For decades, Katalin Karikó’s work into mRNA therapeutics was overlooked by her colleagues. Now it’s at the heart of the two leading coronavirus vaccines
By the mid 1990s, Karikó’s bosses at UPenn had run out of patience. Frustrated with the lack of funding she was generating for her research, they offered the scientist a bleak choice: leave or be demoted. It was a demeaning prospect for someone who had once been on the path to a full professorship. For Karikó’s dreams of using mRNA to create new vaccines and drugs for many chronic illnesses, it seemed to be the end of the road… ”It was particularly horrible as that same week, I had just been diagnosed with cancer,” said Karikó. “I was facing two operations, and my husband, who had gone back to Hungary to pick up his green card, had got stranded there because of some visa issue, meaning he couldn’t come back for six months. I was really struggling, and then they told me this.”
Karikó has been at the helm of BioNTech’s Covid-19 vaccine development. In 2013, she accepted an offer to become Senior Vice President at BioNTech after UPenn refused to reinstate her to the faculty position she had been demoted from in 1995. “They told me that they’d had a meeting and concluded that I was not of faculty quality,” she said. ”When I told them I was leaving, they laughed at me and said, ‘BioNTech doesn’t even have a website.’”
Donald Knuth is a legend amongst computer scientists.
I have been a happy man ever since January 1, 1990, when I no longer had an email address. I’d used email since about 1975, and it seems to me that 15 years of email is plenty for one lifetime.Email is a wonderful thing for people whose role in life is to be on top of things. But not for me; my role is to be on the bottom of things. What I do takes long hours of studying and uninterruptible concentration. I try to learn certain areas of computer science exhaustively; then I try to digest that knowledge into a form that is accessible to people who don’t have time for such study. [emphasis added]
I retired early because I realized that I would need at least 20 years of full-time work to complete The Art of Computer Programming (TAOCP), which I have always viewed as the most important project of my life.
Being a retired professor is a lot like being an ordinary professor, except that you don’t have to write research proposals, administer grants, or sit in committee meetings. Also, you don’t get paid.
My full-time writing schedule means that I have to be pretty much a hermit. The only way to gain enough efficiency to complete The Art of Computer Programming is to operate in batch mode, concentrating intensively and uninterruptedly on one subject at a time, rather than swapping a number of topics in and out of my head. I’m unable to schedule appointments with visitors, travel to conferences or accept speaking engagements, or undertake any new responsibilities of any kind.
John Baez is indeed a relative of that other famous J(oan) Baez. I used to read his blog avidly
The great challenge at the beginning of ones career in academia is to get tenure at a decent university. Personally I got tenure before I started messing with quantum gravity, and this approach has some real advantages. Before you have tenure, you have to please people. After you have tenure, you can do whatever the hell you want — so long as it’s legal, and you teach well, your department doesn’t put a lot of pressure on you to get grants. (This is one reason I’m happier in a math department than I would be in a physics department. Mathematicians have more trouble getting grants, so there’s a bit less pressure to get them.)
The great thing about tenure is that it means your research can be driven by your actual interests instead of the ever-changing winds of fashion. The problem is, by the time many people get tenure, they’ve become such slaves of fashion that they no longer know what it means to follow their own interests. They’ve spent the best years of their life trying to keep up with the Joneses instead of developing their own personal style! So, bear in mind that getting tenure is only half the battle: getting tenure while keeping your soul is the really hard part. [emphasis added]
Scientists straying from their field of expertise in this way is an example of what Nathan Ballantyne, a philosopher at Fordham University in New York City, calls “epistemic trespassing”. Although scientists might romanticize the role and occasional genuine insight of an outsider — such as the writings of physicist Erwin Shrödinger on biology — in most cases, he says, such academic off-piste manoeuvrings dump non-experts head-first in deep snow. [emphasis added]
But I do love the language…
Susan Haack is a wonderfully independent English borne philosopher who loves to roam, casting light wherever her interest takes her.
Better ostracism than ostrichism
Moreover, I have learned over the years that I am temperamentally resistant to bandwagons, philosophical and otherwise; hopeless at “networking,” the tit-for-tat exchange of academic favors, “going along to get along,” and at self-promotion
That I have very low tolerance for meetings where nothing I say ever makes any difference to what happens; and that I am unmoved by the kind of institutional loyalty that apparently enables many to believe in the wonderfulness of “our” students or “our” department or “our” school or “our” university simply because they’re ours.
Nor do I feel what I think of as gender loyalty, a sense that I must ally myself with other women in my profession simply because they are women—any more than I feel I must ally myself with any and every British philosopher simply because he or she is British. And I am, frankly, repelled by the grubby scrambling after those wretched “rankings” that is now so common in philosophy departments. In short, I’ve never been any good at academic politicking, in any of its myriad forms.
And on top of all this, I have the deplorable habit of saying what I mean, with neither talent for nor inclination to fudge over disagreements or muffle criticism with flattering tact, and an infuriating way of seeing the funny side of philosophers’ egregiously absurd or outrageously pretentious claims — that there are no such things as beliefs, that it’s just superstitious to care whether your beliefs are true, that feminism obliges us to “reinvent science and theorizing,” and so forth.
From a wonderful article in the Economist
As Michael Massing shows vividly in “Fatal Discord: Erasmus, Luther and the Fight for the Western Mind” (2018), the growing religious battle destroyed Erasmianism as a movement. Princes had no choice but to choose sides in the 16th-century equivalent of the cold war. Some of Erasmus’s followers reinvented themselves as champions of orthodoxy. The “citizen of the world” could no longer roam across Europe, pouring honeyed words into the ears of kings. He spent his final years holed up in the free city of Basel. The champion of the Middle Way looked like a ditherer who was incapable of making up his mind, or a coward who was unwilling to stand up to Luther (if you were Catholic) or the pope (if you were Protestant).
The test of being a good Christian ceased to be decent behaviour. It became fanaticism: who could shout most loudly? Or persecute heresy most vigorously? Or apply fuel to the flames most enthusiastically?
And in case there is any doubt about what I am talking about.
In Britain, Brexiteers denounce “citizens of the world” as “citizens of nowhere” and cast out moderate politicians with more talent than they possess, while anti-Brexiteers are blind to the excesses of establishment liberalism. In America “woke” extremists try to get people sacked for slips of the tongue or campaign against the thought crimes of “unconscious bias”. Intellectuals who refuse to join one camp or another must stand by, as mediocrities are rewarded with university chairs and editorial thrones. [emphasis added]
As Erasmus might have said: ‘Amen’.
According to a helpful app on my phone that I like to think acts as a brake on my sloth, I retired 313 days ago. One of the reasons I retired was so that I could get some serious work done; I increasingly felt that professional academic life was incompatible with the sort of academic life I signed up for. If you read my previous post, you will see this was not the only reason, but since I have always been more of an academic than clinician, my argument still stands.
Over twenty years ago, my friend and former colleague, Bruce Charlton, observed wryly that academics felt embarrassed — as though they had been caught taking a sly drag round the back of the respiratory ward — if they were surprised in their office and found only to be reading. No grant applications open; no Gantt charts being followed; no QA assessments being written. Whatever next.
I thought about retirement from two frames of reference. The first, was about finding reasons to leave. After all, until I was about 50, I never imagined that I would want to retire. I should therefore be thrilled that I need not be forced out at the old mandatory age of 65. The second, was about finding reasons to stay, or better still, ‘why keep going to work?’. Imagine you had a modest private income (aka a pension), what would belonging to an institution as a paid employee offer beyond that achievable as a private scholar or an emeritus professor? Forget sunk cost, why bother to move from my study?
Many answers straddle both frames of reference, and will be familiar to those within the universities as well as to others outwith them. Indeed, there is a whole new genre of blogging about the problems of academia, and employment prospects within it (see alt-acor quit-lit for examples). Sadly, many posts are from those who are desperate to the point of infatuation to enter the academy, but where the love is not reciprocated. There are plenty more fish in the sea, as my late mother always advised. But looking back, I cannot help but feel some sadness at the changing wheels of fortune for those who seek the cloister. I think it is an honourable profession.
Many, if not most, universities are very different places to work in from those of the 1980s when I started work within the quad. They are much larger, they are more corporatised and hierarchical and, in a really profound sense, they are no longer communities of scholars or places that cherish scholarly reason. I began to feel much more like an employee than I ever used to, and yes, that bloody term, line manager, got ever more common. I began to find it harder and harder to characterise universities as academic institutions, although from my limited knowledge, in the UK at least, Oxbridge still manage better than most 1. Yes, universities deliver teaching (just as Amazon or DHL deliver content), and yes, some great research is undertaken in universities (easy KPIs, there), but their modus operandi is not that of a corpus of scholars and students, but rather increasingly bends to the ethos of many modern corporations that self-evidently are failing society. Succinctly put, universities have lost their faith in the primacy of reason and truth, and failed to wrestle sufficiently with the constraints such a faith places on action — and on the bottom line.
Derek Bok, one of Harvard’s most successful recent Presidents, wrote words to the effect that universities appear to always choose institutional survival over morality. There is an externality to this, which society ends up paying. Wissenschaft als Beruf is no longer in the job descriptions or the mission statements2.
A few years back via a circuitous friendship I attended a graduation ceremony at what is widely considered as one of the UK’s finest city universities3. This friend’s son was graduating with a Masters. All the pomp was rolled out and I, and the others present, were given an example of hawking worthy of an East End barrow boy (‘world-beating’ blah blah…). Pure selling, with the market being overseas students: please spread the word. I felt ashamed for the Pro Vice Chancellor who knew much of what he said was untrue. There is an adage that being an intellectual presupposes a certain attitude to the idea of truth, rather than a contract of employment; that intellectuals should aspire to be protectors of integrity. It is not possible to choose one belief system one day, and act on another, the next.
The charge sheet is long. Universities have fed off cheap money — tax subsidised student loans — with promises about social mobility that their own academics have shown to be untrue. The Russell group, in particular, traducing what Humboldt said about the relation between teaching and research, have sought to diminish teaching in order to subsidise research, or, alternatively, claimed a phoney relation between the two. As for the “student experience”, as one seller of bespoke essays argued4, his business model depended on the fact that in many universities no member of staff could recognise the essay style of a particular student. Compare that with tuition in the sixth form. Universities have grown more and more impersonal, and yet claimed a model of enlightenment that depends on personal tuition. Humboldt did indeed say something about this:
“[the] goals of science and scholarship are worked towards most effectively through the synthesis of the teacher’s and the students’ dispositions”.
As the years have passed by, it has seemed to me that universities are playing intellectual whack-a-mole, rather than re-examining their foundational beliefs in the light of what they offer and what others may offer better. In the age of Trump and mini-Trump, more than ever, we need that which universities once nurtured and protected. It’s just that they don’t need to do everything, nor are they for everybody, nor are they suited to solving all of humankind’s problems. As had been said before, ask any bloody question and the universal answer is ‘education, education, education’. It isn’t.
That is a longer (and more cathartic) answer to my questions than I had intended. I have chosen not to describe the awful position that most UK universities have found themselves in at the hands of hostile politicians, nor the general cultural assault by the media and others on learning, rigour and nuance. The stench of money is the accelerant of what seeks to destroy our once-modern world. And for the record, I have never had any interest in, or facility for, management beyond that required to run a small research group, and teaching in my own discipline. I don’t doubt that if I had been in charge the situation would have been far worse.
Sydney Brenner, one of the handful of scientists who made the revolution in biology of the second half of the 20th century once said words to the effect that scientists no longer read papers they just Xerox them. The problem he was alluding to, was the ever-increasing size of the scientific literature. I was fairly disciplined in the age of photocopying but with the world of online PDFs I too began to sink. Year after year, this reading debt has increased, and not just with ‘papers’ but with monographs and books too. Many years ago, in parallel with what occupied much of my time — skin cancer biology and the genetics of pigmentation, and computerised skin cancer diagnostic systems — I had started to write about topics related to science and medicine that gradually bugged me more and more. It was an itch I felt compelled to scratch. I wrote a paper in the Lancet on the nature of patents in clinical medicine and the effect intellectual property rights had on the patterns of clinical discovery; several papers on the nature of clinical discovery and the relations between biology and medicine in Science and elsewhere. I also wrote about why you cannot use “spreadsheets to measure suffering” and why there is no universal calculus of suffering or dis-ease for skin disease ( here and here ); and several papers on the misuse of statistics and evidence by the evidence-based-medicine cult (here and here). Finally, I ventured some thoughts on the industrialisation of medicine, and the relation between teaching and learning, industry, and clinical practice (here), as well as the nature of clinical medicine and clinical academia (here and here ). I got invited to the NIH and to a couple of AAAS meetings to talk about some of these topics. But there was no interest on this side of the pond. It is fair to say that the world was not overwhelmed with my efforts.
At one level, most academic careers end in failure, or at last they should if we are doing things right. Some colleagues thought I was losing my marbles, some viewed me as a closet philosopher who was now out, and partying wildly, and some, I suspect, expressed pity for my state. Closer to home — with one notable exception — the work was treated with what I call the Petit-mal phenomenon — there is a brief pause or ‘silence’ in the conversation, before normal life returns after this ‘absence’, with no apparent memory of the offending event. After all, nobody would enter such papers for the RAE/REF — they weren’t science with data and results, and since of course they weren’t supported by external funding, they were considered worthless. Pace Brenner, in terms of research assessment you don’t really need to read papers, just look at the impact factor and the amount and source of funding: sexy, or not?5
You have to continually check-in with your own personal lodestar; dead-reckoning over the course of a career is not wise. I thought there was some merit in what I had written, but I didn’t think I had gone deep enough into the problems I kept seeing all around me (an occupational hazard of a skin biologist, you might say). Lack of time was one issue, another was that I had little experience of the sorts of research methods I needed. The two problems are not totally unrelated; the day-job kept getting in the way.
“I have been this close to buying a nursing school.” This is not a sentence you expect to hear from a startup founder. Nursing seems a world away from the high-tech whizziness of Silicon Valley. And, to use a venture-capital cliché, it does not scale easily.
This was from an article in the Economist awhile back. As ever, there is a mixture of craziness and novelty. The gist of the article is about Lambda School, a company that matches ‘fast’ training with labour force shortages (hence the nursing angle). When I first read it, I had thought they had already opened a nursing school, but that is not so. Nonetheless, there are aspects that interest me.
We learn that
The Economist chimes in with the standard “Too often students are treated as cash cows to be milked for research funding.” Too true, but to solve this issue we need to massively increase research costings, have meaningful conversations with charities and government (including the NHS) about the way students are forced to involuntarily subsidise research, and cut out a lot of research in universities that is the D of R&D.
But this is not a sensible model for a university. On the other hand it is increasingly evident to me that universities are not suitable places to learn many vocational skills. The obvious immediate problem for Lambda is finding and funding a suitable clinical environment. That is exactly the problem that medical (or dental) schools face. A better model is a sequential one, one which ironically mimics the implicit English model of old: university study, followed by practical hospital clerkships. Just tweak the funding model to allow it.
I have posted on this topic before, but the comments below speak to me more now than ever. They are reflections on the philosopher Michael Ignatieff’s failed attempt to run for political office in Canada. He wrote a book about these events which is highly recommended (I haven’t read it, yet). A comment on the article, He brought a syllabus to a gun fight and lost, should be understood by all those who wish to protect the academy from the current gangs of populists.
“One of the things that is extremely challenging to my teaching now is the possibility that there are some things you can learn only from experience and can’t be taught. The pathos of teaching is that some things can’t be taught — and one of them might be political judgement. I don’t think that’s a despairing thought, but it does induce humility in a teacher and make the job much more interesting.”
A comment on this article is below
As someone who spent time with Ignatieff on the hustings and whose baby he has indeed kissed, I can say with some confidence that normatively desirable outcomes never address which end of the sign stake goes in the ground. He brought a syllabus to a gun fight and lost. Canada lost more. Comment from Steven McGannety [emphasis added]
That said, his [Chris Bustamente, president of Rio Salado College ] discussion underscored some of the stark labor realities driving the proposed solutions for increased access to higher ed. Rio Salado [in the USA] educates 60,000 students with 22 full time faculty and 1500 adjuncts. Let me say that again, Rio Salado educates 60,000 students with 22 full time faculty and 1500 adjuncts. And while a small percentage of these part-time faculty may do it for the love of teaching as Bustamente suggested, it’s all but certain the vast majority are teaching on subsistence wages to eke out a living, much like many of the students they serve. Such a mixed message about the power of a college education to set you free, at least financially, hasn’t been lost on me since my first adjuncting gig in 1997.
Jim Groom, The bloody waters of Higher Ed (a post from 2014)
I think1 the words are mine:
Every time I hear the term line-manager used about an academic, retirement gets a day closer
But the great JK Galbraith (senior) had some words of his own on line-management (Galbraith, a famous Harvard Professor of Economics, was ambassador to India for JFK)
Galbraith proved up to the task, in part, as Bruce Riedel writes in “JFK’s Forgotten Crisis”, because he had access to the president and his aides. Most ambassadors report to the State Department, but the blunt Galbraith told the president that going through those channels was “like trying to fornicate through a mattress”.
A year ago, “TT [tenure track] or bust” was a common but ill-advised attitude toward the job market. That attitude should be unthinkable today. COVID-19 is an accelerant to a fire in academia that has been raging for at least a decade. When that fire is finally extinguished, the landscape of higher education will be unrecognizable at best and decimated at worst.
Think of it alongside a quote from Stephen Downes:
Educational providers will one day face an overnight crisis that was 20 years in the making. Link
I cannot see the future, but like many, I have private models that I use to order the world, and for which I often have very little data. For instance, I think it obvious that the traditional middle-class professions (medicine, lay, veterinary medicine, architecture, dentistry, academia) are increasingly unattractive as careers1. I am not complaining about my choices — far from it; I benefited on the tailwinds of the dramatic social change that wars and other calamities bring. But my take on what has happened to school teachers and teaching is the model for what will happen to many others. I say this with no pleasure: there are few jobs more important. But the tragedy of schoolteaching — which is our tragedy — will continue to unfold as successive gangs of politicians of either armed with nothing more than some borrowed bullet points play to the gallery. Similarly, in higher education within a timescale of almost 40 years, I have seen at first-hand changes that would make me argue that not only are the days of Donnish Dominion(to use Halsey’s phrase2) well and truly over, but that most UK universities will be unable to recruit the brightest to their cause. I think we see that in clinical academia already — and not just in the UK. Amidst all those shiny new buildings moulded for student experience (and don’t forget the wellness centres…); the ennui of corporate mediocrity beckons. The bottom line is the mission statement.
As for medicine, a few quotes below from an FT article from late last year. I assume that without revolutionary change, we will see more and more medical students, and more and more doctors leaving mid-career. If you keep running to stand still, the motivation goes. And that is without all the non-COVID-19 effects of COVID-19.
One of the major factors for doctors is the electronic record system. It takes a physician 15 clicks to order a flu shot for a patient, says Tait. And instead of addressing this problem, healthcare companies end up offering physicians mindfulness sessions and healthy food options in the cafeteria, which only frustrates them further…[emphasis added]
Over the past few years, efforts have been made to increase the number of medical schools in the US to ensure that there is no shortage of doctors. “When you think about how much we’ve invested to create, roughly, 10 to 12 new medical schools in the last decade, at hundreds of millions of dollars per school, just to increase the pipeline of physicians being trained, we also need to think at the far end of the physicians who are leaving medicine because of burnout,” says Sinsky.
Take the case of a final-year resident doctor in New York, who spends a considerable part of his shift negotiating with insurance companies to justify why his patient needs the medicines he prescribed. “When I signed up to be a doctor, the goal was to treat patients, not negotiate with insurance providers,” he says.
According to Tait, 80 per cent of the challenge faced by doctors is down to the organisation where they work, and only 20 per cent could be attributed to personal resilience.
Re the final quote, 80:20 is being generous to the organisations.
I read Malcolm Bradbury’s satire The History Man many decades ago and loved it as a satire on university life (and which demonstrated to me why medical schools and universities were unlikely bedfellows).
The History Man is Malcolm Bradbury’s masterpiece, the definitive campus novel and one of the most influential novels of the 1970s. Funny, disconcerting and provocative, Bradbury brilliantly satirizes a world of academic power struggles as his anti-hero seduces his away around campus. (Amazon’s brief).
I have forgotten much of the detail, but not how fine a novel I thought it was, nor how funny I found it. But for every great thesis, there is an antithesis. Here is one:
Ignorance of history is a badge of honour in Silicon Valley. “The only thing that matters is the future,” self-driving-car engineer Anthony Levandowski told The New Yorker in 2018… I don’t even know why we study history,” Levandowski said in 2018.
I know which past — and future — I would prefer.
I dislike agreeing with the corporation that is Google as I am always suspicious of their motives, but in this narrow domain, they are surely correct.
College degrees are out of reach for many Americans, and you shouldn’t need a college diploma to have economic security. We need new, accessible job-training solutions—from enhanced vocational programs to online education—to help America recover and rebuild.
I used to think universities were always the solution now I realise they are part of the problem.
That “scientific management” bungled the algorithm for children’s exam results, verifies a maxim attributed to J.R. Searle, an American philosopher: if you have to add “scientific” to a field, it probably ain’t.
AD.Pellegrini in a letter to the Economist.
I have written elsewhere about this in medicine and science. We used to have physiology, but now some say physiological sciences; we used to have pharmacology, but now often see pharmacological sciences1. And as for medicine, neurology and neurosurgery used to be just fine, but then the PR and money grabbing started so we now have ‘clinical neuroscience’ — except it isn’t. As Herb Simon pointed out many years ago, the professions and professional practice always lose out in the academy.
The following is from Scot Galloway at NYU Stern. He shoots from the hip, and sometimes only thinks afterwards. But he is interesting, brave, and more often right than most. I think I would have hated what he said when I was ready (sic) to go to university. But now, I think I wasn’t, and for medicine in particular, allowing 17 year olds to fall into the clutches of the GMC and their ilk should be a crime against….
Gap years should be the norm, not the exception. An increasingly ugly secret of campus life is that a mix of helicopter parenting and social media has rendered many 18-year-olds unfit for college. Parents drop them off at school, where university administrators have become mental health counselors. The structure of the Corona Corps would give kids (and let’s be honest, they are still kids) a chance to marinate and mature. The data supports this. 90% of kids who defer and take a gap year return to college and are more likely to graduate, with better grades. The Corps should be an option for non-college-bound youth as well.
The task of a university is the creation of the future, so far as rational thought, and civilized modes of appreciation, can affect the issue. The future is big with every possibility of achievement and of tragedy.
Nobody then would have imagined how bad it would get. The final word was prescient.
Alfred North Whitehead, The Aim of Philosophy in Modes of Thought, 1938
No certification, here.
As miserable in the job as he was smart, autodidactic, and headstrong, he managed to escape a soul-destroying future trapped behind a shop on the counter by persuading his Latin tutor to hire him as a student teacher, then convincing his mother to pay off the indenture and set him free.
The Future was His, Maya Jasanoff in the NYRB, reviewing Inventing Tomorrow: H.G. Wells and the Twentieth Century by Sarah Cole.
The following is from the Economist and is about schoolteachers.
A bigger question is how many of the new trainees will stay in teaching. Research in America shows that people who enter the profession during recessions tend to make better teachers than those who do not, perhaps because high-skilled workers have fewer other options during a downturn. But they are also a bit more likely to give up. England already has a problem retaining new teachers. About a fifth leave the job within two years of qualifying. About a third go within five.
I don’t have any systematic data on this topic, but the story appears familiar — if different in degree — across other public sector1 jobs such as nursing, higher education and possibly medicine. I am not reassured by the account below, rather, I think we are seeing structural changes that will continue to play out. The change in professional status of teaching and the resulting decline in morale always seemed to me to be the model for what might happen to medicine.
Sam Sims at the UCL Institute of Education says “muscular” policies that were put in place before the pandemic provide reason for optimism. Last year the government said that starting salaries would rise to £30,000 ($39,000) by 2022, a 23% increase. It is offering annual bonuses to teachers of subjects with the biggest shortages. And it is promising more mentoring and training for people who are new to the job. The idea is that new teachers will eventually consider themselves better-paid and better-supported than peers in many other professions. That might make Mr Seadon’s cohort a bit more likely to hang around.
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.
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
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.
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].
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.
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.
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.
You can even get a degree in this sort of behaviour, now: ouroboros studies.
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.
Straight talking from Scott Galloway of Stern, NYU.
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.
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.
Whenever I have looked at the CVs of many young doctors or medical students I have often felt saddened at what I take to be the hurdles than many of them have had to jump through to get into medical school. I don’t mean the exams — although there is lots of empty signalling there too — but the enforced attempts to demonstrate you are a caring or committed to the NHS/ charity sector person. I had none of that; nor do I believe it counts for much when you actually become a doctor1. I think it enforces a certain conformity and limits the social breadth of intake to medical school.
However, I did
do things work outside school before going to university, working in a variety of jobs from the age of 14 upwards: a greengrocer’s shop on Saturdays, a chip shop (4-11pm on Sundays), a pub (living in for a while 😃), a few weeks on a pig-farm (awful) and my favourite, working at a couple of petrol stations (7am-10pm). These jobs were a great introduction to the black economy and how wonderfully inventive humanity — criminal humanity— can be. Naturally, I was not tempted😇. Those in the know would even tell you about other types of fraud in different industries, and even that people actually got awarded PhDs by studying and documenting the sociology of these structures (Is that why you are going to uni, I was once asked).
On the theme of that newest of crime genres — cybercrime — there is a wonderful podcast reminding you that if much capitalism is criminal, there is criminal and there is criminal. But many of the iconic structures of modern capitalism — specialisation, outsourcing and the importance of the boundaries between firm and non-firm — are there. Well worth a listen.
I think there is a danger in exaggerating the role of caring and compassion in medicine. I am not saying you do not need them, but rather that I think they are less important that the technical (or professional) skills that are essential for modern medical practice. I want to be treated by people who know how to assess a situation and who can judge with cold reason the results of administering or withholding an intervention. If doctors were once labelled priests with stethoscopes, I want less of the priest bit. Where I think there are faults is in the idea that you can contribute most to humanity by ‘just caring’. The Economist awhile back reported on an initiative from the Centre for Effective Altruism in Oxford. The project labelled the 80,000 hours initiative advises people on which careers they should choose in order to maximise their impact on the world. Impact should be judged not on how much a particular profession does, but on how much a person can do as an individual. Here is a quote relating to medicine:
Medicine is another obvious profession for do-gooders. It is not one, however, on which 80,000 Hours is very keen. Rich countries have plenty of doctors, and even the best clinicians can see only one patient at a time. So the impact that a single doctor will have is minimal. Gregory Lewis, a public-health researcher, estimates that adding an additional doctor to America’s labour supply would yield health benefits equivalent to only around four lives saved.
The typical medical student, however, should expect to save closer to no lives at all. Entrance to medical school is competitive. So a student who is accepted would not increase a given country’s total stock of doctors. Instead, she would merely be taking the place of someone who is slightly less qualified. Doctors, though, do make good money, especially in America. A plastic surgeon who donates half of her earnings to charity will probably have much bigger social impact on the margin than an emergency-room doctor who donates none.
Yes, the slightly less qualified makes me nervous.
Henry Miller died a few months before I started medical school in Newcastle in 1976. At the time of his death he was VC of the university having been Dean of Medicine and Professor of Neurology. By today’s standards he was a larger than life figure. I like reading what he said about medical education, although with hindsight I think he was wrong about many if not most things. But there was a freshness and sense of spirited independence of mind in his writing that we not longer see in those who run our universities (with some notable exceptions such as Louise Richardson). In the time of COVID we should remember the costs of conformity and patronage.
It would be naive to express surprise at the equanimity with which successive governments have regarded the deteriorating hospital service, since it is in the nature of governments to ignore inconvenient situations until they become scandalous enough to excite powerful public pressure. Nor, perhaps, should one expect patients to be more demanding: their uncomplaining stoicism springs from ignorance and fear rather than fortitude; they are mostly grateful for what they receive and do not know how far it falls short of what is possible. It is less easy to forgive ourselves…..Indeed election as president of a college, a vice chancellor, or a member of the University Grants committee usually spells an inevitable preoccupation with the politically practicable, and insidious identification with central authority, and a change of role from informed critic to uncomfortable apologist.
Originally published in the Lancet, 1966,2, 647-54. (This version from ‘Remembering Henry’, edited by Stephen Lock and Heather Windle).
“I hope the lesson will really be that we can’t afford as a society to create the fire brigade once the house is on fire. We need that fire brigade ready all the time hoping that it never has to be deployed.”
Peter Piot 1
No just in time here. It’s in the statistical tails that dragons lurk and reputations are shattered. Chimes with a quote from Stewart Brand that I posted a short while back.
Education is intellectual infrastructure. So is science. They have very high yield, but delayed payback. Hasty societies that can’t span those delays will lose out over time to societies that can. On the other hand, cultures too hidebound to allow education to advance at infrastructural pace also lose out.
Britain’s universities increasingly look like the late Soviet economy, running down their social capital behind a glitzy screen of Potemkin imagery and glasnost-era statistics. Bits of it are locking up, alternately insulted and goaded by the gap between central government diktat and the reality on the ground. The result will be the same: a very long slide into mediocrity and mendacity.
I don’t have any wise prescriptions to dispense. Stephen Downes gets it right when he says “educational providers will one day face an overnight crisis that was 20 years in the making”. But a clue is surely in his choice of words: ‘educational providers’.
In 1947, Hobsbawm had excused his acceptance of the Birkbeck post by explaining that teaching preparations never took him more than two hours a week, and while he was an inspiring classroom presence, he always adroitly ducked administrative jobs. Evans tells a story of Hobsbawm backing the young Roderick Floud for a professorial chair mostly, Floud later realised, so he wouldn’t have to be head of department himself. It will be hard for today’s young academics, groaning under research assessments and short-term contracts at below the living wage, to read these passages.