Two weeks before we met, Sheng Mingjie was a heroin addict. The tall, well-dressed Shanghai entrepreneur shows me the scars that cover his arms and tells me how, when he could no longer find a vein there to inject the drug, he stuck the needles into his legs. Two weeks before we met, heroin was his life. A committed user for 10 years, he took a hit up to eight times a day while his business crumbled and his family despaired.
Then, two weeks before we met, scientists drilled two holes in Sheng's skull, inserted metal rods deep inside his head, and burned away the part of his brain they believed was driving his addiction. Mingjie is the 11th heroin addict to volunteer for the operation since neuroscientists at the Renji hospital in the centre of Shanghai's Pudong district started offering it in July. The surgeons believe that by destroying the brain cells implicated in addictive behaviour, they are tackling the root cause of the problem. They have performed two operations each week since the summer and there are 150 more addicts on the waiting list.
Pockets of such psychosurgery for conditions including depression linger in the west, a legacy of the postwar boom in lobotomies as a "cure" for everything from bulimia to homosexuality, but 21st-century ethics boards here would never approve the Chinese procedure. One British expert describes it as astonishing.
The Shanghai brain surgeons are not the only scientists in the city, or in China, to find themselves at odds with the social and ethical views of the west. Stem cell research using embryos, field trials of GM crops and neuroscience experiments on monkeys have all pushed ahead. In October last year, as the west questioned the safety of experimental gene therapy following several deaths, China became the first country to license a version for clinical use, to treat head and neck cancer.
It will be at least three months before the Renji neuroscientists will judge if Sheng's operation was a success, but the 39-year-old, his black hair starting to grow back into stubble that does not yet hide the parallel scars 10 centimetres above his eyebrows, is optimistic: "I feel now that even if someone was to place the drugs in front of me, I wouldn't want them."
Before the operation it was different. In and out of state-run detox clinics for a decade, Sheng says he could think of nothing else, and reckons he blew several hundred thousand yuan (tens of thousands of pounds) on the drug. "I couldn't clean up. I still craved it and I failed to stay clean whatever I tried," he says, his eyes fixed in an intense stare. His family, fearing the worst if his drug habit continued, paid the surgeons' fees of 40,000 yuan. "Now I haven't thought about drugs for two weeks."
The question is, what else has he not thought of - and, with an area of his brain permanently removed, will he never think of again? Sex, perhaps? "That's a good question. We will ask the patients about that as part of the follow-up," says Ji-Yao Jiang, chairman of neurosurgery at the hospital.
Leaning back in his chair, Professor Jiang - who, like many of China's top researchers, trained in the US - surveys the mountain of papers on his desk. "Of course there are risks, but there are risks with any brain surgery," he says. "We explain the risks to the patients and they accept them because after years and years of being a drug addict, they all want to quit." He says that severe memory loss and other "short-term psychological effects" are common, but clear up after a few weeks.
The Shanghai work follows trials at Tangdu hospital in Xian. Scientists in St Petersburg used the technique to treat 365 Russian addicts in the 1990s, of whom they claim 237 have been cured. Those operations were halted in 2002 after a former patient who claimed he suffered damaging side-effects won a court case against the clinic. If a procedure is too risky for Russia - a nation not known for its cautious approach to science - it is hardly a ringing recommendation, and some experts have publicly criticised Renji's move.
Shen Mingxian, director of law and ethics at the Chinese National Human Genome Centre in Shanghai, told a local television channel: "The moment we halt his reliance on drugs, responses such as excitement, anxiety and other basic instincts may also be changed. I'm against these operations since it may change people's minds."
Jiang says: "The patients have a right to choose any method and we respect their choice. So far we have had no complaints." He says his group obtained permission from the government, and that the science, ethics and possible complications were discussed at a meeting of more than 100 experts in Beijing in September. Another operation is planned for the next day, and Jiang invites a photographer and me to see it for ourselves.
The patient is a 27-year-old man from Shanghai who has been on heroin for seven years and through rehab 10 times (the scientists say they only take addicts who have exhausted all other options). When we arrive, several staff are struggling to hold him down. The operation is usually performed under a local anaesthetic; the conscious patients recall names and numbers to avoid damage to brain regions responsible for thought and reason. In this case, the man's withdrawal symptoms prevent that. Cold turkey means a general anaesthetic.
Before the surgeons pick up their scalpels, they pore over scans of the addict's brain to pinpoint their target, the nucleus accumbens. The coordinates that identify its position are now scrawled on a piece of paper stuck to the side of a monitor with the familiar peaks of heart rate and other vital signs dancing across the screen. Beneath, they are translated into crude felt-tip crosses drawn on the back of the patient's clamped head. Under that is a bucket.
As the surgeon sends the tip of the hand drill grinding into bone, the patient's feet jerk and his heartbeat increases. Blood oozes from the wound. Within 15 minutes there are two holes, anchored open with metal clips.
Then high-precision surgery turns into high farce when the electrical needle - the end of which has to be hot - fails to switch on. Hurried checks on the connections, phone calls, and an ignominious scrabble under the bed end when one of the team sheepishly flicks the missing switch. The electrode hums into life. With a jarring tone that indicates the resistance of the brain tissue it is up against, the surgeon slides it into place, guided by a precisely aligned tube bolted to the head clamp.
Sixty seconds later the noise stops. Its work done, the surgeon removes the probe, turns his attention to the second hole, and asks us to leave. We do not see the patient again.
"It's an astonishing thing to do," says Barry Everitt of the experimental psychology department at the University of Cambridge. "You have to worry about them treating addiction this way. You would imagine it to have very widespread effects that I don't think are being assessed here." Animal studies and human trials have implicated the nucleus accumbens in the way drugs work, he says, but not in the brain's craving for them. "Neurosurgeons are a law unto themselves, but there would be an outcry if you tried to do this in Britain."
Reports from China suggest the Ministry of Health halted the procedures on November 2, less than two weeks after the Guardian's visit, citing "no accurate conclusions on the effect, safety and other indispensable elements of the operation". No one from the ministry or the hospital could be contacted for comment.
The surgery will provide more ammunition to critics who claim a lack of control over bioethics has turned China into the "wild east" of biology. But Guoqing Fu, director of the Shanghai Science and Technology Commission, insists standards mirror or exceed those of the west. Besides, he says, as Chinese scientists seek wider recognition for their work, it is in their interests to follow the ethical guidelines demanded by the major journals they want to publish their findings.
Fu says there remains a deep-seated prejudice in the west about science in China, and he should know. His commission is funding controversial research at another Shanghai hospital which, more than any other, has thrust the city's science on to the world stage.
In August last year, researchers in the lab headed by Huizhen Sheng revealed they had implanted human DNA into rabbit eggs and extracted stem cells from the resulting cloned embryos. (The Sun greeted the story with the headline: "The bunny monster: why they created creature from hell".)
On the sixth floor of the accident and emergency department at Xin Hua hospital in the north of the city, Professor Sheng's laboratory, filled with microscopes and sterile cabinets, looks as anonymous as any other. Only the floor-to-ceiling Perspex screens are unusual. Those, and a pink-spined book sitting in a locked bookcase: Human Cloning.
Her group uses rabbit eggs because those from humans are a rare resource. Despite the Sun's illustration of a buck-toothed, floppy-eared man with strangely developed legs, there is no intention to keep the cross-species embryos alive beyond a couple of weeks. They only want to investigate the stem cells, which have the potential to develop into any tissue in the body. "China and Shanghai certainly have provided a favourable environment for stem cell research," Sheng says. "The framework has created a regulated yet permissive environment." The Home Office, which governs research using animals, says it would not grant a licence for Sheng's work in Britain.
But some in the west are taking China's efforts in this field more seriously. Stephen Minger, a stem cell researcher at King's College London, visited Sheng's laboratory as part of a DTI-sponsored fact-finding trip in September. "I went with the typical chauvinistic western idea that they were probably lagging considerably behind," he says. "I came back ashamed." He says he has now scrapped plans to forge greater links with academics in the US, where George Bush has banned stem cell research using public money, and will instead look east for collaborations. "I didn't come away with the impression that people were cutting corners. Ethically they were very, very conservative."
It is hard to see irreversible brain surgery for drug addiction in this way, though at Renji hospital Prof Jiang says his patients will be watched for at least two years. If the operations have been halted, then for Sheng Mingjie such a move has come too late, though debates and discussions over whether what was done to him was right seem far from his mind anyway. "It saved my life," he says, lowering his eyes for the first time. "It was some kind of a miracle."
