father in law was physician of a different sort, homeopathic physician. reeves felt that family gatherings you must talk to your life's father, automatically or expelled from our society because you are talking -- that is what a fanatic he was. to give him his credit, he was genuinely committed to public
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health. one of the founding members of the american public health association, very politically astute, he is the one more than anybody else who engineers passage of this law. he is the one who engineers the alliance with the railroad mining corporations. it is important to think of this decision is not creating a national medical profession but instead enabling the legislature one at a time to license things medical and americans tends to forget given the modern debate over what our health world looks like tend to forget that it is a state-by-state practice. doctors are separately licensed in each separate state, they get relicensed or recertified in that state and the requirements for license very from state to
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state. some states license all levels of medicare. some license some. the criteria are surprisingly local at least on a state-by-state basis. i like in the law that was passed to a faith-based death on the future. if we allow medicine to transform itself into a profession and base it on science, you will ultimately help the public health of the population. it does much later than people realize. there is a great debate among medical historians about what benefit does the average patient with the original is going to the average doctorate what point does patient benefit from that and there are different answers. surgery makes advances as a
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result because they discover antisepsis, they have developed anesthesia. 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. it is looked at as progressive -- why did the country waste time on this, the fact is before demonstrating scientific medicine was the way to go, their consolidation, licensing in the 1880s parallels perfectly the growth of big corporations and the consolidations taking place, these doctors are reengineering the american medical marketplace as carnegie was reengineering the steel
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marketplace and rockefeller was reengineering the oil marketplace and union pacific and southern pacific railroad corporations reengineering transportation these doctors were consolidating a new type of medicine which they controlled. there were a number of unintended consequences. people passing the law, certainly reeves and his allies, reeves got half a dozen friends elected to the legislature, they served one term to get this bill passed, they knew what -- to transform medicine the way it has been transformed. they wanted to limit the educational -- narrow the gate of education so only highly educated people could practice medicine. that necessarily limits the number of doctors in the marketplace. allows them to charge whatever they want and they charge more
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and more because there are fewer of them and that is a consequence reeves and his allies were happy with. instead of thinking of themselves as greedy, they thought of themselves as engineering a different direction. the legislatures who passed it did not anticipate the kind of crisis that developed by the end of the 20th century and early 21st-century in which we are badly underdoctored. we need doctors but by assisting on this lab oriented high science way of training physicians it becomes very expensive to train physicians. we don't train nearly as many as we would like. that was in unintended consequence was i don't think anyone who voted for the laws
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would have wanted the expense to have risen as quickly as it has. we are tremendous outlier in the world with regard -- we are pushing 20% of gross national product. the next closest developed nation is half that and there is a third of that, they are getting according to un statistics better care for their populations spending 6%, 7% of gnp whereas we are pushing 20% and not doing better. better is slightly worse. that is not a partisan issue or a republican issue, it is the structural formation that flows from the decision in west
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virginia, the particular type of licensing unique to the united states produced by that decision. i was interested in the case to begin with, it was really important underpinning of the system that people had not seriously looked at. >> the c-span cities tour and booktv's look at eugene continues. next a trip to the university of oregon to learn about the oregon rare books initiative which seeks to increase the use of rare books and archives in the classroom. >> the oregon rare books initiative was begun three or four years ago. so it's a ms. to increase the use of the rare


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