Once in every while an ethical dilemma will swim across the horizon, a dilemma whose wake will induce in me a bout of moral seasickness. My compass spins, my bearings wheel and lurch. One such is the reappearance of “facilitated self-harm”. I am not over-fond of the word “facilitate”. It drips with the oil of evasion. It sits too easily on the smoothest tongues. What is meant here is helping people to hurt themselves. It refers to the practice of providing people who self-harm the sterile means to accomplish it. more…

One thing about the current swine flu pandemic is that it has brought with it a universal sense of fear. As with all fears, individuals respond differently, but we know what they are feeling because the sensation of fear, which varies from a mild anxiety to incapacitating panic, is so much part of our constitution that some see it as a normal component of the human condition. more…

I’m excited to have started at the Ola During Children’s Hospital in Freetown, after hearing so much about it from the Welbodi Partnership, the charity I’ll be working for over the next year.

On first impressions, things at the hospital look good.  There are freshly painted wards and uniformed nurses.  There are notices on the wall:  “Drugs for inpatients are now free” (thanks to a German charity).  The outpatient benches are lined with parents and kids, waiting to be called into three consulting rooms.  The observation ward is full of children, one loudly fighting off the advances of a nurse brandishing a cannula. more…

It’s nice to know how others see us. Several weeks ago, a journal editor based in Europe asked my opinion on a contentious paper he had agreed to publish, had posted online, but about which he now had concerns. I told him that I did not have the scientific expertise to provide a thorough review of the methodology.  However, I did know that, some years ago, one of the authors had been erased from the medical register by the GMC. This followed criticism and a complaint by a High Court judge before whom the doctor had given evidence. The basis of the Court’s criticism was regarding the same subject area as the paper which had been sent to me. more…

Having been sacked from his position as the chief UK government drugs advisor Professor David Nutt may today be reflecting on the precarious position of anyone who seeks to advise politicians on controversial matters. more…

Something has just happened that will almost certainly end the tyranny of impact factors and may well mark another step towards the extinction of most scientific journals. Did you notice it? Probably not, and even if you did you may not have understood what it was or what it may lead to.

It was the appearance of something called rather clunkily “article level metrics.” These are a variety of scores and other bits of information attached to each article in the publications of the Public Library of Science (where I’m on the board). They shift attention from journals to articles, particularly for the academic bean counters anxious to find a convenient and low cost way of ranking academics. more…

Fergie lost it with the referee. The Manchester United manager’s public criticism of the referee’s fitness in their recent match against Sunderland made headlines. Although subsequently making a personal apology he did raise the more general issue of referee’s fitness. Perhaps it was because he knew about the long established referee fitness programme in Scotland pioneered by Stewart Hillis, the recently retired professor of cardiology in Glasgow and doctor to the Scottish Football Association. Dr John McLean continues this cardiovascular screening initiative at the outstanding sports medicine facilities at Hampden Park, and hosted last Friday’s meeting on the benefits of exercise. It is good to be fit- not a new message, even for referees- but there are still many questions for patients and doctors. more…

If the health service takes environmental, social and economic sustainability seriously, it is amazing how many co-benefits there are - for the health of individuals, for the health of the population, and for the cost and quality of the health care system - genuine win-wins - win now, win later. You might think therefore that health systems like the NHS (and the managers, clinicians, and other staff who work within it) would grasp sustainability as a real opportunity to promote quality and contain cost. Well, although there are some outstanding (and even inspiring) examples of action by individuals and organisations in the NHS, we can’t quite say we have a consistent, or systematic or ambitious approach to reaping all the many benefits of making the NHS much more sustainable. more…

The H1N1 vaccination programme is underway in the UK and many other countries across the globe. In Sweden a million people have already been vaccinated. One swine flu vaccine manufacturer, GlaxoSmithKline, expects to produce 440 million doses over the next few months. With newspapers, television and the internet raising doubts about the safety of the vaccine, many doctors will be consulted by anxious patients wanting to know whether the vaccine is safe and effective. more…

A management consultant friend confessed last week that despite advising many media company clients about their digital strategy, he had little interest in Web 2:0 and social networking, shunned the TV when he got home, and ate dinner with his wife while BBC Radio 3 played in the background. more…