Many years ago I was expressing exasperation at what I took to be the layers and layers of foolishness that meant that others couldn’t see the obvious — as defined by yours truly, of course. Did all those wise people in the year 2000 think that gene therapy for cancer was just around the corner, or that advance in genetics was synonymous with advance in medicine, or that the study of complex genetics would, by the force of some inchoate logic, lead to cures for psoriasis and eczema. How could any society function when so many of its parts were just free-riding on error, I asked? Worse still, these intellectual zombies starved the new young shoots of the necessary light of reason. How indeed!

William Bains, he of what I still think of as one of the most beautiful papers I have ever read¹, put me right. William understood the world much better than me — or at least he understood the world I was blindly walking into, much better. He explained to me that it was quite possible to make money (both ‘real’ or in terms of ‘professional wealth’) out of ideas that you believed to be wrong as long as two linked conditions were met. First, do not tell other people you believe them to be wrong. On the contrary, talk about them as the next new thing. Second, find others who are behind the curve, and who were willing to buy from you at a price greater than you paid (technical term: fools). At the time, I did not even understand how pensions worked. Finally, William chided me for my sketchy knowledge of biology: he reminded me that in many ecosystems parasites account for much, if not most, of the biomass. He was right; and although my intellectual tastes have changed, the sermon still echoes.

The reason is that corporate tax burdens vary widely depending on where those profits are officially earned. These variations have been exploited by creative problem-solvers at accountancy firms and within large corporations. People who in previous eras might have written symphonies or designed cathedrals have instead saved companies hundreds of billions of dollars in taxes by shifting trillions of dollars of intangible assets across the world over the past two decades. One consequence is that many companies avoid paying any tax on their foreign sales. Another is that many countries’ trade figures are now unusable. [emphasis added].

Trade Wars Are Class Wars: How Rising Inequality Distorts the Global Economy and Threatens International by Matthew C. Klein, & Michael Pettis.

1. William Bains. Should you Hire an Epistemologist. Nature Biotechnology, 1997. ↩

But after completing medical training, Sacks fled the homophobic confines of his nation and family—his mother had called him “an abomination.” Paul Theroux tells Burns that Sacks’s “great luck” was ending up in Los Angeles in 1960, where he found ample “guys, weights, drugs, and hospitals.”

Advance requires those who can imagine new spaces, and medicine is even more hostile today than it was all those years ago. We pretend otherwise, thinking those tick-box courses will suffice, but real diversity of intellect is the touchstone of our future.

A case study of Oliver Sacks | Science

I read Malcolm Bradbury’s satire The History Man many decades ago and loved it as a satire on university life (and which demonstrated to me why medical schools and universities were unlikely bedfellows).

The History Man is Malcolm Bradbury’s masterpiece, the definitive campus novel and one of the most influential novels of the 1970s. Funny, disconcerting and provocative, Bradbury brilliantly satirizes a world of academic power struggles as his anti-hero seduces his away around campus. (Amazon’s brief).

I have forgotten much of the detail, but not how fine a novel I thought it was, nor how funny I found it. But for every great thesis, there is an antithesis. Here is one:

Ignorance of history is a badge of honour in Silicon Valley. “The only thing that matters is the future,” self-driving-car engineer Anthony Levandowski told The New Yorker in 2018… I don’t even know why we study history,” Levandowski said in 2018.

Scientists use big data to sway elections and predict riots — welcome to the 1960s

I know which past — and future — I would prefer.

You don’t need a college degree

I dislike agreeing with the corporation that is Google as I am always suspicious of their motives, but in this narrow domain, they are surely correct.

College degrees are out of reach for many Americans, and you shouldn’t need a college diploma to have economic security. We need new, accessible job-training solutions—from enhanced vocational programs to online education—to help America recover and rebuild.

A digital jobs program to help America’s economic recovery

I used to think universities were always the solution now I realise they are part of the problem.

Nice article in the Economist on how our ideas about speciation have been revised and updated. And not just for those animals but for humans too. In their words:

To be human, then, is to be a multispecies mongrel.

My experience is limited, but everything I know suggests that much IT in healthcare diminishes medical care. It may serve certain administrative functions (who is attending what clinic and when etc), and, of course, there are certain particular use cases — such as repeat prescription control in primary care — but as a tool to support the active process of managing patients and improving medical decision making, healthcare has no Photoshop.

In the US it is said that an ER physician will click their mouse over 4000 times per shift, with frustration with IT being a major cause of physician burnout. Published data show that the ratio of patient-facing time to admin time has halved since the introduction of electronic medical records (i.e things are getting less efficient). We suffer slower and worse care: research shows that once you put a computer in the room eye contact between patient and physician drops by 20-30%. This is to ignore the crazy extremes: like the hospital that created PDFs of the old legacy paper notes, but then — wait for it — ordered them online not as a time-sequential series but randomly, expecting the doc to search each one. A new meaning for the term RAM.

There are many proximate reasons for this mess. There is little competition in the industry and a high degree of lock-in because of a failure to use open standards. Then there is the old AT&T problem of not allowing users to adapt and extend the software (AT&T famously refused to allow users to add answering machines to their handsets). But the ultimate causes are that reducing admin and support staff salaries is viewed as more important than allowing patients meaningful time with their doctor; and that those purchasing IT have no sympathy or insight into how doctors work.

The context is wildly different — it is an exchange on the OLPC project and how to use computers in schools, but here are two quotes from Alan Kay that made me smile.

As far as UI is concerned — I think this is what personal/interactive computing is about, and so I always start with how the synergies between the human and the system would go best. And this includes inventing/designing a programming language or any other kind of facility. i.e. the first word in “Personal Computing” is “Person”. Then I work my way back through everything that is needed, until I get to the power supply. Trying to tack on a UI to “something functional” pretty much doesn’t work well — it shares this with another prime mistake so many computer people make: trying to tack on security after the fact …[emphasis added]

I will say that I lost every large issue on which I had a firm opinion.

That “scientific management” bungled the algorithm for children’s exam results, verifies a maxim attributed to J.R. Searle, an American philosopher: if you have to add “scientific” to a field, it probably ain’t.

AD.Pellegrini in a letter to the Economist.

I have written elsewhere about this in medicine and science. We used to have physiology, but now some say physiological sciences; we used to have pharmacology, but now often see pharmacological sciences¹. And as for medicine, neurology and neurosurgery used to be just fine, but then the PR and money grabbing started so we now have ‘clinical neuroscience’ — except it isn’t. As Herb Simon pointed out many years ago, the professions and professional practice always lose out in the academy.

1. Sadly, my old department in Newcastle became Dermatological Sciences, and my most recent work address is Deanery of Clinical Sciences — which means both nouns are misplaced. ↩

The following is from Scot Galloway at NYU Stern. He shoots from the hip, and sometimes only thinks afterwards. But he is interesting, brave, and more often right than most. I think I would have hated what he said when I was ready (sic) to go to university. But now, I think I wasn’t, and for medicine in particular, allowing 17 year olds to fall into the clutches of the GMC and their ilk should be a crime against….

Gap years should be the norm, not the exception. An increasingly ugly secret of campus life is that a mix of helicopter parenting and social media has rendered many 18-year-olds unfit for college. Parents drop them off at school, where university administrators have become mental health counselors. The structure of the Corona Corps would give kids (and let’s be honest, they are still kids) a chance to marinate and mature. The data supports this. 90% of kids who defer and take a gap year return to college and are more likely to graduate, with better grades. The Corps should be an option for non-college-bound youth as well.

United States Corona Corps | No Mercy / No Malice

“We’re going through a Copernican revolution of healthcare, where the patient is going to be at the centre. The gateway to healthcare is not going to be the physician. It’s going to be the smartphone.”…

and

“Christofer Toumazou, chief scientist at the Institute of Biomedical Engineering at Imperial College London, says there are “megabucks” to be saved by using technology and data to shift the focus of healthcare towards prevention.”

Ahem. I have been reading Seamus O’Mahony’s excellent Can Medicine be Cured in which he does a great job of following up on the crazy hype of big genetics from 20 year ago (and many other areas of sales masquerading as science). The above quotes are from only seven years ago. Still crazy after all these years, sings Paul Simon. Health care excels at adding tech as a new layer of complexity rather than replacing existing actors. And when will people start realising that prevention — which may indeed reduce suffering — will often increase costs. Life is a race against an army of exponential functions.

 In the FT

The task of a university is the creation of the future, so far as rational thought, and civilized modes of appreciation, can affect the issue. The future is big with every possibility of achievement and of tragedy.

Nobody then would have imagined how bad it would get. The final word was prescient.

Alfred North Whitehead, The Aim of Philosophy in Modes of Thought, 1938