The history of science is the history of rejected ideas (and manuscripts). One example I always come back to is the original work of John Wennberg and colleagues on spatial differences in ‘medical procedures’ and the idea that it is not so much medical need that dictates the number of procedures, but that it is the supply of medical services. Simply put: the more surgeons there are, the more procedures that are carried out¹. The deeper implication is that many of these procedures are not medically required — it is just the billing that is needed: surgeons have mortgages and tuition loans to pay off. Wennberg and colleagues at Dartmouth have subsequently shown that a large proportion of the medical procedures or treatments that doctors undertake are unnecessary².

Wennberg’s original manuscript was rejected by the New England Journal of Medicine (NEJM) but subsequently published in Science. Many of us would rate Science above the NEJM, but there is a lesson here about signal and noise, and how many medical journals in particular obsess over procedure and status at the expense of nurturing originality.

Angus Deaton and Anne Case, two economists, the former with a Nobel Prize to his name, tell a similar story. Their recent work has been on the so-called Deaths of Despair — where mortality rates for subgroups of the US population have increased³. They relate this to educational levels (the effects are largely on those without a college degree) and other social factors. The observation is striking for an advanced economy (although Russia had historically seen increased mortality rates after the collapse of communism).

Coming back to my opening statement, Deaton is quoted in the THE

The work on “deaths of despair” was so important to them that they [Deaton and Case] joined forces again as research collaborators. However, despite their huge excitement about it, their initial paper, sent to medical journals because of its health focus, met with rejections — a tale to warm the heart of any academic whose most cherished research has been knocked back.

When the paper was first submitted it was rejected so quickly that “I thought I had put the wrong email address. You get this ping right back…‘Your paper has been rejected’.” The paper was eventually published in Proceedings of the National Academy of Sciences, to a glowing reception. The editor of the first journal to reject the paper subsequently “took us for a very nice lunch”, adds Deaton.

Another medical journal rejected it within three days with the following justification

The editor, he says, told them: “You’re clearly intrigued by this finding. But you have no causal story for it. And without a causal story this journal has no interest whatsoever.”

(‘no interest whatsoever’ — the arrogance of some editors).

Deaton points out that this is a problem not just for medical journals but in economics journals, too; he thinks the top five economics journals would have rejected the work for the same reason.

“That’s the sort of thing you get in economics all the time,” Deaton goes on, “this sort of causal fetish… I’ve compared that to calling out the fire brigade and saying ‘Our house is on fire, send an engine.’ And they say, ‘Well, what caused the fire? We’re not sending an engine unless you know what caused the fire.’

It is not difficult to see the reasons for the fetish on causality. Science is not just a loose-leaf book of facts about the natural or unnatural world, nor is it just about A/B testing or theory-free RCTs, or even just ‘estimation of effect sizes’. Science is about constructing models of how things work. But sometimes the facts are indeed so bizarre in the light of previous knowledge that you cannot ignore them because without these ‘new facts’ you can’t build subsequent theories. Darwin and much of natural history stands as an example, here, but my personal favourite is that provided by the great biochemist Erwin Chargaff in the late 1940s. Wikipedia describes the first of his ‘rules’.

The first parity rule was that in DNA the number of guanine units is equal to the number of cytosine units, and the number of adenine units is equal to the number of thymine units.

Now, in one sense a simple observation (C=G and A=T), with no causal theory. But run the clock on to Watson and Crick (and others), and see how this ‘fact’ gestated an idea that changed the world.

1. The original work was on surgical procedures undertaken by surgeons. Medicine has changed, and now physicians undertake many invasive procedures, and I suspect the same trends would be evident. ↩
2. Yes, you can go a lot deeper on this topic and add in more nuance. ↩
3. Their book on this topic is Deaths of Despair and the Future of Capitalism published by Princeton Universty Press. ↩

There was a touching obituary of Peter Sleight in the Lancet. Sleight was a Professor of Cardiovascular Medicine at Oxford and the obituary highlighted both his academic prowess and his clinical skills. Hard modalities of knowledge to combine in one person.

Throughout all this, at Oxford’s Radcliffe Infirmary and John Radcliffe Hospital, Sleight remained an expert bedside clinician, who revelled in distinguishing the subtleties of cardiac murmurs and timing the delays of opening snaps.

And then we learn

An avid traveller, Sleight was a visiting professor in several universities; the Oxford medical students’ Christmas pantomime portrayed him as the British Airways Professor of Cardiology. [emphasis added]

This theme must run and run, and student humour is often insightful (and on occasion, much worse). I worked somewhere where the nickname for the local airport was that of a fellow Gold Card professor. We often wondered what his tax status was.

A letter from Colin Mills (Basel) in last week’s Economist

Milk, beer and sweets were listed as “basic necessities” supplied by corner shops, which are thriving during the pandemic (“Turning a corner”, October 17th). Two of the three can hardly be considered necessities. Sweets are bad for you, and many people live perfectly happily without drinking milk.

From the obit of the 007 in the Economist.

Sean Connery as James Bond simply is British manhood: good-mannered, patriotic, entitled.
Both went to Fettes College in Edinburgh, Mr Bond after he was reputedly expelled from Eton, Mr Connery to deliver milk from a barrow. He grew up in Fountainbridge, which used to be known as Foulbridge for the open sewer that ran through it.

And why those milky early morning thoughts matter.

In playing Bond, I had to start from scratch,” he pointed out to an interviewer just after “Dr No” opened. “Nobody knows anything about him, after all. Not even Fleming.”

From this week’s Economist | Breaking through

Yet nowhere too little capital is being channelled into innovation. Spending on R&D has three main sources: venture capital, governments and energy companies. Their combined annual investment into technology and innovative companies focused on the climate is over $80bn. For comparison, that is a bit more than twice the R&D spending of a single tech firm, Amazon.

Market and state failure may go together. Which brings me back to Stewart Brand’s idea of Pace Layering

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.

Pace Layering: How Complex Systems Learn and Keep Learning

I won’t even mention COVID-19.

I came across a note in my diary from around fifteen years ago. It was (I assume) after receiving a grant rejection. For once, I sort of agreed with the funder’s decision¹. I wrote:

My grant was trivial, at least in one sense. Neils Bohr always said (or words to the effect) that the job of science was to reduce the profound to the trivial. The ‘magical’ would be made the ordinary of the everyday. My problem was that I started with the trivial.

As for the merits of review: It’s the exception that proves the rule.

1. Bert Vogelstein, who I collaborated with briefly in the 1990s, after seeing our paper initially rejected by the glossy of the day , informed me that the only sensible personal strategy was to believe that reviewers are always wrong. ↩

I have posted on this topic before, but the comments below speak to me more now than ever. They are reflections on the philosopher Michael Ignatieff’s failed attempt to run for political office in Canada. He wrote a book about these events which is highly recommended (I haven’t read it, yet). A comment on the article, He brought a syllabus to a gun fight and lost, should be understood by all those who wish to protect the academy from the current gangs of populists.

“One of the things that is extremely challenging to my teaching now is the possibility that there are some things you can learn only from experience and can’t be taught. The pathos of teaching is that some things can’t be taught — and one of them might be political judgement. I don’t think that’s a despairing thought, but it does induce humility in a teacher and make the job much more interesting.”

A comment on this article is below

As someone who spent time with Ignatieff on the hustings and whose baby he has indeed kissed, I can say with some confidence that normatively desirable outcomes never address which end of the sign stake goes in the ground. He brought a syllabus to a gun fight and lost. Canada lost more. Comment from Steven McGannety [emphasis added]

THE

It remains overwhelmingly likely that Scotland will vote in September to remain part of the union. But it is also more likely that the UK is sleepwalking towards disintegration — not in this vote but in the next. Political leaders were wrong to think they would bind the UK together through devolution, and they are probably wrong to believe giving more power to Edinburgh will now have that effect. These moves only strengthen the sense of a distinct Scottish identity. They need instead to make being British something to be proud of.— John Kay writing in the FT in 2014… 

Doesn’t look good, does it?

I don’t remember where I was when JFK died; I was too young. And my brother, Alun,  still chastises me for not remembering where we were  when man first landed on the moon (answer: the West Cork hotel in Skibbereen, watching it on TV). I do however remember when my mother told me that Bobby Kennedy has just died after being shot. For some reason she had picked me up from school that day, and some  fragments of our conversation I can still hear. I would have been ten at the time, but an Irish mother and a Catholic school education, meant that the Kennedy clan were not too recondite for even a small boy to not know about.

There is one other ‘event’ from those 1960s days in Cardiff that I do remember well.  It was closer to home.  On this day, in  1966 I can remember the anguish of both my mother, and my Welsh father who had grown up in the Welsh valleys trapped on all sides by slag heaps, both literally and metaphorically.

From Wikipedia

The Aberfan disaster was the catastrophic collapse of a colliery spoil tip at around 9:15 am on 21 October 1966. The tip had been created on a mountain slope above the Welsh village of Aberfan, near Merthyr Tydfil and overlaid a natural spring. A period of heavy rain led to a build-up of water within the tip which caused it to suddenly slide downhill as a slurry, killing 116 children and 28 adults as it engulfed Pantglas Junior School and other buildings.

The Aberfan Disaster Memorial Fund (ADMF) was set up on the day of the disaster. It received nearly 88,000 contributions, totalling £1.75 million. The remaining tips were removed only after a lengthy fight by Aberfan residents, against resistance from the NCB and the government on the grounds of cost. Clearing was paid for by a government grant and a forced contribution of £150,000 taken from the memorial fund. In 1997 the British government paid back the £150,000 to the ADMF, and in 2007 the Welsh Assembly donated £1.5 million to the fund and £500,000 to the Aberfan Education Charity as recompense for the money wrongly taken.[emphasis added]

Some aspects of one’s politics are formed so young, you just forget where they came from.

Grahame Davies, a poet who writes in Welsh and English wrote the following words about another disaster — not Aberfan — but the deaths of 268 men and boys in an explosion at the Prince of Wales Colliery in Abercarn in 1878. They  seem apposite for my purpose.

We do not ask you to remember us:
you have your lives to live as we had ours,
and ours we spent on life, not memory.
We only ask you this – that you live well,
here, in the places that our labour built,
here, beneath the sky we seldom saw,
here, on the green earth whose black vein we mined,
and feel the freedom that we could not find.

The Aberfan disaster featured in the Netflix drama The Crown. In this dramatisation we learn that the Queen was advised to show some emotion — this was South Wales not the Home Counties. There are some heart-wrenching photographs in an article in the Smithsonian ¹ — all the more powerful because they are in black and white. A quote from this article is below:

“A tribunal tasked with investigating the Aberfan disaster published its findings on August 3, 1967. Over the course of 76 days, the panel had interviewed 136 witnesses and examined 300 exhibits. Based on this evidence, the tribunal concluded that the sole party responsible for the tragedy was the National Coal Board.”

“The Aberfan disaster is a terrifying tale of bungling ineptitude by many men charged with tasks for which they were totally unfitted, of failure to heed clear warnings, and of total lack of direction from above,” the investigators wrote in their report. “Not villains but decent men, led astray by foolishness or by ignorance or by both in combination, are responsible for what happened at Aberfan.”

Plenty of them still about.

1. A History of the Aberfan Disaster From “The Crown” | History | Smithsonian Magazine. MEILAN SOLLYSMITHSONIANMAG.COM | Nov. 15, 2019,https://www.smithsonianmag.com/history/true-story-aberfan-disaster-featured-crown-180973565/ ↩

The background is the observation that babies born by Caesarian have different gut flora than those born vaginally. The interest in gut flora is because many believe it relates causally to some diseases. How do you go about investigating such a problem?

Collectively, these seven women gave birth to five girls and two boys, all healthy. Each of the newborns was syringe-fed a dose of breast milk immediately after birth—a dose that had been inoculated with a few grams of faeces collected three weeks earlier from its mother. None of the babies showed any adverse reactions to this procedure. All then had their faeces analysed regularly during the following weeks. For comparison, the researchers collected faecal samples from 47 other infants, 29 of which had been born normally and 18 by Caesarean section. [emphasis added]

Healthy childbirth — How to arm Caesarean babies with the gut bacteria they need | Science & technology | The Economist