Two of American medicine's pioneers, and co-founders of Johns Hopkins Medical School, represented a fork in the road. William Osler, whose scientific humanism pushed back against a healthcare system teetering between commercialism and quackery, created a solution at Hopkins: clinical care, doctors as teachers, patients as teachers, an end to protocols and dogma. He believed in patient centric care: "If you want to know the diagnosis, ask the patient," he said. He believed that America was becoming a society of drugging rather than healing. He believed that nuance and uncertainty were inherent to healthcare, and that there could never be one right answer. His colleague, William Welch, was a pathologist, a eugenicist, a believer in German medicine, an AMA president. He did not believe in the importance of patient centered care, rather advocating laboratory medicine that trumped the patient. He believed in drugs and one-right-answer thinking and he rejected the value of clinical care in education. He wanted a medical education system run only by full time laboratory faculty, not practicing physicians as Osler had set up at Hopkins. Welch, in the end, won the day. Once Osler retired, Welch fired all clinical staff, and imprinted the AMA model upon all of healthcare. He is indeed the father of American healthcare, but of a healthcare system that embraced eugenics and the medical racial script, that marginalized patients, that created diseases out of numerical norms, and that worked with corporations and drug companies. If you want to know where our system came from, you only have to understand Welch's victory over Osler. And if you want to know how to fix the system, you only have to understand and revive Olser.

Alan and Andy discuss why they are dinosaurs, why primary care is becoming extinct and why its disappearance will instigate harm to the health care system, to patients, to our national debt, and to reason and sanity in health care. Talking about changes within the medical environment, they show not only why primary care is being left to die, but also the measures needed to revive it. It's not hard, but any reasonable measures we as a society institute will run into the wall of profits derived from keeping the system dysfunctional.

The AMA grew up in a libertarian America, but chose to change its nature during a top-down Progressive America, where experts and scientifically based rules were determined to be crucial to any viable reforms. Working with corporate foundations, Progressive reformers, and German-inspired Progressive academic doctors, the AMA shifted course and transformed into a top-down organization that sought to control all aspects of American medicine, including education. It changed its structure to rely on a very narrow board of "experts," it adapted a German ideology of care, it worked with corporations and drug companies to increase its base of money and power, and it started to survey medical schools and determine which ones were capable of surviving in a new Progressive age. All of this foreshadowed the Flexner Report, which would vault the AMA into total domination over the medical landscape, normalize German medical thinking, and create a formulaic dogmatic medical script that would be templated upon all medical schools and all licensing requirements.