Radiologists and platforms

by reestheskin on 20/08/2018

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It is not only taxi drivers that are being “uberised” but radiologists, lawyers, contractors and accountants. All these services can now be accessed at cut rates via platforms.

FT

The NHS became such a platform, for good and bad. That is the real lesson here. The tech is an amplifier, but the fundamentals were always about power.

“The song remains the same”

by reestheskin on 17/08/2018

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From an obituary of Paul Boyer.

“Paul Boyer was approaching the finish line of his career when he risked everything with a jaw-dropping proposal. He addressed one of the most important, as-then-unanswered questions in biochemistry”

“We were attending a UCLA seminar in 1972 when I noticed that he wasn’t paying attention to the speaker. Afterwards, Paul approached us in a very excited state. This was surprising because he was known for his calm demeanour. He confessed that he had spent the hour thinking about old unexplained data. He asked: “What would you say if I told you that it doesn’t take energy to make ATP at the catalytic site of ATP synthase,” (as was universally held at the time) “but rather that it takes energy to get ATP off the catalytic site?” This was a eureka moment.

As is often the case with transformational ideas, early reactions were negative. When the Journal of Biological Chemistry rejected our manuscript containing data supporting this concept, Boyer told me without animosity that he could see why they would do that — “It was a very striking claim.”

Well, I have never had an idea to compare with this. But sitting through talks that do not light my fire, I have always found conducive to thinking creatively about something else. Its similar to the way that some writers practice their craft better in a coffee shop than in a silent office. Intellectual white noise.

Remember: the best ideas are not in the literature. If they were…..

Back to basics?

by reestheskin on 16/08/2018

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Those who rent seek on biomedical knowledge wish to seek to define the norms of what is foundational. What is foundational for the practice of medicine should be contested more. Anatomy for surgeons is an easy case to make. But for most non-surgeons, the case for much anatomy is far from simple.

In any historical account of the ascent of modern medicine, Versalius looms large. But this Nature article (Sex, religion and a towering treatise on anatomy) intrigues me for a not so obvious reason: the counterpoint between how such knowledge was represented and understood.

Even Vesalius realized that his images could be confusing, and devised an ingenious method to explain them. A letter or number was printed onto the image of each body part, with a separate key. Unfortunately, the characters were often too small to pick out against the swirling background….

Faced by such challenges, many medics might have given up on the images. Indeed, when we reconstructed what early modern readers and scholars found fascinating about the Fabrica, it was evidently the text. The clear majority of sixteenth- and seventeenth-century readers who annotated the book focused on that and left no traces of having engaged with the illustrations. Sixteenth-century reviews of the Fabrica confirm this impression, because they tended to discuss only the text.

This is no surprise. The Fabrica’s scholarly readership was trained in the traditions of Renaissance humanism, which put a strong emphasis on textual analysis. Even if they found it difficult to interpret visual information, medical practitioners were expert at making sense of long Latin texts.

Always behind

by reestheskin on 15/08/2018

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June, July are the busiest time of year for. It is when I update all my teaching material, and I always underestimate how long it will take me. Here is a guide to some of it. But still I need to catch up with some more, as the new students have already started.

 

Navigating the online resources from jonathan rees on Vimeo.

Numbers

by reestheskin on 10/08/2018

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Points on a distribution, make for fun numbers.

Fifty years ago Japan had just 327 centenarians; in 2017 it had 67,824, and the largest per capita ratio of them in the world.

Link

Enlightenment: its just business, OK?

by reestheskin on 09/08/2018

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As the FT reported Monday, the Middle Eastern kingdom expelled the Canadian ambassador, reacting against Ottawa’s support for jailed human rights activists.

Saudi Arabia also said on Monday that it would suspend all its educational exchange programmes with Canada. An official told state television there are more than 12,000 students and their families currently in Canada. They will be transferred to universities and schools in the US, UK, Australia, New Zealand and Singapore, he said.

In English-speaking countries, higher education sectors have become highly reliant on flows of international students. China, which provides over 60,000 new students to the UK each year, is the most commonly cited example. The Saudi Arabian episode serves as a reminder that the trend extends further afield.

Link

I also know of examples where (despotic) foreign regimes, seek to use their collective bargaining to influence how a particular university behaves. Money doesn’t talk — it swears.

Give me a break

by reestheskin on 08/08/2018

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A day in court for Kit Kat. The European Court of Justice will deliver a verdict on Nestlé’s long-running attempt to trademark the chocolate bar’s shape—”four trapezoidal bars aligned on a rectangular base.” Competitors like Mondelez, Cadbury, and Milka cried foul at Nestlé’s move.

Link

Which is not as obscene as the attempt to patent the space within a shape of a defined size.

MacIntyre’s lecture and Harré’s tutorial were doubly life-changing

by reestheskin on 07/08/2018

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The title above and quotes below are from this article by Lincoln Allison. To create teaching machines, you need to make teaching so bad that even the machines can do it. We are almost there.

The most particular annoyance for me was the doubling of seminar size from nine to 18 – allegedly to free up time for research. As if anyone is going to develop the capacity for original thought because they have two or three more hours available in the week! To some of my colleagues, this was merely a technical change, but to me it was the abolition of the real seminar, the thing we should have been most proud of in the English university system.

….

It was part of a general deprioritising of teaching. I remember a colleague looking at her extremely poor ratings on student “feedback” and remarking gaily: “I’m really not very good at this, am I?” She had just had a book published that was extremely well received, and she couldn’t care less that she was failing in her core duties to communicate her ideas within an academic community. Her remark stiffened my resolve to leave – especially once students picked up the vibe about the level of staff interest in teaching and became less challenging and more instrumental.

Much of what I have seen and heard of UK universities in the 14 years since I retired seems to relate to what I would consider proper university teaching about as much as “value” tinned food relates to fresh food. And I think that just as there are people who have never tasted fresh food, there are people who have not experienced real lectures and seminars.

The importance of being sweaty

by reestheskin on 06/08/2018

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This looks even more alarming if you factor in humidity. Human beings can tolerate heat with sweat, which evaporates and cools the skin. That is why a dry 50°C can feel less stifling than a muggy 30°C. If the wet-bulb temperature (equivalent to that recorded by a thermometer wrapped in a moist towel) exceeds 35°C, even a fit, healthy youngster lounging naked in the shade next to a fan could die in six hours.

At present, wet-bulb temperatures seldom exceed 31°C.

Link

The first paper I ever published was on sweating. It was my entry as a medical student into dermatology, and the product of meeting Sam Shuster (the rest, as they say, is history). Sweat glands don’t get a lot of attention, but the ~3 million mini-kidneys are full of fascinating biology. Did you know you can shift more fluid through your sweat glands that you can pass urine (quite a thought, considering how many pints of beer some people can manage — and no, I do not have a reference for this factoid so readers beware……).

Anyway I think I get the idea of the wet-bulb temperature, but the above (from the Economist) should give cause for thought. Isn’t skin biology and the environment so endlessly fascinating?

Talking the politics of Higher Ed

by reestheskin on 02/08/2018

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Talking Politics: Strike

This is one of the best accounts of what has happened to Higher Ed in the UK. The host is David Runciman, and the guest is Stephen Toope, VC of Cambridge. Helen Thompson and Chris Brooke, feature.

It is about much more than the strike, and I have not heard any better account of the recent politics of Higher Ed in the UK. To me at least, whatever the forces lined up against them, the universities have been caught sleeping and are going to be punished for their fall from grace. Locally, I do not think the message has got through.

The link for the series of podcasts is here.

“On being the right size*”

by reestheskin on 24/07/2018

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Leading the pack was the University of Sydney, which increased its overseas enrolments from about 15,530 in 2014 to 30,943 in 2017.

“Secret report reveals snowballing international student numbers” THE.

This will end not in tears but in devaluation. The same is true over here too, and you can understand why the ‘multiversity’ is going to take the ‘university’ down with it. See: UK universities’ research funding deficit soars to £3.9 billion.

* JBS Haldane

In your Prime, why bother indeed?

by reestheskin on 23/07/2018

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Rather than go to university—why bother, when she could discuss John Donne as well as any other Edinburgh girl?—she took a course at Heriot-Watt College in precis-writing. That helped shape the economy of her sentences

Muriel Spark was born 100 years ago. Economist

There is always time for another bubble

by reestheskin on 20/07/2018

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If universities are now financialised operations, they are subject to financial disruptions of their own.

FT

Nature Cannot Be Fooled

by reestheskin on 19/07/2018

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Education is probably the field in which we deceive ourselves the most, because the damage only appears decades later. We pretend that all children learn at the same rate and in the same way. Every teacher and parent knows this to be untrue, and to deny it is folly. But deny it we do.

Jonathan Katz.

The fatal attraction of meaningless metrics

by reestheskin on 18/07/2018

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The Scylla and Charybdis of the subject level TEF is that the aggregation of students into groups large enough to make meaningful statistical analysis possible debases the validity of the analysis by treating disparate groups of students with a variety of educational experiences, studying different subjects, located in disparate units of university governance, as if they were in fact homogeneous. Randomness is not something the Office for Students or the Department for Education can change. Without a robust account of how they intend to deal with it, the prospects for a viable subject level TEF look poor.

Link

No time for sex at home, please

by reestheskin on 17/07/2018

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This article from the Economist is much more nuanced than you might think — especially about all the benefits of attending school that are unrelated to what specifically goes on in the classroom. But if you couple it with a close reading of Bryan Caplan’s ‘The Case Against Education’ then it is hard not to feel that the academy has been guilty of failing to check out their own entrails before passing judgement on everybody else’s.

It sounds like a counsel of despair. If every child went to school, millions more would sit in woeful, boring classrooms. But while this sounds awful, it would probably still be good for them, their families and broader society. For, as Justin Sandefur of CGD points out, there is plenty of evidence that even when children do not learn much at school, they still do better for having gone.

Some benefits are economic. Attending school for longer is associated with earning more in later life, in part because those with additional schooling are more likely to get non-agricultural jobs and move to cities. This may indicate that young people are in fact learning something useful at school that is not being picked up by researchers. But it could also be a signalling effect: a shopkeeper may prefer workers who stayed at school for at least five years.

One is simply that if girls are at school they are not having sex at home

Exams and the internet

by reestheskin on 16/07/2018

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Algeria Shut Down the Internet to Prevent Students from Cheating on Exams

Via Bruce Schneier. The solution in New South Wales, Australia was to ban smartphones.

Fifty years on

by reestheskin on 12/07/2018

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There are some interesting memes for our time in this FT podcast: 1968: The Year that Music Changed. Fifty years ago. What moved me most was the link (27:30 in) to the YouTube speech from Bobby Kennedy, where he told an audience — who were still unaware — that Martin Luther King has just been assassinated, making use of the following lines of Aeschylus.

“Even in our sleep, pain which cannot forget falls drop by drop upon the heart, until, in our own despair, against our will, comes wisdom through the awful grace of God.”

I am not certain what other people of my age say in answer to the question, “Where were you when JFK died?” I have no memory for Dallas. But I do remember where I was in Cardiff, when my Irish mother picking me up to drive me somewhere, told me that Bobby Kennedy had just been assassinated. And I was expected to know why this was important, and why it was important to her. And just go compare with what we see now across the pond, drifting.

A theory of everything

by reestheskin on 11/07/2018

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the problem is that education has become the default solution to everything.

Andrew Keen, in How to Fix the Future. A speaker at last year’s OEB meeting. Worth a read.

Well, not entirely a politics free zone

by reestheskin on 10/07/2018

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Fintan O’Toole in the Irish Times writes

what you are left with is just this – a country that has gone to enormous trouble to humiliate itself.

You can guess the context. (Via he who swims off Penglas in West Cork)

MOOCs revisited

by reestheskin on 09/07/2018

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One selling point of MOOCs (massive online open courses) has been that students can access courses from the world’s most famous universities. The assumption—especially in the marketing messages from major providers like Coursera and edX—is that the winners of traditional higher education will also end up the winners in the world of online courses.

But that isn’t always happening.

In fact, three of the 10 most popular courses on Coursera aren’t produced by a college or university at all, but by a company. That company—called Deeplearning.ai—is a unique provider of higher education. It is essentially built on the reputation of its founder, Andrew Ng, who teaches all five of the courses it offers so far. Link

The MOOC story is like so much of tech — or drug discovery for that matter. Finding a use for a drug invented for another reason often offers the biggest payback. This story has barely begun.

Reinventing the personal physician

by reestheskin on 06/07/2018

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From JAMA

Davidson had had enough. “I wasn’t even making 6 figures, and I was killing myself,” she recalled.

“Frustrated, she googled “ideal practice” one sleepless night and came across Atlas MD in Wichita, Kansas. That practice does not accept insurance, although patients still need to have insurance to cover health care beyond the scope of primary care. Instead of co-payments and deductibles, Atlas MD patients pay a monthly “membership fee” that covers all of the primary care their physician provides. But more importantly, this retainer guarantees unhurried, same-day appointments and round-the-clock accessibility to their physician, who would get to know their story “inside and out,” thanks to having to care for only around 500 patients.”

The most interesting thing in this article is the lengths the opponents go to to oppose such a change:

“For now, said Weisbart, chair of the Missouri chapter of Physicians for a National Health Program, there’s no evidence to support the argument that DPC [the model describe here], by allowing physicians to spend more time with patients, can prevent expensive downstream medical problems. “If they could prove it, I’d be one of their advocates,” he said, adding that he understands the attraction of DPC for physicians. “They can see a third or a quarter of the number of patients (as fee-for-service practices) and preserve their income.”

“Weisbart remains skeptical, though. Direct primary care practices might attract a different population of patients. The only way to compare how well the 2 models improve health and cut costs would be to conduct a trial that randomly assigned patients to DPC or fee-for-service practices. But, Weisbart added, such a trial would be difficult if not impossible to conduct. For one, it’s unlikely that a representative sample of US patients would agree to enroll in a study in which they were randomly assigned to a primary care physician. “And,” he added, “it would have to be large to show meaningful impact, which means the study would be expensive.”

Nobody cares anymore

by reestheskin on 04/07/2018

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Polling undertaken for the NHS recruitment campaign found that many people had an outdated view of nursing. It suggested most saw nurses primarily as “caring”, with far fewer regarding them as “leaders” or “innovators”.

Apparently this is not approved of. My mother would be turning over in her grave.

Link

skincancer909 usage

by reestheskin on 03/07/2018

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Just saying….

Here are the figures for skincancer909 my online textbook of skin cancer for medical students. The site was rewritten and updated in the final quarter of last year (with videos).  Usage is 80% from search, with the rest from direct links. In June about 4,600 sessions. Local usage (Edinburgh) is around 5%. I am pleased, but financially poorer.

 

People in glasshouses

by reestheskin on 03/07/2018

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‘True science thrives best in glass houses where everyone can look in. When the windows are blacked out, as in war, the weeds take over; when secrecy muffles criticism, charlatans and cranks flourish’.

Max Perutz (1914-), Austrian born biochemist. Shared 1962 Nobel Prize for X-ray crystallography of haemoglobin.

Link

Reflect on!

by reestheskin on 29/06/2018

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A revered teacher, Seldin was known for his pithy expressions, including: “A good medical education leaves much to be desired”; “One of the dangers of a medical education is that it leads to graduation from medical school”; and “The greatest crime is to do the right thing for the wrong reason.”

An obit of Donald W Seldin – The Lancet.  I do not know the source of my favourite cognate aphorism:

most students turn into good doctors despite the earnest attempts of medical educationalists

The educational singularity — just went by.

by reestheskin on 28/06/2018

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This article (Can vocational education make a comeback?) is about vocational training and higher ed in Australia. It contains some nice examples of dishonesty driven by financial gain. For example:

Regulators didn’t blink when a private college suddenly started charging A$22,000 (£12,350) for a web design diploma that cost about A$4,500 elsewhere, or when a competitor’s student population snowballed from about 300 one year to almost 12,000 the next.

Or how about these examples:

The light regulatory touch encouraged scores of scams, known in Australian parlance as “rorts”, as unscrupulous colleges pushed the rules to the fringes of criminality. In one infamous case, a Melbourne college awarded football club members certificates in outdoor recreation for a few nights of “learning” on their own premises. It gave participants and their clubs A$1,500 kickbacks, bankrolled from state government subsidies worth up to A$5,000 per student, and called them “scholarships”.

In another case, the directors of a soon-to-be-bankrupt college paid their shareholders – including themselves – A$15 million in dividends, on the same day that Australia’s consumer watchdog launched proceedings to recover tens of millions of dollars in improperly obtained student loans. The company subsequently collapsed with unpaid debts of about A$80 million, having swallowed A$222 million in loans.

Well, what do you expect? This is the higher ed equivalent of imagining that you can ‘install democracy’ everywhere overnight; or that you run a company based on legal contracts between its own employees. But what really caught my eye, was this critique of current higher ed in favour of shorter vocational courses (it is about the money, what else!).

This discourages degree-educated people from obtaining top-up training in areas such as coding and data analytics, which are now vital to many occupations. Such needs are best met through short VET courses after graduation, Gallagher says, because digital skills taught as part of three- or four-year degrees will be obsolete by the time people leave university. “The half-life of those skills is getting shorter and shorter,” he says.

I cannot think of a better definition of what higher education is not about than this. Now surely we know what degrees not to fund.

 

 

This discourages degree-educated people from obtaining top-up training in areas such as coding and data analytics, which are now vital to many occupations. Such needs are best met through short VET courses after graduation, Gallagher says, because digital skills taught as part of three- or four-year degrees will be obsolete by the time people leave university.

“The half-life of those skills is getting shorter and shorter,” he says.

Inter alia

Regulators didn’t blink when a private college suddenly started charging A$22,000 (£12,350) for a web design diploma that cost about A$4,500 elsewhere, or when a competitor’s student population snowballed from about 300 one year to almost 12,000 the next.

The light regulatory touch encouraged scores of scams, known in Australian parlance as “rorts”, as unscrupulous colleges pushed the rules to the fringes of criminality. In one infamous case, a Melbourne college awarded football club members certificates in outdoor recreation for a few nights of “learning” on their own premises. It gave participants and their clubs A$1,500 kickbacks, bankrolled from state government subsidies worth up to A$5,000 per student, and called them “scholarships”.

In another case, the directors of a soon-to-be-bankrupt college paid their shareholders – including themselves – A$15 million in dividends, on the same day that Australia’s consumer watchdog launched proceedings to recover tens of millions of dollars in improperly obtained student loans. The company subsequently collapsed with unpaid debts of about A$80 million, having swallowed A$222 million in loans.

The case against education

by reestheskin on 27/06/2018

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This is a tweet from Dylan Wiliam — who knows more about education than…..well I am too polite to go there.

“goes straight to the top of my list of studies that I trust but wish were not true. I think it is the most important book on education I have ever read.”

He is referring to Bryan Caplan’s disturbing and excellent book. (The case against education). One comment of mine: not in all possible worlds.

The affair is over

by reestheskin on 26/06/2018

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Did the NHS save your life, or did Doctors and Nurses save your life?

It’s an earnest question. A comment on an excellent FT piece: “Is Britain loving the NHS to death?”

AI winter, revisited

by reestheskin on 25/06/2018

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Hype is not fading, it is cracking.

I like the turn of phrase. It is from a post on the coming AI winter. Invest wisely.

AI winter – Addendum – Piekniewski’s blog