Once it seemed that people wanted to negate the hyperlink, and confine us to walled gardens. Think AOL etc. Sadly, many of the organisations I am forced to deal with want to give up what we have  learned about UI, and spend more and more time learning how their portal works. So, if I want to fill in CPD, I have to use this portal; if I want to be appraised, I have to use this portal. Etc, etc. Of course, I don’t seem to have any choice, I am obliged as a condition of employment. No longer can I see students and make notes in a software system that is universal (as in a textfile) and that is designed so as to encourage writing, but I have to type into badly designed online data management systems. All so  the users, the people who do the work can be audited. And the audit gets in the way. I posted earlier about David Graeber, and he seems to have it right. I quoted Gillian Tett, of the FT, herself once an anthropologist:

But even if you disagree with his politics, Graeber’s book should offer a challenge to us all. Should we just accept this bureaucracy as inevitable? Or is there a way to get rid of all those hours spent listening to bad call-centre music? Do policemen, academics, teachers and doctors really need to spend half their time filling in forms? Or can we imagine another world?

There are no easy answers. But the next time you see a bureaucratic form — and I have several sitting in my inbox right now — it is worth asking who really benefits from it? And, more importantly, who would suffer if we were to all suddenly rip them up? It is, perhaps, one of the more subtly revolutionary ideas of our age.

So what has upset me now? I gave a talk at an international meeting, one of those overview talks, rather than presentation of primary data. Kindly, the editor of a journal asked me would I turn it into an essay. I agreed, I had put a lot of work into the talk, and he and I both agreed that some of  my thoughts deserved a wider audience. All well and good, except the journal is not very OA, and my working prejudice is that I will not publish in, nor review articles for journals that are not predominantly OA and where the prices are modest, and where the journal is  a not-for-profit (not a rule, a sort of bias). Anyway, I thought about it, and carried on, knowing that at least I can put the essay on this site in its original spoken form.

Then the proofs arise. Now, I am older enough to remember paper MS doubled spaced using a typewriter, then paper pdfs, but now what do I have to wrestle with? I have to download Adobe Reader, and go through a particular publishers portal. Not amend a pdf, and email it back. Nor am I allowed to use the pdf editor that sits on my machine that is simpler and more robust than Adobe’s but no, I have to alter my workflow, download software I don’t like, to undertake all those tasks that publishers used to do.  Finally, please, please can everybody do what my colleagues in computing science have been doing for so long: BibTeX and LaTeX, or similar, rather than all these ridiculous journal specific font and references styles. Rant over. Maybe this is why the economists have commented that we see the ‘benefits of IT everywhere except in the productivity figures’. We have reinvented Babel. Rant over.

Fairly dismal reading here and here. Much of what has happened in the UK is a result of a health service that is not based around clinical need, and in which most decision makers might as well believe in fairies. The mistake is to imagine that we got into this mess because of a lack of money. We got into this mess for much the same reason that much of  UK industry has collapsed: the people making decisions have no technical competence in the relevant domains. If it was left to the NHS,  BMW would not employ engineers (‘its just process management, isn’t it, so let’s reorganise the workflow, and set some targets?’).

I cannot escape the ethicist and lawyer, Daniel Sokol, it seems. If he is not in the THE, he in the BMJ. Last week he wrote a thoughtful piece for the BMJ. Some quotes to give a flavour:

[Following a presentation in Australis to the Royal Australian College of Surgeons]

Between sessions, I asked delegates from several countries if ethics formed part of their national medical school curriculum. It did, but all my interviewees added that the subject had a poor reputation among students. It seems, sadly, that this is a widespread view.

The possible explanations for this apparent distaste ranged from poor teaching to wrong content, premature delivery in the preclinical years, incompatibility with the scientific temperament, and institutional indifference to the subject.

For me, the key statement here is ‘premature delivery in the preclinical years’. He then goes on to argue that if only the subject were integrated into ‘real’ clinical practice, things would improve. I think he is right, but I am interested in this issue more generally. Clinical medicine is fragmented, and its practitioners, the same. Much of this is a necessity reflecting the complexity of modern medicine. But, from a student’s perspective, this comes at a cost. Given that undergraduate medicine should be simpler (and more superficial in some respects) than post-graduate medicine, the staff who deliver much, if not most teaching, need not be clinical generalists, but undergraduate generalists. It is not so much an integrated curriculum we need, but integrated teachers. If you teach undergraduates you cannot join all the dots unless you know what others teach, and how your students have been taught before you see them. This means many of those providing the teaching need  to move away from the lens of a particular discipline, but in addition see the course overall.  That we don’t do this, says a lot about how deeply we think about teaching and learning. Sokal is right that the expropriation of content outwith the clinical environment is a problem. The solution is to change the way we train those who teach. Staff cannot do everything.

In March 2015, a third bombshell dropped: a draft chapter on “investor-state dispute settlement” (ISDS). It would empower foreign companies to sue member countries for hundreds of millions of dollars in damages in a wide range of cases in which they argue that their expected future profits have been undermined. These challenges would be heard by “arbiters” — typically private lawyers, many of whom cycle in and out of industry — with no prospect of independent review by a national court.

This is about the TPP, (trans-Pacific Partnership; but includes health) from the NEJM. 800 years after Magna Carta.

Well, after struggling with that bloody paperclip for years, I am not too optimistic. But do we really have to live in a world infested with such advertising?

 

I was going to ignore this, but I have just chanced upon some more comments about it, so writing therapy is required. The article with the above title was written by Richard Smith, and published in the THE a few weeks back. I  always worry if I agree with Richard Smith’ arguments, but on this topic he is largely correct:

Yet peer review persists because of vested interests. Absurdly, academic credit is measured by where people publish, holding back scientists from simply posting their studies online rather than publishing in journals. Publishers of science journals, both commercial and society, are making returns of up to 30 per cent and journals employ thousands of people. As John Maynard Keynes observed, it is impossible to convince somebody of the value of an innovation if his or her job depends on maintaining the status quo.

Scrapping peer review may sound radical, but actually by doing so we would be returning to the origins of science. Before journals existed, scientists gathered together, presented their studies and critiqued them. The web allows us to do that on a global scale.

But I think he gets a few things dangerously wrong.

First, journals have taken over ‘peer review’ forgetting that its original meaning was judgment by one’s peers. It was always silly to image that 2 -10 people judging a MS could provide robust scrutiny or recognition of excellence. Peer review is why we recognise Watson and Crick, or Wiesel and Hubel, a half century on. Journal editors use this intellectual sleight to make their organs more appear more powerful, when in point of fact many  journals work outside the real community of science.

Second, he states, ‘The most cited paper in Plos Medicine, which was written by Stanford University’s John Ioannidis, shows that most published research findings are false.’ This is imply untrue. Ioannidis’s study was limited to medicine and largely concerned papers that tried to define truth using ‘probability management’. One the reasons we are in this mess, is that we have confused what I would call academic A/B testing with science. The former is, at best, technology assessment, and however important it is for medicine , it is not science— or at least not science if we define science as the attempt to  produce broad and deep conceptual understanding of the natural world. You cannot do science without an attempt to produce theories about how the world works. That is why most RCT fail as science, because they are not obsessed with the structure of the world. They are frequently expensive forms of A/B testing.

Third, he states: ‘Cochrane reviews, which gather systematically all available evidence, are the highest form of scientific evidence.’ They are not the highest form of scientific evidence; and they do not systematically gather evidence (much of the evidence is in people’s heads). What they frequently are, are reasonable attempts to summarise domains of knowledge in which we lack critical insight, and have to rely on probability management (as if often the case in medicine). You may have to do this, but nothing in a Cochrane compares with say the theory of evolution, or the base structure of DNA, or how we define fitness, or laws of the conservation of energy etc etc. Probably the greatest series of scientific breakthrough over the last half century — the breakthroughs that allow the medium I write on to exist — owe nothing to Cochrane. The more you need Cochrane, the less you can be confident about what you are saying.

Rant over. I feel better already.

When you hear me grumbling about the state of educational research, it is because education is second only after weight loss as the source of conflicting data, contradictory conclusions, and outright bad research.

I didn’t say that that, but I could have. Quote from Stephen Downes. The prompt was a story about weight loss and chocolate. [direct link to this aside] 

Neel Sharma: Reforms in medical education—are we missing something? But I think he is wrong on some points. The last thing much of med ed needs, is to ape the ‘Poverty of Trialism’. The search space for med ed is too big, and we are getting confused between science and design. And I really don’t think we have seen much change. Perhaps easier for me to state: I disagree with most of what he says.

What Happened to Educational Television: The Story of ‘The Learning Channel’. This is a great series of articles by Audrey Watters. But amidst the tropes (not that she sees them) about the last great educational tech being either the blackboard or the school bus, tech is going to be the direction of travel, and not just in the private sector [I hope].

Some experiences of life at Imperial College London. There are some updates here for those who have been following the story. It is hard to gauge the minds of some wannabe clinical academics. Many, I suspect are planning careers in which they know they will jump ship to the NHS —whatever they say at interviews for fellowships— but events at Imperial, Warwick, Cardiff and Dundee, suggest to me that the brightest need to go elsewhere.

The trouble with science. Via John Naughton. Yes. And, yes, again.

We need more nurses.. This is about the US, but brings back more unhappy memories of the care my late father received at a leading (sic) UK teaching hospital. We need more nurses, but more importantly, we need to put some trust back in the professional judgment of those on the wards. That of course is why many hospitals are called Trusts: there isn’t any. And, we need much more investigative journalism — it is more likely to change things than academic research.

The doctor shortage. US style. From the AAMC: you are warned.

One fine day, I will compile a list of all the bloody things that medical students are supposed to be trained/educated/tick-boxed/brainwashed in. Eventually they will be so busy, there will no time to left to learn how to take a history, come up a differential and explain to the patient what options there are for what should or should not happen next. This week, we have moved on from ‘resilience training’, to ‘mandatory training in whistleblowing’ (BMJ 30May 2015). We have been here before— it just makes everything worse.

[direct link to this aside] 

“The big blunders in this book are not accidental but intentional.”

Freeman Dyson, in his new book ‘Dreams of Earth and Sky.’ Why he continues to disturb the universe; and why he changed 20th century physics. No grant applications here.

[direct link to this aside]