Flexner’s Ethical Oversight Reprised? Contemporary Medical Education and the Health Impacts of Corporate Globalization
Abraham Flexner’s famous reports of 1910 and 1912 “Medical Education in the United States and Canada” and “Medical Education in Europe,” were written to assist development of a positive response in university curricula to a revolution in understanding about the scientific foundations of clinical medicine. Flexner pointed out many deficiencies with medical education that retain contemporary resonance. Generally underemphasized in Flexner’s reports, however, were recommendations promoting a firm understanding of and commitment to medical ethics as a basis of medical professionalism. Indeed, Flexner’s praise for the scholastic basic of German medical education became somewhat ironic when the ethical inadequacies of prominent Nazi doctors were revealed at the Nuremberg Trials. This article suggests that contemporary medical educators, like Flexner, may be at risk of inadequately addressing a major challenge to evolving medical professionalism. Whilst medical ethics and health law are now increasingly being emphasized in medical curricula, the same cannot be said of the international human right to health and, in particular, its conflict with lobbying principles arising from the structures of corporate globalization. Today it is this normative tension that must urgently become the subject of major recommendations for reshaping the teaching of medical professionalism. We recommend that contemporary curricula modify instruction in medical ethics and health law to express how such norms are likely to be influenced by, or conflict with, corporate lobbying strategies. Students could learn, for example, the means for distinguishing principles and rules legitimated by the rule of law, from the bargaining devices or constructive ambiguities of corporate globalization. Examples of the latter include “transparency” (in reality, often selective protection of corporate commercial-in-confidence agreements), “recognition of pharmaceutical innovation,” (monopoly protection of brand-name products against less expensive but equally efficacious generic drugs) “liberalization of trade in hospital services” (removal of all regulatory barriers to private ownership) “dismantling of discriminatory price controls” (undermining government drug pricing systems that seek to reference new products against overall social enefit). Such corporate principles are likely to increasingly, discreetly propel professional and social regulation in directions favorable to corporate interests and away from protection of public goods.