Regulating the puddle, not the leak.
That’s how most health regulators still operate. They discipline license holders at the point of care— while the real levers of outcome sit upstream, in corporate policy. In a new Journal of Medical Regulation article, Professor Zubin Austin from Leslie Dan Faculty of Pharmacy, University of Toronto and I call this a “dual loyalty” problem. Licensed professionals in corporate leadership roles are pulled between their: 1. duty to patients; and 2. duty to the corporation. This isn’t ordinary conflict of interest. Disclosure and recusal don’t fix it.
A pharmacy example: medication-review quotas imposed as an employment condition—despite warnings about time, staffing, and feasibility. The result? Predictable triage. Unnecessary services. Downstream blame. Front-line professionals get drenched. The boardroom stays dry. If public protection is the mandate, regulators need a vocabulary—and a pathway—for corporate misconduct: accountability for policies that predictably distort professional judgment, even when the decision-maker never touches a patient. Regulation can’t be allergic to power. Full article here: https://meridian.allenpress.com/jmr/article/111/3/6/508286/Dual-Loyalty-The-Wicked-Problem-of-Corporatization
