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…

Reader I am sick, sick if not quite unto death then very nearly unto despair. There is a gnawing within that will not let me rest. I have searched in vain for what to call my malediction. I have been sacking my shelves, rifling my dictionaries and encyclopedias, consulting with the most eminent physicians, but it hovers elusive just beyond the reach of diagnosis. The symptoms are daily growing stronger: an indignant tightening in the chest; bouts of impotent rage; a hopeless bewildered clamouring after social justice. Finally, reluctantly, after months of fruitless searching I have decided to take the matter into my own hands, to become my own diagnostician. All good maladies require a name and to mine I have given the moniker Mandelson’s Distemper, in honour of the most vexatious of its symptoms. For reader I am not relaxed, not at all relaxed - and so very much not “intensely” relaxed - about people getting filthy rich. more…

As this is a scientific journal, I imagine its readers will have more than a passing interest in Darwin. It is hardly surprising. Darwinism is a scientific hypothesis of such revelatory brilliance, of such simplicity and such reach, of such sheer explanatory power that it is difficult to remain unmoved by it. more…

A few days ago I was reading an account by a journalist of a visit he had made to the refugee camps on the Nord pas de Calais coast just days before they were destroyed by the French police. Known collectively as “the jungle”, these camps are – or were – home to a floating population of refugees and economic migrants, mainly young men from Afghanistan and Eritrea, men consumed by a desire to get to the UK so passionate as to be almost suicidal. more…

It was the White Queen who told Alice that she had at times thought six contradictory things before breakfast. We humans have a remarkable tolerance for incompatibility, happily living with any number of self-cancelling beliefs about ourselves and the world. So difficult is it to imagine – or at least for me to imagine – what an entirely coherent set of beliefs would look like that I’m tempted to think it impossible, something best left for angels, or even, hallowed be their name, philosophers. more…

So they’ve been at it again, the men in white coats. Putting on their grey beards and playing God, getting the jump on poor old mother nature. There are times when you could almost feel sorry for her. All those pipette-pushers forever tunnelling deeper and deeper into her mysteries. Leave her alone, I can almost hear myself saying, leave the poor old dame a few rags of the unknown to clothe herself in. And while you’re at it, leave us, leave poor bewildered modern us something to wonder at and to revere. But then I remember that this is a piece for the BMJ and it is scientists I am talking to, people who surely demand more from their arguments than soft-eyed sentiment. more…

In my early twenties I was felled by a bout of mental illness. It started with a panic attack. I was standing on the station at Leamington Spa waiting for a train and shivering slightly in the early autumnal chill when, without warning, a paralysing wave of fear broke over me. The terror that swept over me that afternoon was intense. Although an otherwise unremarkable day - I was waiting for the London train to visit my girlfriend - I might as well have been in line for my own annihilation, so strong and so plausible was the fear. more…

It is often said of military planners that they spend their time preparing to fight the last battle, not the next one. The same could be said of regulators. Take research ethics. Recently I was with the WHO in Geneva looking at the regulation of research during health emergencies. The question we were invited to consider was whether ordinary ethical standards could be modified in times of crisis. Pandemic flu was clearly in mind, although several spoke of viral haemorrhagic fevers in all their fear and drama. more…

Audiences can be fickle things. Last week I clambered down from my ivory tower and emerged, blinking, onto a brilliantly-lit podium at the Cheltenham Science Festival. The theme of the evening: Playing God – Risk in Surgery. I was on a panel with two surgeons, but my job was to do the ethics. I figured the live issue would be about balancing paternalism and autonomy. Was there a limit to the amount of risk a patient could be asked to take on? Could illness and the possibility of death be coercive? Could an ambitious surgeon, keen to make a name, lead the desperate into taking impossible and mutilating risks?

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At a certain point in life you start eyeing the word ‘crisis’ suspiciously. Inflationary pressures in the media devalue the linguistic coin and you could be forgiven for thinking that journalists have given up getting out of bed for anything less than a fully fledged catastrophe. But even a troglodyte like me cannot escape a sense that something seismic is taking place. Slightly more than six months ago, the global banking sector failed. The costs are going to hobble a generation. Over the last fortnight, the Telegraph has drip-fed the media with ever more depressing accounts of the petty venality of MPs. It is not the scale or the audacity of the claims that kills, it is their banality. Parliamentary democracy ends not in a bang but a whimper. Within less than a year, two of the UK’s leading institutions are on their knees. more…