If not now, when?

by reestheskin on 12/02/2020

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I have lots of thoughts about why and when I retired (from paid employment). And I do not feel able to dismiss them, nor not introspect on them. The following is a from the ‘The Daily Stoic’ (a retirement gift from Caroline M). Apposite.

Is this the life I really want? Every time you get upset, a little bit of life leaves the body. Are these really the things on which you want to spend that precious resource? Don’t be afraid to make a change – a big one.

The thrill is in the leaving..

by reestheskin on 11/02/2020

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I titled a recent post musing over my career as ‘The Thrill is Gone’. But I ended on an optimistic note:

‘The baton gets handed on. The thrill goes on. And on’

But there are good reasons to think otherwise. Below is a quote from a recent letter in the Lancet by Gagab Bhatnaga. You can argue all you like about definitions of ‘burnout’, but good young people are leaving medicine. The numbers who leave for ever may not be large but I think some of the best are going. What worries as much is those who stay behind.

The consequences of physician burnout have been clearly observed in the English National Health Service (NHS). F2 doctors (those who are in their second foundation year after medical school) can traditionally go on to apply to higher specialist training. Recent years have seen an astounding drop in F2 doctors willing to continue NHS training4 with just over a third (37·7%) of F2 doctors applying to continue training in 2018, a decrease from 71·3% in 2011. Those taking a career break from medicine increased almost 3-fold from 4·6% to 14·6%. With the NHS already 10 000 doctors short, the consequences of not recruiting and retaining our junior workforce will be devastating.

Physician burnout – The Lancet

Before reproducibility must come preproducibility

by reestheskin on 10/02/2020

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This is an article by Philip Stark in Nature published awhile back. I like it.

In 1992, philosopher Karl Popper wrote: “Science may be described as the art of systematic oversimplification — the art of discerning what we may with advantage omit.” What may be omitted depends on the discipline.

You can say this another way: all experiments do violence to the natural world. We always want to cleave at the joints. But doing so may lead to error.

In 1992, philosopher Karl Popper wrote: “Science may be described as the art of systematic oversimplification — the art of discerning what we may with advantage omit.” What may be omitted depends on the discipline. Results that generalize to all universes (or perhaps do not even require a universe) are part of mathematics. Results that generalize to our Universe belong to physics. Results that generalize to all life on Earth underpin molecular biology. Results that generalize to all mice are murine biology. And results that hold only for a particular mouse in a particular lab in a particular experiment are arguably not science.

Science should be ‘show me’, not ‘trust me’; it should be ‘help me if you can’, not ‘catch me if you can’. If I publish an advertisement for my work (that is, a paper long on results but short on methods) and it’s wrong, that makes me untrustworthy. If I say: “here’s my work” and it’s wrong, I might have erred, but at least I am honest.

In medicine we have particular problems. Repeating experiments in model organisms is often possible whereas in man things are much harder. There is an awful lot of published medical research that is not a reliable guide to action.

Before reproducibility must come preproducibility

The thrill is gone

by reestheskin on 31/01/2020

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Today is my last day of (paid) work, and of course a day that will be infamous for many more people for other more important reasons. Europe and my professional life have been intertwined for near on 40 years. In the mid 1980s I went to start my dermatological career in Vienna. I had been a student at Newcastle and done junior jobs there, as well as some research on skin physiology with Sam Shuster as an undergraduate student. Sam rightly thought I should now move somewhere else — see how others did things before returning — and he suggested Paris, or Vienna under Klaus Wolff. Vienna was, and perhaps still is, the centre of the dermatological universe, and has been since the mid 19th century. Now, even if I haven’t got very far into this post — it is a day for nostalgia — so allow me an aside: The German literature Problem.

The German Literature

As I have hinted at above, in many ways there have only been two schools of dermatology: the French school, and the German school. The latter has been dominant. Throughout the second half of the 19th century dermatology was a ‘German speaking’ subject. To follow it you would be wise to know German, and better still to have visited the big centres in Germany, Switzerland or Austria. And like most of the modern research university, German medicine and science was the blueprint for the US and then belatedly — and with typos— for England (Scotland, reasonably, had taken a slightly different path).

All of the above I knew, but when I returned to Newcastle after my first sojourn away (a later one was to Strasbourg), I naturally picked up on all these allusions to the German literature, but they were accompanied by sniggering by those who had been around longer than me. Indeed there seemed to be a ‘German Literature Problem’. Unbeknown to me, Sam had written “das problem ” up in ‘World Medicine’, but World Medicine had been killed off by those from Mordor, so here is a synopsis.

The German literature seemed so vast that whenever somebody described a patient with what they were convinced must be a ‘new syndrome’, some bright spark would say that it had already been described, and that it was to be found in the German literature. Now the synoptic Handbuch der Hautkrankheiten on our shelves in the library in Newcastle ran to over 10 weighty volumes. And that was just the start. But of course only German speaking dermatologists (and we had one) could meaningfully engage in this conversation. Dermatology is enough of a a nightmare even in your own mother tongue. Up to the middle of the 20th century however, there were indeed separate literatures in German, French and English (in the 1960’s the newly formed ESDR had to sort out what language was going to be used for its presentations).

Sam’s sense of play now took over (with apologies to Shaw: nothing succeeds like excess). It appeared that all of dermatology had already been previously described, but more worryingly for the researchers, the same might be true of skin science. In his article in World Medicine he set out to describe his meta-science investigation into this strange phenomenon. Sam has an unrivalled ability to take simple abstract objects — a few straight lines, a circle, a square — and meld them into an argument in the form of an Escher print. A print that you know is both real, unreal and illegal. Imagine a dastardly difficult 5 x 5 Rubik’s cube (such as the one my colleagues recently bought me for my retirement). You move and move and move the individual facets, then check each whole face in turn. All aligned, problem solved. But then you look in the mirror: whilst the faces are all perfect in your own hands, that is not what is apparent in the mirror. This is my metaphor for Sam’s explanation. Make it anymore explicit, and the German literature problem rears its head. It’s real — of a sort. Anyway, this was all in the future (which didn’t exist at that time), so lets get back to Vienna.

Night train to Wien

Having left general medical jobs behind in Newcastle, armed with my BBC language tapes and guides, I spent a month travelling through Germany from north to south. I stayed with a handful of German medical students who I had taught in Newcastle when I was a medical registrar (a small number of such students used to spend a year with us in Newcastle). Our roles were now reversed: they were now my teachers. At the end of the month I caught the night train in Ulm, arriving in Vienna early one morning.

Vienna was majestic — stiff collared, yes — but you felt in the heart of Europe. A bit of Paris, some of Berlin and the feel of what lay further east: “Wien ist die erste Balkanstadt”.  For me, it was unmistakably and wonderfully foreign.

It was of course great for music, too. No, I couldn’t afford the New Year’s Day Concerts, but there were cheap seats at the Staatsoper, more modest prices at the Volksoper, and more to my taste, some European jazz and rock music. I saw Ultravox sing — yes, what else— “Vienna” in Vienna. I saw some people from the ECM label (eg Eberhard Weber), a style of European jazz music that has stayed with me since my mid teens. And then there was the man (for me) behind ‘The Thrill is Gone’.

The Thrill

I saw BB King on a double bill with Miles Davies at the Stadthalle. Two very different styles of musician. I was more into Miles Davies then, but he was not then at his best (as medics in Vienna found out). I was, however, very familiar with the ‘Kings’ (BB, Freddie, Albert etc) after being introduced to them via their English interpreters. Clapton’s blue’s tone on ‘All Your Love’ with John Mayall’s Bluesbreakers still makes the hairs on my neck stand up (fraternal thanks to ‘Big Al’ for the introduction).

The YouTube video at the top of the page is wonderful (Montreux 1993), but there is a later one below, taken from Crossroads in 2010 which moves me even more. He is older, playing with a bunch of craftsmen, but all still pupils before the master.

But — I am getting there — germane to my melancholia on this day is a video featuring BB King and John Mayer. Now there is a trope that there are two groups of people who like John Mayer: girlfriends; and guitarists who understand just how bloody good he is. As EC pointed out, the problem with John Mayer is that he realises just how good he is. True.

But the banter at the beginning of the video speaks some eternal truths about craft, expertise, and the onward march of all culture — including science. Mayer plays a few BB King licks, teasing King that he is ‘stealing’ them. He continues, it was as though he was ‘stealing silverware from somebody’s house right in front of them’. King replies: ”You keep that up and I’m going to get up and go”. Both know it doesn’t work that way. Whatever the provenance of the phrase ‘great artists steal, not copy’, except in the most trivial way you cannot steal or copy culture: people discover it in themselves by stealing what masters show them might be there in their pupils. Teachers just help people find what they suspect or hope is there. The baton gets handed on. The thrill goes on. And on.

On shifting dullness

by reestheskin on 30/01/2020

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Henry characterise the less attractive teaching rounds as examples of shifting dullness

Henry Miller (apologies, a medic joke)

On one word after another

by reestheskin on 28/01/2020

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Well, I doubt if any readers of these scribblings will be shocked. After all TIJABP. But this piece by the editor of PNAS wonders if the day of meaningful editing is over. I hope not. Looking backwards over my several hundred papers, the American Journal of Human Genetics was the most rigorous and did the most to improve our manuscript.

On a subject no one wants to read about (about which no one wants to read?) | PNAS

“Communication” remains in the vocabulary of scientific publishing—for example, as a category of manuscript (“Rapid Communications”) and as an element of a journal name (Nature Communications)—not as a vestigial remnant but as a vital part of the enterprise. The goal of communicating effectively is also why grammar, with its arcane, baffling, or even irritating “rules,” continues to matter. With the rise of digital publishing, attendant demands for economy and immediacy have diminished the role of copyeditor. The demands are particularly acute in journalism. As The New York Times editorial board member Lawrence Downs (4) lamented, “…in that world of the perpetual present tense—post it now, fix it later, update constantly—old-time, persnickety editing may be a luxury…. It will be an artisanal product, like monastery honey and wooden yachts.” Scientific publishing is catching up to journalism in this regard.

One thing I won’t miss in retirement

by reestheskin on 27/01/2020

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Being a renowned scientist doesn’t ensure success. On the same day that molecular biologist Carol Greider won a Nobel prize in 2009, she learnt that her recently submitted grant proposal had been rejected. “Even on the day when you win the Nobel prize,” she said in a 2017 graduation speech at Cold Spring Harbor Laboratory in New York, “sceptics may question whether you really know what you’re doing.”

Secrets to writing a winning grant

We are not of this world

This is from Larry Page of Google (quoted in “The Age of Surveillance Capitalism: The Fight for a Human Future at the New Frontier of Power” by Shoshana Zuboff)

CEO Page surprised a convocation of developers in 2013 by responding to questions from the audience, commenting on the “negativity” that hampered the firm’s freedom to “build really great things” and create “interoperable” technologies with other companies: “Old institutions like the law and so on aren’t keeping up with the rate of change that we’ve caused through technology. . . . The laws when we went public were 50 years old. A law can’t be right if it’s 50 years old, like it’s before the internet.” When asked his thoughts on how to limit “negativity” and increase “positivity,” Page reflected, “Maybe we should set aside a small part of the world . . . as technologists we should have some safe places where we can try out some new things and figure out what is the effect on society, what’s the effect on people, without having to deploy kind of into the normal world.

As for his comments on safe spaces, I agree. There are plenty of empty planets left.

I wish I had said that..

A comment on an article:

With reference to Janan Ganesh’s column (“What the US lost when the Berlin Wall fell”, November 7). This is such a clever line.

“It is as though hatred obeys the first law of thermodynamics. Like energy, it can be transferred but never destroyed.

This apropos the US right’s shifting from the Soviet Union to immigration and climate. I’m trying to figure out how to work it into my own stuff. Full credit, of course.

Link

A working life

by reestheskin on 17/01/2020

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I don’t like the work-life balance meme. I know what it means, but I never wanted it. Medicine was once talked of as a vocation, and when I was a medical student I can remember many doctors who clearly believed so as well. Neonatologists who appeared to live on the special care baby unit; surgeons whose idea of Christmas day was to do a ward round and bring their children with them; and ‘be a paediatrician and bring up other people’s children’. The job was not just any job. I remember the wife of one professor who appeared on the ward when I was a houseman very late one night. “Had I seem the professor, her husband?” I had: I saw him there most evenings when I was on call. On this night, for whatever reason, she had accompanied him. Sadly for her, he had forgotten, and gone home without her. Thales and the well.

For me being an academic was a ‘calling’. A grand phrase, I know. But it has for most of my career been a way of life beyond the paycheque. I believe in the academic ideal, but increasingly fear the institutions no longer do. For me, home and office were not distinct. I vaguely remember — and it is quite possible I am mistaken here — that my first Professorial contract at the University of Newcastle stated ‘that by the nature of the work no hours of work are stipulated’. As my children would testify, weekend mornings were spent in the (work) office, and the afternoon in the gym and pool with them.

I retire* in the near future, and I face a practical problem. Much of my ‘work’ is at home — books and papers of course, but also the high spec iMac Pro that I have used to produce videos, alongside video cameras and lights. On the other hand, my office is full of things that strictly speaking are personal, in that I bought them with my own money rather than with a univeristy purchase order. But my work space — measured in square metres if not mental capacity, I hope — is diminishing. A domestic negotiation is required.

*From paid employment, not from my work.

Diseases of Deans

Woodrow Wilson once remarked that it is easier to change the location of a cemetery than it is to change a curriculum.

Via Jon Talbot, commenting on an article on the failures of online learning. I would only add the comment made by Henry Miller (in the context of medicine):

Curriculum reform, a disease of Deans.

The itch that rashes

by reestheskin on 15/01/2020

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My earliest conscious memory of disease and doctors was in the management of my atopic dermatitis. Here is Sam Shuster writing poetically about atopic dermatitis in ‘World Medicine’ in 1983.

A dozen years of agony; years of sleeplessness for child and parents, years of weeping, itching, scaling skin, the look and feel of which is detested.

The poverty of our treatments is made all the worse by the unfair raising of expectations: I don’t mean by obvious folk remedies; I mean medical folk remedies like the recent pseudoscientific dietary treatments which eliminate irrelevant allergens. There neither is nor ever was good evidence for a dietary mechanism. And as for cows’ milk, I would willingly drown its proponents in it. We have nothing fundamental for the misery of atopic eczema and that’s why I would like to see a real treatment—not one of those media breakthroughs, and not another of those hope raising nonsenses like breast-feeding: I mean a real and monstrously effective treatment. Not one of your P<.05 drugs the effect of which can only be seen if you keep your eyes firmly double-blind, I mean a straightforward here today and gone tomorrow job, an Aladdin’s salve—put it on and you have a new skin for old.

Nothing would please me more in the practice of clinical dermatology than never again to see a child tearing its skin to shreds and not knowing how long it will be before it all stops, if indeed it does.

Things are indeed better now, but not as much we need: we still don’t understand the itch nor can we easily block the neural pathways involved. Nor has anything replaced the untimely murder of ‘World Medicine’. A glass of milk has never looked the same since, either.

You don’t have to be mad to read this

by reestheskin on 13/01/2020

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There is an interesting review in the Economist of the ‘Great Pretender: The Undercover Mission that Changed out Understanding of Madness,’ written by Susan Cahalan. The book is the story of the American psychologist David Rosenhan who “recruited seven volunteers to join him in feigning mental illness, to expose what he called the ‘undoubtedly counter-therapeutic’ culture of his country’s psychiatry”.

Rosenthal’s studies are well known and were influential, and some might argue that may have had have a beneficial effect on subsequent patient care. The question is whether they were true. The review states:

in the end Rosenham emerges as an unpalatable symptom of a wider academic malaise”.

As for the ‘malaise’, the reviewer goes on:

Many of psychology’s most famous experiments have recently been discredited or devalued, the author notes. Immense significance has been attached to Stanley Milgram’s shock tests and Philip Zimbardo’s Stanford prison experiment, yet later re-runs have failed to reproduce their findings. As Ms Cahalan laments, the feverish reports on the undermining of such theories are a gift to people who would like to discredit science itself.

I have a few disjointed thoughts on this. There are plenty of other considered critiques of the excesses of modern medical psychiatry. Anthony Clare’s ‘Psychiatry in Dissent’ was for me the best introduction to psychiatry. And Stuart Sutherland’s “Breakdown’ was a blistering and highly readable attack on medical (in)competence as much as the subject itself (Sutherland was a leading experimental psychologist, and his account is autobiographical). And might the cross-country diagnostic criteria studies not have happened without Rosenham’s work?

As for undermining science (see the quote above), I think unreliable medical science is widespread, and possibly there is more of it than in many past periods. Simple repetition of experiments is important but not sufficient, and betrays a lack of of understanding of why some science is so powerful.

Science owes its success to its social organisation: conjectures and refutations, to use Popper’s terms, within a community. Just repeating an experiment under identical conditions is not sufficient. Rather you need to use the results of one experiment to inform the next, and with the accumulation of new results, you need to build a larger and larger edifice which whilst having greater explanatory power is more and more intolerant of errors at any level. Building large structures out of Lego only works because of the precision engineering of each of the component bricks. But any errors only become apparent when you add brick-on-brick. When a single investigator or group of investigators have skin in the game during this process — and where experimentation is possible — science is at its strongest (the critiques can of course come from anywhere).

An alternative process is when the results of a series of experiments are so precise and robust that everyday life confirms them: the lights go on when I click the switch. This harks back to the reporting of science as ‘demonstrations’.

By these two standards much medical science may be unreliable. First, because the fragmentation of enquiry discourages the creation of broad explanatory theories or tests of the underlying hypotheses. The ‘testing’ is more whether a publishable unit can be achieved rather than nature understood. Second, in many RCTs or technology assessments there is little theoretical framework on which to challenge nature. Nor can everyday practice act as the necessary feedback loop in the way the tight temporal relationship between flipping the switch and seeing the light turn on can.

Term of the day

Negative egalitarianism (also known as jealousy)

Richard Gombrich

We need more STEM (STEAM etc)

by reestheskin on 08/01/2020

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Perhaps, perhaps not. But when and where is even more important.

Hailed as a maths prodigy at school, Shields accepted a junior position at Merrill Lynch after studying engineering, economics and management at Oxford University because the trading room floor offered him a thrilling, dynamic environment. He was not alone: of 120 engineers in his year group at university, Shields added, only five went into engineering.

I think we should be much more cautious in attempting to direct young people’s choices beyond providing them with an education. We should feel proud of their independence of mind, remembering that supply side factors will likely win out over central planning. It is the supply side that we need to deal with, not least Putts Law. The same applies to medicine.

This personal story is worth a read for other lessons, too.

‘The men who plundered Europe’: bankers on trial for siphoning €60bn | Business | The Guardian

What do you want?

The government has instructed Health Education England to consult patients and the public on what they need from “21st century” medical graduates

Patients to be asked what they need from doctors | The BMJ

It won’t end well.

On (or off) New Year’s Resolutions

by reestheskin on 06/01/2020

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The productivity abyss…and how to escape its gravitational pull. Here is an article extolling time-wasting.

To which she has two responses — first, most people overestimate the amount of time they actually work and second, she proposes accepting that your to-do-list will never get done.

Let’s rebrand a bit of time-wasting as healthy living | Financial Times

The fist I agree with. Awhile back I tried time tracking using the Timery app and Toggl. It’s scary. And that is even when you include meetings as work. But the second point, entailing an amnesty on all the things you thought or think you are going to do, conflicts with my sense of original sin. The sun has to rise, just like guilt.

We need a science of the night

by reestheskin on 03/01/2020

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One-third of everyone employed in London, 1.6 million people, work at night.

In 2018, at least 8,855 people slept rough on the streets of London, a 140% increase over the past decade, with similar trends globally.

We need a science of the night

Finnish lessons

by reestheskin on 19/12/2019

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No, not Pasi Salberg, but cognate.

But idealists now have another international beacon of social mobility: long live the Finnish dream, in which a 34-year-old woman who once worked in a shop can become prime minister.

“I am extremely proud of Finland. Here a poor family’s child can educate themselves and achieve their goals in life. A cashier can become even a prime minister,” tweeted Sanna Marin

Meanwhile back in the UK as the FT rightly comments:

..egregious examples of rigging the game endure: on being rejected by the voters, Zac Goldsmith is to be elevated to the House of Lords, from where he will carry on as a minister in the government of Boris Johnson, also an Etonian from a high-profile family.

Looking in envy at Finland’s social mobility pin-up PM | Financial Times

On not being the Queen of Sciences

by reestheskin on 16/12/2019

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“If biology is difficult, it is because of the bewildering number and variety of things one must hold in one’s head”.
John Maynard Smith (1977).

Leo Szilard recalled, that when he did physics he could lounge in the bath for hours and hours, just thinking. Once he moved into biology things were never the same: he was always having to get out to check some annoying fact. Dermatology is worse, trust me.

Mark Blyth on Goldman

Goldman [Sachs) are smart: they can rip your grandmother’s face off and make her feel good about it.

The Crash of 2008: 10 years on

Check your privilege

by reestheskin on 13/12/2019

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An article fit for this deceitful day by Nick Laird in the NYRB. UK education doesn’t escape from it either, but the context is Ireland or that British problem.

“I thought, if these bastards are voting Remain, I’m voting Leave.”

As for ‘identity’

An old friend of mine, a Catholic and a fellow poet from Belfast, was in New York City last week and described being told once to “check her privilege.” She had replied that the privilege her identity had given her was a mild form of PTSD. The phrase “identity politics” has a darker resonance in Northern Ireland.

Every evil act I’ve ever seen committed was done in the name of identity

Blood and Brexit | by Nick Laird | NYR Daily | The New York Review of Books

 Breakfast reading

The Lancet as breakfast reading. Not a medical meeting, just a nice hotel in the Middle East.

Even the human world is queerer than I can imagine

The world is indeed very strange and common sense not much of a guide. Facts, my dear boy, facts…

link

Fiction, apparently.

“…what he read was clear proof of an Anglo-American covert operation already in the planning stage with the dual aim of undermining the social democratic institutions of the European Union and dismantling our international trading tariffs…In the post-Brexit era Britain will be desperate for increased trade with America. America will accommodate Britain’s needs, but only on terms. One such term will be a joint covert operation to obtain by persuasion — bribery and blackmail not excluded — officials, parliamentarians and opinionmakers of the European Establishment. Also to disseminate fake news on a large scale in order to aggravate existing differences between member states of the Union”

Agent Running in the Field, John le Carré

Knowing more than we can see

by reestheskin on 05/12/2019

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I spent near on ten years thinking about automated skin cancer detection. There are various approaches you might use — cyborg human/machine hybrids were my personal favourite — but we settled on more standard machine learning approaches. Conceptually what you need is straightforward: data to learn from, and ways to lever the historical data to the future examples. The following quote is apposite.

One is that, for all the advances in machine learning, machines are still not very good at learning. Most humans need a few dozen hours to master driving. Waymo’s cars have had over 10m miles of practice, and still fall short. And once humans have learned to drive, even on the easy streets of Phoenix, they can, with a little effort, apply that knowledge anywhere, rapidly learning to adapt their skills to rush-hour Bangkok or a gravel-track in rural Greece.

Driverless cars are stuck in a jam – Autonomous vehicles

You see exactly the same thing with skin cancer. With a relatively small number of examples, you can train (human) novices to be much better than most doctors. By contrast, with the machines you need literally hundreds and thousands of examples. Even when you start with large databases, as you parse the diagnostic groups, you quickly find out that for many ‘types’ you have only a few examples to learn from. The rate limiting factor becomes acquiring mega-databases cheaply. The best way to do this is to change data acquisition from a ‘research task’ to a matter of grabbing data that was collected routinely for other purposes (there is a lot of money in digital waste — ask Google).

Noam Chomsky had a few statements germane to this and much else that gets in the way of such goals (1).

Plato’s problem: How can we know so much when the evidence is do slight.

Orwell’s problem: How do we remain so ignorant when the evidence is so overwhelming.

(1): Noam Chomsky: Ideas and Ideals, Cambridge University Press, (1999). Neil Smith.

Books

We commonly think of books as containers of ideas or wrapping for literature, but they can be understood in other ways—as if they were blood cells carrying oxygen through a body politic or data points as infinite as stars in the sky. Books lead lives of their own, and they intersect with our lives in ways we have only begun to understand.

Best Sellers by the Bargeload | by Robert Darnton | The New York Review of Books

A job for life

In the essay “Telling,” he describes the upsetting case of the director of a hospital who, struck down by Alzheimer’s, is admitted to his own hospital. He behaves as if he were still running it, until one day by chance he picks up his own chart. “That’s me,” he says, recognizing his name on the cover. Inside, he reads “Alzheimer’s disease” and weeps. In the same hospital a former janitor is admitted; he too is convinced that he is still working there. He is given harmless tasks to perform; one day he dies of a sudden heart attack “without perhaps ever realising that he had been anything but a janitor with a lifetime of loyal work behind him.”

Truth, Beauty, and Oliver Sacks | by Simon Callow | The New York Review of Books

My mother, a nurse, took on such imagined roles when she too was demented and in a care home.

Downward mobility for all!

by reestheskin on 02/12/2019

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Obituaries are a source of much joy and enlightenment. None more so than those in the Economist. Last week’s was devoted to the ’60’s photographer Terry O’Neill (you can see some of his iconic images here.

Stars had been his subject since 1962, when he was sent to photograph a new band at the Abbey Road Studios. The older blokes at the Sketch scorned that kind of work, but the young were clearly on the rise, and he was by far the youngest photographer in Fleet Street at the time. At the studios, to get a better light, he took the group outside to snap them holding their guitars a bit defensively: John, Paul, George and Ringo. Next day’s Sketch was sold out, and he suddenly found himself with the run of London and all the coming bands, free to be as creative as he liked. A working-class kid from Romford whose prospects had been either the priesthood or a job in the Dagenham car plant, like his dad, had the world at his feet. He wouldn’t have had a prayer, he thought, in any other era.

And obviously it couldn’t last. In a couple of years he would find a proper job, as both the Beatles and the Stones told him they were going to. For it was hardly serious work to point your Leica at someone and go snap, snap.

Obituary: Terry O’Neill died on November 16th – Catching the moment

The reason I found this particularly interesting is the way social mobility appeared to work and the way it was tied to genuine innovation and social change. I have always loved the trope that when jobs are plentiful, and your committments minimal, you can literally tell the boss to FO on a Friday and start another job on the Monday. Best of all you can experiment and experiment lifts all. This to me is one of the best 1960’s rock n’ roll stories.

If you lift your head above the parapet in universities you come across various conventional wisdoms. One relates to ‘mental wellbeing’ or ‘mental issues’, and another is the value of education in increasing social mobility. My problem is that in both cases there seem (to me at least) many important questions that remain unanswered. For the former, are we talking about mental illness (as in disease) or something else? How robust is the data — aside from self-reporting? The widely reported comments from the former President of the Royal College of Pyschiatrists receive no answer (at last not in my institution). An example: I have sat in a meeting in which one justification for ‘lecture capture’ (recording of live lectures) was to assist students with ‘mental health issues’. But do they help in this context? Do we trust self-reflection in this area? Under what conditions do we think they help or harm?

Enhancing life chances and social mobility is yet another area that I find difficult. I picked up on a comment from Martin Wolf in the FT

We also believe that changing individual characteristics, principally via education, will increase social mobility. But this is largely untrue. We need to be far more honest.

He was referring to the work of John Goldthorpe in Oxford. Digging just a little beneath the surface made me realise that much of what I had believed may not true. Goldthorpe writes:

However, a significant change has occurred in that while earlier, in what has become known as the golden age of mobility, social ascent predominated over social descent, the experience of upward mobility is now becoming less common and that of downward mobility more common. In this sense, young people today face less favourable mobility prospects than did their parents or their grandparents.

This research indicates that the only recent change of note is that the rising rates of upward, absolute mobility of the middle decades of the last century have levelled out. Relative rates have remained more or less constant back to the interwar years. According to this alternative view, what can be achieved through education, whether in regard to absolute or relative mobility, appears limited.

[Jnl Soc. Pol. (2013), 42, 3, 431–450 Cambridge University Press 2013 doi:10.1017/S004727941300024X]

There is a witty exchange in Propect between the journalist (JD) and Goldthorpe (JG).

JD: Would you say that this is something that politicians, in particular, tend not to grasp?

JG: Yes. Tony Blair, for instance, was totally confused about this distinction [between absolute and relative rates of mobility]. He couldnʼt see that the only way you can have more upward mobility in a relative perspective is if you have more downward mobility at the same time. I remember being in a discussion in the Cabinet Office when Geoff Mulgan was one of Blairʼs leading advisors. It took a long time to get across to Mulgan the distinction between absolute and relative rates, but in the end he got it. His response was: “The Prime Minister canʼt go to the country on the promise of downward mobility!”

On both these topics I am conflicted. And on both these topics there are the tools that characterize scholarly inquiry to help guide action: this is what universities should be about. I am however left with a strong suspicion that few are interested in digging deep, rather we choose sound bites over understanding. Working in a university often feels like the university must be somewhere else. That is the optimistic version.

Not only God plays dice

There is an article this week in Nature about how some funders are explicitly funding grant proposals randomly (lotteries). The cynic might say they have been doing this for a longtime.