Handing out penalties at the bottom. Ignoring who’s pushing from the top. That’s the blind spot in most health regulatory systems.
In a new Journal of Medical Regulation commentary, RxLaw founder Aly Háji and Professor Zubin Austin of the Leslie Dan Faculty of Pharmacy, University of Toronto examine what they call the “dual loyalty” problem in healthcare. Licensed professionals in corporate leadership roles are pulled between their duty to patients and duty to the corporation. This goes beyond ordinary conflict of interest. Disclosure and recusal aren’t designed to address it.
A pharmacy example illustrates the challenge: medication-review quotas imposed as an employment condition—despite concerns about time, staffing, and feasibility. The boulders roll downhill. Frontline professionals scramble to catch them. And when one drops, the whistle blows—at them. If public protection is the mandate, regulators may need new frameworks for corporate misconduct: accountability for policies that predictably shape professional judgment, even when the decision-maker never touches a patient.
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