Privatising medical education

Never mind the ides of March, write Mary Raftery. Beware instead the doldrums of August.

Never mind the ides of March, write Mary Raftery. Beware instead the doldrums of August.

It is generally a sound principle to view with deep suspicion all public announcements made around this time of year, when we are all either away or not paying attention.

Apply this principle, for instance, to a major development in healthcare announced last Tuesday, the day after the August bank holiday weekend - a period rivalling Christmas as a favoured burial ground for news.

Two of the largest hospitals in the land, the Mater and St Vincent's, are to merge and amalgamate with UCD's medical school, creating a brand new entity called Dublin Academic Health Care. This, we are told, "will pool the expertise and resources of the three organisations to improve integration of patient care, enhance medical training and advance collaboration between biomedical researchers and clinicians". Sounds wonderful. So what's the problem? In fact, there are several. Firstly, what it actually means is the effective privatisation of a very large proportion of Irish medical education. Both hospitals in question are examples of our uniquely Irish model of healthcare - they are entirely publicly-funded institutions under the total control of entirely private interests.

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The Mater is wholly owned by a group of private citizens known as the Sisters of Mercy. St Vincent's is likewise in the full ownership of the Irish Sisters of Charity. These private interests control every aspect of their two properties by appointing in their entirety the various boards which run them.

Examining then the proposed governance of what appears - in all but name - to be a new super-hospital, we find that each of the three constituent organisations of this amalgamated entity (ie the two hospitals and UCD) nominates three members to the new board of directors.

Consequently, were a dispute to arise (say over a matter of Catholic ethos, for instance), UCD could be outvoted two to one by the Catholic Church in the shape of the two congregations of nuns in question.

And lest anyone think this is fanciful, it is worth remembering the disgraceful debacle surrounding the trials of various cancer drugs almost two years ago.

The Mater suspended its trial of Tarceva, a lung cancer drug, on the basis that it contravened the hospital's Catholic ethos by necessitating the use of birth control. As with many similar drugs, it was strongly recommended that anyone taking it should ensure that they not become pregnant because of the potential damage to the foetus.

The Mater apparently didn't like the sound of this and stopped the drug. An ethics sub-committee comprised of a priest, a nun, and a businessman mulled over whether people should be allowed a potentially life-saving drug. Thankfully, the public outcry forced the hospital into an embarrassing and complete capitulation. The trials were resumed and Tarceva once again made available.

Similar issues of the conflict between Catholic dogma and clinical drug trials arose in St Vincent's. These were reportedly raised at the board, but in the face of determined opposition from medics, no trials were interfered with.

This then is the nature of the beast which will in future control the bulk of medical training in this country. What UCD is about, allowing itself to become a junior partner to organisations with such peculiar priorities is a bit of a mystery.

Whatever about the shortcomings of medical education up till now - and there are several - it could at least be argued that it was in the main under the control of public bodies, namely the universities. With this new entity, it is now fair to say that the greater part of it is in the process of being transferred into private (and determinedly Catholic) hands.

Finally, and equally worrying, is the background of the chairman of the board of this new, enormous hospital group - Thomas Lynch. He is a large shareholder and chairman of the board of a pharmaceutical company called Amarin, whose backers include Dermot Desmond and Tony Ryan.

Amarin has made huge losses lately, as trials of its drug for Huntingdon's disease have been disappointing. This is déjà vu for Lynch, who is a former chief financial director with Elan, another pharma company which ran into money trouble after one of its experimental drugs was found to cause serious side effects. When Elan's share price crashed as a result of concerns over its accounting practices, Lynch resigned in 2002 to concentrate on other ventures.

It is surely worth raising the question as to whether it is appropriate to have someone with such large financial interests in the pharmaceutical industry as chairman of the board of a publicly-funded entity responsible for dispensing millions of drugs to patients. Is it not possible that there may exist a conflict of interest here? There has been silence from the Department of Health on all of this, which is surprising and alarming given the vast nature of the proposed changes.