I think the quip was from the series Cardiac Arrest: the ITU used to be called the ICU (intensive care unit) until they realised nobody did.
In March, 2019, a doctor informed 78-year-old Ernest Quintana, an inpatient at a hospital in California, USA, that he was going to die. His ravaged lungs could not survive his latest exacerbation of chronic obstructive pulmonary disease, so he would be placed on a morphine drip until, in the next few days, he would inevitably perish. There was a twist. A robot had delivered the bombshell. There, on a portable machine bearing a video screen, crackled the pixelated image of a distant practitioner who had just used cutting-edge technology to give, of all things, a terminal diagnosis. The hospital insisted that earlier conversations with medical staff had occurred in person, but as Mr Quintana’s daughter put it: “I just don’t think that critically ill patients should see a screen”, she said. “It should be a human being with compassion.”
There was a touching obituary of Peter Sleight in the Lancet. Sleight was a Professor of Cardiovascular Medicine at Oxford and the obituary highlighted both his academic prowess and his clinical skills. Hard modalities of knowledge to combine in one person.
Throughout all this, at Oxford’s Radcliffe Infirmary and John Radcliffe Hospital, Sleight remained an expert bedside clinician, who revelled in distinguishing the subtleties of cardiac murmurs and timing the delays of opening snaps.
And then we learn
An avid traveller, Sleight was a visiting professor in several universities; the Oxford medical students’ Christmas pantomime portrayed him as the British Airways Professor of Cardiology. [emphasis added]
This theme must run and run, and student humour is often insightful (and on occasion, much worse). I worked somewhere where the nickname for the local airport was that of a fellow Gold Card professor. We often wondered what his tax status was.
A letter from Colin Mills (Basel) in last week’s Economist
Milk, beer and sweets were listed as “basic necessities” supplied by corner shops, which are thriving during the pandemic (“Turning a corner”, October 17th). Two of the three can hardly be considered necessities. Sweets are bad for you, and many people live perfectly happily without drinking milk.
The background is the observation that babies born by Caesarian have different gut flora than those born vaginally. The interest in gut flora is because many believe it relates causally to some diseases. How do you go about investigating such a problem?
Collectively, these seven women gave birth to five girls and two boys, all healthy. Each of the newborns was syringe-fed a dose of breast milk immediately after birth—a dose that had been inoculated with a few grams of faeces collected three weeks earlier from its mother. None of the babies showed any adverse reactions to this procedure. All then had their faeces analysed regularly during the following weeks. For comparison, the researchers collected faecal samples from 47 other infants, 29 of which had been born normally and 18 by Caesarean section. [emphasis added]
‘Statisticians have already overrun every branch of science with a rapidity of conquest rivalled only by Attila, Mohammed, and the Colorado beetle’
Maurice Kendall (1942): On the future of statistics. JRSA 105; 69-80.
Yes, that Maurice Kendall.
It seems to me that when it comes to statistics — and the powerful role of statistics in understanding both the natural and the unnatural world — that the old guys thought harder and deeper, understanding the world better than many of their more vocal successors. And that is without mentioning the barking of the medic-would-be-statistician brigade.
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”.
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.
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.
His younger co-workers, with their zippy metabolisms and surplus collagen, started referring to him as “the elder.”
The Economist heaps praise on Ireland’s ability to get its way:
Ireland has a good claim to be the world’s most diplomatically powerful country
We learn that Ireland beat off Canada to win a seat on the UN Security Council but that like Canada Ireland also has ‘a bigger, sometimes boorish, neighbour’.
Alongside more subtle overtures, the push for the Security Council seat [by Ireland] involved free tickets to Riverdance and a U2 gig. The best that Canada could muster was Celine Dion.
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.
Its natural, Jim. From an obituary of Julian Perry Robinson in Nature
In 1981, the US government publicly accused Soviet-backed forces in southeast Asia of waging toxin warfare and violating their legal obligations under the 1925 Geneva Protocol and 1972 Biological Weapons Convention. It alleged that aircraft dispersed ‘yellow rain’ containing mycotoxins that were “not indigenous to the region”. Julian Perry Robinson, working alongside biologist Matthew Meselson at Harvard University in Cambridge, Massachusetts, established that what actually fell was wild-honeybee faeces containing naturally occurring toxins. He died on 22 April, aged 78.
Just because your doctor has a name for your condition, doesn’t mean he knows what it is — Franz Kafka.
I hadn’t come across this quote by Franz Kafka before. It is of course true, but the converse is even more worrying. I like Sam Shuster’s aphorism better: the worst thing you can do is make a diagnosis (because it stops you thinking about what really is going on).
No, not post-covid nor even post-final Heineken or six-nation rugby 2020 🙁, but rather the default drink of the networker. As Bronowski might have said of a golden period of 20th century physics: it was done as much in coffee houses an in laboratories. Is imbibing alone also subject to that other familiar disapprobation?
What began as an obscure berry from the highlands of Ethiopia is now, five centuries later, a ubiquitous global necessity. Coffee has changed the world along the way. A “wakefull and civill drink”, its pep as a stimulant awoke Europe from an alcoholic stupor and “improved useful knowledge very much”, as a 17th-century observer put it, helping fuel the ensuing scientific and financial revolutions. Coffeehouses, an idea that travelled with the refreshment from the Arab world, became information exchanges and centres of collaboration; coffee remains the default drink of personal networking to this day.
The value of wine exchanged yearly between consumers, connoisseurs and collectors—the secondary market—has quadrupled to $4bn since 2000, says Justin Gibbs of Liv-ex, a wine-trading platform. He reckons that just 15% of those buying wine on his website are doing so to drink it. The rest see it as a store of value.
Annoying, isn’t it? But we all tend to a naive idea of value. Especially when we think about pricing drugs.
As a human being, and a citizen of this country, I deplore almost everything that’s going on in public life,” Mr Herron says. “As a novelist with a bent towards the satirical, it’s a gift.
Mick Herron quoted in the Economist.
Henry characterise the less attractive teaching rounds as examples of shifting dullness
Henry Miller (apologies, a medic joke)
The productivity abyss…and how to escape its gravitational pull. Here is an article extolling time-wasting.
To which she has two responses — first, most people overestimate the amount of time they actually work and second, she proposes accepting that your to-do-list will never get done.
The fist I agree with. Awhile back I tried time tracking using the Timery app and Toggl. It’s scary. And that is even when you include meetings as work. But the second point, entailing an amnesty on all the things you thought or think you are going to do, conflicts with my sense of original sin. The sun has to rise, just like guilt.
“If biology is difficult, it is because of the bewildering number and variety of things one must hold in one’s head”.
John Maynard Smith (1977).
Leo Szilard recalled, that when he did physics he could lounge in the bath for hours and hours, just thinking. Once he moved into biology things were never the same: he was always having to get out to check some annoying fact. Dermatology is worse, trust me.
Putt’s Law: “Technology is dominated by two types of people, those who understand what they do not manage and those who manage what they do not understand.”
Putt’s Corollary: “Every technical hierarchy, in time, develops a competence inversion.” with incompetence being “flushed out of the lower levels” of a technocratic hierarchy, ensuring that technically competent people remain directly in charge of the actual technology while those without technical competence move into management.
This is from a recent article in Nature describing how its new custom typeface got its name.
A custom typeface, Harding, has been created for Nature’s new logo and much else: you’re reading it right now [you are not]. Harding is named after the late neurologist Anita Harding. Brilliant and generous, she published in Nature before she died in 1995 at age 42. According to colleagues, she was known for taking questions from the clinic back into the laboratory, and for her wry sense of humour. When she learnt that she had a terminal illness, she apparently joked that at least she wouldn’t have to buy Windows 95.
He would have found the industrial-style intellectual labour that has entrenched itself in much of academic life over the past twenty-odd years impossible to take seriously. He wrote for himself and anyone else who might be interested; it is unlikely that anyone working in a university today could find the freedom or leisure that are needed to produce a volume such as this. Writing in 1967, Oakeshott laments, ‘I have wasted a lot of time living.’ Perhaps so, but as this absorbing selection demonstrates, he still managed to fit in a great deal of thinking.
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My youngest daughter lived in South Korea for a while and I visited on a couple of occasions. It was a lot of fun in all sorts of ways. The following rings(!) true
The government initially tried to fight the “smombie” (a portmanteau of “smartphone” and “zombie”) epidemic by distributing hundreds of stickers around cities imploring people to “be safe” and look up. This seems to have had little effect even though, in Seoul at least, it recently replaced the stickers with sturdier plastic boards.
Instead of appealing to people’s good sense, the authorities have therefore resorted to trying to save them from being run over. Early last year, they began to trial floor-level traffic lights in smombie hotspots in central Seoul. Since then, the experiment has been extended around and beyond the capital. For the moment, the government is retaining old-fashioned eye-level pedestrian lights as well. But in future, the way to look at a South Korean crossroads may be down.
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Genital scabies was, to the English, “Scotch itch,” and Scotland was “Itch-land.” The pox was the Spanish or Neapolitan Disease to the French; the French Disease to the Spanish, English, and Germans; the Polish Disease to the Russians; the Portuguese Disease to the Japanese. Captain Cook was chagrined to learn that it was called the British Disease in Tahiti as, in so many words, it was in Ireland: in Ulysses the Citizen, a rabid Irish nationalist, mocks Leopold Bloom’s reference to British civilization: “Their syphilisation you mean.”
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On some Swedish trains, passengers carry their e-tickets in their hands—literally. About 3,000 Swedes have opted to insert grain-of-rice-sized microchips beneath the skin between their thumbs and index fingers. The chips, which cost around $150, can hold personal details, credit-card numbers and medical records. They rely on Radio Frequency ID (RFID), a technology already used in payment cards, tickets and passports.
One of these is going to end up being sectioned as some time….waiting for the first case-report. Not often I can get two puns in a three word title.
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It is said that much of the foundations of 20th century physics was done in coffee houses (or in the case of Richard Feynman in strip bars), but things were once done differently in the UK
With neither institutional nor government masters to answer to, the British cyberneticians were free to concentrate on what interested them. In 1949, in an attempt to develop a broader intellectual base, many of them formed an informal dining society called the Ratio Club. Pickering documents that the money spent on alcohol at the first meeting dwarfed that spent on food by nearly six to one — another indication of the cultural differences between the UK and US cyberneticians.
The work of the British pioneers was forgotten until the late 1980s when it was rediscovered by a new generation of researchers… A company that I cofounded has now sold more than five million domestic floor-cleaning robots, whose workings were inspired by Walter’s tortoises. It is a good example of how unsupported research, carried out by unconventional characters in spite of their institutions, can have a huge impact.
A review from 2010 by Rodney Brooks of MIT of “The Cybernetic Brain: Sketches of Another Future” in Nature (For more on Donald Michie and “in spite of their institutions” see here).
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I have had of all people a historian tell me that science is a collection of facts, and his voice had not even the ironic rasp of one filing-cabinet reproving another.
Jacob Bronowski | Science and Human Values
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I have removed the name of the institution only because so many queue to sell their vapourware in this manner
Precision Medicine is a revolution in healthcare. Our world-leading biomedical researchers are at the forefront of this revolution, developing new early diagnostics and treatments for chronic diseases including cancer, cardiovascular disease, diabetes, arthritis and stroke. Partnering with XXXXX, the University of XXXX has driven … vision in Precision Medicine, including the development of a shitload of infrastructure to support imaging, molecular pathology and precision medicine clinical trials…… XXXXXX is now one of the foremost locations in a three mile radius to pursue advances in Precision Medicine.
And He declared to them, “It is written: ‘My house will be called a house of prayer. But you are making it ‘a den of robbers.'” Matthew 21:13
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Statistics — to paraphrase Homer Simpson’s thoughts on alcohol — is the cause of, and solution to, all of science’s problems.
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