A week in quotes: 5

by reestheskin on 18/08/2017

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“What we see unfolding right before our eyes is nothing less than Moore’s Law applied to the distribution of misinformation: an exponential growth of available technology coupled with a rapid collapse of costs.”

Frederic Filloux.

A week in quotes: 4

by reestheskin on 17/08/2017

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“In a profession that is all about untapping individual potential, increasingly impersonal corporatism hangs like a dark cloud”

Interview with Stephen Milner

A week in quotes: 3

by reestheskin on 16/08/2017

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”There are the cohorts of bureaucrats in every university making a living out of keeping score of publications and citations, manipulating the impact of papers and producing empty marketing verbiage extolling the supposed research excellence of their institutions.”

A week in quotes: 2

by reestheskin on 15/08/2017

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“Fortunately, Bowie’s schooling didn’t interfere with his education.”


A week in quotes: 1

by reestheskin on 14/08/2017

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“Management is the antidote to innovation.”

FT. Comment on an article about GSK.

Conspicuous education

by reestheskin on 11/08/2017

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Veblen’s conspicuous consumption rides on:

Rather than filling garages with flashy cars, the data show, today’s rich devote their budgets to less visible but more valuable ends. Chief among them is education for their children: the top 10% now allocate almost four times as much of their spending to school and university as they did in 1996, whereas for other groups the figure has hardly budged.

Book review in the Economist: The Sum of Small Things: A Theory of the Aspirational Class. By Elizabeth Currid-Halkett

Keeping the patients coming: Not so elementary, Watson.

by reestheskin on 10/08/2017

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Well, I thought the Swiss connection with Sherlock Holmes were the Reichenbach falls (I had to visit, a few years back). But no, I read that:

Except in Switzerland, where the stories were banned from railway bookstalls for fear they’d inspire criminality, Sherlock Holmes was big business from the moment of his inception.

But of more interest to the medic:

In 1882, as a newly qualified doctor with a practice in Southsea, Arthur Conan Doyle found himself chronically short of sick people. He therefore used the empty office hours to write his tales about the “consulting detective” who was based on Joseph Bell, the Edinburgh surgeon who knew at a glance what was wrong with the patients parading before him

There is a widespread delusion in the UK that you can accurately plan how many doctors you need. This is a mistake, both for society and for the doctors themselves. As we move forward, I think we will see more medics emulating one of the great ones.

And, as for the book, reviewed in the FT (‘The life and death of Sherlock Holmes’), it highlights that Holmes’ nemesis was not Moriarty, but lawyers.

Punctuated non-equilibrium

by reestheskin on 09/08/2017

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This is via the ever insightful Status-Q:

“A couple of months ago I quoted this phrase from Sam Altman:”

‘The hard part of standing on an exponential curve is: when you look backwards, it looks flat, and when you look forward, it looks vertical. And it’s very hard to calibrate how much you are moving because it always looks the same.’

Plotting the future | Status-Q

I talk about a variant of it that I thought Larry Summers used, although when I have tried to check my memory, I turn nothing up. I see two straight lines, one with a shallow gradient close to zero, the other with a steep one, joined at an inflection point. When you are on the shallow line, you never perceive anything is changing. And even when you know things are going to change  — or you wish for change —you have no idea when. At least with an exponential function you can calculate: with a sudden shift, all you can do is pray. An optimist is somebody who wishes the inflection point comes soon. As does the fool.

Sunsetters on the horizon

by reestheskin on 08/08/2017

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WHAT do you call someone who is over 65 but not yet elderly? This stage of life, between work and decrepitude, lacks a name. “Geriactives” errs too much on the side of senescence. “Sunsetters” and “nightcappers” risk being patronising. Perhaps “Nyppies” (Not Yet Past It) or “Owls” (Older, Working Less, Still earning) ring truer.

I am OK with soon (as in the David Bowie song) being patronised. I like ‘sunsetters’ best. Sipping G+T watching the sun go down, in Africa.


Note added in proof: Here are some more:

Hopskis: Healthy Old People Spending Kids’ Inheritance

Woopies and Jollies: Well Off Older People, and Jolly Old Ladies with Lots of Loot

Turbotic teaching awards

by reestheskin on 07/08/2017

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“I’ve written extensively on the now famous Georgia Tech example of a tutorbot teaching assistant, where they swapped out one of their teaching assistants with a chatbot and none of the students noticed. In fact they though it was worthy of a teaching award”

I keep reading this as ‘turbot’, and wondered what the fish things was. I guess the tutorbot would have corrected me soon enough.

Chips, chips, chips. And more chips, please.

by reestheskin on 04/08/2017

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“Children say they prefer IT in their lessons and courses? Do schools listen when kids say they prefer chips for lunch every day?”

An understatement follows:

Education policy is particularly vulnerable to political whims, fads and untested assumptions. From swapping evolution for creationism to the idea that multiple types of intelligence demand multiple approaches, generations of children are schooled according to dogma, not evidence.

Amen to all that. And not just school children, but university students. The Nature article is referring to: original paper here (The myths of the digital native and the multitasker. Paul A. Kirschnera, Pedro De Bruyckerec. DOI)

No scab doctors here

by reestheskin on 03/08/2017

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“Just fun or a prejudice? – physician stereotypes in common jokes and their attribution to medical specialties by undergraduate medical students”

Paper here. Seriously.

Undergraduate medical teaching

by reestheskin on 02/08/2017

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The survey found that UK medical schools employed 3041 full time equivalent clinical academic staff employed by UK medical schools, with a headcount of 3361. This is a 2.1% decline since 2015 and a 4.2% decline since 2010. By comparison, since 2010 the number of NHS consultants has risen by 20.6%.

(link here, from report here)

Reform of, and improving how we educate medical students requires a rethink of medical school staffing, and how clinical academics work. There are plenty of heads in the sand. I think you can improve education and drastically cut costs at the same time. Just stop accelerating into the rose tinted image in the rear view mirror.

Science works! Rewrite the textbooks

by reestheskin on 01/08/2017

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Little evidence is found for higher-order organization into 30- or 120-nm fibers, as would be expected from the classic textbook models based on in vitro visualization of non-native chromatin.

Well, chromatin structure might not be everybody’s cup of tea but I once shared an ‘office’ with a couple of French / Polish researchers in Strasbourg. It was all above my head, so I had to make do with the textbooks, and I stuck to my simple cloning of upstream regulatory regions of a retinoid receptor. Now, it appears from this article in Science, the textbooks will need rewriting. Science works.

RCTs and the kudos of stacking shelves

by reestheskin on 31/07/2017

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Many many years ago I wrote a few papers about — amongst other things — the statistical naivety of the EBM gang. I enjoyed writing them but I doubt they changed things very much. EBM as Bruce Charlton pointed out many years ago has many of the characteristic of a cult (or was it a Zombie? — you cannot kill it because it is already dead). Anyway one of the reasons I disliked a lot of EBM advocates was because I think they do not understand what RCTs are, and of course they are often indifferent to science. Now, in one sense, these two topics are not linked. Science is meant to be about producing broad ranging theories that both predict how the world works and explain what goes on. Sure, there may be lots of detail on the way, but that is why our understanding of DNA and genetics today is so different from that of 30 years ago.

By contrast RCTs are usually a form of A/B testing. Vital, in many instances, but an activity that is often a terminal side road rather than a crossroads on the path to understanding how the world works. That is not to say they are not important, nor worthy of serious intellectual endeavour. But the latter activity is for those who are capable of thinking hard about statistics and design. Instead the current academic space makes running or enrolling people in RCT some sort of intellectual activity : it isn’t, rather it is a part of professional practice, just as seeing patients is. Companies used to do it all themselves many decades ago, and they didn’t expect to get financial rewards from the RAE/REF for this sort of thing. There are optimal ways to stack shelves that maths geeks get excited about, but those who do the stacking do not share in the kudos — as in the cudos [1] — of discovery.

Anyway, this is by way of highlighting a post I came to by Frank Harrell, with title:

Randomized Clinical Trials Do Not Mimic Clinical Practice, Thank Goodness

Harrell is the author of one of those classic books…. . But I think the post speaks to something basic. RCT are not facsimiles of clinical practice, but some sort of bioassay to guide what might go on in the clinic. Metaphors if you will, but acts of persuasion not brittle mandates. This all leaves aside worthy debates on the corruption that has overtaken many areas of clinical measurement, but others can speak better to that than me.

[1] I really couldn’t resist.

The end of an age of optimism

by reestheskin on 28/07/2017

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This is from CP Snow’s ’Two Cultures’. I have never read the book, always warming to critiques of it from others. But I like this snippet quoted by John Naughton, recently.

“I can’t help thinking of the Venetian republic in their last half-century. Like us, they had once been fabulously lucky. They had become rich, as we did, by accident. They had acquired immense political skill, just as we have. A good many of them were tough-minded, realistic, patriotic men. They knew, just as clearly as we know, that the current of history had begun to flow against them. many of them gave their minds to working out ways to keep going. It would have meant breaking the pattern into which they had been crystallised. They were fond of the pattern, just as we are fond of ours. They never found the will to break it.”

Maybe I should go back and look at it. CP Snow, Two Cultures

First again!

by reestheskin on 27/07/2017

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“One-third of UK universities and colleges are awarding firsts to at least 25% of their students, four times as many as five years ago, figures show.”

Surprised this figure is not an input into the TEF……..

A .. deep thinking, highly rigorous, no-BS [bullshit] research scientist..

by reestheskin on 26/07/2017

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Hours later, with Blackburn’s approval, the institute issued comments on the scientific records of the two women. It had “invested millions of dollars” in each scientist, Salk stated, but a “rigorous analysis” showed each “consistently ranking below her peers in producing high quality research and attracting” grants. Neither has published in Cell, Nature, or Science in the last 10 years, it said. Lundblad’s salary “is well above the median for Salk full professors ($250,000) … yet her performance has long remained within the bottom quartile of her peers.” The institute wrote that Jones’s salary, in the low $200,000 range, “aligns” with salaries at top universities, although she “has long remained within the bottom quartile of her peers.”

This is from an article in Science (Gender discrimination lawsuit at Salk ignites controversy). The context is a sex discrimination case, but the account is about an astonishing lack of vision. Short termism of stock markets is not the only way value is being destroyed by a cash-in-hand mentality. The best rugby coaches have rarely been the greatest players. Nobel laureates may not be the best leaders. No (bull) shit here…

Don’t outcomes matter?

by reestheskin on 26/07/2017

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So, it is reported that the UK has the best health system in the developed world (according to the Commonwealth Fund). But when you read a little more, the UK comes third (of 11) on access, and 10th (of 11) on healthcare outcomes (mortality and morbidity). The UK also has the second highest rate of deaths amenable to healthcare after the US (Switzerland is lowest). The latter is no surprise if you know anything about Swiss healthcare or hospitals across Europe. Their doctors don’t look so scruffy as the UK ones, either. I guess you can make your composite measures in many ways, but I know what I would choose. (22 July 2017, BMJ 2017;358:j3442)

Blocking the Ivory tower

by reestheskin on 25/07/2017

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This year the University of Edinburgh plans to become one of the first big European universities to launch a blockchain course. Aggelos Kiayias, chair in cyber security and privacy and director of the blockchain technology laboratory at the university, says: “Blockchain technology is a recent development and there is always a bit of a lag as academia catches up.”

What interests me is how we think about all the things that universities do first. And why and how we lose that advantage for our students.

Universities add blockchain to course list

Student debt (again)

by reestheskin on 24/07/2017

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This (via the Intercept) is from the US, but….

”IN MAY, A MELBOURNE-BASED real estate mogul’s claim that millennials would be able to afford homes if only they cut back on discretionary expenses such as avocado toast went viral — with many heaping mockery on the suggestion. Now the Federal Reserve has its own hot take to throw on the pile. Except this one is based on empirical research. In a paper published last week by the Federal Reserve Bank of New York, five researchers offered an explanation for declining home ownership rates among millennials that does not require avocado toast. Looking at nine student cohorts, they concluded that the increase in public tuition and resulting student debt can account for anywhere between 11 and 35 percent of the decline in home ownership for 28- to 30-year-olds in the years between 2007 and 2015.”

Inverse care law and cats

by reestheskin on 21/07/2017

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My mother in law has two ‘Italian’ cats. One has worms, the other apparently not. Medication time. The diseased cat refuses the medication, whatever enticements are on offer. The undiseased (or cat at ease) scoffs not only his own medication, but that of his partner.

There are plenty of cats in South Wales, and I doubt that coal dust kills off the worms. Julian (Tudor-Hart), where did the idea come from? [ Yes, before you write in, not quite the inverse care as JTH meant it, but metaphors are the viruses of novelty, so who knows.]

Tools of the trade

by reestheskin on 20/07/2017

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by reestheskin on 19/07/2017

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I am hard at work on a new version of skincancer909, so odd breaks from blogging will occur, as my deadline is fast approaching. Instead, a few images, to assuage my guilt, will follow. It won’t compare with the quality of the masters (below), but the technology allows some of us to stand high on their shoulders.



The audit society roles on

by reestheskin on 18/07/2017

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Smita Jamdar writing on Wonke about what the OfS changes will mean for universities.

Ever more intrusive and interventionist regulation – all regulators start with a desire to be risk-based and light touch, but it only takes one or two regulatory failures (either a rogue provider, or indeed a sector-wide failure to deliver a desired outcome) and the gloves come off.

These are not features that have typified the approach to the quasi-regulation we have had in the sector to date and, if implemented, they have the potential to change the culture of universities quite substantially, not least because they will focus so strongly on teaching, rather than research. They may (perhaps almost inevitably, will) push universities towards a more centralised, command and control model of management than many have adopted to date.

Those who run many UK Universities have almost willingly embraced the darker side of corporatisation. Many students will — reasonably in my opinion — think it is payback time.

Not so much split personality, but man-in-the-middle

by reestheskin on 17/07/2017

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Via Bruce Schneier:

The trouble began last year when he noticed strange things happening: files went missing from his computer; his Facebook picture was changed; and texts from his daughter didn’t reach him or arrived changed. “Nobody believed me,” says Gary. “My wife and my brother thought I had lost my mind. They scheduled an appointment with a psychiatrist for me.”

But he built up a body of evidence and called in a professional cybersecurity firm. It found that his email addresses had been compromised, his phone records hacked and altered, and an entire virtual internet interface created. “All my communications were going through a man-in-the-middle unauthorised server,” he explains.

What goes round…

by reestheskin on 14/07/2017

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There have been a similar set of category errors in play this month over TEF. I can’t find a lot wrong with putting metrics in the mix when making judgements and assessments. But to suggest that the precise collection of metrics with their precise weighting is somehow innately in all students’ interests is preposterous. As is the aggregating of all the metrics relating to different student experiences on different programmes into a single institutional score. That this is then further boiled into one of three medals, well, it’s almost as ridiculous as the UK degree classification system!

Jim Dickinson. The full article is well worth reading — especially about hidden costs and changes to course delivery.

Creating stories

by reestheskin on 12/07/2017

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I often have great difficulty understanding the way the legal system works. The way ‘learned’ is usually appended to ‘judge’, and the track record of corruption when legal officers do the dirty work of governments, suggests to me that a great deal of scepticism is warranted. That is before we get to the inability of judges to understand what sort of statements we can make the empirical world. Then there is the problem of the interpretation of statistics. Physicists try to measure the speed of light, and they can only report the answer when they have worked out a way to do it. By contrast, law (like much economics) seems to just make it up — whether it is possible to answer a question or not, instead of remaining silent (“Wovon man nicht sprechen kann, darueber muss man schweigen”).

Anyway the above little rant was provoked by what I thought were some bizarre statements in the BMJ in an article from the ethicist and barrister, Daniel Sokol (BMJ 2017;357:j2949). I am going to take some of the argument out of context, so beware.

This issue was about an adverse medical event, and to what extent the failure of a junior doctor to ask a question led to the event and whether the junior doctor should have asked the question. Sokol summarises an argument underpinning the judgment as follows:

“In short, the law expects history taking to be the same, whether it is by an inexperienced junior doctor or a senior consultant. Lord Justice Jackson Sai that history taking was a basic skill that hospital doctors at all levels should possess”

As I said, I am not debating the particular case, but the generality. So, let me alter some words in the above:

“In short, the law expects surgical skills to be the same, whether it is by an inexperienced junior doctor or a senior consultant.”

Or, how about:

“In short, the law expects diagnostic skills taking to be the same, whether it is by an inexperienced junior doctor or a senior consultant.”

Now, my two statements are patently absurd. If they are not, then we can get rid of all consultants, and save all this money. Indeed I notice when you consult members of the legal profession they show you a scale of fees that reflect different levels of expertise — and you have to choose.

The mistake is to view history taking as a checklist of questions. It is not. Or at least in many situations it is not. Some doctors are much better at it than others and just like you can quickly objectively score surgical ability based on videos of surgeons operating, to me it is obvious that the ability to elicit a history is highly variable. But most doctors get better at it over time.

A long time ago, there were three consultant neurologists in the unit I worked at in Newcastle. They all — reasonably I think — were viewed as excellent clinicians (and BTW they were terrific teachers of medical students and junior doctors). Two of them remarked that the third was not so good at eliciting physical signs but was better at taking a history than either of them.

I believed this at the time and still do. But more importantly the statement underpinning the judgment seems to be to based on a failure to understand what a history is. It is an active process, and reality does not reveal itself without an interaction between doctor and patient, that is dependent on the prior experience of both. It is not a checklist, and there is not a finite list of questions to regurgitate. Just as in science, it is experiment rather than observation, that reveals the true nature of reality. And some are better at it than others — as we should expect. So the idea that doctors of widely different experience will be able to ‘interrogate’ the same way or with the same skill is mistaken.

Rant over.

Just one T-shirt away

by reestheskin on 11/07/2017

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This can be read as typical Silicon Valley hype, but I think it is more right than wrong. Just as government thought computer education in schools was about using MS Office, too many in higher education think it is about copies of dismal Powerpoints online,  lecture capture, or online surveillance of students and staff. The computer revolution hasn’t happened yet. Medical education is a good place to start.

What can we do to accelerate the revolution? From our observation, the computer revolution is intertwined with the education revolution(and vice versa). The next steps in both are also highly overlapped: the computer revolution needs a revolution in education, and the education revolution needs a revolution in computing.

We think that, for any topic, a good teacher and good books can provide an above threshold education. For computing, one problem is that there aren’t enough teachers who understand the subject deeply enough to teach effectively and to guide children. Perhaps we can utilize the power of the computer itself to make education better? We don’t hope to be able to replace good teachers, but can the computer be a better teacher than a bad teacher?

Tutoring System

Weak and unstable

by reestheskin on 10/07/2017

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One key finding is that because interest rates on student debt are very high — up to 3 per cent above RPI — the average student accrues £5,800 of interest while studying, meaning they borrow £45,000 but have a debt of £50,800 on the day of graduation. By contrast, the average debt burden on students in the US is far lower at $36,000 (£27,900), even though the cost of tuition varies far more at US institutions.

Arguments about university funding are everywhere (and here and here and from the IFS, too). The UK government is indulging in fantasy / PFI like economics again, and much of this story looks like another mis-selling scandal. The universities again, come out of this badly (FT). Whereas many have behaved badly, they are going to end up being treated worse.

My eldest daughter warned me that reading comments will make me sad or angry. But sometime anger is more valuable than sadness. The comment below, in the FT, from Matt_us is germane (The case for reform of UK university finances)

Hang on a minute. Students now graduate with about £50k of student debt (tuition and maintenance loans and interest). Student loans cannot be repaid by the majority of students. That is because the interest rate is higher than the repayment schedule. Despite repaying loans, the student debt continues rising. It is a pyramid scheme. 

In detail: Graduates have to earn over £56k to even repay £1 of their loans, otherwise the loans get bigger, rather than smaller. Graduate starting salaries are between £20k and £30k. And only the best graduates will earn over £45k after five years in the job.  During that time all loans will increase by 6% per year.