Written by an Irish medical insider, Professor of Surgery Liam Kirwan, An Unholy Trinity is highly critical of the historic relationship between politics, the Church and the medical profession, which he argues is the genesis of the dysfunctional health service in Ireland today. As it is necessary to study the famine to understand how Ireland evolved, we similarly need to go back to the events of the 1950s to appreciate how our inefficient and inequitable health system has developed. The seeds of this dysfunction were sown in 1951 when Noel Browne, Minister for Health, attempted to introduce a free Mother and Child Scheme which was fiercely opposed by the Catholic hierarchy, in particular by the all-powerful Archbishop McQuaid. The Hierarchy wanted Big Church, Small State, which also suited the medical establishment. The verbiage of Browne's antagonists was hysterical with the Irish Medical Association speaking of the cancer of socialised medicine and the Bishops of totalitarianism. Despite the benign and inoffensive nature of the scheme, the Government capitulated completely to the Bishops and Browne was forced to withdraw his proposal. The defeat of Browne, a coup d'eglise, saw the victory of an unelected sectional interest with the Bishops retaining control of most important hospitals which they delegated to compliant senior doctors. Arguments presented by the profession and the Bishops with regard to the threat to patient confidentiality and clinical independence were bogus. The elites, Church and medical, effectively ensured that patients should be triaged according to their means rather than their pathology - a hybrid and unequal arrangement. What is disparaged today by the citizens as the two-tier system was born.