The response by Goldberg (Reference Goldberg2004) to Khan (Reference Khan2004) on the recruitment of consultants from poor countries for work in the UK deserves careful scrutiny. True, ‘India overproduces doctors and not all of them can [or are necessarily experienced enough to] find consultant posts there’. But the Fellowship Programme does not recruit jobless doctors of India, it draws out her medical elite in an orchestrated brain drain. To send back then a number of National Health Service (NHS) volunteers to India to ‘improve services’ there is odd and paradoxical. There is already a shortage of psychiatrists in India; only one psychiatrist for every 300 000 people (World Health Organization, 2001). By recruiting 84 consultants from India, the Department of Health has deprived about 28 million Indians of their consultant psychiatrists.

Goldberg asserts: ‘we have not recruited in Africa, nor have we recruited in Pakistan’ but his own Table 1 shows that at least 9 consultants have been recruited from Africa and Pakistan depriving 9 million people. (Also, the table does not represent the total number of consultants in all specialties recruited from the Third World.) In this epoch of real-time communication, when the Department of Health advertises the Fellowship Programme on the internet, is there such a big difference between recruit ‘from’ and recruit ‘in’ for us to fuss about prepositions? Goldberg claims that the UK is ‘the only country to produce a list of developing countries from which active recruitment to the NHS should not take place’. ‘Active’ recruitment means sending representatives to, or running huge advertising campaigns in, the target country. The UK does not do it actively in the Third World, but passively through the internet. And is it really passive? The International Fellowship Website (Department of Health, 2004) ‘is offering qualified medical specialists with fluent English from outside the UK opportunities… The planned growth in [the NHS] staff numbers creates openings for suitably qualified professionals from elsewhere in the world to come and join the NHS.’ It does not discourage or exclude any doctor from any country whatsoever.

Surely the Fellowship Programme can easily pursue its aim of providing the UK public with adequate medical services by recruiting only from developed countries. It is time for the College to come out with an assertive resolution on the unethical aspect of what is more like ruthless marketing and commerce than medicine refined by responsible, ethical conduct.