Skin trade

by reestheskin on 03/09/2020

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No, not that sort of skin trade, but inking1. This is from an article in the Economist, and sadly, although I cannot show them here, the images are remarkable. But some nice word lines too about the acquisition of high level skills and apprenticeship — vocation, if you will.

In China several prominent tattooists are taking a different approach. They have set up schools. In Wu Shang’s studio four students are hunched over flat pieces of silicon rubber—mimicking skin, just like his model arms—trying to recreate images that they first painted on paper.

That might seem inoffensive, but it goes against a widespread but unwritten code. Masters may take an apprentice or two under their wings, but only if they are truly committed to the craft. The idea that anyone can just show up, pay a tuition fee and after a few months apply ink to skin leaves purists aghast. Even in China some are critical. Mr Shen, the neo-traditionalist, says that he honed his technique over many years by wielding needles by hand. “You need to learn about the relationship between skin and needle. You can’t just get that overnight in school,” he says.

Many university staff would echo these thoughts.

The new ink masters – China makes its mark on the world of tattoos | Books & arts | The Economist

  1. Image of traditional Samoan tattoo via WikiP. Attribution CloudSurfer CC BY 3.0

Education is…

Mr Handy says this gave him the opportunity to learn from his mistakes in private. He argues that “education is an experience understood in tranquillity. You look back and see where you went wrong.”

Looking back over his career, he believes that teaching and writing is all about creating the “Aha!” moment. That occurs when people realise that an idea the teacher or writer has advanced is both useful and something they already knew but had not articulated.

No Excel or TEF here. The plain language belies the depth of the insight.

Charles Handy, Reflections of a business guru – Bartleby

Everybody wants growth but..

“Everyone wants growth but no one wants change.”

Paul Romer

Production functions: Those middle of the day blues

Every one of us has learned how to send emails on Sunday night. But how many of us know how to go to a movie at 2pm on Mondays? You’ve unbalanced your life without balancing it with something else.

Ricardo Semler

Via Status-Q. All too true. And now there is rugby on TV in the middle of the day on a weekday…

On lowering the tone with a very clumsy pair of hands

by reestheskin on 28/08/2020

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Beautiful obituary of the wonderful classical guitarist and lutenist Julian Bream. Some of this story I knew already.

Almost as he started his long love affair with the guitar, Julian Bream was aware he was doing something disreputable. When he was caught as a teenager practising Bach in the Royal College of Music, he was warned not to bring that instrument into the building again. It lowered the tone.

Even the Army shared the snobbery

Signing on to do his National Service in an army band, he was told he could play piano and cello, fine, but the guitar only “occasionally”.

And it is not just rock musicians who sleep in the van before driving back up the M1 (note: an Austin, rather than a Transit)

Audiences clapped long and hard when he performed in the Wigmore Hall at 18, in 1951, but as he toured round Britain in the mid-1950s, sleeping in his Austin van to save on hotels, not many came to hear him.

Those from the home of the guitar were no less enthusiastic about this man from those Isles.

And from Spain, the spiritual and historical home of the guitar, came the loudest scorn of all. An Englishman playing a guitar, said one virtuoso, was a kind of blasphemy.

What I didn’t know was that he was essentially self-taught. This is common in rock, folk, and jazz and blues, but I assume rare in Classical music. Although Segovia was moderately well known, perhaps the lack of popularity of the guitar in the UK made this necessary. Readers of this rag will know that I am fascinated by autodidacts and what skills you can — and cannot —learn to a high level without formal instruction. My prejudice is also-taught: the energy needed to acquire mastery alone is worth so much more than the competence gained on the transactional shoulders of others. Passion and perspective are worth more than 50 IQ points, as they say.

There are limits, however. In this video he talks about his fingers and technique:

‘Unfortunately the Almighty bequeathed me with a very clumsy pair of hands… and very slow’ (link)

He had form on the lute as well, playing with the nails rather than the fingers, and again faced the distain of the ‘experts’.

Below, a video on why Bream thought of himself as a meat and potatoes Englishman.

Those qualified need not apply

From a letter in last week’s Economist from Andrew Carroll, commenting on the Economist’s own description of Clement Atlee

He “lacks the conspicuous attributes of a leader” but “has undeniable ability, judgment and integrity” (“Mr Attlee and Sir A. Sinclair”, November 30th 1935)

Now I know where we have been going wrong.

The end of medical schools

by reestheskin on 27/08/2020

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A few months back, I was walking past the entrance of the old Edinburgh Medical School, founded in 1726. A not-so-crazy thought came into my head, one that I could not dismiss: we need to move on from the idea that a Medical School must be situated within a University (and of course, it wasn’t always, anyway).  The founding set of ideas that we have struggled with ever since Flexner, we should now recast for a very different world. We need to create something new, something that makes sense in terms of a university and something that puts professional training within a professional context. At present, we fail on both of these accounts. Rather than integrate we should fracture. We need to search out our own new world.

 

On making humans as stupid as machines

by reestheskin on 25/08/2020

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Specialisation and the division of labour is as old as humanity, and of course it goes way back further when we are talking biology. Adam Smith may have formalised why and how it was important economically but he did not invent it. Most specialisation relies on expertise, at least it used to until Crapita and the like started mining the seams of government ignorance.

The quote below is from an article in the Economist in May this year. It is about Public Health England (PHE) and how since they only possessed 290 contact tracers, they needed to call on those wonderful experts in everything, Serco, to help them out. Of course, expertise in such tasks always used to reside with Local Government, not PHE, but Boris and his bunch of Maoists, when they are not having their eyes tested in the fast lane, have decreed that Local Government — along with the opposition, the judges, the education sector and more — are enemies of the people. Given this mindset, we are left with those whose main area of expertise is commercialising ignorance.

Firms such as Serco, a big contractor, are in talks with the government to provide the workforce. It should be possible to train new recruits fairly quickly—the requirements of the job are similar to those of 111 operators, for whom the training time is just four hours. They will work from a script that guides them through the various stages of an interview [emphasis added].

Awhile back, I ended up corresponding with somebody in the Scottish government about how misleading their self-help pages on skin disease were: they contained factual errors, and would mislead people seeking medical help. The content had clearly not been written by a medical practitioner — defined as somebody with domain clinical expertise and who might have actually dealt with patients by shaking hands with them. Asking for validation studies or some sort of empirical evidence to support the content, was unhelpful as the content was supplied by another agency and was commercially ‘confidential’. I didn’t follow up because the person I corresponded with clearly knew that his own position was both untenable, and uncomfortable. Its just business: you know, ‘new ways of working’, ‘direction of travel’, and all those other vacuous suitcase terms that just mark a space where reason or domain expertise used to reside.

Rather than making clever machines, or allowing humans to do what only humans can do1, it seems we are content to make humans behave as stupidly as Excel spreadsheets. 111 is not for BoJo et al.; 111 is for poor people waiting to be levelled up, even if the best way to do that, is to go to straight to A&E. 2

TIJABP

  1. See Norbert Wiener’s classic The Human Use of Human Beings
  2. Image at top of page via Wikimedia here

Graph of the day

by reestheskin on 24/08/2020

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Because you are not worth it.

by reestheskin on 21/08/2020

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I read about the QALY (quality adjusted life year) during my intercalated degree in 1980-81, when we were exposed to some health economics. It was considered new and interesting at the time. It took me about 10 minutes to sense that it was nonsense, even if I couldn’t quite put my feelings into words that quickly1. The goal was fine, but the methodology was metaphysical in nature, rather than grounded in the world that you could touch with your fingers. At least not if you look at the world through the prism of the natural sciences.

Economists have a disturbing habit of confusing how the world works with their own (strange) ideas of rationality. If only the world could be said to work in a way that was amenable to their methods. When physicists wanted to estimate the speed of light they recognised that they had to create some theory and some technology in order to obtain the correct answer. Embarrassingly — at least from the economists point of view — they had to do some experiments and see if their answer made sense when applied to new observations in the external world. Until they had done this, they stayed shtum.

Not so, for our economists. Their solution is effectively to agree some conventions, and then define what the speed of light should be. Whether their theory explains the way the world really works is neither here-nor-there. So QUALYs became a make-believe that suited both economists and the technocrats in government. The former, because the need for QUALYs became a job creation scheme for health economists (just as evidence based medicine (EBM) became a lifeline for all those epidemiologists who belatedly realised that much of their subject was methodologically deeply flawed). The technocratic governments liked what the economists brought them because it exiled judgement (and hence blame), allowing human suffering to be traded in arbitrage markets from which they could metaphorically wash their hands — ‘just following the science’, ‘just following the science’ (ring any bells?). Many politicians don’t want to do politics, but they do want to stay in power. As do economists2, who appear pathologically obsessed with rank and status3. The Economist had a nice line earlier this year germane to my doubts:

But unlike poets, economists prefer to quantify their analogies—to measure whether thou art 15% or 20% more lovely and more temperate.

But if you think that artificial models that cannot predict the world are still useful — useful in the way the philosophers trolley problems are — then the quote below should indeed make you sit up and stare.

If we’re willing to pay $150,000 for each quality-adjusted extra year of life (a commonly used estimate), then we ought to view a 10% increase in spending per capita as a good investment if it extended average life expectancy by 2.5 days. That number may give readers pause — hence the importance of clarifying our spending priorities and focusing on care that produces real value for patients. With such a focus, we could feel more confident that higher health care spending was worth it.

Do We Spend Too Much on Health Care? | NEJM

 

  1. A nice critical (and perhaps dated) introduction from a once QUALY-enthusiast who returned from the dark side is Erik Nord’s, Cost-Value analysis in Health Care: Making Sense out of QALYs, CUP, 1999. The rearguard action is still ongoing (advance proceeds one funeral at a time …(Max Planck)).
  2. Here is a revealing quote from Alan Maynard, a health economist: “… unless we tackle the doctors, health reforms will fail to deliver … processes of health care are dominated by clinicians, who merely represent their own vested interests, we must therefore strengthen the role of health managers and economists, who would speak for society at large.” Quoted in Julian Tudor-Hart, Lancet 2004. Well good luck with that!
  3. A strange quirk of economists is that they appear obsessed with proxies for their own self-doubts. US economists cannot help but focus on why you have to graduate from the top five schools with a PhD in order to obtain a faculty position at the same school, and how critical math scores are to being academically successful(‘I could have been a physicist — honest!’) It is quite a contrast with the lives of some of the greatest natural scientists. Natural science is much more open. 

(Image of NotGeld (emergency money) at top of page from here)

Just three?

Doctors need three qualifications: to be able to lie and not get caught; to pretend to be honest; and to cause death without guilt.” So wrote Jean Froissart, a diarist of the Middle Ages, after an outbreak of bubonic plague in the 14th century. Fake news then meant rumours that the plague could be cured by sitting in a sewer, eating decade-old treacle or ingesting arsenic.

The Economist | Return of the paranoid style

Finding your way in your world

by reestheskin on 19/08/2020

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I read Educated by Tara Westover earlier this year (it was published in 2018 and was a best seller). It is both frightening and inspiring. And important. Her story is remarkable, and it says more about real education than all the government-subjugated institutions like schools and universities can cobble together in their mission statements. WikiP provides some background on her.

Westover was the youngest of seven children born in Clifton, Idaho (population 259) to Mormon survivalist parents. She has five older brothers and an older sister. Her parents were suspicious of doctors, hospitals, public schools, and the federal government. Westover was born at home, delivered by a midwife, and was never taken to a doctor or nurse. She was not registered for a birth certificate until she was nine years old. Their father resisted getting formal medical treatment for any of the family. Even when seriously injured, the children were treated only by their mother, who had studied herbalism and other methods of alternative healing.

All the siblings were loosely homeschooled by their mother. Westover has said an older brother taught her to read, and she studied the scriptures of The Church of Jesus Christ of Latter-day Saints to which her family belonged. But she never attended a lecture, wrote an essay, or took an exam. There were few textbooks in their house.

As a teenager, Westover began to want to enter the larger world and attend college.

The last sentence above has it, as The Speaker of the House of Commons might say.

She gained entry to Brigham Young University (BYU), Utah, without a high school diploma and her career there was deeply influenced by a few individuals who saw something in her. She was awarded a Gates scholarship to the University of Cambridge to undertake a Masters and was tutored there by Professor Jonathan Steinberg. Some of their exchanges attest to the qualities of both individuals, and not a little about a genuine education.

‘I am Professor Steinberg,’ he said. ‘What would you like to read?’

‘For two months I had weekly meetings with Professor Steinberg. I was never assigned readings. We read only what I asked to read, whether it was a book or a page. None of my professors at BYU had examined my writing the way Professor Steinberg did. No comma, no period, no adjective or adverb was beneath his interest. He made no distinction between grammar and content, between form and substance. A poorly written sentence, a poorly conceived idea, and in his view the grammatical logic was as much in need of correction.’

‘After I’ve been meeting with Professor Steinberg for a month, he suggested I write an essay comparing Edmund Burke with Publius, the persona under which James Madison, Alexander Hamilton and John Jay had written the Federalist papers.’

‘I finished the essay and sent it to Professor Steinberg. Two days later, when I arrived for our meeting, he was subdued. He peered at me from across the room. I waited for him to say the essay was a disaster, the product of an ignorant mind, that it had overreached, drawn to many conclusions from too little material.’

“I have been teaching in Cambridge for 30 years,” he said. “And this is one of the best essays I’ve read.” I was prepared for insults but not for this.

At my next supervision, Professor Steinberg said that when I apply for graduate school, he would make sure I was accepted to whatever institution I chose. “Have you visited Harvard?” he said. “Or perhaps you prefer Cambridge?”…

“I can’t go,” I said. “I can’t pay the fees.” “Let me worry about the fees,” Professor Steinbeck said.

You can read her book and feel what is says about the value of education on many levels, but I want to pick out a passage that echoed something else I was reading at the same time. Tara Westover writes of her time as a child teaching herself at home despite the best attempts of most of her family.

In retrospect, I see that this was my education, the one that would matter: the hours I spent sitting at the borrowed desk, struggling to parse narrow strands of Mormon doctrine in mimicry of a brother who’d deserted me. The skill I was learning was a crucial one, the patience to read things I could not yet understand [emphasis added].

At the same time as I was reading Educated  I was looking at English Grammar: A Student’s Introduction by Huddleston & Pullum (the latter of the University of Edinburgh). This is a textbook, and early on the authors set out to state a problem that crops up in many areas of learning but which I have not seen described so succinctly and bluntly.

We may give that explanation just before we first used the term, or immediately following it, or you may need to set the term aside for a few paragraphs until we can get to a full explanation of it. This happens fairly often, because the vocabulary of grammar can’t all be explained at once, and the meanings of grammatical terms are very tightly connected to each other; sometimes neither member of a pair of terms can be properly understood unless you also understand the other, which makes it impossible to define every term before it first appears, no matter what order is chosen [emphasis added].

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As a follow up to the previous entry

“Keep the company of those who seek the truth; run from those who have found it.”

Vaclav Havel, quoted by Randy Sullivan via the Economist

We should worry more about righteousness

I am no fan of Henry Kissinger (an easy statement to make), but the quote below says something worthy of careful consideration.

‘the most fundamental problem of politics… is not the control of wickedness but the limitation of righteousness’.

I am not certain where I came across the phrase so beware. If I had made it up I would be even happier.

Going back to the future

by reestheskin on 13/08/2020

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“Harvard sees me as a dollar sign, and not a person,” wrote one student on a petition currently circulating. The university did not respond to requests to comment. (link)

“With a significantly reduced value proposition, you should not be surprised that people will ask for lower fees,” said Andreas Schleicher, director for education and skills at the OECD. “In the long run, the unbundling of educational content, delivery and accreditation through digitalisation will make that inevitable anyway.”

I am no fan of much of what Andreas Schleicher says about education, and the above views have been circulating since at least the mid-1990s. I have been sceptical, and would add many caveats. Now I think I may have been too cautious, and have underestimated how fast the political landscape may change. If he and others turn out to be right, the traditional universities have only themselves to blame. The lower piece of bread of the educational sandwich may well be swallowed whole, but much of the filling is going to go, too. For the record, at least with respect to medicine and some other professional domains, the unbundling existed in the past, and it is not hard to reimagine how things could change back. Possibly for the better, even without the emetic that is Covid.

US universities under pressure to cut fees because of remote learning | Financial Times

Contagion: the sequel.

by reestheskin on 12/08/2020

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On September 1, I’m scheduled to teach 170 students in a windowless room. After 12 sessions of 3 hours in the sealed room with 170 people, 50 of them will then disperse back to their 20+ native countries for the holidays. If the producers of Contagion decide on a sequel, I have an idea for their opening scene.

Post Corona: Higher Ed, Part Deux | No Mercy / No Malice

No marks out of ten

by reestheskin on 11/08/2020

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Q: If you had to rate your satisfaction with your life so far, out of 10, what would you score?

A: I would be very dissatisfied with my life if it was ruled by marks out of 10.

Lovely answer. Interview with Jennifer Pike: My ambition is to continue fighting for the future of classical music

Competence, and the lack of it.

by reestheskin on 11/08/2020

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Someone in your family has fallen ill with a respiratory infection that has already killed large numbers. Your small house means that you do not have enough room to quarantine them. Your have little money, and the hospitals are full. You contact the local public health authority.

Not to worry, you are told: A crew will be by shortly to set up a sturdy, well-ventilated, portable, tiny house in your yard. Once installed, your family member will be free to convalesce in comfort. You can deliver home-cooked meals to their door and communicate through open windows — and a trained nurse will be by for regular examinations. And no, there will be no charge for the house.

A fascinating story by Naomi Klein in the Intercept. Seemingly from a time when government knew what government was for.

This is not a dispatch from some future functional United States, one with a government capable of caring for its people in the midst of spiraling economic carnage and a public health emergency. It’s a dispatch from this country’s past, a time eight decades ago when it similarly found itself in the two-fisted grip of an even deeper economic crisis (the Great Depression), and a surging contagious respiratory illness (tuberculosis).

How Not to Lose the Covid-19 Lockdown Generation

Dear boy, I’d rather see you in your coffin.

by reestheskin on 10/08/2020

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I thought the above quote was going to be from an exchange between James Hunt and Niki Lauda. But no, it was some advice from a mother to her son (Richard Seaman) on the choice of his bride.

At a party earlier that year he had met Erika Popp, the daughter of a director of BMW. When they decided to get married his mother disinherited him. Her final words to him were: ‘Dear boy, I would rather see you lying in your coffin than that you should contract this disastrous marriage.’

Seaman was dead six months later in a crash on the track so his mother did not have to wait long. Even the spectators got in the spirit of things:

During a race on the Pescara circuit in Italy in 1937, a driver crashed into a marker stone and collided with another car before spinning off into the crowd. Four spectators were killed at the scene, others had their legs severed and five died later from their injuries. ‘The race continued,’ Williams reports, ‘as races always did.’ After the 1955 Le Mans disaster, in which 83 people were killed by flying debris, crowd safety was vastly improved, but in Seaman’s day spectators died almost as often as drivers.

Now attitudes are different: even our attitude to the nuts and bolts:

The [F1]regulations cover everything from engine size to aerodynamic shape, and part of the game is to work out how much you can get away with while still obeying them. Some innovations are modest. Before it was banned in 2012, teams used helium rather than compressed air to power the guns used to remove wheel nuts during pit stops. The helium’s lower density made the guns spin faster, allowing them to get the nuts off fractionally quicker. The incremental gains add up. When the F1 championship began in the 1950s the average pit stop took 67 seconds. Nowadays a decent one takes around two seconds.

The power of incremental change.

Jon Day · Dear boy, I’d rather see you in your coffin: Paid to Race · LRB 16 July 2020

The Great Unwashed

by reestheskin on 07/08/2020

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Two letters in the LRB on the now settled status of student hygiene.

The first from Otto Saumarez Smith:

Keith Thomas reminisces about his introduction to regular baths when at Oxford in the 1950s (LRB, 16 July). The architectural historian Gavin Stamp once told me that when George Frederick Bodley came to build new student accommodation at King’s College, Cambridge in 1888, he asked the fellows whether he should include a bathroom, but was told not to be ridiculous: as terms were only eight weeks long the undergraduates could bathe after they got home.

The second from Richard J Evans, in conversation with a porter at an Oxford college:

‘What’s the main difference between the old days and now?’ I once asked him. ‘Well, sir,’ he replied, after some thought, ‘in the old days the young gentlemen used to change their shirt every day and take a bath once a week. Nowadays they take a bath every day and change their shirt once a week.’ It was clear from the shaking of his head that he did not regard this as an improvement.

I was delighted to get out of university halls, to the luxury of a toilet and bathroom only shared with five fellow students (and their occasional guests). The downsides included rodents, and ice on the inside of the bathroom windows. My memory is that the rent in 1977 was £1.85 per person for a salubrious🤣 central location on the Westgate road (opposite the Harley-Davidson shop, and a house of dubious repute). I was in hospital for a few weeks (as a patient) during this period and, at discharge, my father picked me up at the hospital, and we drove to the house so that I could collect some more clothes before heading back to my parents home;  he knew better than to come in.

Why Is College So Expensive?

by reestheskin on 06/08/2020

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From an article in the Atlantic a couple of years back (but the song remains the same).

“I used to joke that I could just take all my papers and statistical programs and globally replace hospitals with schools, doctors with teachers and patients with students,” says Dartmouth College’s Douglas Staiger, one of the few U.S. economists who studies both education and health care.

Both systems are more market driven than in just about any other country, which makes them more innovative—but also less coherent and more exploitive.

State cutbacks did not necessarily make colleges more efficient, which was the hope; they made colleges more entrepreneurial.

Why Is College in America So Expensive? – The Atlantic

You can even get a degree in this sort of behaviour, now: ouroboros studies.

Roll Over Beethoven it is not.

At the same time, Vox found ways of reaching groups of voters who were disgruntled by other aspects of modern life that the mainstream parties weren’t addressing. Think about how record companies put together new pop bands: they do market research, they pick the kinds of faces that match, and then they market the band by advertising it to the most favourable demographic. New political parties now operate like that: you can bundle together issues, repackage them, and then market them, using exactly the same kind of targeted messaging – based on exactly the same kind of market research – that you know has worked in other places. The ingredients of Vox were the leftover issues, the ones the others had ignored or underrated, such as opposition to Catalan and Basque separatism; opposition to same-sex marriage; opposition to feminism; opposition to immigration, especially Muslim immigration… It wasn’t an ideology on offer, it was an identity: carefully curated, packaged for easy consumption, queued up and ready to be “boosted” by a viral campaign.

Anne Applebaum in the Twilight of Democracy. Her description of Boris Johnson — her once fellow traveller — is well worth a read; I am glad the lawyers thought so too.

Queerer than I can imagine

by reestheskin on 05/08/2020

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“Although adult beetles were easily eaten by frogs, 90% of swallowed beetles were excreted within 6 h (0.1–6.0 h) after being eaten and, surprisingly, were still alive.” The aquatic beetle Regimbartia attenuata can swim right through a frog, found biologist Shinji Sugiura. ( Current Biology paper) (Watch a video of it happening in The New York Times, if that’s what you’re into.)

Nature Briefing reporting on a story in the New York Times

In the year of the plague 1666

by reestheskin on 03/08/2020

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I procured me a Triangular glass-Prisme, to try therewith the celebrated Phenomena of Colours. And in order thereto having darkened my chamber and made a small hole in my window-shuts, to let in a convenient quantity of the Suns light…but I surprised to see them in an oblong form; which, according to the received laws of Refraction, I expected should have been circular.

Well, Isaac Newton obviously had better functioning shutters than my bedroom blackout blinds. Most summer mornings (which at this latitude last much of the night…) I receive — without choice — lessons in physics 101. Here are some iPhone shots from this morning. The quote says a lot about science: note the terms, convenient quantity, surprised and expected.

No Mercy / No Malice / Killer whales

The killer whales (cash cows) of high-tuition prestige universities are international students. We claim we let them in for diversity. This is bullshit. International students are the least diverse cohort on earth. They are all rich kids who pay full tuition, get jobs at multinational corporations, and often return to the family business. At NYU, they constitute 27% of our student body and likely half our cash flow, as they are ineligible for financial aid. We have a pandemic coupled with an administration committed to the demonization of foreigners, including severely limiting the prospects of highly skilled grad students. This means the whales may just not show up this fall, leaving us with otters and penguins — an enormous fiscal hole.

Post Corona: Higher Ed, Part Deux | No Mercy / No Malice

Straight talking from Scott Galloway of Stern, NYU.

Late night thoughts of a clinical scientist.

by reestheskin on 30/07/2020

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More accurately, late night thoughts from 26 years ago. I have no written record of my Edinburgh inaugural, but my Newcastle inaugural given in 1994 was edited and published by Bruce Charlton in the Northern Review. As I continue to sift through the detritus of a lifetime of work, I have just come across it. I haven’t looked at it for over 20 years, and it is interesting to reread it and muse over some of the (for me) familiar themes. There is plenty to criticise. I am not certain all the metaphors should survive, and I fear some examples I quote from out with my field may not be as sound as I imply. But it is a product of its time, a time when there was some unity of purpose in being a clinical academic, when teaching, research and praxis were of a piece. No more. Feinstein was right. It is probably for the best, but I couldn’t see this at the time.

 

Late night thoughts of a clinical scientist

The practice of medicine is made up of two elements. The first is an ability to identify with the patient: a sense of a common humanity, of compassion. The second is intellectual, and is based on an ethic that states you must make a clear judgement of what is at stake before acting. That, without a trace of deception, you must know the result of your actions. In Leo Szilard’s words, you must “recognise the connections of things and the laws and conduct of men so that you may know what you are doing”.

This is the ethic of science. William Gifford, the 19th century mathematician, described scientific thought as “the guide of action”: “that the truth at which it arrives is not that which we can ideally contemplate without error, but that which we may act upon without fear”.

Late last year when I was starting to think what I wanted to say in my inaugural lecture, the BBC Late Show devoted a few programmes to science. One of these concerned itself with medical practice and the opportunities offered by advances in medical science. On the one side. Professor Lewis Wolpert, a developmental biologist, and Dr Markus Pembrey, a clinical geneticist, described how they went about their work. How, they asked, can you decide whether novel treatments are appropriate for a patient except by a judgement based on your assessment of the patient’s wishes, and imperfect knowledge. Science always comes with confidence limits attached.

On the opposing side were two academic ethicists, including the barrister and former Reith Lecturer Professor Ian Kennedy. You may remember it was Kennedy in his Reith lectures who quoting Ivan Illicit described medicine itself as the biggest threat to people’s health. The debate, or at least the lack of it. clearly showed that we haven’t moved on very far from when C P Snow (in the year I was born) gave his Two cultures lecture. What do I mean by two cultures? Is it that people are not aware of the facts of science or new techniques?… It was recently reported in the journal Science that over half the graduates of Harvard University were unable to explain why it is warmer in summer than winter. A third of the British population still believe that the sun goes round the earth.

But, in a really crucial way, this absence of cultural knowledge is not nearly so depressing as the failure to understand the activity rather the artefacts of science. Kennedy in a memorable phrase described knowledge as a ‘tyranny’1. It is as though he wanted us back with Galen and Aristotle, safe in our dogma, our knowledge fossilised and therefore ethically safe and neutered. There is, however, with any practical knowledge always a sense of uncertainly. When you lift your foot off the ground you never quite know where it is going to come down. And, as in Alice in Wonderland, “it takes all the running you can do to stay in the same place”.

It is this relationship, between practice and knowledge and how if affects my subject that I want to talk about. And in turn, I shall talk about clinical teaching and diagnosis, research and the treatment of skin disease.

 
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Politics as a class of dominant negative mutation

by reestheskin on 29/07/2020

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Today many scientists describe their research as apolitical, but Haldane knew that was impossible: ‘I began to realise that even if the professors leave politics alone, politics won’t leave the professors alone.’

From a review in the Economist of a biography of JBS Haldane by Samanth Subramanian.

Two things to add. Haldane’s paper A Defense of Beanbag Genetics is a personal favourite, but sticking with the genetics theme, I think of politics, and many politicians, as examples of dominant negative mutations.

Not Waiting to be an Actor

At the beginning of his career, an actor is a waiter who goes to auditions. Getting work makes him a successful actor, but he doesn’t only become an actor when he’s successful.

Paul Graham

Peter Green (1946-2020)

by reestheskin on 27/07/2020

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Most of the music I enjoy I came to via my brother (Al of Penglas in West Cork). There are a few exceptions: I discovered Ralph Towner and the whole ECM catalogue after an aside in an interview  with Larry Coryell; and Mahler, and morning music, from my time in Vienna.

I can remember one particular album that Alun bought as something special. It was a compilation and cost 19/11, and not surprisingly had a blue cover: The World of Blues Power. To my ear the music was incredibly varied, such that I couldn’t imagine how this was a coherent genre. Some tracks I disliked intensely whilst others were just magical. Amongst the latter were three tracks featuring John Mayall’s Bluesbreakers. On two, Eric Clapton was the lead: Steppin Out, which I later learned to play (badly), and All the Love, the guitar part of which — still to this day—  makes the hairs on the back of my neck stand up. If you listen 1’22” in you hear what digital amps and gear now refer to as the British Blues sound (or some such similar name). It is slowhand playing slowly. Magical. A giant beneficial  mutation in the history of the blues.

The third track, Greeny, was very different. It was John Mayall again, but this time with the late Peter Green who died just two days ago. The guitar was just so different, a delta of influences. BB King captures both the sound and Green:

He has the sweetest tone I ever heard; he was the only one who gave me the cold sweats.

On truth

by reestheskin on 26/07/2020

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Yes, a big word. From a review by Martin Wolf of Anne Applebaum’s Twilight of Democracy. Just pencil in your favourite organisation or person.

Her theme is not just this split. It is about the role of intellectuals in supporting the would-be despots. In this, she follows Julien Benda, author of a classic book, La trahison des clercs (1927). Benda’s target were the ideologues of his time, whom he accused, in Applebaum’s words, “of betraying the central task of the intellectual, the search for truth, in favor of particular political causes”.

How did people she knew come to support these new authoritarians? One answer, is “resentment, revenge and envy”. Replacing people of talent and principles with mediocrities who will do anything for success has never been difficult. Finding greedy people happy to join a corrupt new business elite is just as simple. She describes perceptively people who have done such things.

Alarm signals of our authoritarian age | Financial Times