Surplus collagen

His younger co-workers, with their zippy metabolisms and surplus collagen, started referring to him as “the elder.”

A New Luxury Retreat Caters to Elderly Workers in Tech (Ages 30 and Up) – The New York Times

The Cognitive load of everyday life

by reestheskin on 25/07/2020

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The Cognitive load of everyday life

I’m struggling. There is this continuous battle to counteract the exaggerations and misinformation that corporations spend so much time creating. Including universities, now. Those seeking to subvert the intention of regulators, have more money, more time, and abuse the externalities that society has allowed them to work within.

Poor Celine

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.

Charlemagne – How Ireland gets its way | Europe | The Economist

Crime pays but leave it off the CV

by reestheskin on 23/07/2020

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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.

 

  1. See below  for a long aside on this point.

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.

Higher education: things have, and will get worse

The next five years will be worse for English universities than the past five years have been. And the five after that could be worse still.

 Alison Wolf quoted  in THE and on this blog in 2015. Still on course.  [direct link to this aside]

How to be remembered

by reestheskin on 20/07/2020

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John le Carré is one of my favourite authors. There is a wonderful sense of rebellion, coupled with both dismay and hope in his fiction (and non-fiction) writings. Here are a few lines from his speech in Stockholm on 30 January 2020 when he received the Olaf Palme award.

How would Palme wish to be remembered? Well, by this for a start. For his life, not his death. For his humanism, courage, and the breadth and completeness of his humanist vision. As the voice of truth in a world hell-bent on distorting it. By the inspiring, inventive enterprises undertaken yearly by young people in his name.

 

Is there anything I would like to add to his epitaph? A line by May Sarton that he would have enjoyed: One must think like a hero to behave like a merely decent human being.

 

And how would I like to be remembered? As the man who won the 2019 Olof Palme prize will do me just fine.

John le Carré on Brexit: ‘It’s breaking my heart’ | Books | The Guardian

It is less easy to forgive ourselves

by reestheskin on 17/07/2020

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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).

No just in time here

by reestheskin on 16/07/2020

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“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.

  1. (Virologist Peter Piot,  co-discoverer of  Ebola and who worked on treating and preventing HIV, talking about getting COVID-19 on his institution’s podcast. (London School of Hygiene & Tropical Medicine podcast )

The Dream is Over*

by reestheskin on 12/07/2020

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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.

Britain’s universities are on the verge of unravelling | Universities | The Guardian.

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’.

* The Dream Is Over: The Crisis of Clark Kerr’s California Idea of Higher Education. Simon Marginson

A classics business model to die for

by reestheskin on 08/07/2020

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He needed glory and he needed cash. The quickest route to glory was beating up barbarians; stealing their wealth and selling their bodies into slavery got him the cash.

The above is from a stomach-penetrating piece on the life of Julius Caesar (and not Boris Johnson). I do not know whether it is an effect of age, but perhaps the more one is aware of dying —with or without dignity— the more I find such descriptions, such as the one below, are hard to let go of when you close you eyes with the hope that they might open again.

Unlike most ancient swords, the legionary shortsword, or gladius Hispaniensis, was designed for stabbing, not slashing. While longswords and sabres create horrific, often deadly wounds, even an inch of steel can deliver a lethal puncture – especially given the limits of ancient medicine. Yet as combat instructors know, stabbing another human being at close quarters is much harder than cutting them: we have a psychological block against penetrating others’ bodies in that way, a visceral aversion that must be overcome by stern, psychologically brutalising discipline. Roman legionaries were taught to hurl their spears at the enemy line, then advance with shields held close, plunging their gladii in and out of the men arrayed against them. Units that could stomach this gruelling work against heavily armoured fellow citizens were simply killing machines against the less disciplined and lightly armoured Gauls [emphasis added]

Michael Kulikowski · A Very Bad Man: Julius Caesar, Génocidaire · London Review of Books | 18 June 2020

Meliorism certified

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.

Susan Pedersen reviews ‘Eric Hobsbawm’ by Richard J. Evans · LRB 18 April 2019

Mathiness, scientism and give me the money.

by reestheskin on 06/07/2020

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Two nice quotes from Paul Romer about his paper Mathiness in the Theory of Economic Growth

The alternative to science is academic politics, where persistent disagreement is encouraged as a way to create distinctive sub-group identities.

The usual way to protect a scientific discussion from the factionalism of academic politics is to exclude people who opt out of the norms of science. The challenge lies in knowing how to identify them.

I can agree go along with both, but it is in the details that the daemons feast. It appears to me that the ‘norms of science’ argument is itself problematic, reminding me of those silly things you learn at school about the scientific method 1. The historical origin of the concept of the scientific method owed more to attempts to brand certain activities in the eyes of those who were not practicing scientists 2. As a rough approximation, the people who talk about the scientific method tend not to do science. Of course, in more recent times, the use of the term ‘science’ itself has been a flag for obtaining funding, status or approval. Dermatology is now dermatological sciences ; pharmacology is now pharmacological sciences. Even more absurd, in the medical literature I see the term delivery science (and I don’t mean Amazon), or reproducibility science. The demarcation of science from non-science is a hard philosophical problem going back way before Popper; I will not solve it. The danger is that we might end up exiling all those meaningful areas of human rationality that we once — rightly — considered outwith science, but still valued. There is indeed a subject that we might reasonably call medical science(s). It is just not synonymous with the principles and practice of medicine. It is also why political economy is a more useful subject than economics (or worse still, economic sciences).

  1. I guess this depends on how you interpret the ‘they’ in Romer’s second quote. It is the people or the norms that are the problem? I tend to think of both.
  2. There is an excellent recent article in the New York Review of Books that touches upon this issue Just Use Your Thinking Pump! by Jessica Riskin.

The secret of how to get rich

Angus Deaton: Many people have said that there are two ways of getting rich: One way is by making things, and the other is by taking things. And one of the ways of taking things is to make the government give you special favors. Those special favors don’t create anything, but they can make you rich, at the expense of everybody else.

What’s Wrong With America?: “The Despair Is Smoldering in Society” – DER SPIEGEL

Advice for graduating doctors…

by reestheskin on 03/07/2020

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I have forgotten who asked me to write the following. I think it was from a couple of years ago and was meant for graduating medics here in Edinburgh. (I am still sifting through the detritus of academic droppings)

As Rudolf Virchow was reported to say: sometimes the young are more right than the old. So, beware. This is my — and not his — triad.

First, when you do not know, ask for help. And sometimes ask for help when you do know (for how else would you check the circumference of your competence?).

Second, much as though science and technology changes, the organisation of care will change faster. Think on this in any quiet moments you have, for it may be the biggest influence on your career — for good and bad (sadly).

Third, look around you and do not be afraid to stray. The future is always on the periphery along a rocky path to nowhere in particular.

My organ is bigger than your organ

by reestheskin on 02/07/2020

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One thing that sticks with me from medical school onwards (both as student and faculty) is the partisan nature of specialties. Most of this is harmless fun: my organ (skin, liver, kidney etc) is bigger than your organ; the brain is more complicated than any other organ and therefore neurologists must be smarter than everybody else (although curiously this doesn’t seem to stretch to neurosurgeons — at least when neurologists are talking). Let’s call it organ imperialism. The humour of little boys judging their vitality by how high they can p*** up the wall. There are more vital things to get angry about.

There are however some darker sides to this professional ethnicity. Doctors indulging in advocacy for particular patient groups can often seem like doctors wishing their own unit or disease of interest receives more resources. A salient example in dermatology is the way that NHS resources for cancer (or children) frequently trump other demands. It is easier to lobby successfully for skin cancer1 than acne or hair loss in the absence of any meaningful attempt to weigh patient suffering (or just to assume it is self-evident)2. The contrast between paediatrics and geriatrics is often informative about underlying values.

One area that does worry me more is the encroachment of politics on medical education. I am thinking in particular on a priori claims about the superiority of certain models of care, or the attempts to subvert student choice of career in the name of what the ‘NHS needs’.

Undergraduate medical education should be both scholarly and intellectually neutral as to how health care is organised. We should of course introduce students to the various systems, and encourage them to criticise them. We should teach them to be analytical, and to understand the various reasons why people have chosen different systems (or how their views are manipulated). But we should be neutral in the sense that judgments need to be based on rational argument rather than slogans, and that students must be able to argue based on evidence.

I would say the same about career choice. Our primary duty in a university is to students. If a university were to demand that their graduates in computing were only to work for a British computing company and confine themselves to topics of ‘national importance’, or that its graduates in economics were only to work for the public rather than the public sector, they would no longer be taken seriously as an educational institution. And rightly so. Medicine should be no different.

  1. And note my clinical interests were focussed on skin cancer.
  2. I am of course neatly sidestepping the existential difficulty of comparing oranges and apples here. Do not tell me that QUALYs are the answer: it is easy to construct a spreadsheet that tells you the area of skin involvement in a patient with psoriasis, but do not confuse this with the human judgment of whether somebody has bad psoriasis.

The search space is always bigger…

by reestheskin on 02/07/2020

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Defining the appropriate probability space is often a non-trivial bit of statistics. It is often where you have to end up leaving statistics and formal reasoning behind. The following quote puts this in a more bracing manner.

There are no lobby groups for companies that do not exist.

The same goes for research and so much of what makes the future captivating.

The man from Cyberspace on the FQ

by reestheskin on 01/07/2020

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Some quotes from William Gibson in an interview with the FT

“we’re looking at the collapse of the only liveable planetary ecosystem we know of anywhere”.

He fears that the world’s FQ — or F***edness Quotient, as he calls it — is rising to a worrying degree.

And this one gets you

If I could learn one thing about the future,” he says, “I would want to know what they think of us because that would tell me everything I’d want to know about them.”

William Gibson — the prophet of cyberspace talks AI and climate collapse | Financial Times

Peter Piot in the Guardian

As with HIV, “an epidemic reveals the fault lines in society. The big one this epidemic has revealed is how we treat the elderly. We often park them in pre-mortuary type institutions and give a bit of money and hope it is OK”.

Make masks compulsory in public in UK, says virus expert | Coronavirus outbreak | The Guardian

When the tide goes out you see who is not wearing bathing costumes…

On the Origin of Species

by reestheskin on 30/06/2020

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Once there was General Practice, medicine in the image of the late and great Julian Tudor-Hart. Then there was Primary Care. The following article from Pulse made me sit up and wonder whether we have got it right.

Under the five-year contract announced last year, networks were to receive 70% of the funding to employ a pharmacist, a paramedic, a physiotherapist and a physician associate, and 100% of the funding for a hiring social prescriber, by 2023/24… Six more roles will now be added to the scheme from April  ‘at the request of PCN clinical directors’ – pharmacy technicians, care co-ordinators, health coaches, dietitians, podiatrists and occupational therapists…PCNs can choose to recruit from the expanded list to ‘make up the workforce they need’…The document added that mental health professionals, including Improving Access to Psychological Therapy (IAPT) therapists, will be added from April 2021 following current pilots…NHS England will also explore the feasibility of adding advanced nurse practitioners (ANPs) to the scheme [emphasis added].

PCNs to get 100% funding for all extra clinical staff as further roles are added | News Article | Pulse Today

Adam Smith among others pointed out the advantages of specialisation. We owe virtually all of the modern capitalist world to the power of this insight. But we also know that there are opposing forces — and not just those of the Luddites. Just think back to Ronald Coase and the Theory of the Firm. Why do companies not outsource everything? Why are there companies at all? Simply because under some circumstances transaction costs and formalisation of roles and contracts limit outsourcing 1. Contra the English approach is that of the Buurtzorg (links here, here and here) in the Netherlands where it is explicit that many of the tasks undertaken by highly skilled staff do not require high level skills. But — so the argument goes — the approach is more successful, robust and rewarding for both patients and staff. This is closer to the Tudor-Hart model. It really does depend on what sort of widgets you are dealing with, and whether fragmentation of activity improves outcomes, or merely diminishes costs in situations where outcomes are hard to define in an Excel spreadsheet.

  1. I realise I am speaking more metaphorically here than literally in terms of Coase’s work. My argument is about transaction costs in domains where much knowledge is not explicit or capable of easy formalisation, and where there is in one sense path dependency between patient and clinician.

Read that again

Zuckerberg also said the company will not be changing its policies that allow lying in paid political advertisements.

Facebook policy changes fail to quell advertiser revolt as Coca-Cola pulls ads | Facebook | The Guardian

Quote of the day

by reestheskin on 27/06/2020

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‘Today’s meritocratic ideology glorifies entrepreneurs and billionaires. At times this glorification seems to know no bounds. Some people seem to believe that Bill Gates, Jeff Bezos, and Mark Zuckerberg single-handedly invented computers, books, and friends.’

Thomas Piketty, Capital and Ideology. p713

Graph of the day

by reestheskin on 26/06/2020

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Another telling figure from Thomas Piketty’s Capital and Ideology. The stiking thing about much of this book is how predicable and widespread so many social trends are.

 

Let’s break things.

by reestheskin on 25/06/2020

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From the Financial Times a few months back, this is a story about Facebook and the life of its content moderators (as in, the people who watch those videos of obscene or violent acts).

The document was distributed to all moderators at the European facility in early January via email, asking them to sign it immediately. It stated: “I understand the content I will be reviewing may be disturbing. It is possible that reviewing such content may impact my mental health, and it could even lead to post-traumatic stress disorder (PTSD).”

The two-page form also outlines Accenture’s WeCare programme, which provides employees with access to “wellness coaches” from whom they can receive mental health support. The company says, however, that “the wellness coach is not a medical doctor and cannot diagnose or treat mental disorders”.

What caught my eye was a phrase that you see more and more: ‘X’ is not a medical doctor and cannot diagnose or treat mental disorders’. ‘X’ can be a person or simply some text on a web page.

Too much of modern hypercapitalism is about arbitrage between honesty or morality, and the law as it is codified. The business model is dishonesty, or worse. It would be impossible to act this way if the contact was human rather than digital. This is the very feature (not a bug!) that allows the push-button extinguishing of civilian lives in far-away parts of the world by people who drive to work and pick up the kids on the way home. As for medicine, corporations will insist on exploiting similar fault lines. There was once a time when ‘medicine’ was a small part of the economy, and when it could play by an insular set of rules that both society and the practitioners recognised, if not agreed upon. Nowadays there is simply too much money to be made.

A comment from Icarus Fallen on this article:

In the new social network gig economy, your mental health, has an hourly price. Try not to sell it.

(1) Facebook content moderators required to sign PTSD forms | Financial Times

Graph of the day

by reestheskin on 25/06/2020

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Another revealing figure from Thomas Piketty’s Capital and Ideology. French education is highly stratified but this pattern will be there in the UK too.

On being an eternal student.

by reestheskin on 22/06/2020

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Freeman Dyson died February 28th this year. There are many obituaries of this great mind and eternal rebel. His book, Disturbing the Universe, is for me one of a handful that gets the fundamental nature of discovery in science and how science interacts with other modes of being human. His intellectual bravery and honesty shine through most of his writings. John Naughton had a nice quote from him a short while back.

Some mathematicians are birds, others are frogs. Birds fly high in the air and survey broad vistas of mathematics out to the far horizon. They delight in concepts that unify our thinking and bring together diverse problems from different parts of the landscape. Frogs live in the mud below and see only the flowers that grow nearby. They delight in the details of particular objects, and they solve problems one at a time. I happen to be a frog, but many of my best friends are birds. The main theme of my talk tonight is this. Mathematics needs both birds and frogs.

In truth he was both frog and an albatross. Here are some words from his obituary in PNAS.

During the Second World War, Dyson worked as a civilian scientist for the Royal Air Force’s Bomber Command, an experience that made him a life-long pacifist. In 1941, as an undergraduate at Trinity College, Cambridge, United Kingdom, he found an intellectual role model in the famed mathematician G. H. Hardy, who shared two ideas that came to define Dyson’s trajectory: “A mathematician, like a painter or a poet, is a maker of patterns,” and “Young men should prove theorems; old men should write books.”

Heeding the advice of his undergraduate mentor, Dyson returned to his first love of writing. He became well-known to a wide audience by his books Disturbing the Universe (1979) (1) and Infinite in All Directions (1988) (2), and his many beautiful essays for The New Yorker and The New York Review of Books. In 2018, he published his autobiography, Maker of Patterns (3), largely composed of letters that he sent to his parents from an early age on.

And as for us eternal students, at least I have one thing in common.

…Dyson never obtained an official doctorate of philosophy. As an eternal graduate student, a “rebel” in his own words, Dyson was unafraid to question everything and everybody. It is not surprising that his young colleagues inspired him the most.

Freeman J. Dyson 1923–2020: Legendary physicist, writer, and fearless intellectual explorer | PNAS

Autodidacticism

by reestheskin on 18/06/2020

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Story 1

I started my dermatological career in Vienna in the mid-1980s as a guest (I am deliberately not using the cognate German term) of Prof Klaus Wolf. Vienna, for close to two hundred years, has been a Mecca for all things dermatological, and Sam Shuster, in Newcastle, thought it wise to go somewhere else for up to a year — before returning to Newcastle. The plan was to learn some clinical dermatology and see how others worked. I had a great time — Vienna is a wonderful European city – and I didn’t work too hard. I learned some clinical basics, enjoyed the music (more ECM than opera) and spent some of my time doing a little lab work, more as a technician than anything else. I knew that when I returned to Newcastle I would spend a year or so as a registrar before applying for a MRC or Wellcome Training Fellowship (and for the medics amongst you, no, I never registered for higher training). In the meantime, as well as learning some clinical dermatology, I needed to learn some cell biology.

I went to medical school in 1976 and qualified in 1982, having taken a year out to study medical statistics (with an emphasis on the medical) and epidemiology, so I hadn’t any lab or cell biological experience. It was now 1986-87 and the preceding decade has seen a revolution in what we now call molecular cell biology — or just biology(?). I needed to teach myself some. Luckily, the best textbook I have ever read — the Molecular Biology of the Cell was published by James Watson and a bunch of other wonderful scientists in 1983 and my memory is that it was this first edition I bought. The book had attitude. The authors clearly loved their subject, and thought science was to do not so much with facts but the activity of designing and implementing experiments that whispered to you how the biological universe worked. They wanted to share that feeling with you, because one day, just perhaps, you might… On the back cover there was a picture of the authors pretending to be real superstars like the ‘fab four’ on that most famous of pedestrian-crossings in the world. (There is more on this here and here)

In the company of a good companion (a book in this case) there is little in biology that is very difficult. If you are motivated, even the absence of a personal teacher is not too serious a drawback. You would be better off with a teacher — if the cost of teacher was zero — but it would be wasteful to imagine that you need a teacher for a significant fraction of the time you need to spend studying. For some areas of biology, say quantitive genetics, the above statements may need tweaking a little, but the general point holds.

Story 2

Almost a quarter century ago, I read a paper in PNAS on statistics by Peter Donnelly and David Balding on how to interpret DNA forensic evidence. I had studied a little statistics in my intercalated degree but a sentence from this paper made me sit up

We argue that the mode of statistical inference which seems to underlie the arguments of some authors, based on a hypothesis testing framework, is not appropriate for forensic identification.

The paper itself was remarkably clear even to somebody with little mathematics, and unpicking it signalled that I knew even less than I thought I knew. Several years later, it prompted me to go back and try and re-learn what little mathematics I had grasped at school, so that I might appreciate some modern genetics (and medical statistics) a little better.

Learning mathematics is different form learning biology. The absence of a teacher is more of an issue, but there are lots of historical examples showing that a good ‘primer’ with questions and answers allows many children to develop, if not high level skills, a facility with numbers. (I am talking here about using mathematics as a toolbox to follow how one can solve well defined problems — not push back the frontiers). A key aspect of this is the nature of mathematical proof, and how well you can obtain feedback on your abilities by submitting to the discipline of simple exercises with unambiguous answers. I don’t think there is a direct equivalent to this in most of biology but in the process of writing this today I see there are workbooks for the Molecular Biology of the Cell textbook. No doubt they help, but the uniqueness of the correct answer in maths is a wonderful guide and fillip.

Story 3

I retired earlier this year (yes, thanks for asking, it’s wonderful), and one of the projects I had lined up was to learn a little more about a domain of human knowledge in which my ignorance had been bugging me for years. I had made some attempts in this area before — bought some books as an excuse for lack of effort — but had failed. I had found an excellent primer (in fact I bought it ten or so years ago), but speaking of the present, I have to say that I find the task hard, very hard. For me, its tougher than intermediate mathematics, and although there are questions at the end of each chapters there are no given answers. This is not a criticism of the book, but rather reflects the nature of the subject. A teacher or even a bunch of fellow masochists students would help greatly. I make progress, but some more pedagogical infrastructure would, I feel, push me around the winding path a little faster. So, for several months I have been plodding away, mostly being disciplined, but because I have other things to do, occasionally falling off the wagon (indeed I note that I can multitask by falling off several wagons simultaneously).

All three stories are germane to how I think about undergraduate medical education and how it is far too wasteful and expensive. As for the how, that I must leave for another day very soon. Even without an exam in sight, I have to get some studying done. Spaced recall and immersion is the student’s friend.

Queerer that I can imagine

by reestheskin on 16/06/2020

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Its natural, Jim. From an obituary of Julian Perry Robinson in Nature

Julian Perry Robinson (1941–2020)

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.

The beginning is where its at.

by reestheskin on 12/06/2020

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The best way to foster mediocrity is to found a Center for Excellence.

This is a quote from a comment by DrOFnothing on a good article by Rich DeMillo a few years back. It reminds me of my observation than shiny new research buildings often mean that the quality (but maybe not the volume) of reseach will deteriorate. This is just intellectual regression to the mean. You get the funding for the new building based on the trajectory of those who were in the old building — but with a delay. Scale, consistency  and originality have a troubled relationship. Just compare the early flowerings of jazz-rock fusion (below)  with the technically masterful but ultimately sterile stuff that came later.

If I Sleep for an Hour, 30 People Will Die

by reestheskin on 11/06/2020

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Beautiful and moving video about the child forger Adolfo Kaminsky (via the NYT).

Teach yourself medicine

by reestheskin on 10/06/2020

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Being an emeritus professor has lots of advantages. You have time to follow your thoughts and allow your reading to take you where it goes. Bruce Charlton pointed out to me many years ago that increasingly academics were embarrassed if you caught them just reading in their office (worse than having a sly fag…). It was looked upon as a form of daydreaming. Much better to fire up the excel spreadsheet or scour the web for funding opportunities. Best of all, you should be grant writing or ensuring that the once wonderful idea that only produced some not-so-shiny results can be veneered into a glossy journal.

Of course, being retired means you don’t have to go to management meetings. For most of career I could reasonably avoid meetings simply because if you spend most of your time researching (as I did), all you care about is publishing and getting funded. The university is just a little bit like WeWork — only the finances are were stronger.

One aspect of teaching-related meetings particularly irked me: student representatives, and how people misunderstand what representatives should and shouldn’t contribute. This is not specific to meetings — the same problem exists in the ‘happy sheets’ that pass for feedback — but is what I see as a problem in inference. Humans are very capable of telling you how they feel about something especially if they are asked at the time of, or soon after, a particular event. What is much harder is to imagine what the results will be if a change is made in how a particular event is undertaken, and how this will relate to underlying goals. This is a problem of inference. It needs some theory and data. So, if students say Professor Rees doesn’t turn up for teaching sessions, or doesn’t use a microphone or uses slides with minuscule text in lectures, this is useful knowledge. What is less helpful, is when you wish to appear to be empathetic (‘student centred’) and allow students to demand that you accept their views on pedagogy. This is akin to the patient telling the surgeon how to perform the operation. Contrary to what many believe, a lot is known about learning and expertise acquisition, and much of it is very definitely not common sense. And do not get me started on bloody focus groups.

Having got that bitching out of the way, I will add that one of my jobs over the last few years was to read virtually all the formal feedback that students produced for the medical school. Contrary to what you might think, it was an enjoyable task and I learned a lot. The biggest surprise was how restrained and polite students were (I wished they would get a little more angry about some things), and often how thoughtful they were. There were the occasional gems, too; my favourite being a comment about a clinical attachment: ‘I am sure the teaching would have been of a high standard — if we had had any.’ Still makes me smile (and the latter clause was accurate, but I am not so sure about the rest).

Now, I don’t want to feign any humblebragging but a few weeks back I received this comment from a former (anonymous) student (yes, the university is efficient at stopping your pay-cheque but thankfully is not good at terminating staff and in any case I still do some teaching..).

“Honestly you just need to look through the website he has built (http://reestheskin.me/teaching/). Who else has created an open-access textbook, lord knows how many videos (that are all engaging and detailed enough without being overwhelmingly complex) and entire Soundcloud playlists that I listen to while I’m driving for revision. I bet you could learn to spot-diagnose skin cancers without even being medical, just learn from his websites.”

Now of course this is the sort of feedback I like 😂. But it’s the last sentence that pleases and impresses me most. The student has grasped the ‘meta’ of what I spent about seven years trying to do. There is an old aphorism that medical students turn into good doctors despite the best attempts of their medical school. Like many such aphorisms they are deeper than they seem. One of the foundation myths of medical schools is that undergraduate medicine really is as is was portrayed in Doctor in the House with just a smattering of modern political correctness thrown in. Sadly, no. Even without covid-19 universities and medical schools in particular are weaker than they seem. Demarcating what they can do well from things that others might do better needs to be much higher up the agenda. This particular student wasn’t taught that but learned it herself. Good universities can get that bit right occasionally.