Medical Matters: In all the gloom and doom of the health services, it is heartening to see that ordinary, often unnamed people can still make a difference. The two junior nurses who went along to the health board official and voiced their concerns about Dr Michael Neary in Our Lady's Hospital in Drogheda clearly made a difference.
Lots of nurses go to lots of health board officials and complain, but on this occasion somebody listened, Dr Neary has been struck off and further and wider action continues to follow.
Sometimes making a difference takes time. Long-time campaigners against tobacco, Prof Luke Clancy, a respiratory physician, and Dr Fenton Howell, a public health specialist, have been part of a struggle that has led to the banning of smoking in pubs and restaurants.
Indeed, the discussion about the ban has put the dangers of tobacco on the nation's agenda.
Many GPs are now finding that patients are coming in and initiating discussion on their nicotine addiction.
This time people doing their jobs well have put us at the forefront of tobacco campaigning in Europe.
Getting politicians to listen and act has been the key to progress.
Recently two dieticians working in the Health Promotion Unit in the Mid Western Health Board objected to the location of a McDonald's drive-thru' in Ennis. The rationale is that young people are getting more obese, developing diabetes and heart disease. The recent hard-won health gains in heart disease are in danger of being undone by the current eating culture and lack of exercise.
A drive-thru' fast food restaurant merely requires the family to drive up, order and eat in the car. When they get home, all are probably hungry again and raid the fridge before sitting in front of the television. The fast food industry is contributing to a modern day epidemic.
Without McDonald's, Ennis is not deprived of fast food as it already has 10 such outlets. But it is not only about fast food as McDonald's has pointed out - it will be providing 70 much-needed jobs in Ennis. It also point out that it uses only the finest Irish beef in its hamburgers.
The libertarians, who have clearly had enough of Ireland banning things, say we simply need more sports facilities so that we can work off excess calories. But Prof Cecily Kelleher of NUI Galway pointed out that you need to walk nine miles to get rid of the calories provided by the hamburger.
No community can turn down 70 jobs even if they are part-time, minimum wage jobs. Even though they have not spoken, it is difficult to believe that the purveyors of finest Irish beef have not made their views known. The Faustian pact between McDonald's and the farmers of Ireland will not be easily untangled.
The Mid Western Health Board has now moved to distance itself from the objections of its two dieticians. Fianna Fáil Councillor Pat Daly described their objection as "a solo run". Party colleague Councillor Sean Hillery said the objection was lodged without the knowledge of the health board members.
With such political fire power trained on them, it is hardly surprising that the dieticians have gone to ground.
Councillors Daly and Hillery are probably as concerned about the epidemic of obesity as the next person. However, such a broad view is quickly overtaken by backyard issues such as jobs, farmers and re-election.
However, the two health board dieticians, Audrey Lyons and Dr Anne Griffin, have got the nation thinking.
Micheál Martin agrees with their central argument about our growing obesity. He is to begin a consultation process with all aspects of the food industry in order to prepare a strategy to address obesity in Ireland. This is a big agenda that will have to tackle salt, sugar and fat manufacture.
It will need a combination of education, restriction, taxation and most of all retraining our palates away from stodge towards sensible portions of good simple food. We will have to reinstate the old-fashioned idea of 'a treat' when a thin bar of chocolate or a thin wafer ice cream was hard earned. Treats have now become snacks which is what you do between meals.
The McDonald's issue has now moved over to Ennis Town Council and will be decided shortly. The chances are high that the young people of Ennis will be tucking into McDonald's Happy Meals soon in the back seat of the car. What a way to live.
• Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP - Dr Muiris Houston returns next week.