To the Editor: It is easy to contemplate redesigning the medical wheel in the face of grossly dysfunctional health services. Garling’s scholarly report1 is unlikely to be adopted to any significant extent by a government that has already sent negative signals. Menadue’s suggestions for new and reassigned responsibilities2 are counsels of perfection for systems that are not capable of making radical changes. Indeed, as illustrated by Van Der Weyden,3 there is a general perception that all informed action has been replaced by ignorance, inertia and an appalling loss of morale.

A superficial scan of the Internet reveals some remarkable information. In December 2008, the federal government approved the distribution of $580 million to 11 universities for various education-investment projects in science, research and health.4 The University of Adelaide Library lists more than 70 public health organisations in Australia.5 The Australian Health Economics Society advertises 33 sources of teaching and research available from local and international teams of 35 to 60 experts.6 These represent only a small sample of many similar sites.

Clearly, there are a vast number of enterprises in Australia that are considered — by themselves or reputable others — to be capable of advising on research and development. Of course, their credentials cannot be taken for granted, but a majority seem to be supported by distinguished institutions and personnel with expertise in health management, economics, research and policy. Despite this, we keep seeking new minds, commissions and inquiries to reshape what has long since become a square wheel.

I suspect that we might already have much more expertise than we need or could ever use. The cast-aside opinions of long-established groups should be disinterred and urgently re-examined before directing new funds and more time to destructively unproductive and ill-informed bureaucracies.

It may be that crucial medical decisions should only be made by those who at some time have worked — and wept — in busy emergency or intensive care wards late at night. Equally, the remarkable organisation and expertise of military hospitals in Iraq and Afghanistan clearly show that miracles can be accomplished when a mix of workers, will and wisdom7 is applied to supreme demands. Can we not learn from that?