Is Ethical Corporate Medical Practice An Oxymoron?

Abstract

Consider the grim situation of physicians employed in corporate medical departments. As portrayed by Elaine Draper, based on interviews with sixty physicians employed by companies large and small, government and union officials, and others, corporate physicians are disdained by their colleagues in clinical practice for having poor skills and for kowtowing to management, yet their corporate bosses view them as suspect for an outlook that derives from medical training rather than from the bottom-line values of an MBA culture. Some try to take solace in seeing themselves as the worker’s doctor, but that, too, is impossible, since workers well understand the doctors’ real conflicts of interest. Perpetually at risk of being replaced by independent contractors, corporate physicians respond by demonstrating what good team players they are. They write medical evaluations favoring management positions, discount evidence of hazardous substances in the workplace, breach confidentiality, become adjuncts of corporate legal departments, and administer drug tests and other medical screens they don’t believe in. Support for resisting pressures and incentives that lead to these practices is nowhere to be found, since, according to Draper, their professional association is dominated by a corporate outlook; she even quotes editors to suggest that its journal is edited to favor corporate positions. Although it is written in academic prose (Draper is a professor of sociology at California State University, Los Angeles), the relentlessness of Draper’s account makes one wonder whether the picture is exaggerated. But the details are sobering and reinforced by the many quotations laced with either cynicism or resignation at the chasm between professional values that stress the overriding ethical obligation to the patient’s health and the day-to-day demands of corporate practice. The account is convincing, too, in illuminating the legal and business context in which this conduct takes place. Draper shows how corporations in a globalized economy, constantly seeking to lower labor costs, approach health-related questions such as drug testing and other screens for employees, federal health and safety regulation, and workers’ compensation with strategies to displace responsibility for workers’ or public health onto others. Counterincentives to foster a healthy workforce, much less a healthy community, are generally absent, and in most industries the most effective antidote—labor unions—has declined. In this world, corporate physicians who “are under constant pressure to cast their medical judgments in profit terms and show the business value of medicine” are no different from other workers. It follows that for Draper, the only appropriate responses are legal requirements, economic incentives, and regulatory regimes that place a greater responsibility on the corporation to protect the health of its