Sir, - What was the purpose of Kathy Sheridan's report on Tommie Gorman's experience as a patient with carcinoid tumour (Health, December 31st)? Was it simply a human interest story with a happy outcome?

The front-page caption, "form E112 probably saved Tommie Gorman's life", pointed the way. The messages in the article itself seemed to be: 1. Tommie was lucky to have been fortuitously pointed in the direction of Dr Öberg in Sweden; otherwise his treatment would have been at best sub-optimal. 2. He could not have had the tumour treated to international standards here. 3. Irish patients should use the Internet to have themselves referred across Europe to the best specialist services using E112 forms. 4. If world-class Swedish medics are paid £70,000 a year, then why should not Irish consultants work for £70,000 a year?

First, consider a few facts. The published Irish incidence of carcinoid tumours is 13 per million per year. Because these tumours are slow-growing, the average time lapse between symptoms and diagnosis is 4.5 years. World-class treatment is available in Ireland. Biochemical screening for carcinoid has been available to any and every requestor at my department in Beaumont Hospital since 1989.

Jim Mitchell appeared with Pat Kenny on the Late Late Show to discuss his own experience with the same disease. Jim had the primary gut tumour and liver secondaries surgically removed at St Vincent's Hospital, Dublin, when he became the second TD to have a successful liver transplant.

Tommie Gorman is now considering radiotherapy treatment for his liver secondaries. Dr Öberg's work is impressive but isotope-labelled drug hormone investigations are available in Ireland. Patients are sometimes sent abroad, usually to London, for the isotope treatment options. The expertise is in Dublin but special facilities are needed to service the need and should be developed at St Luke's Hospital.

In a review published in Digestion in 2000, Dr Öberg noted that there was insufficient data to be certain about the survival advantages of various treatments for these slow-growing tumours.

Recently, I met a disease-free Jim Mitchell campaigning in Cabra. He was in fine form. Dr Peter Morrison, the Sligo surgeon who facilitated Tommie Gorman's E112 form, is likely to remember both Oscar Traynor, the St Vincent's transplant surgeon, and myself. We were in the same class in UCD. Sligo is nearer Dublin 4 than Uppsala. Why was Tommie Gorman sent to Sweden?

I readily admit to being prejudiced in favour of Irish medical expertise. I am sure that Tommie Gorman could have all treatment modalities somewhere in Dublin. Radio-labelled compounds may have a role in his tumour treatment. It depends on the circumstances. I, like my other medical colleagues, wish him well in the future, irrespective of his choice of doctor.

Irish doctors, given more beds and back-up resources, will satisfy even the most cynical Irish patient. We also know that our value is greater than £70,000 per year and to hell with the begrudgers. - Yours, etc.,


Department of

Chemical Pathology,

Beaumont Hospital,

Dublin 9.