“Would you trade a bad bout of constipation for an erection?” he asks. “I would.”

Context matters. Serious issue. Read on in the NEJM. [direct link to this aside]

From boingboing. This reminds me of the story told by Kary Mullis  when he tried to explain PCR to people at a meeting. Nobody — including Nobel laureates —  could see why he was excited.

To commemorate the 50th anniversary of the first publication of the word “hypertext,” Gigaom talks to Ted Nelson, who coined the term and then introduced it in a 1965 paper for the Association for Computing Machinery. 

What kind of reaction did you get from others? 

No one, absolutely no one that I met, could imagine interactive computer screens. Whereas I could see them with my eyes closed, practically touch them and make them respond. It was very sensual. 

And all during the 1960s and 1970s I was trying to tell people what interactive screens would be like, in my writings and my talks. But no one got it.

I was gossiping with a bunch of fourth year students the other day about what medicine might look in a few years, and how possible changes will affect their lives and careers. Big topic, with few certainties. One of the clear messages was that they felt that nobody really critically talks about these issues to them. Instead, there appears to be lots of what might be called soft propaganda: how there is a shortage of GPs, and how important it is for them to serve by becoming these GPs; how the UK model is self-evidently superior to that available in the rest of the world; or denial of the observation that people voting with their feet (as in migrating) is one of the key ways human societies advance. Despite the ‘global health’ movement, they seem to know little about how health care is organised in different countries, especially those just across the channel. And they seemed interested to know more, so I suspect the fault is ours, not theirs. Little is done (it seems to me) to move beyond the tired stereotypes of US medicine (show your credit card or you will be declined emergency care etc) on the one hand, and the NHS ‘free’ but ‘world class‘ health care on the other (world-class, along with ‘holistic’ is the canary in the mine for bullshit). 

Such views are of course lacking in depth. Much of mainland Europe provides lessons for how to provide good health care and maintain solidarity across social strata. Anybody who knows a little about health care in England (think, Circle and dermatology; and NHS dentistry) knows that it is likely that for much of their careers many of our students might not be employed by the NHS, but by private for profit corporations, and that the exercise of monopoly power by government is stronger now than ever. The main political parties in England want to privatise health care, and seem to believe that corporate culture plays no role in delivery of ‘any service’: Virgin, United Health Care, it is all just the same, or so New labour believed. Waitrose, or Walmart: it doesn’t matter! Just look at Steve Ballmer and Steve Jobs: clones aren’t they? When independent regulation has been lost, and most health care is delivered by the same organisation that controls training in ever more microscopic ways, economics 101 will make predictions about what will happen to salaries and working conditions and —here is the crunch — how providers will manipulate customers / clients / patients. Indeed, gossip to many doctors in any hospital and you can make guesses as to what awaits many of these young people. For some for them, Australia seems closer than it did to me. 

We need to educate our students to look to the world, not their own backyards, something that Scotland was once very proud of. I have just shown a US visitor the plaques on the wall of the old Edinburgh Medical School in Teviot Place, commemorating the contributions our students made to both medicine and society (ies) across the world. Not one of them, a ‘widget’, I wager.

The MOOC revolution that wasn’t. Useful brief summary of MOOCs — cMOOCs, then the Ivy league (and New York Times) by Audrey Watters. I still think the story isn’t over, and remain puzzled by the absence of discussion about the fact that the OU really did so much of this so long ago. I forget the origin of the aphorism, but remember: ‘The two most potent educational forces of the 20th century were Penguin books, and the Open University’. I can still remember buying Penguin science books in my early teens; and staring at the TV on a Sunday morning, watching all these strange looking people, who didn’t look like my parents: they were called academics, and the dress sense was not what I was used to. And, in turn, my kids think I look a bit like them: strange.

But, I still think the whole movement is positive. We are going to use online more, and few areas of human endeavour don’t benefit from scrutiny and challenge. I think we can improve teaching, and improve it at scale and reduce the cost. I am however puzzled about those in the business of MOOCs. If the article is correct in arguing that more and more the future for some MOOCs is in business and technical education — the pivot, so to speak— do the founders really want to be in this space?

There is a heartfelt letter in Academic medicine. Is is from a former graduate specialty program director (PD) (TK Swoboda) and to me it speaks of what happens when teaching and education is industrialised along the lines of the fast-food business under the influence of corporate HR.

When I began as a PD, I believed that I had reached one of the most important academic jobs in my clinical specialty. I loved the work of developing curriculum and assessment instruments for my residents. It felt innovative, needed, and important. I could see how my work was directly related to the effectiveness of our residents’ education.

This changed with the Accreditation Council for Graduate Medical Education’s (ACGME’s) Next Accreditation System (NAS). Immediately, I became a manager of our program’s dashboard on the ACGME Accreditation Data System (ADS) and had little time for any innovative educational work due to the continual need for upkeep of the complex ADS data. The “fun” educational work became the domain of less experienced assistant or associate PDs. The job of PD had fundamentally changed overnight. It became a managing job, while leadership and innovation became a smaller secondary role.

What are the consequences of this change? American medical education is in the process of losing many experienced PDs who do not want to just be a manager. 

This is just one manifestation of what Michael Power in his book The Audit Society described as ‘rituals of verification’ Education as applied HR.

The quality of Wikipedia entries is a topic of vigorous debate, and even with its semiformal internal peer review process, the small size of the active medical community means fewer than 1% of medical articles have passed review. Yet medical information on Wikipedia is widely accessed. About 5 billion page views were logged for its medical content in 2013. Of medical students, 92% to 94% use it, and 50% to 70% of practicing physicians report also doing so [15,20,21]. A 2009 survey of UK junior physicians found that 70% use Wikipedia on a weekly basis, making it the most used content provider, ahead of eMedicine.com, which was used by nearly 50% [22].

Article on OA Point of Care Medical Info in PLoS. Editorial here. The debate about BC ND etc with Creative Commons roles on: what is open? [direct link to this aside] 

Simon Jenkins in the Guardian (old article):

Willetts has celebrated the 50th anniversary of the Robbins report with a pamphlet questioning one aspect of the expansion it stimulated. Pre-Robbins, British universities devoted 60% of their time to teaching and 40% to research. Now those percentages are reversed, so that universities are “lopsided away from teaching”. Only in the former polytechnics does teaching predominate.
Today’s students may not realise how far this has gone, but their graduate parents might. Contact time has declined. Essay writing has halved. Fifty years ago two-thirds of students received oral (as well as written) feedback, now two-thirds get none. Willetts wonders how this was ever allowed to happen. The answer is easy. Willetts and his Whitehall predecessors made it happen. Universities have become creatures of government, paid to do what government says. Ever since Thatcher abolished the arms-length university grants committee and eventually “nationalised” higher education in 1988, universities have followed the money.

Oliver Sacks has died. I haven’t read any of his books for a long time, but I loved ‘Awakenings’, and ‘The man who mistook his wife for  a hat’. I have never known what many brain people thought of him, but he was a link with the great age of medical description in my own subject in the 19th century. Others have said something similar before: you can learn more about the brain from n of 1 studies than from mega studies that are devoid of meaningful insight. To recognise the world, you have to imagine it first.

I wrote in an earlier post after reading some of his memoirs something about medical education:

When we choose students, so obsessed are we with the avoidance of risk, that we have forgotten that the best defence against whatever adversity the future might throw against us, is diversity.

I doubt if Sacks would have survived much of what we subject our students and you doctors to.

Much of what makes humans special is our visual system (as he says), but he had the wonderful voice to go with his approach, sounds that makes the telling of his stories all the more special.

Innovation as Discipline, Not Fad.

Former head of china’s genome powerhouse starts new chapter. I just find this sort of thing silly. Just me?

Obstacles to developing cost-lowering health tech. The Innovators dilemma. The problem that is not going away. See Jack Scannell and eroom’s law. Cost matters, and we fund research as though it does’t. The result is yet more subsidies to corporations that increasingly resemble banks; and a failure to promote real innovation.

The benefits of a liberal education do not go out of date. I always wonder what to make of the fact that most UK medics do not do other degrees first. I tend to think medicine is, in large part, a liberal art.

The end of the internet dream. Jennifer Granick talk at Blackhat. The battle is not lost. Yet.

‘US education is a $1.5 trillion industry and growing at 5 percent annually. On the face of it, those figures warrant attention from investors.’ As Dylan Wiliam tweeted:’ McKinsey’s latest report—Capitalists preparing to plunder education or a much-needed source of investment? You decide.’

This is up on my Vimeo page , as well. How to approach and think about pigmented lesions. #fOAmed.