Sir, - Maev-Ann Wren, Muiris Houston and other correspondents are to be congratulated on their comprehensive, detailed and largely substantiated review of the health services. Their efforts and the discussion they provoke are vital to mobilise the political will to address this large, unreformed sector of the Irish economy. I was particularly pleased that Ms Wren had the temerity not just to describe the problem, but actually to suggest how it might be addressed.
She presented a reasoned and informed analysis of the erosion of structural investment by government; the conflicts of interest that beset practitioners of private and public medicine; a consultants' cartel system that would make Hugo Chavez blush; and the loss of young physicians who choose training over indentured servitude. Her brief recitations of fact also stand in elegant contrast to claims that the Irish health service is "on a par with the best in the developed world" and therefore does not need change .
There are many dedicated, hard-working and altruistic people in the Irish health service - including, no doubt, some of Ms Wren's critics. However, touchy proclamations of wounded pride merely affirm the cartoon image of the Irish consultant and do not contribute to rational consideration of necessary reform. It is good to see this discussion emerge from the Department of Health and professional interest groups and move squarely into the public arena; it is, after all, about the public's health. - Yours, etc.,
Garret A. Fitzgerald, M.D., F.R.C.P.I., University of Pennsylvania, Philadephia, USA.