Discussing the shortage of GPs, a locus GP writes:
As so often, there are several factors. Many GPs have retired early – the causes are often quoted as falling GP work earnings, disenchantment with CCGs, the CQC, and revalidation. I think more significant is the sense that we have suffered a loss of control of our work, with QOF making us ask pointless questions about emergency contraception to 45-year-olds, prescribing software pop-ups that order us around for petty savings, warnings about FGM on computers of doctors in areas with no ethnic minorities. These are very harmful to our sense of doing a worthwhile job.
And we have failed to recruit new GPs. Quite an achievement when one considers that the training is three years rather than seven, salaries are good, and there is no out-of-hours work if you don’t want it. How have the deaneries managed that? I have talked to many young doctors and most of the ones who have done F2 in general practice have felt exploited and hated it. They feel that have been chucked in at the deep end. There seems to have been lots of investment in the system for training registrars who often work at the practices of the doctors in the training hierarchy, but very little in F2 practices – who are after all the shop window that we need to perform well if we are to attract new GPs.
Well, this was the modest description of a ‘new’ way to test blood. Except it wasn’t. The reality distortion field in hyperspace. If you don’t know the Theranos story — or doubt the importance of real journalism — have a look.
The journalist who broke the story, John Carreyrou, has a book coming out soon. Jean-Louis Gassée, a shrewd observer of Silicon Valley, has a nice piece about it. Note the turtle neck.
In this week’s privacy nightmare, an Oregon couple discovered their Amazon Echo smart speaker recorded their conversation and sent the audio to an acquaintance — without their knowledge.
The claim seemed improbable, until the company confirmed it really happened. Amazon said it was reviewing how its smart speakers work to avoid similar situations.
Business schools are being reinvigorated by the apprenticeship levy, with 40 out of 113 universities creating specific MBA courses to take advantage of the tax, according to a new survey.
Businesses are permitted to spend the money on MBAs, but only up to £18,000, compared with the typical course fee of £24,000 in the UK. Tuition fees at the top MBA providers can rise up to £80,000.
Several of the new courses, however, are stripped down to fall within the levy funding limits.
Those that back levy-funded MBAs, however, point to research by the Office for National Statistics, which concluded that a 0.1 rise in management effectiveness led to a 9.6 per cent rise in productivity.
Business schools create new courses to tap apprenticeship levy
Vargas Llosa tells me he is starting a new novel, and I wonder if he will ever stop writing, as Philip Roth did as he approached 80. “Writing is what I do. It is my life,” he replies immediately. “To be alive but dead is the worst possible thing, although it happens to many people.” Vargas Llosa then bows his head low to the table in a gesture of the abundant grace and humanity that I had not expected to see two hours earlier. “In fact, I hope to die writing.”
John Paul Rathbone in the FT
Maybe it is just me, but I find many of the graphics in the BMJ hard to follow. The image below is from a clinical update on “Depression and anxiety in patients with cancer” (BMJ 28 April 2018, p116-120). It occupies two whole pages. I am not certain what problem the graphic is trying to solve. For me, it just induces a sense of incomprehension. Or nausea.
In dermatology, there was a famous US academic known for producing slides with numerous arrows, many involving feedback. It was professional cargo-cult science (as the BMJ is cargo-cult education). Sam Shuster always cautioned: more than 3 or 4 arrows per slide, usually means bullshit.
That which is simple is wrong; that which is complicated is useless (Paul Valery).
But outside in Times Square, the LED news tickers were telling a different story. On Tuesday, Gibson Brands, Inc – with the biggest product line in the guitar business – filed for bankruptcy, succumbing to an estimated $500m debt load and a failed reinvention in 2014 as a “lifestyle brand”.
Now I know things are really bad.
Troubles in the land of the six-string are not restricted to Gibson. Ten years post-recession, the guitar industry in the US continues to bob, with the 2,633,000 units sold in the United States in 2017 about 5% short of where things stood in 2008, according to Music Trades magazine. The heavyweight retailer on the American scene, Guitar Center, carries $1.6bn in debt.
Played out? Gibson’s bankruptcy fuels fears for the guitar’s future | Music | The Guardian
And here, too.
Science 21 June 2013: 1394-1399.
For most alumni, university fundraising may seem to be uncoordinated and lacking in focus—an assortment of phone calls, solicitous letters, and invitations to a class reunion. But for Steven Rum, it’s a science. And the goal is to carry out more research.
Rum is senior vice president for development and chief fundraiser for Johns Hopkins Medicine in Baltimore, Maryland. Last year, his team had a banner year, raising $318 million. Their approach places the physician scientists at Hopkins on the donor front lines. The goal is to turn the positive feelings of “grateful patients” into support for new research, faculty chairs, academic scholarships, bricks and mortar, or simply defraying the cost of running a multibillion-dollar medical center.
Rum has 65 full-time fundraisers on a staff of 165. Each one is responsible for meeting weekly with physicians—their “caseloads” range from a dozen to more than 30 docs—to discuss which of their patients might be potential donors. The conversation is designed to help them identify what Rum calls a donor’s “qualifying interest” and connect it to their “capacity,” that is, the ability to make a donation.
More often than not, Rum’s team finds that sweet spot…..
”Ideally, I’d like to have one gift officer manage no more than six doctors,” he says.
Exactly in the same way that Big Tobacco has been free to fill the lungs of Asian of African populations, with little interference from local health administrations, Facebook will have a free hand to lock up these markets. (If you find my comparison with the tobacco industry exaggerated, just ask the Rohingyas or people in the Philippines about the toxicity of Facebook to democracy — or read this Bloomberg Business Week piece, “What happens when the government uses Facebook as a weapon?”)
Mark Zuckerberg’s long game: the next billion – Monday Note
A beautifully written vignette in the NEJM by Abigail Luger
Moving On | NEJM
Now I’m the one contemplating a permanent departure. My health is fine, but my stamina is pretty much gone. Our health care system is not kind to the chronically ill and marginally insured, and it is not particularly kind to their doctors, either. Our patients are condemned to an unending swim against a hostile tide. Doctors can head for shore.
Great story. Only true.
Schrems sent the complaints to the Irish data protection commissioner in Portarlington, a town with a population of 8,000. From a modest office above a supermarket, the Irish DPC was responsible for regulating all the tech companies that nominated their Dublin-based subsidiaries as “data controllers”. Despite its role protecting millions of EU citizens, the commissioner had just 26 staff at the time.
This all reminds me of that wonderful scene in the film Local Hero when the visitors from the US mega corporation discover that the same person (played by Denis Lawson) runs the bar, hotel, office, professional services etc. in the small Scottish village where it is set.
BTW: instead of the mandatory GDPR corporate training, can we just not watch Local Hero again?
My third issue is more nuanced. The biggest reason for cataract blindness is the dearth of ophthalmologists. Orthopaedic surgeons in Leicester faced with a backlog of carpal tunnel surgery decided to train intensively one theatre nurse. As a result, our carpal tunnel surgery service is probably the best and most cost effective in the country. Having a person who is not a “fully qualified doctor and surgeon” operating on cataracts could be the best solution.
Quote from, John Sandford-Smith, retired ophthalmologist, Leicester. BMJ 2018;360:k640
This sort of argument is old, and largely correct. But you can only scale such a process with the help of some form of certification, because without it, there is no durable career structure. And without this, there is no investment.
I used to think this whole topic was overblown. But then again, I once thought those who foresaw the obesity epidermic were selling something. Wrong on both counts.
Former Google Design Ethicist: Relying on Big Tech in Schools Is a ‘Race to the Bottom’ | EdSurge News
I see this as game over unless we change course,” says Tristan Harris, a former ethicist at Google who founded the Center for Humane Technology. “Supercomputers play chess against your mind to extract the attention out of you. The stock price has to keep going up, so they point it at your kid and start extracting the attention out of them. You don’t want an extraction-based economy powered by AI, playing chess against people’s minds. We cannot win in that world.”
In an interview with EdSurge, Harris noted that the focus of their campaign started with children because they were the most vulnerable population. He says that particularly children in schools had little agency over whether they opted into or out of a technology platform because of pressure from both peers and educators handing out assignments.
Some nice turns of phrase and perspective from this article in the FT
In 1829, the great Scottish historian and essayist Thomas Carlyle wrote: “Were we required to characterise this age of ours by any single epithet, we should be tempted to call it . . . the Mechanical Age. It is the Age of Machinery . . . the age which, with its whole undivided might, forwards, teaches, and practices the greater art of adapting means to ends.”
He continued with a lament for older ways of doing and being: “On every hand, the artisan is driven from his workshop, to make room for a speedier, inanimate one. The shuttle drops from the fingers of the weaver and falls into iron fingers that ply it faster. The sailor furls his sail, and lays down his oar, and bids a strong unwearied servant . . . bear him through the waters.”
It is a measure of just how much speedier our age is that no one today will take the time to write or read such comparatively languorous prose. What is striking about Carlyle’s writing from today’s vantage point is how early in the industrial revolution he mounted a protest against it. By 1829, the steam engine was entering its heyday, but the explosion of iron, steel, coal and oil that we associate with the industrial age was visible only on the horizon.
Article in Nature. I largely agree, although my views are as much based on the hype-upon-hype that characterises so much of medical research, especially cancer. I do not have a reference, but whatever one’s views about the late David Horrobin, his Lancet article about cancer trials — written when he was dying from lymphoma — is worth a read. What a mess!
Key quotes from this article:
In 2017, my colleagues and I completed a study of all 48 cancer drugs approved by the European Medicines Agency between 2009 and 2013 (C. Davis et al. Br. Med. J. 359, j4530; 2017). Of the 68 clinical indications for these drugs (reasons to use a particular drug on a patient), only 24 (35%) demonstrated evidence of a survival benefit at the time of approval. Even fewer provided evidence of an improved quality of life for symptoms such as pain, tiredness and loss of appetite (7 trials; 10%). Most indications (36 of 68) still lacked such evidence three or more years after approval. Other groups in other regions have observed similar trends. For example, a 2015 study demonstrated that only a small proportion of cancer drugs approved by the FDA improved survival or quality of life (C. Kim and V. Prasad JAMA Intern. Med. 175, 1992–1994; 2015).
But the key point he makes is:
I believe that the low bar also undermines innovation and wastes money.
When assessments — whether in medicine or education — are flawed the loss in value is not in short term financial costs, but in what might have happened 10 years down the road.
The Medical Council of India has asked state councils to investigate the problem of “ghost” teachers in medical colleges following the discovery of more than 400 fake teachers in four colleges in three states.
He said that the Maharishi Markandeshwar College in Ambala, established in 2008, has an annual intake of 150 students.“It needs a minimum of 108 faculty members as per the Medical Council of India norms. On paper it has 145 teachers listed. But that’s on paper. The college would retain a majority of the names adding new ones off and on. During inspections the doctors would appear and then disappear once the inspections were over.”
We learn that:
These “ghost teachers” are registered as faculty members drawing a hefty salary, but have never taken a single class. Most of them run private clinics, and only attend the college when there is an impending medical inspection.
Well, one wit once remarked that the collective noun for a group of professors is “An absence of professors”.
Günter Blobel (1936–2018) | Science
Günter taught us to distinguish experiments that should be done from those that could be done; he taught us to cherish the paradox over the obvious next thing. Importantly, Günter excelled at standing up firmly for one’s convictions in the face of controversy.
Born in Buckinghamshire in 1942, Sulston described his young self as a mechanically minded artisan who preferred science to sport
From an obituary of John Sulstan (by Judith Kible), whom I meet only once when some of our red hair work was featured on the Christmas Lectures. But the phrase harks back to a true characterisation of some types of science. Tool makers; and theorists.
“Why do doctors feel the need to do this? A study in The BMJ in 2015 suggested that there is an association between increased defensive practice and a reduced likelihood of being involved in litigation.2 One might conclude that defensive practice is a logical behaviour in the face of a culture that leads to doctors being fearful of the consequences of making an error or even of a known adverse outcome.
“No doctor sets out to practise defensively, but a system has been created where this is inevitable. The GMC acknowledges that medicine has become more defensive.3 Doctors often lack confidence in the fairness and competence of investigations and continue to see the GMC as threatening.”
Tom Bourne quoted in the BMJ
A “world renowned” consultant radiologist has been suspended from the medical register for six months after being convicted of failing to pay more than £400,000 in tax on his private practice earnings. XXX a professor of cardiovascular imaging, was given a 15 month suspended prison sentence and fined £200,000 in 2015. The GMC argued that he should be erased from the register. But the medical practitioners tribunal concluded that he made a unique contribution to the care of critically ill patients and the development of cutting edge techniques.
Bmj September 30 , 464, 2017
And third, the internet is disrupting death as it has life. Comparison sites shed light on funeral providers’ services. And though not many bereaved relations yet “bring their own coffin”, a quick browse online gives people a far better idea of what it should cost. Startups are offering more radical disruption: rocket-launches for ashes; QR codes on graves linked to online tributes; new ways of disposing of bodies besides burying or burning.
I like that you can now go ‘direct’. Purgatory is now optional.
(Isaiah)Berlin had learned that if you studied them with philosophical intent, certain second-rate minds grappling with first-rate problems could teach you more than first-rate minds lost in the shrubbery. (Another reason, perhaps, that he abandoned analytic philosophy.).
Mark Lilla in the NYRB
Which for some reason reminds me of a quote from the Economist:
Professors fixated on crawling alone the frontiers of knowledge with a magnifying glass.
Despite my professional area of interest, I always forget how fast fingernails grow. But no longer.
Thanks to plate tectonics, America and Europe are moving apart at about the speed that fingernails grow. (Thanks to Bill Bryson)
A Wonke podcast well worth listening to featuring Matt Robb of EY Parthenon on higher education. I think it will all end in tears, but it has the virtue of laying out what is happening and — to use one a phrase I detest — the direction of travel.
Wonkhe podcast here.
Some selective notes below (not necessarily his views): there remains much misery to go around.
- increasing rate of change
- the nature of change
- HE is increasingly commercial and internationalised
- universities having to be more extroverted
- HE sector facing segmentation
- global elite versus high-end Russell and the low-end…..
- (some) protection by grouping by brand
- international students to drive research to drive rankings to attract students…
- your ranking is under threat
- rise of TEF
- the TEF proof of ‘value added’ at bottom of rankings is the only defence against the ‘too many going to university’ argument. (Well, too many are going…)
- the great challenge (for part of this sector) is to explain what teaching looks like if it is not research led teaching (which is not the mass of higher education).
- contract lecturers ……more ‘financial’ flexibility
- online / blended allowing……. more ‘financial’ flexibility
- Segmentation rules!
- University Leadership does not have the strategic competence or backup to run universities.
- a nice analogy between spreadsheets, and strategy versus planning.
Never underestimate the ability of the UK to reflect on, and then destroy its own brands, particularly if consultants are involved. You can make a lot of money as the ship goes down.