Are public health doctors a waste of money? Readers reply to columnist Alan Maynard

What a nasty fellow Alan Maynard ('Looking askance', 10 June) is in challenging my right to slop about as a consultant in public health medicine on an inflated salary set by supply and demand - with which economics professors should have passing familiarity.

I have expended much effort gaining lots of qualifications, and now he expects me and my kind to work.

Much public health consultant work could be done by cheaper personnel, but he should have acknowledged that in the politically charged NHS, a piece of work's end-product may not necessarily reflect its originator. Well-researched work, leading to decisive money-saving or health-advancing conclusions, can be diluted by political considerations or even scrapped.

This is wasteful, but does not devalue the originator.

Would the professor consider himself devalued were I to burn his diatribe?

Public health departments would love to have access to health economists and particularly data analysts, and might sacrifice a consultant or two to buy them.

But these non-medical worthies would not necessarily prove more cost- effective.

It is also possible that, as the professor acknowledges is the case with public health consultants, their quality might vary, too.

The NHS's greatest problem is its lack of a value system.

We are learning more about costs and what is received for the given outlay. But there is no way to meld the two:£10,000 of drug treatment may be observed to buy, say, a six-month stay of execution for a cancer sufferer, but who can say whether this is money well spent?

Every economics textbook defines opportunity cost - the abstract way of deciding on the best use of a given sum - but the definition involves identifying the next best way of spending the money.

We don't have a value system to tell us the best way, and hence we cannot rank the alternatives with any subtlety beyond valuing that which manifestly works well over that which manifestly doesn't.

One could ask, in the absence of an NHS value system - the clear province of health economists - what value can be placed on Alan Maynard and

his ilk. The quoted£40,000-£45,000 a year sounds a bit steep.

Dr Fraser Hadden

Consultant in public health medicine