My article "Can patients trust the Medical Council?" (The Sunday Times, October 9) appears to have simultaneously triggered off the wrath of Dr Martin Balzan, the secretary general of the Medical Association of Malta, and the diatribe against me, as is manifest in his letter (October 23).

Anyone familiar with his writings in The Sunday Times is probably aware of the rigid stance he adopts on issues that run contrary to MAM's views. I find your columnist Roamer's comment in his weekly column apt in relation to Dr Balzan's negative attitude: "It is clear that Dr Balzan finds difficulty with the possibility that somebody tells the truth" (August 7).

My purpose in raising the issue of the Medical Council in as sharp and correct a way as possible was my hope that, as a lay person, I would play a modest part in influencing events that, in time, might alter the landscape dramatically for the benefit of patients the council is meant to protect.

Indeed, I would have preferred a much more robust arrangement in which the Minister of Health took the responsibility to provide the shortest possible route for a further upgrading of the Medial Council but, regrettably, he is either living in cloud cuckoo-land or, as I put in my article: "His silence to date suggests, at best, a dismissive or complacent attitude, and, at worst, a stubborn and paternalistic refusal to acknowledge the need for a continued dialogue on the reform of the Medical Council".

First, I question Dr Balzan's motive in coming out so vehemently in defence of the Medical Council. I would have thought that, in such circumstances, the Medical Council had the legal, medical and lay expertise to defend itself in the media. To date, the Medical Council has opted to keep mum on my comments on its lack of transparency, inclusivity, fairness, accountability and other issues. I invite readers to draw their own conclusions.

Secondly, Dr Balzan appears to have more than an adequate knowledge of the case in question which the Medical Council summarily dismissed. His conclusion appears to be based either on a secondary source of information, such as a media report, or on a primary one, such as an insider's or the medical practitioner's version of events.

For all I know, had he impartially heard the complainant's story, he would have possibly felt less justified in smearing my name.

Thirdly, Dr Balzan categorically informs us: "In the European Union there are only two medical councils which have lay representation, in Malta and the UK." He appears to be ignorant of the fact that the Republic of Ireland, which is an EU member, has a model of regulation which uses both medical and lay representation. I do not have to remind him that there exist other countries outside Europe that have lay representations on their medical councils. It would have helped Dr Balzan to get his facts right before putting pen to paper in the media.

Fourthly, Dr Balzan thinks that not having elected members of the MAM council from holding any position on the Medical Council is a safeguard; moreover, that the presence of a judge presiding over the Medical Council offers a degree of impartiality. This is certainly not a black and white issue.

I do not wish at this point to attempt a legal or philosophical or moral definition of what constitutes impartiality as an aid to independent thought and action. The question is whether anything would be gained from having a legally qualified or a non-legally qualified president on the Medical Council. My view is that any member of the Medical Council, as long as he/she is robustly independent of any sectional interest, including members of MAM and the government, and acts without fear or favour for the people he/she is appointed to protect, that is the patients, should qualify for the post of president of the Medical Council.

On balance, I would stick with a non-legally qualified president, preferably a member of the medical profession, provided he/she is well-trained and that there is a very good legal assessor. The legal assessor is actually quite crucial.

Fifthly, Dr Balzan states that I seem to be confusing the patient-doctor relationship with a plaintiff and complainant situation. I should have by now a good grasp of this distinction, given that I spent many years working in the High Court and Family Proceedings Court in London.

I feel gratified to know that MAM shares my view that the Medical Council should set up an online register as soon as possible. However, I invite MAM to comment on the key issues I raised in my article, such as the Medical Council's delay in dealing with complaints and its lack of transparency, inclusivity, fairness and accountability. For whatever reason, I find Dr Balzan's fudging of such fundamental issues disturbing.

I do take on board Professor Muscat's constructive, comprehensive and incisive critique of my article (October 23). Professor Albert Cilia-Vincenti has taken the road very often less travelled by a number of other professionals, that is, in bringing to the attention of the readers certain persistent rumours of commission payments to doctors for referrals of patients to specialists, laboratories and hospitals, and of doctors paying commissions to hotel staff for referral of tourists (October 23).

It was indeed daring and admirable of him to bring up this matter to the attention of the public. I invite the Medical Council to publicly comment on these persistent rumours in the interest of the patients its members are appointed to protect. Silence on this matter can prove unnerving.