The importance of obsession

by reestheskin on 16/12/2018

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How a Welsh schoolgirl rewrote the rules of publishing | Financial Times by Gillian Tett

In 2011, Beth Reeks, a 15-year-old Welsh schoolgirl studying for her GCSE exams, decided to write a teenage romantic novel. So she started tapping on her laptop with the kind of obsessive creative focus – and initial secrecy – that has been familiar to writers throughout history. “My parents assumed I was on Facebook or something when I was on my laptop – or I’d call up a document or internet page so it looked like I was doing homework,” she explained at a recent writers’ convention. “I wrote a lot in secret… and at night. I was obsessed.”

But Reeks took a different route: after penning eight chapters of her boy-meets-girl novel, The Kissing Booth, she posted three of them on Wattpad, an online story-sharing platform …. As comments poured in, Reeks turned to social media for more ideas. “I started a Tumblr blog and a Twitter account for my writing. I used them to promote the book…[and] respond to anyone who said they liked the story,” she explained in a recent blog post. 

… while Reeks was at university studying physics, her work was turned into an ebook, then a paperback (she was offered a three-book deal by the mighty Random House) and, this year, Netflix released it as a film, which has become essential viewing for many teenage girls.

Statistical pitfalls of personalized medicine

by reestheskin on 14/12/2018

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This is from an article by Stephen Senn in Nature. He keeps making this point — for the very good reason that people want to pretend there is no problem. But there is.

Personalized medicine aims to match individuals with the therapy that is best suited to them and their condition. Advocates proclaim the potential of this approach to improve treatment outcomes by pointing to statistics about how most drugs — for conditions ranging from arthritis to heartburn — do not work for most people. That might or might not be true, but the statistics are being misinterpreted. There is no reason to think that a drug that shows itself to be marginally effective in a general population is simply in want of an appropriate subpopulation in which it will perform spectacularly.

When you treat patients with chronic diseases such as psoriasis, it quickly becomes clear that there is considerable within person variation is response to treatments. We do not understand what this variation is due to. What we do know however, is that assuming variation in response between people at single time points may be misleading in that we have no measure of within person variance. This is only one of the problems. But hey, precision, personalised.. whatever: it shifts units (as Frank Zappa once said of Michael Jackson).

EBM meets capitalism — prescription for carnage

by reestheskin on 13/12/2018

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This is from a book review in the FT of American Overdose. by Chris McGreal — prescription for carnage.

McGreal has written an interview-based book, with especially vivid reporting from West Virginia, the state hit hardest by the epidemic. In the little town of Williamson, or Pilliamson as people came to call it, pharmacies were dispensing opioids at a staggering rate both to locals and to out-of-state visitors, who clogged its streets with their cars but boosted some local businesses as well as city tax revenues.

When the federal authorities belatedly raided one Williamson clinic in late 2009, they found that an individual doctor had written 355,132 opioid prescriptions over the previous seven years — about 1,000 for every inhabitant of the town. Another wrote 118,443 scrips over the same period. Most were handed out for cash fees without the doctors bothering to see their patients. The investigators estimated that the clinic took in $4.6m cash during 2009 and they found banknotes stuffed into safes and cupboards in the doctors’ homes and offices.

In the beginning was the..

by reestheskin on 12/12/2018

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My  “Beginner’s Guide” to the messy world of medical education over at Wonkhe.

[Link]

Red..well any hair colour, again.

by reestheskin on 11/12/2018

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Genome-wide study of hair colour in UK Biobank explains most of the SNP heritability.

Michael D. Morgan, Erola Pairo-Castineira, Konrad Rawlik, Oriol Canela-Xandri, Jonathan Rees, David Sims, Albert Tenesa & Ian J. Jackson

[Link to Nature Comm paper]  https://doi.org/10.1038/s41467-018-07691-z

My guess is this is likely my last ‘research paper’ (although I now choose to redefine what counts as research). But not my last ‘thinking paper’. I cannot help but contrast the sheer volume of activity with that from our original papers on red hair. Things seemed so much simpler when we were young. But it is a nice coda to a career fugue.

Maxim 2 of 2

by reestheskin on 11/12/2018

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If you can reliably assess knowledge and capabilities within a standardised and regulated framework it is not education.

Maxim 1 of 2

by reestheskin on 08/12/2018

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Any real education is incapable of robust widely accepted psychometric assessment that will satisfy a professional regulator.

The academy and asymmetric information.

by reestheskin on 06/12/2018

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Paul Romer on the Unrivaled Joy of Scholarship (Ep. 55)

Great interview with Paul Romer over at Conversations with Tyler. Romer won the Nobel prize for economics this year, and has had a wonderfully varied career (academic; founder of a software company that produces computer assisted learning material (Aplia); and time at the World bank. There are some earlier statements by him about education  on my web page.

What caught my eye in this interview was:

“We should always remember that the education business is one of the ones that has the biggest problems with asymmetric information. A young person who pays somebody to educate them is very dependent on the decisions that the educator makes about “Study this, go in this direction.”

……

“I think that the problem in higher ed is that the institutional incentives don’t provide the kind of training that would maximize the opportunities for the students or, for that matter, maximize outcomes for the nation.”

Indeed:  in many ways, the situation is even worse than in medicine.

“Bad strategy flourishes because it floats above analysis, logic, and choice, held aloft by the hot hope that one can avoid dealing with these tricky fundamentals and the difficulties of mastering them.”

Richard Rumelt “Good strategy/Bad strategy”. A moral for our time

Not so much compatible scholarship as built to order

by reestheskin on 05/12/2018

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Well, no surprises here.

DfE study of English universities’ costs seen as path to fee cut | Times Higher Education (THE)

The UK Department for Education has commissioned accountants KPMG to conduct a study of how much it costs universities to teach their students, in a move seen by some as a potential mechanism to lower the tuition fee cap in England.

The world is full of ‘compatible scholarship’ (Noam Chomsky’s phrase I think). But if you want to be 100% certain that the results are built to order, then you need professional service firms — just look at their track record! Academics come cheap, so only use them when you are not too worried about the results.

What drives graduate student numbers?

by reestheskin on 05/12/2018

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Interesting to sees the levers of scale. This is a piece about expansion at Harvard (the Allston expansion), drives by the shift to science and engineering (the proportion of students choosing applied math, computer science or engineering has gone from 6 to 20% (of the total annual intake of 2000 students)

Harvard’s Allston expansion ‘the next great innovation centre’ | Times Higher Education (THE)

The shift in student preferences towards science and engineering is creating a far greater net need for space than would be created by growth in other fields. More science and engineering students means more academics and classes, which in turn means more graduate students to help teach those undergraduates, which in turn means more lab space to house the graduate students [emphasis mine].

On being a para-academic, and the tyranny of counting

by reestheskin on 04/12/2018

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From an article in the THE, talking about Katherine Randell.

Scholars who write children’s literature | Times Higher Education (THE)

Rundell, whose books have already won several prizes, is a fellow of All Souls College in Oxford and describes herself as a “para-academic”. She is not required to submit work to the research excellence framework but is researching a book about the poet John Donne as well as preparing an edition of his works.

I return to something Larry Lessig said:

I would push hard to resist the tyranny of counting. There is no necessary connection between ease of counting and the production of education. [as in ‘likes’ etc after leaving lecture hall etc]. And so it will be easy for the institution to say this is what we should be doing but we need to resist that to the extent that that kind of counting isn’t actually contributing to education. The best example of this, I am sure many of you know are familiar with this, is the tyranny of counting in the British educational system for academics, where everything is a function of how many pages you produce that get published by journals. So your whole scholarship is around this metric which is about counting something which is relatively easy to count. All of us have the sense that this cant be right. That can’t be the way to think about what is contributing to good scholarship.

Well, much — but not all — of UK Higher Ed is little concerned with scholarship.

“The real world doesn’t care what you are bad at, it only cares what you are good at.” (It is not like school). CP Grey. On the podcast  ‘Cortex’.

Sinking not swimming.

by reestheskin on 30/11/2018

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At my old university, we were encouraged to explore our subjects and to love what we were studying. Now, at medical school, the emphasis seems to be don’t burnout, focus on not making mistakes, and understand that life is going to be hard, so develop the resilience to cope.

The above is from a letter to this month’s Academic Medicine [83(12) 1745-1884, 2018] written by a graduate student at Warwick medical school (TC Shortland). The title is what caught my eye: “Enjoying, and Not Just Surviving, Medical School”

He goes on:

At Warwick Medical School, staff and students are trying to build a more positive environment. Staff and students have organized art classes, interstaff/ student sports events, and several baking competitions; the last winner featured cupcakes that could be injected with either a salted caramel or raspberry filling. As positive health care workplaces and positive cultures are associated with better patient outcomes,why shouldn’t medical schools try and create such environments for future medical professionals?

I am not against the various suggestions (…well, I am actually), but what I and others are in despair about is how much (?most) medical education has become so dull, tedious, and brutal, rather than humane. When I have spoken to others, some hold similar views: the students put up with it, because they want to be doctors, but they no not enjoy most of it. If they are obliged to attend, they do; but out of choice, many would skip much of what we offer.

Now this is not a new thought or phenomenon. I didn’t enjoy — in fact I actively hated — the preclinical years (aka: the prescientific years) — but I did get a big kick out of the clinical years, and loved my intercalated degree. What made the clinical years work, was that the opportunity for some kind of personal  bond with some teaching staff made up for all the despots and dull souls who should have been destined to be gravediggers. And unless somebody has recently discovered something I have missed, scale and intimacy rarely go together.

Of course, what makes matters worse, is that the ennui and anomie will get worse: for many junior doctors, after the initial high of being qualified, their working jobs are miserable. If they get to higher training, things may improve, but not for all.

George Steiner’s comments in a slightly different context are apposite:

“Bad teaching is, almost literally, murderous and, metaphorically, a sin. It diminishes the student, it reduces to gray inanity the subject being presented. It drips into the child’s or the adult’s sensibility that most corrosive of acids, boredom, the marsh gas of ennui.”

The NHS (for this is the fault of the NHS rather thant the universities) is accumulating a massive moral debt, borrowing on the very market it has rigged (because it can!), forgetting that this is like PFI on steroids. It assumes it is too big to fail: I think otherwise.

Hemingway:

How did you go bankrupt: slowly and then suddenly.

 

Peanuts….I wish I had said that

by reestheskin on 28/11/2018

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This is from an editorial in the NEJM, discussing the results of a trial of a synthetic peanut antigen to facilitate tolerance. Prevously the ‘raw’ stuff had been shown to be useful. The synethic version will of course cost a lot, and might be considered IPR created through regulatory arbitrage.

AR101 and other, similar products such as CA002, which is being developed by the Cambridge group, would therefore appear to have a role in initial dose escalation. The potential market for these products is believed to be billions of dollars. It is perhaps salutary to consider that in the study conducted by the Cambridge group, children underwent desensitization with a bag of peanut flour costing peanuts.

Costing penauts: I wish I had said that

Oral Desensitization to Peanuts | NEJM

The frenzy of metrics rolls on

by reestheskin on 27/11/2018

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What are metrics good for? Reflections on REF and TEF from Dorothy Bishop

John Burton RIP

by reestheskin on 26/11/2018

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(Professor) John Burton died recently. He worked in Newcastle before my time there, but his reputation was ever present. When I did some research on eccrine glands as a medical student, I came across some of the papers he published with Sam (Shuster) on sebum. But it was his textbook “Essentials of Medicine” that I still marvel at. A textbook that in places made you break out in laughter the way a Tom Sharpe novel did (The scene on a train was as follows: somebody quietly reading would foolishly try to suppress the inevitable convulsion of laughter — a glance at the book cover, would confirm the hypothesis). I suspect subsequent editions of ‘Essentials’ were sanitised — not certain the Welder from Wigan with Warts, or the differential diagnosis of lipstick on that most prized of organs, survived.

When I actually got to meet John, what struck me most was how dull and conventional he appeared. I am not certain what I expected, but at least with Sam, when you got to meet him, his appearance betrayed his intellect and ability to prick pomposity.

Since I was in charge of organising Sam’s retirement festivities in 1992, I invited John to provide the humour. The ‘old’ seminar room was standing room only, and John’s irreverence and ability to play an audience was — and I realised it at the time — magical. Perhaps the only occasion I ever saw Sam reduced to silence. As they say in Wales about such moments, ‘I was there’.

The Long Now

by reestheskin on 21/11/2018

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John Kennedy told the story of Marshal Hubert Lyautey (1854–1934), a French army general and colonial administrator in Morocco. Lyautey asked his gardener to plant a certain tree. The gardener objected that the tree would grow slowly and wouldn’t reach maturity for a century. “In that case,” the marshal replied, “there is no time to lose. Plant it this afternoon.”

From Larry Lessig in America, Compromised.

What is thing we call education?

by reestheskin on 15/11/2018

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There is one of those beautifully written pieces on Medium, written by the ex-editor of Nature, Philip Ball [link]. It speaks of something particular, and also in the round.

My handwriting has been terrible as long as I can remember. I have tried on various occasions to improve it, but these attempts seldom last as long as the end of the day. In truth, it is not just others who find my writing hard to decipher — after a few minutes I seldom can make much sense of it. And much as though I would like to blame being a doctor for my troubles, I suspect this is just wishful thinking.

Ball’s article is about the fixation on cursive versus, rather than manuscript writing. He writes:

Something like modern cursive emerged from Renaissance Italy, perhaps partly because lifting a delicate quill off and on the paper was apt to damage it and spatter ink. By the 19th century cursive handwriting was considered a mark of good education and character.

I just smile when I read titbits like this. One of those fascinating explanations for something I had never considered or thought about. He argues that the usual arguments for cursive writing — that it is faster, or that it helps with spelling, or that it is useful for those with dyslexia are not well founded. So why does it persist?

He fixes (rightly) on the strange set of beliefs that constitute considered thought in education. You know, the sorts of things that are not far away from the “ I went to school, so I understand education” trope. (The medicine version is of course: ‘I know how to treat people, so I know how to teach other people to treat people’).

He writes:

It suggests that what teachers “know” about how children learn is sometimes more a product of the culture in which they’re immersed than a result of research and data. It seems unlikely, in this regard, that teaching cursive is unique in educational practice. Which forces us to wonder: What happened to evidence?

And then:

This must surely lead us to wonder how much else in education is determined by a belief in what is “right,” unsupported by evidence. Education and learning are difficult to pin down by research. Teaching practices vary, it’s often impossible to identify control groups, and socioeconomic factors play a role. But it’s often the case that the very lack of hard, objective evidence about an issue, especially in the social sciences, encourages a reliance on dogma instead. The danger is greater in education, which, like any issue connected to child rearing and development, is prone to emotive views.

This all bothers me. Not that I think he is wrong, but rather, I find it hard to conceptualise what character of enquiry is both robust and useful in this domain. One look at medical education, and you realise, we are nowhere close to being there.

Time and lives have gone by

by reestheskin on 13/11/2018

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Over 40 years ago, I remember lectures on basic demography, and what changes to the  population  mix of the UK were likely. The late John Grimley Evans was one lecturer, but others went over cognate themes including Klaus Bergmann who pointed out the relevance of increased mobility when considering family and / or social support. ‘Were we prepared to adopt each other people’s grannies?’, stuck in my mind. If you look at the family structures in some working class areas (think parts of Newcastle), and how they have changed, it was obvious what might happen. The sociologist Peter Townsend published studies based in London, highlighting the depth of community support that once existed.

Which is why I get so cross when you come across this as a new problem, as though all these baby boomers (like me) were born yesterday. As though we didn’t know; as though nothing could have been done to prepare for such a change. Remember too, when to study dementia or stroke, or seek funds for such topics was……well futile.

The following is from an article  in the FT (How Britain can heal its ailing social care system | Financial Times). Once again the dismal leadership of the UK compares unfavourably with that of some other European countries

The pressure on staff is becoming unbearable. Good social care is about creating relationships. Staff who work for domiciliary care operations like those run by Allied Healthcare must walk into the home of a stranger, reassure them, figure out what is needed, and build trust. That takes maturity, emotional resilience and time. Yet, all too often, the reality is rushed visits from a plethora of different faces.

A few years ago, I met an 89-year-old man who had made a note of every carer who had crossed his threshold in the past year — Meals on Wheels, district nurse, domiciliary care staff. He showed me the list. There were 102 names on it. Some had only come once, then vanished — probably into better paying jobs at a supermarket. That is the stark reality of how little we value our elderly.

For-profit means, for-profit

by reestheskin on 12/11/2018

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A tidy phrase from Stephen Downes in a comment on corporate cash and universities:

There’s nothing especially new here, though it is helpful to remember that when for-profit corporations donate money, it is with a for-profit objective.

[Link]

Never knowingly relevant

by reestheskin on 11/11/2018

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A few words from Melvyn Bragg about his radio programme ‘In our time’

He insisted that the programme should be “never knowingly relevant” and jumped wildly from the gin craze of the 18th century to the Palaeocene-Eocene thermal maximum. He expected to be out of a job in six months

The Economist | Sweetness and light

In times like ours, not a bad motto to live by.

Universities ‘must read applicants’ work

by reestheskin on 08/11/2018

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Leading universities should pledge to actually read the work of applicants for research positions rather than use controversial metrics during the selection process, a Nobel prizewinner has argued.

No, not a spoof, but words from Harold Varmus. Sydney Brenner, a good while back, observed that people tended not to read papers anymore, they just xeroxed them.

Modesty

by reestheskin on 05/11/2018

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Modesty seems to be under negative selection — among modern scientists, at least. So I warmed to this comment on a report of some recent work on the genetics of Africa and hunter-gatherers.

Rare genetic sequences illuminate early humans’ history in Africa

Deepti Gurdasani, a genetic epidemiologist at the Wellcome Sanger Institute in Hinxton, UK. But it’s plausible, she adds. “There is literally nothing in Africa that is not possible since we have no idea what humans were doing on the continent 5,000 years ago.”

On observing those not so ‘minute particulars’

by reestheskin on 01/11/2018

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This is from an article in Nature.

Under pressure to turn out productive lab members quickly, many PhD programmes in the biomedical sciences have shortened their courses, squeezing out opportunities for putting research into its wider context. Consequently, most PhD curricula are unlikely to nurture the big thinkers and creative problem-solvers that society needs.

That means students are taught every detail of a microbe’s life cycle but little about the life scientific. They need to be taught to recognize how errors can occur. Trainees should evaluate case studies derived from flawed real research, or use interdisciplinary detective games to find logical fallacies in the literature. Above all, students must be shown the scientific process as it is — with its limitations and potential pitfalls as well as its fun side, such as serendipitous discoveries and hilarious blunders.

And from a letter in response

My father designed stellar-inertial guidance systems for reconnaissance aircraft and, after he retired, would often present his work to physics and engineering students. When they asked him what they should study to prepare for such a career, he would reply: “Read the classics,” by which he meant Aristotle, Ralph Waldo Emerson, Jean-Jacques Rousseau and Blaise Pascal.

The best scientific and technical progress does not come out of a box. It is more likely to emerge from trying to fit wild, woolly and tangential ideas into useful societal and economic contexts.

As the historian Norman Davies once said:

“Since no one is judged competent to offer an opinion beyond their own particular mineshaft, beasts of prey have been left to prowl across the prairie unchecked.”

Or as the Economist once put it”

“…professors fixated on crawling alone the frontiers of knowledge with a magnifying glass.”

This is the tragedy of our age: 90% right and 100% wrong. And that is even before we get to  medicine.

Money matters

by reestheskin on 31/10/2018

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This article and data on funding streams in higher ed is well worth exploring. It adds a necessary counterpoint to any consideration of what has happened to HE in the UK over recent decades. And, I see the time span maps closely to my own career as a Professor. I still struggle with the ‘why’ question. Some of the graphs are scary.

Wonga: not dead yet

by reestheskin on 30/10/2018

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This is a THE quote referring to the late Sir David Watson. [Link]

In England, he said, undergraduates had been reduced to “state-sponsored Wonga-style customers”; you can see what I mean about that turn of phrase.

I can indeed. And I claim to have come up with  similar terminology independently.

Exodus

by reestheskin on 25/10/2018

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I do not have a coherent overview of many of the traditional professions, but I wonder if people will soon say similar things about doctors.[Link]

“The big issue that concerns me at the moment in the English education system is the supply of high-quality teachers. We’ve seen quality issues in recruitment to teaching and our schools are getting increasingly desperate to find decent teachers. The whole workload issue has come to a big head again in England with teachers having very big workloads and their conditions of service is deteriorating a lot recently. We’re seeing a big exodus in teaching and so of course, we need a bigger inflow to maintain the balance.”

Michael Day.

Dylan Wiliam talking sense again

by reestheskin on 24/10/2018

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Wiliam is talking about schooling, but it is also true of medical education.[Link]. 

“For me, I think the issue in the United States in particular is how we improve education at scale. I argue there are two things that have particularly powerful impact. One is a knowledge-based curriculum, recognizing that the purpose of curriculum is to build long-term memory into our students and what distinguishes novices from experts is knowledge not skills. And the second one is creating a culture where every teacher accepts the need to improve, not because they’re not good enough, but because they can be even better.”

I am pleased with the  comment about long-term memory: intellect’s ballast. Knowing things matters. 

“They have mobile phones, social media, but no proper toilets and clean water.” Link.