I have every sympathy with Dr Neale’s opinion and feel he is entirely correct in worrying about the apparently overwhelming tendency for technological investigation and expertise instead of a more considered diagnostic and management approach (Gut 2003;52:770–1). I would also agree with his view of the aspirations of many gastroenterological specialist registrars, apparent from talking to many of them. He has highlighted the potential problems of such a technical dictum and not even mentioned what might happen when further advances in imaging obviate the need particularly for diagnostic colonoscopy.

What will all the technicians do?

However, Dr Neale has …