I’ve spent a good deal of time writing and thinking about Dr. John Buchanan in recent years. His colorful career saw him play many roles including physician, author, educator, patent medicine entrepreneur and…criminal. His infamy, despite having been largely forgotten today, rests upon his latter role as the moving force behind America’s largest medical diploma mill in the 19^th century. (See my forthcoming book Diploma Mill: The Rise and Fall of Dr. John Buchanan and the Eclectic Medical College of Pennsylvania from Kent State Univ. Press, August 2018.)

Over a career spanning roughly four decades, John Buchanan’s transgressive behaviors included the sale of medical degrees, conspiracy to defraud, bribery, apparent theft of corpses for anatomical instruction, allegations of criminal abortion and political chicanery designed to swing a state legislative election to one of his colleagues.

Buchanan’s career, while colorful, is not entirely unique. Scoundrels populate the history of medical regulation in America. The rogues’ gallery where Buchanan resides includes hucksters and charlatans like goat gland specialist John Brinkley, cancer-cure specialists like Norman Baker and Harry Hoxsey, snake-oil salesman Clark Stanley and countless locally infamous rascals that bedeviled state medical boards and the medical profession.[1]

(Left to right: John Buchanan, John R. Brinkley, Harry Hoxsey)

One of the questions I have found difficult to answer about Buchanan should be a simple one.  Why did he do it? Why did he risk—and ultimately throw away—a promising medical career at a legitimate educational institution?

Money—that’s the obvious answer, right? The diploma trade proved not only lucrative but relatively easy to conduct during the post-Civil War era despite the periodic outcry of critics.

But that doesn’t really answer the question. Think about it. There is nothing at this moment preventing you or I from engaging in an activity that could reap a financial windfall—drug dealing, income tax evasion, identity theft, various types of fraud, etc. And yet we don’t do these things from a mixture of motives, e.g., our sense of moral or ethical values, our fear of being caught and punished. Indeed, the vast majority of the human population rejects transgressive behavior on a daily basis in favor of our remaining in good standing in what is collectively hopefully a safer, stable, more just social order.

If greed doesn’t wholly explain John Buchanan’s behavior, what does? Here I think it is helpful to see John Buchanan as a specific type of scoundrel in the medico-regulatory world. Not the confidence man of the sort represented by a Brinkley, Baker and their ilk but as a type we more often think of as a creature of the 20^th century—the white collar criminal.

The federal prosecutors who charged Buchanan with mail fraud in 1880 attempted to portray him as a con man preying upon the public through his issuance of mail order diplomas that became the basis for some physicians to secure a medical license. While this was a rational argument to present in trying to secure a conviction on mail fraud charges, it represented an overreach. Why? Quite simply, no fraud entered into the transaction between Buchanan and the purchasers of the diplomas as both sides were aware of the true nature of the transaction. The judge agreed, acquitting Buchanan on this specific charge. (below left)

No, unlike the con men fleecing naïve but ultimately trusting patients, John Buchanan acted in a manner more consistent with the white collar criminal. The term itself dates to the late 1930s and its introduction by the sociologist Edwin Sutherland. Generally defined as a non-violent offense involving financial motive, we generally think of white collar criminals as professional men who have exploited their position or authority for personal gain, e.g., Bernie Madoff, Jeffrey Skilling (Enron), etc.

Traditionally, scholars explained white collar criminal behavior in wholly rational terms—as individuals engaged in a conscious, almost deliberative mental process involving analysis of risk and reward related to a specific opportunity. More recent research,[2] including interviews with convicted white collar criminals, suggests a more nuanced explanation involving a triangulation of variables:

• perceived pressure
• perceived opportunity
• individual integrity/rationalization

Here I believe we find the more compelling answer to why John Buchanan moved into diploma sales. Financial pressures on Buchanan and his school increased markedly in the early 1860s with the start of the Civil War and the disrupted flow of matriculating students. In his published confession from 1881, Buchanan also cited personal financial pressures.

As for opportunity, at the time Buchanan joined the school faculty in 1860, there were virtually no legal restrictions on the practice of medicine anywhere in the United States. As the professionalizing trend evolved in medicine, pressures mounted to increase standards for medical education, including the issuance of medical degrees. Legitimate degree issuance practices such as ad eundem and honorary degrees and the awarding of advance standing to experienced physicians were practices vulnerable to abuse for those willing to “rationalize” deviations from conventional or accepted standards.

In this regard, Dr. John Buchanan differed markedly from the contemporary charlatans knowingly peddling nostrums based upon hokum and pseudo-science to a gullible public. Buchanan’s downfall derived from the hubris of a criminal who convinced himself that his drift into questionable practices could be justified in the laissez-faire era of lax business practices and that his golden goose (the diploma trade) could lay eggs just a little longer despite the emerging regulatory landscape rapidly changing his world.

The opinions expressed reflect the views of the author and not those of the FSMB.

Sources:

David Alan Johnson. Diploma Mill: The Rise and Fall of Dr. John Buchanan and the Eclectic Medical College of Pennsylvania (Kent State Univ. Press, August 2018)

Bill Barrett. “Inside the Mind of the White Collar Criminal.” Accessed July 24, 2018 at https://www.accountingweb.com/technology/trends/inside-the-mind-of-the-white-collar-criminal

[1] See Pope Brock, Charlatan (New York: Three Rivers Press, 2008) and Eric S. Junhke, Quacks and Crusaders (Lawrence: Univ. of Kansas Press, 2002)

[2] Experts in the field have also identified psychopathic traits commonly seen among white collar criminals. See Isabella Merzagora, et. al., “Psychology and Psychopathology of White Collar Crime,” Organized Crime, Corruption and Crime Prevention October 2013.