Sir,

I am disappointed that the editors of a high quality, refereed journal such as Health Economics, Policy and Law think it appropriate to print ‘in its last issue’ Calum Paton’s ‘howl of rage’ (Nicholas Timmins’ term that Paton says he accepts) over the English NHS reforms. Among this piece’s many lapses from academic standards, it cites an alleged conversation with me of more than a decade ago, and makes other slighting personal references. (For the record, I have no recollection of the conversation he alludes to, and he did not have the courtesy to check it with me.)

With respect to the ‘substance’ of Professor Paton’s howl, it is easy to draw up a list of problems with market-oriented health care reforms, especially when you present little evidence for your assertions. Paton is not the first to do this, nor will he be the last. What is of more interest is to compare these reforms with other forms of health care delivery, such as those that rely upon trust, voice or command and control, to examine what hard evidence exists concerning their relative successes and failures, and then to assess which, at the end of the day, is the least worst in most circumstances. This is what I have tried to do in my policy advice and in my writings; see most recently Le Grand (Reference Le Grand2007). Professor Paton would be more convincing if he adopted that style of argument instead of relying upon howls and abuse.