Conspicuous Destruction
Conspicuous Destruction | Kim Phillips-Fein | The New York Review of Books
Private equity has become such a force in dermatology that job postings now emphasize when the business is “NOT private equity.”
Just like the buses
John Lanchester · Get a rabbit: Don’t trust the numbers · LRB 21 September 2023
One way of explaining how Britain got to this place is to say that we waited all this time for the worst prime minister in history, and then four came along at once.
On building for our children’s future
Arianne Shahvisi | Liable to Collapse · LRB 12 September 2023
The education secretary, Gillian Keegan, seemed both surprised and peeved that the prospect of concrete falling on children’s heads would cause so much bother. She observed that ‘schools can collapse for many reasons,’ mithered that no one had told her ‘you’ve done a fucking good job,’ and breezily tweeted: ‘most schools unaffected’. (Keir Starmer’s press team live for this kind of low hanging fruit, and were quick with the obvious riposte: ‘most beachgoers not eaten by big shark’.)
While in Susa, de Morgan oversaw the excavation of a seven-foot basalt stele inscribed with the Code of Hammurabi, the best-preserved copy of one of the world’s oldest legal texts, drawn up by the sixth Amorite king of the Old Babylonian Empire. It is now on display in the Louvre, five thousand miles (and a great many political barriers) away from the sight of modern Iranians. The code, which lists 282 provisions and their punishments, is the first recorded example of the lex talionis principle, predating the Torah’s ‘eye for an eye’. It also lays out the earliest written building regulations:
- If a builder build a house for someone, and does not construct it properly, and the house which he built fall in and kill its owner, then that builder shall be put to death.
- If it ruin goods, he shall make compensation for all that has been ruined, and inasmuch as he did not construct properly this house which he built and it fell, he shall re-erect the house from his own means.
- If a builder build a house for someone, even though he has not yet completed it; if then the walls seem toppling, the builder must make the walls solid from his own means.
Timing
Rishi Sunak used helicopter for trip from London to Norwich | Rishi Sunak | The Guardian
Rishi Sunak has used a helicopter to travel to and from an engagement in Norwich, a trip of little more than 100 miles, Downing Street has confirmed, in another example of the prime minister’s fondness for flying brief distances.
UWE Bristol rugby player waited five hours for ambulance, inquest hears | Bristol | The Guardian
A 20-year-old university student who died after being injured in a rugby match and acquiring an infection in hospital lay in agony on the pitch for more than five hours while she waited for an ambulance, an inquest has heard.[she had a dislocated hip]
Patients in England will become the first in the world to benefit from a jab that treats cancer in seven minutes.
It is expected that the majority of these people will now get the drug via a seven-minute injection instead of intravenously, which usually takes 30 minutes to an hour.
How many months they wait to be seen, scanned or started off on treatment is not mentioned.
On being old
FT business books — what to read this month | Financial Times
From a book review in the FT The Perennials: The Megatrends Creating a Postgenerational Society’, by Mauro Guillén.
The loneliness and emptiness of retirement could be alleviated if classrooms and offices welcomed all comers, regardless of age. Big shifts in thinking will be needed to bring this about, not least inside educational institutions and executive suites. But it’s a change that is long overdue, says [ Mauro] Guillén, who pointed to words written about a century ago by anthropologist Margaret Mead:
It is utterly false and cruelly arbitrary to put all the play and learning into childhood, all the work into middle age, and all the regrets into old age.
And yes, I do think about these things more and more.
Essay grades: not funky, just tight
Lorna Finlayson’s Diary took me back to the 1970s when my husband’s lecturer in Buddhism at Lancaster University offered this sublime assessment of one of his essays: ‘Tight. Like Bill Wyman’s bass or the Liverpool defence.’ Happy days.(Caroline Walker)
Which brings to mind Geoff Norman’s phrase to the effect that objectivity is not a useful objective, the only judge of expertise is subjective.
Those sensible Dutch persons
Race to lead European Investment Bank heats up – POLITICO
DUTCH CAMPAIGN GEARING UP: From an EU perspective, Dutch elections used to be simple: about 20 parties fought a fierce campaign and in the end, Mark Rutte was back at the European Council table.
The defacement of public office
Braverman’s war on the ‘crooked lawyers’ – POLITICO
Or as Tory Deputy Chairman Lee Anderson put it: “If they don’t like barges then they should f*ck off back to France.”
Splendid. Which brings to mind Aneurin Bevan’s infamous description of the Tory party. My sympathy, as ever, is with the Welshman.
Don’t aim to work in the NHS
A little while back, Lisa and I were out for dinner at a friend’s house. The mother, ’M’ was a doctor and the husband, ‘H’, worked in finance. M ticked all the boxes for what you might wish for if you were a patient: technically competent, deeply caring, and worked way beyond her contractual hours. Nor did she park her patients in some tidy box somewhere: her job was part of who she was.
M and H had a few children under 11. As often happens, while watching the children play and interact, the question was asked what they might end up doing as a career. H spoke immediately and with conviction: ‘I just hope neither of them ever works for the NHS.’ Note, not I hope they do not become doctors, but rather I don’t want them ever working in the NHS.
I find it hard to imagine this same conversation a quarter-century ago. Things have changed.
Training is in tatters as doctors prioritise urgent care and discharges | The BMJ
“During my last job on an acute medical unit, one of the FY1s would sit in a box room separate from the doctor’s office for three days a week and write up to 15 discharge letters a day. It’s farcical to suggest that’s rounded training.”
…
“Prioritising training for juniors isn’t just about having competent and confident doctors in the NHS but actually having them at all. It’s hard to feel compelled to pursue a career in the NHS after a week in which your sole learning point was how to make the ward photocopier work,” she said.
A dog at the master’s gate predicts the ruin of the state. (William Blake)
I wish I had said that
Nicholas Spice speaks of ‘the conductor demanding ever more rehearsal time, the players wanting to get home and have a life’ (LRB, 16 March). This put me in mind of Frank Zappa’s definition of conducting as ‘drawing designs in the nowhere which are interpreted as instructional messages by guys wearing bowties who wish they were fishing’.
Chris Sansom
Roger Searle Payne (1935–2023) | RIP
Roger Searle Payne (1935–2023) | Science
He changed the world. Humanity takes longer to come aboard.
Roger Searle Payne, the biologist who pioneered studies of whale behavior and communication and advocated for their protection, died on 10 June. He was 88. Payne was widely known to both scientists and the public for his groundbreaking discovery of the songs of humpback whales.
Born on 29 January 1935 in New York City, Payne received a BA in biology from Harvard University in 1956 and a PhD in animal behavior from Cornell University in 1961. From 1966 to 1984, he served as a biology and physiology professor at The Rockefeller University in New York. In 1971, Payne founded Ocean Alliance, an organization established to study and protect whales and their environment, and he remained its director until 2021.
Initially, Payne’s research focused on auditory localization in moths, owls, and bats, but he changed course to focus on conservation and selected whales for their status as a keystone species. In 1967, he and his then-wife Katharine (Katy) first heard the distinctive sounds of the humpback whales on a secret military recording intended to detect Russian submarines off the coast of Bermuda. Payne and his collaborators, including Scott McVay and Frank Watlington, were the first to discover that male humpback whales produce complex and varied calls. Mesmerized by the recordings, Payne realized that the recurring pattern and rhythmicity constituted a song. He published his findings in a seminal Science paper in 1971. After many years and many additional recordings, he and Katy further realized that the songs varied and changed seasonally.
These hauntingly beautiful whale songs captured the public’s attention thanks to Payne’s extraordinary vision. He released an album, Songs of the Humpback Whale, in 1970 that included a booklet in English and Japanese about whale behavior and the dire situation that many species of whales faced. He recognized the power of juxtaposing the plaintive and ethereal songs of humpbacks with images of whaling.
The album remains the most popular nature recording in history, with more than two million copies sold. Humpback whale songs are now carried aboard the Voyager spacecrafts as part of the signature of our planet.
Playing a corrupt signalling system
The ticking clock for America’s legacy admissions | Financial Times
This article from the FT is about Ivy league admissions in the USA but I think has relevance to the way people gain entry to medical schools in the UK. I was never involved in med student selection at either Newcastle or Edinburgh so I feel free to admit that I have always felt vaguely hostile to the grade 8 violin crowd. Now, self-taught guitarists, are another matter, as are those who have worked in paid employment whilst at school.
Many of us know at least one wealthy person whose kids spent a week in India or Tanzania building houses or digging latrines. Bizarrely, I know of a family that travelled to a nameless developing country on their private jet on precisely that quest. Competitive volunteering as a means of glamorising résumés for Ivy League applications long ago reached absurd heights. The ideal student would play concert-level violin, cure river blindness, win yachting competitions and get intensively coached into high SAT scores. At some point, the system has to collapse under the weight of its self-parody. I don’t know how close that moment is, or what a revolution in university admissions would precisely look like. But the data keeps pouring in.
Shit life syndrome
The Enlightened Economist | Economics and business books
The over-burdened welfare state is not quite coping with people suffering from what (I learned here) doctors describe as “Shit Life Syndrome” when they go to their GPs for help with depression or other mental ill-health conditions. And there will not be enough money to fix any of this unless growth picks up. But that would require a competent, effective government able to take clear decisions, build cross-party consensus, devolve money and powers, and stick with the plan without changing ministers and policies every 18 months.
As a med student I remember sitting in with an Irish senior registrar in psychiatry as he saw a young woman whose life seemed to consist of one random but state-induced tragedy after another. That she could still get out of bed and care for her numerous children seemed to me to attest both to her sanity and her moral character.
The psychiatrist’s assessment was blunt: the patient had no need of a physician, but needed to join the f***ing labour party and mobilise for office. Quite so.
An ode to regulation
Guardrails | No Mercy / No Malice
People have always been stupid, and everyone is stupid some of the time. (Note: Professor Cipolla’s definition is people whose actions are destructive to themselves and to others.) One of society’s functions is to prevent a tragedy of the commons by building safeguards to protect us from our own stupidity. We usually call this “regulation,” a word Reagan and Thatcher made synonymous with bureaucrats and red tape. Yes, Air Traffic Control delays and the DMV are super annoying, but not crashing into another A-350 on approach to Heathrow, not suffocating as your throat swells from an allergic reaction, and being able to access the funds in your FTX account are all really awesome.
The NHTSA is one of the many boring state and federal agencies critical to a healthy society. Before the Food and Drug Administration, the sale and distribution of food and pharmaceuticals was a free-for-all. The Federal Aviation Administration is the reason your chances of dying in a plane crash are 1 in 3.37 billion. Next time someone tells you they don’t trust government, ask them if they trust cars, food, pain killers, buildings, or airplanes.
Amen.
Peer review
Shakespeare’s First Folio assembled the world’s greatest literature from TheEconomist
In 1612 the founder of Oxford University’s Bodleian Library had even warned against collecting play-texts: worthless “baggage books”.
No freeman (or woman) is free if judged by their peers. [JLR]
No tracksuits here
Mary Quant launched the clothes that made the Sixties swing from The Economist
Not just because they could playfully imitate men, by borrowing men’s tailoring and their cardigans, but mostly because mini-dresses freed them to move. She designed them, she said, to be alive in. More important still, high hemlines, paired with opaque tights, let girls run for the bus in order to get to work. You could never run for the bus in a Dior dress. In Quant, women felt they could leave the house and dare a different life.
Not like Everest at all
Phyllida Barlow had a lifetime of adventure making art | The Economist
Why do humans make sculpture? George Mallory is supposed to have said he wanted to climb Mount Everest simply because it was there. Sculpture’s special power, by contrast—the reason why Phyllida Barlow made sculpture at all—is that it isn’t there. That was where her adventure began.
More airline/pilot vs medicine/doctor metaphors
Cait Hewitt: ‘I hope the era of aviation exceptionalism is over’ | Financial Times
This year, the British government proudly unveiled an “ambitious” plan to make airports in England net zero by 2040. Only one problem: the target does not include the actual flights, which account for 95 per cent of airports’ emissions.
But Rishi Sunak’s government champions “guilt-free flying”: its so-called Jet Zero strategy is built on “ambitious” assumptions of future technology. Here Hewitt, mild-mannered, stretches to exasperation. “If you went to the doctor as a smoker, and said, ‘What shall I do?’ And the doctor said, ‘I think you should carry on with your 40-a-day habit, because I’m a very optimistic person, I believe in future there’s going to be some technology that will allow us to replace your lungs.’ Would you describe that person as ambitious or just completely reckless?”
UK exceptionalism
The UK accounts for 2 per cent of global manufacturing and 2 per cent of global R&D. You’re not a science superpower if you do 2 per cent…You can’t go around claiming that in seven years’ time the UK is going to be a climate leader or leader in green tech, it just doesn’t make sense
The British economy needs to follow a policy of improvement, not a policy of chest-beating and claiming to be on the cusp of transformative breakthroughs.
David Edgerton, the historian of science and technology, quoted in The New Statesman 14-20 July 2023 page 143
UK Academia
UK universities set to secure big cut in pensions bill | Financial Times
Comment by shug4476 in response to the above article
Academia…. has become a profession for the rich and the desperate.
Too true. Hard to recommend.
Rees’s law of education
(After a John Hennessy quote that the time to assess a Stanford degree is ten years (or more?) after graduation).
Any real education is incapable of a robust widely accepted psychometric assessment of the sort that will satisfy a professional regulator.
Another formulation:
If you can reliably assess knowledge within a standardised and regulated framework it is not education.
Call my agent
Friday 7 July, 2023 – by John Naughton – Memex 1.1
(The following via John Naughton — link above. Original report in the Irish Times)
Fintan O’Toole on RTE’s slow-rolling crisis.
JN: RTE is Ireland’s national broadcaster and it’s now embroiled in an epic crisis because of revelations about its chaotic management, casual ethics and undercover payments to a leading broadcasting celebrity named Ryan Tubridy. The trigger point for the crisis was the discovery of undercover payments made to Tubridy during the Covid lockdown to compensate him for reductions in his non-broadcasting income caused by the pandemic.
JN: Since public money is involved, the Republic’s legislators opened hearings on the matter, which meant that from Day One my fellow-citizens have been enthralled (and increasingly enraged) by daily revelations about the managerial chaos, ineptitude and arrogance that prevailed in the country’s leading media organisation.
JN:From the outset, though, Tubridy maintained an air of high-minded detachment. All of those non-disclosed payments had been negotiated by his agent, Noel Kelly, disclosed to the revenue authorities, and the tax due on them had been duly paid. “Nothing to see here: any questions see my agent” was the general tenor of his responses.
JN: This pose has exasperated Fintan O’Toole, Ireland’s leading opinion columnist, and he penned a terrific column about it the other day. Like most of his stuff it is hidden behind the Irish Times’s paywall, but since I pay through the nose for a subscription I think it’s time some of his high-octane indignation got a wider airing. So here goes…
He starts with a story about Seamus Heaney, Ireland’s greatest poet since Yeats.
In 1981, Seamus Heaney wrote to his American agent, Selma Warner, about the fees she was demanding for readings by him on US campuses. He was angry because they were too high.
Heaney was not yet quite as famous as he would become, but his reputation was already very considerable and he was a mesmerising performer of his own work. Warner had started to ask for $1,000 for a reading – the equivalent of about $3,300 today.
Heaney’s complaint was that this was too much money:
“I do not wish to be a $1,000 speaker. Apart from my moral scruples about whether any speaker or reader is worth anything like that, I do not wish to become a freak among my poet friends, or to press the budgets of departments of literature at a time when the money for education is drying up in the United States.”
Which later brings him (FO’T) to Tubridy:
Let’s not succumb to “my agent made me do it” stories. Agents, however colourful and assertive, are intermediaries: these deals were done between RTÉ and Tubridy.
It was Tubridy’s job to have the “moral scruples”. Kelly is not his Father Confessor – he’s his attack dog. It is always up to the conscience of the client as to whether the dog should be called off before he bites off any particular pound of flesh.
Remember Johnson’s line: no official told me having a piss-up was against the law.
To be a daisy
Who could not love the fact that a “daisy” gets its name from being the “day’s eye”, because the flower opens in sunlight?
Why does the commonest verb in English—“to be”—have the wildly irregular conjugation am-is-are-was-were? Nobody would design such a verb, and indeed no one did. It is in fact a mash-up of three proto-Germanic roots, one of which produced am-is-are, one of which yielded was-were (replacing the past tense of the am-is group, in a process called suppletion), and one resulting in be itself.
It is the duck-billed platypus of verbs, an odd hybrid of features.
But just as evolutionary biology explains the platypus, historical linguistics shows how the three verbs piled up on each other.
Johnson in the Economist
Painting over humanity
Murals of cartoon characters including Mickey Mouse and Baloo from The Jungle Book painted on the walls of an asylum seeker reception centre to welcome children have been removed on the orders of the immigration minister, Robert Jenrick.
The murals were painted over because he thought they were too welcoming and sent the wrong message — to children…
Doctors, medicine and the NHS 1966
Like many of my colleagues I no longer try to dissuade my juniors from leaving to work in the United States. Medicine is more important than nationalism and will outlive the indifference of governments: it is better that a good man should work where he can make the best contribution to the advance of medicine than that he should stay to be frustrated by a society too myopic to appreciate his potential. A dead patient presents no economic problem.
It would be naive to express surprise at the equanimity with which successive governments have regarded the deteriorating hospital service, since it is in the nature of governments to ignore inconvenient situations until they become scandalous enough to excite powerful public pressure. Nor, perhaps, should one expect patients to be more demanding: their uncomplaining stoicism springs from ignorance and fear rather than fortitude; they are mostly grateful for what they receive and do not know how far it falls short of what is possible. It is less easy to forgive ourselves…..Indeed election as president of a college, a vice chancellor, or a member of the University Grants committee usually spells an inevitable preoccupation with the politically practicable, and insidious identification with central authority, and a change of role from informed critic to uncomfortable apologist.
Originally published in the Lancet, 1966,2, 647-54.(This version in Remembering Henry, edited by Stephen Lock and Heather Windle).
Henry Miller was successively Dean of Medicine, and VC of the University of Newcastle. No such present day post-holder would write with such clarity or honesty.
G-g-generation
Went to see The Who last night at Edinburgh castle. Great show, and the weather blessed us. First time I had been to a concert in the open air since seeing Van Morrison at Stirling castle over a decade ago. Playlist here.
Two ‘wee guys’ sat in front of us. The seats were not made to measure. The two of them must have weighed in close to that of the French front-row. They were both thirsty, requiring frequent radiator top-ups; leakage was not marginal.
They were close, perhaps brothers or cousins. Each time a song started they would turn to each other, make eye contact, smile, and then start what I can only describe as star-jumping within a combined space. When they looked around, if they saw that somebody else too had guessed the song from the first bar they would beam big smiles. I was so honoured.
Towards the end of the show, one turned around, facing me, and said The Who was his Dad’s favourite band. Eyes full of tears, he wanted to say more but, unlike Roger Daltrey, choking up, his voice couldn’t manage it.
Plain silly
He imagines a day when teachers could use AI to create individual lesson plans for every student, or nurses might be able to take on much greater roles in, for example, diagnosing diseases. “Why is it that nurses cannot prescribe medications? Why must everything go through this very hierarchical approach where you have to call a doctor [to do that]?” As it is today, the people who spend the most time with patients — nurses, not doctors — are those who are paid and valued the least. Using technology to empower such workers would raise overall productivity and quality of care while also raising wages.
Why not? Simply because doctors and nursing are complementary professions. If you do the prescribing and diagnosing, you become the doctor. The danger is that the whole ethos of ‘caring’ — what was once so central — is being lost. I remember the teaching point: nurses sat on beds talking to patients without seemingly doing anything else are working.
The book the FT is reviewing (Power and Progress: Our Thousand-Year Struggle Over Technology and Prosperity) has been well received but the argument behind this quote seems to me very superficial.
Boris Johnson exits as he entered, with deceit and contempt
Boris Johnson exits as he entered, with deceit and contempt | Financial Times
Truly, nothing in his public life exposed him like the leaving of it.
Robert Shrimsley
Governments can do it too.
Crypto-gram: June 15, 2023 – Schneier on Security
Now, tech giants are developing ever more powerful AI systems that don’t merely monitor you; they actually interact with you—and with others on your behalf. If searching on Google in the 2010s was like being watched on a security camera, then using AI in the late 2020s will be like having a butler. You will willingly include them in every conversation you have, everything you write, every item you shop for, every want, every fear, everything. It will never forget. And, despite your reliance on it, it will be surreptitiously working to further the interests of one of these for-profit corporations.
There’s a reason Google, Microsoft, Facebook, and other large tech companies are leading the AI revolution: Building a competitive large language model (LLM) like the one powering ChatGPT is incredibly expensive. It requires upward of $100 million in computational costs for a single model training run, in addition to access to large amounts of data. It also requires technical expertise, which, while increasingly open and available, remains heavily concentrated in a small handful of companies. Efforts to disrupt the AI oligopoly by funding start-ups are self-defeating as Big Tech profits from the cloud computing services and AI models powering those start-ups—and often ends up acquiring the start-ups themselves.
Yet corporations aren’t the only entities large enough to absorb the cost of large-scale model training. Governments can do it, too. It’s time to start taking AI development out of the exclusive hands of private companies and bringing it into the public sector. The United States needs a government-funded-and-directed AI program to develop widely reusable models in the public interest, guided by technical expertise housed in
I worry the UK government will sell all of the rights to NHS image libraries and raw patient data, rather than realise that the raw material is the gold dust. The models and tech will become a utility. Unless you steal, annotation of datasets is still the biggest expense ( the NHS considers it ‘exhaust’). Keep the two apart.
My disease is more important than your disease
Acute myeloid leukaemia – The Lancet
Acute myeloid leukaemia accounts for over 80 000 deaths globally per annum, with this number expected to double over the next two decades. The 5-year relative survival for patients in the USA diagnosed with acute myeloid leukaemia is currently 30·5%, improved from only 18% in the year 2000.5
Sometimes raw numbers — rather than rates — are appropriate. But not often. Instead, I suspect authors quote raw numbers to bolster ‘importance’. I have even see figures projected into the next quarter century. Why stop there, why not the next century?
In general and in this case the authors should have quote mortality rates. The standard, which usually works is per 100,000 of population. In the case, AML, a truly dreadful disease has a mortality rate of close to 1:100,000. The rate figure allows easy comparisons with other causes of death without having to check on the population numbers of the world population or other denominator.
It just bugs me. The Lancet is full of this sloppy editing. And how much of the projected increase is due to changes in the age structure of the world population? Yes, it all matters, but the frequent coupling of partisanship and hype needs a polite divorce.