Transcendental good intentions

![Graphic][1] In his great novel Chance , Joseph Conrad describes: > ‘… the trouble of transcendental good intentions, which, though ethically valuable, I have no doubt cause often more unhappiness than the plots of the most evil tendency.’1 In her Harveian Oration at the Royal College of Physicians, Iona Heath quotes Conrad in her critique of gung-ho surgery and of screening programmes which reveal ‘the seductive possibility of preventing disease ratcheting up good intentions and the wishful thinking which too often underpins them’.2 Unfortunately, the influence of ‘transcendental good intentions’ extends widely within today’s medical establishment, reaching even the President of the RCGP. In his presidential address to the BMA, Sir Michael Marmot urges doctors to adopt … [1]: /embed/inline-graphic-1.gif