The “downgrading of medicine’s professional status” perceived as a serious threat by Black may be welcomed by patients used to feeling helpless in the face of the powerful medical hierarchy.ROGER GOSS Co-director, Patient Concern London SW5Sir: It is obvious at Westminster that our major professions are all suffering similar difficulties. Professor Carol Black has made the mistake of considering one profession in isolation. The reduction in the influence of the medical profession is no more than we see in other professions such as the academic and the legal.Professor Black has drawn attention to two difficulties. One is the determination of the Government to fix the standards in all professions, whether it knows anything about them or not. The other is that both sexes will now need to find time for childcare. The Royal Society, wanting Government money in 2003, suddenly discovered six women worthy of membership, whose achievements reached back to the 1950s.We need open recruitment and development for senior positions in business and the professions, and newspapers could report on women’s achievements, without focusing on gender and family responsibilities. Black’s diatribe shows just how far we are from the Government’s goal of a patient-centred service.

Does this also apply to politics where we have one of the lowest number of women MPs and Cabinet ministers in Europe, to universities where only 10 per cent of professors are women, or newspaper editors?The problem with women’s advancement in surgery is that consultants prefer to promote “one of the boys” rather than look more widely at women’s different experience. To assume that women cannot have an effective political voice is simply wrong; women are less constrained by convention and can wield a highly effective blow when needed.Dr SARAH BURNETT London SW11Sir: Professor Carol Black bemoans the fact that a female-dominated profession will lead it into a decline in prestige and a fall in doctor’s pay. But all this happened while medicine is still largely run by middle-aged men in badly fitting suits.The BMA lost its bite many years ago and the Royal Colleges are run by cronies so focused on their impending gongs that they do not stand up and fight for their colleagues. She should try forging a successful career as a doctor while being a single mother with two children at primary school. I have no doubt that the Government does not listen to women doctors, but it does not listen to the male ones either, and it has gone out of its way to belittle and deprofessionalise doctors.

If she thinks that childcare is a problem holding women back then she should focus her efforts on changing work practices rather than denigrating women’s abilities.It is pompous and arrogant to assume that female doctors no longer need to make sacrifices. She seems to think that only female doctors want a civilised life and I firmly believe she is wrong Nobody really wants to work long hours. Moreover, the losses suffered by Americans, Iraqis and everyone else have not diminished the threat of terrorism, given the instability generated in Afghanistan and Iraq by utterly short-sighted US (and UK) policies.Meanwhile, other parts of the world that need help from international institutions go wanting, because the resources and unity that these institutions require have been undermined by those same policies.If Bush wins again, this bad situation can only get worse; with Kerry there is at least hope for something better.ANDREW GARDNER London NW1 Women will not lead medicine into decline Sir: I was incensed by Professor Carol Black’s comments about female doctors lacking the political ability to cope as senior doctors (report, 2 August; letters, 3 August). He should be well aware that the blood-price for “peace” is being paid largely by the people of Iraq.

So much for “compassionate conservatism”.Rev RONALD GARNER London NW7Sir: I suspect Bruce Anderson will enjoy goading anti-Bush readers with his Opinion piece on John Kerry That doesn’t mean he should go unchallenged. Yet his carefully chosen campaign team are mounting what will turn out to be the dirtiest, most cynical campaign in American history. At the very least there should be a notice on every pole-vault bar warning contestants that they are undertaking a potentially harmful activity and they are doing this at their own risk.”But surely a pole vaulter won’t have nearly enough time to read a warning notice as he springs into the air?”No, it’s not really for him to read while he is vaulting. In the 2000 campaign President Bush promised that “no child would be left behind’” and proposed a programme of pre-school support for poor families; now this programme founders because of his administration’s failure to fully fund it from its inception.All of these cover the President’s biggest flip-flop of all – that he was going to be the president who brought together a sharply polarised nation. Shortly after 9/11, Bush said he wanted Osama bin Laden “dead or alive”; in later months, as his focus turned from Afghanistan to Iraq, he stated that Osama bin Laden’s capture was not important. Setting out ten minutes earlier for a meeting is a small price to pay to save lives, but we find it increasingly intolerable.