Well, I thought the Swiss connection with Sherlock Holmes were the Reichenbach falls (I had to visit, a few years back). But no, I read that:

Except in Switzerland, where the stories were banned from railway bookstalls for fear they’d inspire criminality, Sherlock Holmes was big business from the moment of his inception.

But of more interest to the medic:

In 1882, as a newly qualified doctor with a practice in Southsea, Arthur Conan Doyle found himself chronically short of sick people. He therefore used the empty office hours to write his tales about the “consulting detective” who was based on Joseph Bell, the Edinburgh surgeon who knew at a glance what was wrong with the patients parading before him

There is a widespread delusion in the UK that you can accurately plan how many doctors you need. This is a mistake, both for society and for the doctors themselves. As we move forward, I think we will see more medics emulating one of the great ones.

And, as for the book, reviewed in the FT (‘The life and death of Sherlock Holmes’), it highlights that Holmes’ nemesis was not Moriarty, but lawyers.

This is via the ever insightful Status-Q:

“A couple of months ago I quoted this phrase from Sam Altman:”

‘The hard part of standing on an exponential curve is: when you look backwards, it looks flat, and when you look forward, it looks vertical. And it’s very hard to calibrate how much you are moving because it always looks the same.’

Plotting the future | Status-Q

I talk about a variant of it that I thought Larry Summers used, although when I have tried to check my memory, I turn nothing up. I see two straight lines, one with a shallow gradient close to zero, the other with a steep one, joined at an inflection point. When you are on the shallow line, you never perceive anything is changing. And even when you know things are going to change  — or you wish for change —you have no idea when. At least with an exponential function you can calculate: with a sudden shift, all you can do is pray. An optimist is somebody who wishes the inflection point comes soon. As does the fool.

WHAT do you call someone who is over 65 but not yet elderly? This stage of life, between work and decrepitude, lacks a name. “Geriactives” errs too much on the side of senescence. “Sunsetters” and “nightcappers” risk being patronising. Perhaps “Nyppies” (Not Yet Past It) or “Owls” (Older, Working Less, Still earning) ring truer.

I am OK with soon (as in the David Bowie song) being patronised. I like ‘sunsetters’ best. Sipping G+T watching the sun go down, in Africa.

Economist.

Note added in proof: Here are some more:

Hopskis: Healthy Old People Spending Kids’ Inheritance

Woopies and Jollies: Well Off Older People, and Jolly Old Ladies with Lots of Loot

“I’ve written extensively on the now famous Georgia Tech example of a tutorbot teaching assistant, where they swapped out one of their teaching assistants with a chatbot and none of the students noticed. In fact they though it was worthy of a teaching award”

• Donald Clark Plan B: Tutorbots are here – 7 ways they could change the learning landscape.

I keep reading this as ‘turbot’, and wondered what the fish things was. I guess the tutorbot would have corrected me soon enough.

“Children say they prefer IT in their lessons and courses? Do schools listen when kids say they prefer chips for lunch every day?”

An understatement follows:

Education policy is particularly vulnerable to political whims, fads and untested assumptions. From swapping evolution for creationism to the idea that multiple types of intelligence demand multiple approaches, generations of children are schooled according to dogma, not evidence.

• The digital native is a myth : Nature News & Comment

Amen to all that. And not just school children, but university students. The Nature article is referring to: original paper here (The myths of the digital native and the multitasker. Paul A. Kirschnera, Pedro De Bruyckerec. DOI)

“Just fun or a prejudice? – physician stereotypes in common jokes and their attribution to medical specialties by undergraduate medical students”

Paper here. Seriously.

The survey found that UK medical schools employed 3041 full time equivalent clinical academic staff employed by UK medical schools, with a headcount of 3361. This is a 2.1% decline since 2015 and a 4.2% decline since 2010. By comparison, since 2010 the number of NHS consultants has risen by 20.6%.

(link here, from report here)

Reform of, and improving how we educate medical students requires a rethink of medical school staffing, and how clinical academics work. There are plenty of heads in the sand. I think you can improve education and drastically cut costs at the same time. Just stop accelerating into the rose tinted image in the rear view mirror.

Little evidence is found for higher-order organization into 30- or 120-nm fibers, as would be expected from the classic textbook models based on in vitro visualization of non-native chromatin.

Well, chromatin structure might not be everybody’s cup of tea but I once shared an ‘office’ with a couple of French / Polish researchers in Strasbourg. It was all above my head, so I had to make do with the textbooks, and I stuck to my simple cloning of upstream regulatory regions of a retinoid receptor. Now, it appears from this article in Science, the textbooks will need rewriting. Science works.

Many many years ago I wrote a few papers about — amongst other things — the statistical naivety of the EBM gang. I enjoyed writing them but I doubt they changed things very much. EBM as Bruce Charlton pointed out many years ago has many of the characteristic of a cult (or was it a Zombie? — you cannot kill it because it is already dead). Anyway one of the reasons I disliked a lot of EBM advocates was because I think they do not understand what RCTs are, and of course they are often indifferent to science. Now, in one sense, these two topics are not linked. Science is meant to be about producing broad ranging theories that both predict how the world works and explain what goes on. Sure, there may be lots of detail on the way, but that is why our understanding of DNA and genetics today is so different from that of 30 years ago.

By contrast RCTs are usually a form of A/B testing. Vital, in many instances, but an activity that is often a terminal side road rather than a crossroads on the path to understanding how the world works. That is not to say they are not important, nor worthy of serious intellectual endeavour. But the latter activity is for those who are capable of thinking hard about statistics and design. Instead the current academic space makes running or enrolling people in RCT some sort of intellectual activity : it isn’t, rather it is a part of professional practice, just as seeing patients is. Companies used to do it all themselves many decades ago, and they didn’t expect to get financial rewards from the RAE/REF for this sort of thing. There are optimal ways to stack shelves that maths geeks get excited about, but those who do the stacking do not share in the kudos — as in the cudos [1] — of discovery.

Anyway, this is by way of highlighting a post I came to by Frank Harrell, with title:

Randomized Clinical Trials Do Not Mimic Clinical Practice, Thank Goodness

Harrell is the author of one of those classic books…. . But I think the post speaks to something basic. RCT are not facsimiles of clinical practice, but some sort of bioassay to guide what might go on in the clinic. Metaphors if you will, but acts of persuasion not brittle mandates. This all leaves aside worthy debates on the corruption that has overtaken many areas of clinical measurement, but others can speak better to that than me.

[1] I really couldn’t resist.

This is from CP Snow’s ’Two Cultures’. I have never read the book, always warming to critiques of it from others. But I like this snippet quoted by John Naughton, recently.

“I can’t help thinking of the Venetian republic in their last half-century. Like us, they had once been fabulously lucky. They had become rich, as we did, by accident. They had acquired immense political skill, just as we have. A good many of them were tough-minded, realistic, patriotic men. They knew, just as clearly as we know, that the current of history had begun to flow against them. many of them gave their minds to working out ways to keep going. It would have meant breaking the pattern into which they had been crystallised. They were fond of the pattern, just as we are fond of ours. They never found the will to break it.”

Maybe I should go back and look at it. CP Snow, Two Cultures