Some time ago Prof John Crown was asked for his best life advice. "Don't send that email for 24 hours," he replied.

What would he answer now?

“Life is not a popularity contest.”

The two answers combined provide a guide of sorts to his life’s trajectory. He has undoubtedly fired off more than a few impulsive emails. “I’m a fairly passionate sort of person. Sometimes I think with my heart ahead of my head on some issues,” confesses the outgoing Senator.

Cantankerous and combative are words often applied to him, and sit oddly with his work as a highly-respected consultant medical oncologist and clinical researcher, nationally and internationally.

“Cantankerous? I was just as cantankerous when I was 36. I’ve mellowed. You should have seen me then.”

His ego is the size of Manhattan, according to a colleague, though hardly unusual in a medical caste long treated as God’s representatives on earth. Then again, few of his peers would have the tagline “adding a little flair to life” on their website.

"You probably lick yourself every night before you go to bed," snapped the then minister of state Brian Hayes to Crown during one infamous exchange in the Seanad.

“The word ‘prat’ comes to mind,” Crown responded.

He laughs out loud when reminded of it.

“I like Brian,” he chortles.

Born in New York to a taxi driver turned shopkeeper – and illegal Irish immigrant – and a nurse, he was 10 when the family returned to Ireland in 1967. His father was able to buy a shop “and achieve a modest level of prosperity” with compensation for a serious back injury. “I know where I come from,” he says.

After graduating from UCD, he went back to New York and landed a consultant job “at the Mecca of oncology”, the Memorial Sloan- Kettering Cancer Centre. Yet oddly for a fiercely ambitious and competitive young doctor back then, getting a job back home was the ultimate goal.

“That’s how we were conditioned as young doctors in Ireland.”

And so in 1993, at 36, against fierce competition, he won a post as consultant in St Vincent’s Hospital.

The gilt wore off quickly. “I’ve seen third world and Ireland wasn’t third world – but it was locked at the bottom of first world. At a time when the non-mastectomy option was available, women here were losing their breasts because of poor services.”

Within a couple of years his propensity for speaking his mind was making him unpopular with the Department of Health.

“I was saying that things were really appalling...They made vague promises and told us to shut up. I said there would be no omerta. And I’ve had a difficult relationship with the bureaucracy ever since.”

This is true.

Ambitious to get Ireland on the cancer research map, he found himself continually thwarted by the system.

I became angry

“That’s when I became angry. I think that’s what drove me to the reputation I have for being a cranky guy, because I always wanted it better. It used to really hurt me that patients were dying – I thought needlessly – or having their chances of cure compromised because stuff that was routinely available in some other countries wasn’t available here.”

His allegations of a cover-up of a €1 million fraud at St Vincent’s private hospital 13 years ago were followed in 2013 by more shocking allegations – made from his seat in the Seanad chamber – that hospital management had retaliated by trying to prove his cherished clinical research programme was “illegal”, thus attempting to “criminalise part of their own organisation”, as he put it.

Consequences

His research programme was suspended for 18 months following his initial claims. Were there personal or professional consequences arising from his recent resurrection of the allegations?

“Yes, there were personal consequences for me. I’d prefer not to go into detail now but, yes, it did hurt me in the hospital.”

Controversy has followed him like a faithful yappy dog, and he has stoked it and embraced it, clearly at some cost.

Through numerous platforms – including newspaper columns, passionate and articulate broadcast performances, an active Twitter account and a NUI Seanad seat since 2011 – he has berated healthcare administrators and politicians.

In a small profession in a small country, where establishment medicine, politics and religion intersect in many ways, his outspokenness has also bred a wariness of him in some of his peers, often torn by competing agendas.

Is some of this fearless combativeness perhaps attributable to his American formation?

“There’s a little part of me that kinda regrets coming back to Ireland. I sometimes think Ireland and me weren’t a good mix. I would not be considered so way-out-there in America. I think the Irish medical profession – especially at senior levels – is fairly conservative, and I would depart from that conservatism in some ways. I definitely have an outgoing personality.”

Flamboyant even?

“Certainly I have personality aspects of that, but a lot of it was that I was very ambitious, not just for me – although I was – but I was ambitious for the country.

“I used to look at smaller countries like Denmark, Switzerland and Belgium which punched above their weight, and I used to look forward to the day when somebody from Ireland would walk up the steps of the American Society of Clinical Oncology at one of the big international meetings and the first speaker would say ‘Ireland’ – and I did that, and that meant a lot to me when I did that.”

He contrasts the “desire for excellence” in Memorial Sloan-Kettering as “something we don’t get in Ireland. We’re kind of mediocre in general; happy if it’s good enough.”

He is 59 now, with a new wife, Orla Murray – a civil servant – and a young baby, in addition to three grown-up children from a previous marriage. He comes across now as more measured, more cautious. "I don't want to be knocking people," he says wryly.

“I’d like to talk about the research,” he says repeatedly, before distracting himself with a run at how politics is conducted or the failures of the health system.

The dismaying aspect for his detractors is that he speaks as an intelligent insider – one able to join the dots clearly and accessibly and makes a lot of sense, a lot of the time, about the iniquity of waiting lists, of patients routinely being seen by trainee doctors, of cancer patients on trolleys, the cost of drugs and on and on.

His zeal for health reform is unassailable. He obtained an MBA just to forestall “smirky health administrators saying I wouldn’t know anything about this because I was only a technician”.

He emerged as a “huge fan” of the German healthcare system. This is based on a system of cross-subsidised mandatory insurance, and Ireland has already “slightly” started it, he says.

“The average person with VHI now – teachers, taxi drivers, civil servants – already has something that looks like the universal health insurance model for hospital care...” (Which is why doctors “make so much money”, he said. “It’s because there are so few of them in a country where a much higher percentage of people have insurance than the European average”).

Bubble world

Why not complete the path to the German standard then?

“We could but for four words: the Irish civil service...It is a bubble world which imagines that it, and it alone, never acts out of self-interest. They do. Their self-interest is based in conservatism, power, limited change...And there would be a colossal change in deregulating the health system. A lot of patronage would go. Real change would require truly visionary political change to do it; it will never come from within. I completely place the blame for the sclerosis in Irish public life on the permanent government.”

He becomes most animated when talking about waiting lists. These, he claims, are the “business plan” that underpins the system, one where hospitals’ funding is decided by government by some kind of beauty contest, and where that funding must last till midnight on New Year’s Eve. And so, inevitably, the better a hospital becomes at something, the more patients will come and the more money will be drained from the funds.

“And the only way the hospital can deal with that is waiting lists. Because the patient on the waiting list costs no money. But with more linkage of reimbursement to activity, activity goes up and waiting lists disappear.”

If he could wave a magic wand ?

“Tell the hospitals they are going to be funded on the basis of efficiency and activity and on quality. If your quality slips, it’s going to hurt you. If you have patients on the waiting list, you ain’t getting paid for them. If we think you’re ordering unnecessary tests or are price gouging, we’ll penalise you or perhaps put you in prison.”

There is much more,of course. But the man sitting here is pretty disillusioned. He ran for the Seanad on the twin goals of health and Seanad reform, offering what he called “fresh thinking, new abilities, and a different perspective”.

And now ? “I naively thought that I could have a greater impact than I had.”

He is not running for election again.

It was “psychologically important” that one of his own Bills was accepted by government – the Protection of Children’s Health from Tobacco Smoke Bill (smoking in cars) – but ultimately he is defeated.

He has a lot of time for James Reilly, personally and professionally, and regarded him as an advocate for change while minister for health. "To be honest, a bit of my heart left [the Seanad] the year he was deposed."

By his reckoning Leo Varadkar is "the smartest guy" in the Oireachtas.

“I think what drives him is that rising to be prime minister is a higher political ambition to him than wreaking an Anuerin Bevan-like fundamental change in the health system. I think he wants to fix a lot of the country’s problems.”

He would like to have been taoiseach himself, in another life, but his time in politics is over. Nonetheless, the whole experience has left him with “zero regrets – and funny enough, much more respect for the political process”.

Really?

“I very much enjoyed my time in Leinster House, and really got an understanding of how people could get absolutely addicted to being in there. I always knew it was not my only option and job in life so I was a bit cosseted, but I got a real understanding of the crushing feeling people must get when they lose their seat ; that this is their avowed vocation in life to become a politician, either to become deeply dug-in as the go-to person in their constituency or with ambitions toward national office.

Hard life

“I found myself being very sympathetic to people of all parties who were putting themselves forward, even thinking on a purely personal human level: ‘This is an awful job’. They work long hours. It’s a hard life.

"I remember talking to one politician and this politician's entire raison d'être was a critical competition within their constituency [with a rival] and this person was discounting the importance of everything in life in return for trying to make 1,000 people like them more than they liked another person.

“When you drill it down to that you have to ask yourself are you setting the bar of your ambition in life high enough?”

For himself it always comes back to oncology and his pride in research on new treatments for breast cancer; his co-founding of the Irish Co-Operative Oncology Research Group; his collaboration with some of the greats of world oncology such as Dr Dennis Slamon and Dr James Holland.

“I can’t imagine a post-oncology life for me,” he says, railing at the mandatory retirement age of 65 in this country. “I will have a six-year-old when I retire at 65. I can’t afford to retire at that age; it just won’t happen.

"I love life. I am full of joie de vivre. I love treating people with incurable cancer – I know that sounds awful but I have quite a few patients who had 'incurable' cancer diagnosed 10 years ago who are still alive.

“It’s not just me, we have some brilliant cancer specialists in this country. The courage that people show in the face of a cancer diagnosis really inspires me.”