Daniel S. Greenberg (1931–2020) has died. Nice obituary about him and why he mattered in this week’s Science.

Daniel S. Greenberg (1931–2020) | Science

At the time, the idea of a journalist-written section in a publication devoted to publishing research papers was highly unusual, and so was the approach that Dan and his team took. They covered basic research policy in much the same way a business reporter would cover development of economic policy: as a set of competing interests…[emphasis added].

However, it was not greeted with universal enthusiasm. In a preface to the second edition, Dan noted that it sparked “reactions that flowed from the belief that the scientific community should be exempt from the types of journalistic inquiries that are commonplace to other segments of our society.” He called that attitude “nonsense.”

The millennial generation — the first to have lived entirely inside the mature meritocracy — appreciates these burdens most keenly. Elite millennials can be precious and fragile, but not in the manner of the special snowflakes that derisive polemics describe. They do not melt or wilt at every challenge to their privilege, so much as shatter under the intense competitive pressures to achieve that dominate their lives. They are neither dissolute not decadent, but rather tense and exhausted.

The Meritocracy Trap, Daniel Markovits.

(“Twenty years of schooling and they put you on the day shift – look out out kid, they keep it all hid”, Bob Dylan)

Many years ago I acted as the host of a visiting US dermatologist. He was due to give lectures in Edinburgh and elsewhere in the UK. I knew of him and, as I remember things, had spoken with him previously on a few occasions at US meetings. However, I did know of his research and, although it was in an area of skin research that was a long way from my professional interests, I admired it. He has taken a group of skin diseases (blistering aka bullous diseases) and explained at the molecular level what they all had in common. He had pulled back the veil, and shown the underlying unity of things that up until then had appeared different. I consider his work a beautiful example of clinical science.

I spent the day with him showing him around Edinburgh. We talked science and, as is often the case, the ‘meta’ of science: how is it done, how is it funded, what is good, and of course how the proposed work has been turned down for funding (’no track’ record’) etc.

At that time he was at NIH in the US. He stated that the great advantage of NIH — as he saw it then — was that if something bugged you at 9am you could spend the rest of the day (or week) thinking and reading about it. He wasn’t seeing patients, he wasn’t doing any formal teaching and admin was minimal. But he was insistent that blisters were ‘his problem’. If nobody would fund his interest in blisters he would do something else. Move to a university or a full time clinical role, but he wasn’t going to work on any other problem.

I know he did move several years later (to become Chair at an Ivy Laguen school) although I do not know the exact reasons why. I wouldn’t be surprised if kids going to college made him review his finances.

But the idea of spending you day in ‘your thoughts’ reading and asking questions appeals to some lifelong academics. Retirement has its pleasures (it is just the pay cheque that is missing).

I have been reading the ‘The Fifth Risk’ by Micheal Lewis. It is a book for out time, telling many stories about how competent governments can be. Or not, as is increasingly the case in many modern states. We can blame a group of ideologues for our current crisis. A quote about the book by Cory Doctorow (in the frontispiece) strikes the right tone. The book he says is:

‘A hymn to the “deep state,” which is revealed as nothing more than people who know what they’re talking about’

35 years ago, Isaac Asimov was asked by the Star to predict the world of 2019. Here is what he wrote | The Star

Schools will undoubtedly still exist, but a good schoolteacher can do no better than to inspire curiosity which an interested student can then satisfy at home at the console of his computer outlet. There will be an opportunity finally for every youngster, and indeed, every person, to learn what he or she wants to learn in his or her own time, at his or her own speed, in his or her own way. Education will become fun because it will bubble up from within and not be forced in from without.

Not in this world, I would add, or at last not yet. Many — possibly most — medical students view university as akin to clearing airport security: a painful necessit if you want to go somehwere. They are no more generous about their schooling.

Original link Via Stephen Downes

Bruce Charlton pointed me to this entry in Wikipedia on Seymour Cray

“One story has it that when Cray was asked by management to provide detailed one-year and five-year plans for his next machine, he simply wrote, “Five-year goal: Build the biggest computer in the world. One year goal: One-fifth of the above.” And another time, when expected to write a multi-page detailed status report for the company executives, Cray’s two sentence report read: “Activity is progressing satisfactorily as outlined under the June plan. There have been no significant changes or deviations from the June plan.”

Which brings to mind Sydney Brenner’s comments that eventually requests for research grant funding will eventually resemble flow diagrams recording who reports to who.

The article is about government secrecy and obfuscation (“ I quite simply misled myself”) (a review in the London Review of Books of The State of Secrecy: Spies and the Media in Britain, by Richard Norton-Taylor)

His second point, desperately urgent in these early months of Boris Johnson’s administration, is that the law has often stood up for open government and rejected the establishment’s ingrained secrecy. Most people probably assume that when a government decision lands before a court, the judges move to the bench with a bucket of Cabinet Office whitewash ready beside their chairs. This has often been true in the past. Now it is not.

One can but only hope that the whitewash is less scarce than protection.

COVID-19’s General Blindness is Also a Journalistic Failure

A query with the catchy expression “global pandemic” or “global pandemic preparedness” in scientific databases, restricted to a 2009–19 range, will return more than 1400 results in JAMA (Journal of the American Medical Association), 30 in-depth papers in ArXiv (Cornell University), and a stunning 17,000 results in Google Scholar, which aggregates multiple repositories. As for the general public, it had the choice between no less than 98 TED Talks on the matter.

We had no excuses.

Some history:

Just before the H1N1 episode in 2009, France had accumulated an inventory of 1 billion high protection masks (N95 equivalent). It was the consequence of the SARS epidemic. In the same way, the government had stored 20 million doses of vaccine. Later, the Health Ministry responsible for this precaution was blasted for this “excessive” stockpile — which was eventually destroyed as it decayed.

Frederik Filloux makes (and has for a while been making) an argument about journalism and journalism schools that I have not seen advanced by anybody else. The changing economics of the press mean that the modern Fourth Estate lacks expertise across many domains of modern life. He suggests that journalism schools need to regroup and change how they work and take advantage of the fact that most expertise will reside with those who did not go to journalism school in their 20’s. Rather, the press will need to rely on those with professional skills gained in particular domains. He writes:

The shortage of experts is also rooted in a priority shift that plagues major news organizations. All of them became obsessed with not being left in the dust by digital-native organizations riding the wave of social networks. As a consequence, newsroom managers, supported by bean-counters, found it clever to hire bunches of expendable digital “content” serfs who were mandated to keep up with the social frenzy. It was seen as a better investment than keeping a former doctor turned medical correspondent, even if he or she was loaded with decades of expertise, able to lean on a reliable network on practitioners, surgeons, epidemiologists, public health officials, etc. A pure cost vs. benefit choice, and ultimately a bad one.

I do not think there will be any shortage of candidates who possess  medical degrees and medical experience.

We are living in dark times, and since I have been sifting through the ashes of a career, it is no surprise that failures signal through like radioactive tracers. Below is one.

Through most of my career I have been interested in the relation between science and medicine. In truth, if what matters is what you think about in the shower, I have been more interested in the relation between science and medicine than I have been interested in either activity in isolation. If I were to use a phrase to describe my focus, although it is a term that I would not have used then, I am interested in the epistemological foundations of medical practice. Pompous, I agree. I could use another phrase: what makes medicine and doctors useful? Thinking about statistical inference is a part of this topic, but there is much more to explore.

These issues became closer to my consciousness soon after I moved to Edinburgh. My ideas about what was going on were not shared by many locally, and I was nervous about going public in person rather than in print at a Symposium hosted by the Royal College of Physicians of Edinburgh. My nervousness was well founded: whilst I liked my abstract, my talk went down badly. Not least because it was truly dreadful (and the evident failure still rankles). Jan Vandenbroucke, one of the other speakers and somebody whose work I greatly admire (his paper in the Lancet, Homoeopathy trials: Going nowhere. [Lancet.1997;350:824], was to me the most important paper published in the Lancet in the 1990s), said some kind words to me afterwards, muttering that I had tried to say far too much to an audience that was ill prepared for my speculations. All true, but he was just being kind. It was worse than that.

Anyway, some  tidying up deep in my hard drive surfaced the abstract. I still like it, but it is  a shame that at the appropriate time I was unable to explain why. 

JAMES LIND SYMPOSIUM: From scurvy to systematic reviews and clinical guidelines: how can clinical research lead to better patient care? (31-10-2003, RCPE Edinburgh)

Guidelines, Automata, Science and Algorithms

There are three great branches of science: theory, experiment, and computation. (Nick Trefethen)

Advance in the mid-third of the twentieth century, the golden age of medical research, was predicated on earlier discoveries in the nineteenth century in both physiology and medicinal chemistry (1). Genetics dominated biology in the latter third of the twentieth century and many believe changes in medical practice will owe much to genetics over the next third-century (1). I disagree, and I will give an alternative view more credence: in 30 years’ time we will look back more to Neumann and Morgenstern than we will to Watson and Crick. What the Nobel laureate Herbert Simon referred to as The Sciences of the Artificial (2), subjects which have largely been peripheral to medicine, will become central.

Over the last 20 years we have seen the first (largely inadequate, I would add) attempts to explicitly demarcate methods of obtaining and promulgating knowledge about clinical practice (3,4). This has usually taken the form of proselytising a particular set of terms – systematic reviews, evidence-based practice, guidelines and the like, terms that have little to commend them or rigour. What is interesting, however, is that they reflect a long overdue renaissance of interest with the practice of medicine and medical epistemology.

The change of emphasis from the natural to the artificial is being driven by a number of forces, mostly extraneous to biomedicine: the increasing instrumental role of science in medicine and society; the increase in corporatisation of knowledge, whether by private corporations or monopsonistic institutions like the NHS (5); the rising costs of healthcare; and a remaining inability to frame questions with broad support about how to chose between alternative disease states at the level of society (6,7).

I will try to illustrate some of these issues by the use of three examples. First, the widespread use of a mode of statistical inference largely ill-suited to medicine, namely Neyman-Pearson hypothesis testing (decision-making), and the way in which this paradigm has been used to undermine expert opinion (8). Second, I will argue that we need to think much harder about clinical practice and fashion a more appropriate theoretical underpinning for clinical behaviour. Third, I will suggest how UK medical schools, in so far as they remain interested in clinical practice, should look to alternative models, perhaps business and law schools, for ideas of how they should operate (2).

1. Rees J. Complex disease and the new clinical sciences. Science 2002; 296:698-700.
2. Simon HA. The sciences of the artificial. Cambridge, Mass. MIT Press; 1969
3. Rees J. Evidence-based medicine: the epistemology that isn’t. J Am Acad Dermatol 2000; 43:727-9.
4. Rees J. Two cultures? J Am Acad Dermatol 2002; 46:313-16.
5. Hacking I. The emergence of probability: a philosophical study of early ideas about probability, induction and statistical inference. Cambridge: Cambridge University Press; 1975.
6. Ziman J. Real science. Cambridge: Cambridge University
7. Ziman J. Non-instrumental roles of science. Sci Eng Ethics
   2003;9:17-27.
8.  Gigerenzer G, Swijtink Z, Porter T et al. The empire of chance: how probability changed science and everyday life. Cambridge: CUP; 1989.

Afterword. The symposium used structured abstracts, a habit that might have a place somewhere in this galaxy, but out of choice I would prefer to live in another one. Anyway, in the published version, it reads:

• Methods: Not submitted
• Results: Not submitted
• Conclusions: Not submitted

A fair cop.

A majority of people in Britain now in their seventies spent some of their childhood growing up in social housing — almost entirely in council houses. When someone of that generation tells you that they grew up in a council house, they are telling you that they were normal. (Danny Dorling, Times Higher Education, 13-2-2020, p46)

And please don’t get me started on the ‘first in my family to go to uni’ trope so beloved of many in academia.

TIJABP