A beautifully written vignette in the NEJM by Abigail Luger

Moving On | NEJM

Now I’m the one contemplating a permanent departure. My health is fine, but my stamina is pretty much gone. Our health care system is not kind to the chronically ill and marginally insured, and it is not particularly kind to their doctors, either. Our patients are condemned to an unending swim against a hostile tide. Doctors can head for shore.

Great story. Only true.

Schrems sent the complaints to the Irish data protection commissioner in Portarlington, a town with a population of 8,000. From a modest office above a supermarket, the Irish DPC was responsible for regulating all the tech companies that nominated their Dublin-based subsidiaries as “data controllers”. Despite its role protecting millions of EU citizens, the commissioner had just 26 staff at the time.

FT

This all reminds me of that wonderful scene in the film Local Hero when the visitors from the US mega corporation discover that the same person (played by Denis Lawson) runs the bar, hotel, office, professional services etc. in the small Scottish village where it is set.

BTW: instead of the mandatory GDPR corporate training, can we just not watch Local Hero again?

My third issue is more nuanced. The biggest reason for cataract blindness is the dearth of ophthalmologists. Orthopaedic surgeons in Leicester faced with a backlog of carpal tunnel surgery decided to train intensively one theatre nurse. As a result, our carpal tunnel surgery service is probably the best and most cost effective in the country. Having a person who is not a “fully qualified doctor and surgeon” operating on cataracts could be the best solution.

Quote from, John Sandford-Smith, retired ophthalmologist, Leicester. BMJ 2018;360:k640

This sort of argument is old, and largely correct. But you can only scale such a process with the help of some form of certification, because without it, there is no durable career structure. And without this, there is no investment.

I used to think this whole topic was overblown. But then again, I once thought those who foresaw the obesity epidermic were selling something. Wrong on both counts.

Former Google Design Ethicist: Relying on Big Tech in Schools Is a ‘Race to the Bottom’ | EdSurge News

I see this as game over unless we change course,” says Tristan Harris, a former ethicist at Google who founded the Center for Humane Technology. “Supercomputers play chess against your mind to extract the attention out of you. The stock price has to keep going up, so they point it at your kid and start extracting the attention out of them. You don’t want an extraction-based economy powered by AI, playing chess against people’s minds. We cannot win in that world.”

In an interview with EdSurge, Harris noted that the focus of their campaign started with children because they were the most vulnerable population. He says that particularly children in schools had little agency over whether they opted into or out of a technology platform because of pressure from both peers and educators handing out assignments.

Some nice turns of phrase and perspective from this article in the FT

In 1829, the great Scottish historian and essayist Thomas Carlyle wrote: “Were we required to characterise this age of ours by any single epithet, we should be tempted to call it . . . the Mechanical Age. It is the Age of Machinery . . . the age which, with its whole undivided might, forwards, teaches, and practices the greater art of adapting means to ends.”

He continued with a lament for older ways of doing and being: “On every hand, the artisan is driven from his workshop, to make room for a speedier, inanimate one. The shuttle drops from the fingers of the weaver and falls into iron fingers that ply it faster. The sailor furls his sail, and lays down his oar, and bids a strong unwearied servant . . . bear him through the waters.”

It is a measure of just how much speedier our age is that no one today will take the time to write or read such comparatively languorous prose. What is striking about Carlyle’s writing from today’s vantage point is how early in the industrial revolution he mounted a protest against it. By 1829, the steam engine was entering its ­heyday, but the explosion of iron, steel, coal and oil that we associate with the industrial age was visible only on the horizon.

FT

Stalin, Krushchev and Brezhnev are riding on a train when it suddenly stops. Stalin says “Comrades we must execute the driver to motivate the others”. The poor driver is dragged out into the snow and shot. the train still doesn’t move. Krushchev says “Comrades, we have made a dreadful error. We must set this thing straight and rehabilitate the poor driver.” So the driver is posthumously rehabilitated. Still the train doesn’t move. “Listen”, says Brezhnev, “The solution is obvious. Let’s pull down the curtains, bounce up and down on the seats and pretend the train is moving”.

Article in Nature. I largely agree, although my views are as much based on the hype-upon-hype that characterises so much of medical research, especially cancer. I do not have a reference, but whatever one’s views about the late David Horrobin, his Lancet article about cancer trials — written when he was dying from lymphoma — is worth a read. What a mess!

Key quotes from this article:

In 2017, my colleagues and I completed a study of all 48 cancer drugs approved by the European Medicines Agency between 2009 and 2013 (C. Davis et al. Br. Med. J. 359, j4530; 2017). Of the 68 clinical indications for these drugs (reasons to use a particular drug on a patient), only 24 (35%) demonstrated evidence of a survival benefit at the time of approval. Even fewer provided evidence of an improved quality of life for symptoms such as pain, tiredness and loss of appetite (7 trials; 10%). Most indications (36 of 68) still lacked such evidence three or more years after approval. Other groups in other regions have observed similar trends. For example, a 2015 study demonstrated that only a small proportion of cancer drugs approved by the FDA improved survival or quality of life (C. Kim and V. Prasad JAMA Intern. Med. 175, 1992–1994; 2015).

But the key point he makes is:

I believe that the low bar also undermines innovation and wastes money.

When assessments — whether in medicine or education — are flawed the loss in value is not in short term financial costs, but in what might have happened 10 years down the road.

The Medical Council of India has asked state councils to investigate the problem of “ghost” teachers in medical colleges following the discovery of more than 400 fake teachers in four colleges in three states.

He said that the Maharishi Markandeshwar College in Ambala, established in 2008, has an annual intake of 150 students.“It needs a minimum of 108 faculty members as per the Medical Council of India norms. On paper it has 145 teachers listed. But that’s on paper. The college would retain a majority of the names adding new ones off and on. During inspections the doctors would appear and then disappear once the inspections were over.”

We learn that:

These “ghost teachers” are registered as faculty members drawing a hefty salary, but have never taken a single class. Most of them run private clinics, and only attend the college when there is an impending medical inspection.

Link

Well, one wit once remarked that the collective noun for a group of professors is “An absence of professors”.

Günter Blobel (1936–2018) | Science

Günter taught us to distinguish experiments that should be done from those that could be done; he taught us to cherish the paradox over the obvious next thing. Importantly, Günter excelled at standing up firmly for one’s convictions in the face of controversy.

Born in Buckinghamshire in 1942, Sulston described his young self as a mechanically minded artisan who preferred science to sport

From an obituary of John Sulstan (by Judith Kible), whom I meet only once when some of our red hair work was featured on the Christmas Lectures. But the phrase harks back to a true characterisation of some types of science. Tool makers; and theorists.