Sir, - Fintan O'Toole (August 28th) gives the impression that medical research involving collaboration between laboratories and patient work is little done in Ireland. He describes the first-rate jobs of some Irish medical graduates working in the University of Pennsylvania Medical Centre in Philadelphia and states: "It is simply insane that someone good enough to do this kind of work in one of the world's best medical centres can't even aspire to do it in Ireland." He promised that he would provide the solution in his column the following week.
I could hardly wait, but unfortunately on September 4th Mr O'Toole failed to deliver. Instead, he trotted out a number of cliched and outdated generalisations to show that consultants, on appointment to positions in Irish hospitals, immediately focus on private practice and money-making to the exclusion of more cerebral professional activity.
The objective evidence must be examined. In the new contract of employment which came into force in January of this year, consultants negotiated the right to participate in research within the hospital.
Without being in any way comprehensive, it is easy to cite the work of many consultants collaborating with biomedical scientists in Ireland which is "world class". Examples include the importance of homocystine in coronary artery disease as shown by Prof Ian Graham and his group in the Meath/ Adelaide hospitals; work on the retinoblastoma gene done by Prof McConnell in Trinity College; the role of alpha-one antitrypsin in Wegener's Granulomatosis by Prof McElvanney and Dr O'Neill in Beaumont Hospital; the immunology of asthma by Dr Conor Burke and his team in James Connolly Memorial Hospital; work on steroid endocrinology by Prof T. Joseph McKenna in St Vincent's Hospital; helicobacter pylori in peptic ulcer disease by Prof O'Morain and his group in the Meath Hospital; the biology of inflammation done by Prof Bouchier-Hayes and colleagues in Beaumont Hospital; the science and clinical relevance of folic acid metabolism by Profs Weir and Scott in TCD; Dr Des Carney's work on cancers in the Mater; Prof Michael Farrell's work on muscle mitochondria at Beaumont; computer diagnosis of disease by Prof O'Moore in St James's and Prof Muldowney at St Vincent's; work on differential gene expression in diabetic kidney disease by Prof Hugh Brady in the Mater Hospital; work on the immunology of inflammatory bowel disease by Drs Kelleher and Shanahan. And so on.
Fintan O'Toole is correct in drawing attention to the low number of consultants in Irish public hospitals, but draws the silly conclusion that this serves the primary purpose of keeping consultants' private incomes artificially high. Mr O'Toole should try peddling that line to recent consultant appointees to Dublin hospitals who have been offered no office, theatre or bed space on taking up their positions. The presence of delegations of medical consultants at the Department of Health begging for new consultant appointments in our hospitals is not a cyberspace fantasy, it is boringly real. The claim that "if anything, research is a disadvantage", as it gets in the way of private practice, is gratuitously insulting. Dr Garret Fitzgerald, to whom Mr O'Toole refers, is a truly brilliant man who spent some recent time as professor of medicine in UCD at the Mater. His publication list in the medical sciences is awesome. He chose to return to Pennsylvania in preference to continuing at the Mater. I do not believe that he was short of research funding in Dublin.
More publicly funded consultant appointments to academic positions in teaching hospitals, backed up by the concurrent appointment of high-flying medical scientists, is likely to be more productive in research terms than increasing the number of hospital consultants in general. Furthermore, access to hospital laboratories for students in third-level science departments should be made routine, rather than an exceptional arrangement. I have tried to pursue such a policy in my own department at Beaumont Hospital. - Yours, etc., Bill Tormey,
Consultant Chemical Pathologist,
Glasnevin Avenue,
Dublin 11.