The Ramazzini Institute
for Occupational and Environmental Health Research   

Who Are We?

Elaine Draper, The Company Doctor: Risk, Responsibility, and Corporate Professionalism, New York: Russell Sage Foundation, 2003.

A look at Corporatized Occupational Medicine

     Worldwide, there are only a handful of competent social scientists describing and analyzing the public policy implications of the realities of the work environment, their meaning for corporate and union policy, workers and public health, and the shaping of the globalization of industry. Of these, Elaine Draper stands pre-eminent in the effective use of thorough, structured interviews with a backdrop of exhaustive literature review and documentation. 
     The result of her prior work has been dispassionate descriptive analysis. A Visiting Scholar at the Institute for Social Change at University of California, Berkeley, and a professor at California State University, Los Angeles, Draper is also author of Risky Business: Genetic Testing and Exclusionary Practices in the Hazardous Workplace, Cambridge University Press: Cambridge 1991. 
     In this work, Draper has again written an objective chronicle dissecting the social and professional caste inhabited by 'The Company Doctor". She has described a subculture the negative repercussions of which go beyond the immediate confines of plant medicine to what Draper calls "the broader social trend of eroding trust in physicians and, more generally, in the professional experts who are responsible for protecting health and the environment along with the public welfare."
     Professor Draper has taken a hard look at what she calls the "corporatization" of medical practice in industry. To do this, besides burial in the mountains of literature on the subject, she conducted 100 confidential interviews, including corporate executives and attorneys, as well as corporate physicians. Much of her 'data' is not found elsewhere, not only because of corporate pressures, she writes that company lawyers are at times more forthcoming, but also because of the reluctance of the physicians themselves. 
     The result is a useful digest of key issues of organizational psychology and employment, in the context of industry itself and the need of the corporation to have physicians, including professional autonomy, loyalty, privacy, the patient-physician relationship, objectivity, workplace screening and testing, information control, legal liability and responsibility, effects of downsizing and contracting, and other questions. 
     What are the "implications for society and for social policy", to quote the title of Draper's closing chapter? There are ethical problems, galore, but the author contends that: "the conflicting organizational demands from being both a corporate employee and an autonomous professional constitute a social and structural problem rather than a problem of individual ethics." 
     Elaine draper makes a number of practical suggestions under the guise of promoting effective preventive health measures and legal and social policy protections and organizational incentives. None, however, are as critical as her conclusion that health services must be separated from employer control. Without that separation, the need, and therefore the right, to know information critical a worker's health, insurability, employment and place in society must always be under a cloud of misinterpretation. The collector should be "agencies independent of their employer…Physician's services are likely to improve if control, over them is separated from employment. Physicians could instead work for a third party chosen by both management and employee representatives," such as "regional health resource centers" paid both by the companies and the government. Without these changes, Draper concludes, current conflicts over whether individual workers, corporations, or society as a whole should bear the work-related costs of chemical exposure risks and medical care are likely to expand over the next decade." 
     By looking at the "corporatization" of their professional life, and rejecting the conventional [and nearly useless] framework of atomistic 'principles' that prevail in contemporary systems of medical ethics as standards of behavior, Dr. Draper provides the corporate physician and associated professions with an empirically based argument for greater professional independence.