Monthly Archives: January 2015

Worth a glance #4

by reestheskin on 26/01/2015

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The continuing mess of funding for students to receive higher education. The only certainty is that nobody will sort this out for the long term and that all suggestions will be for short term political gain.

More on the battle between about and capital (from Yochai Bencher). Just watch if you think the NHS and Higher Ed is immune.

Philip Greenspun and academic deceit: “Economists, who get paid to teach at colleges, experiment with ways to get more young people from poorer-than-average families to become customers of colleges.”

More on MOOCs and unbundling. We are still at the beginning.

“We may not have GPs in ten years’ time; healthcare will have changed that much. What we do, who does it and where… all up for grabs.” Roy Lilley has some harsh and sympathetic words to say about UK general practice. I am not convinced by the detective metaphors but he is surely right to focus on the mismatch between what many are projecting primary care is about, and the realities. It is this divergence that students and young doctors are picking up on. I do not think the problem is that young doctors need more ‘education’ about primary care. By contrast, primary care is being demolished by our political masters. The idea of a personal physician is something to value, it is just that modern primary care can’t deliver this at the same time as doing all the others jobs that government has dumped on it. [link to this post]

Well, when was the exam?

by reestheskin on 21/01/2015

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Access to skincancer909 Well, when was the exam?



Students please repeat after me: “Attention is so central to our ability to think”. The ever sensible Daniel Willingham in an article in the NYT. He goes on to say, ‘People’s performance on basic laboratory tests of attention gets worse if a cellphone is merely visible nearby’. [link to this post]

Ivory Tower

by reestheskin on 19/01/2015

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Worth a view if you want to know a little bit more about where the UK may be going.

Worth a glance #3, or the heart of darkness

by reestheskin on 19/01/2015

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The Soul of the Research University, by Nicholas Lemann. This is one of the best (brief) histories of the modern research university and the conflicts that arise between teaching and research, and between the Ivory Tower, and training for that little bit of the world that is outside Higher Education. Nice summaries of Newman, Flexner, Clark Kerr etc. The author is a professor of journalism, and a former Dean at Columbia. It shows.

Pharma:We need to talk about Kevin…. oops I mean Pharma [link]. Depressing and dismal, if not shameful.

More dismal reading: The major scientific discoveries of the 20th Century would not have happened under today’s rules, they would not get funding now. [link]

Why good people leave science [link]

Rescuing US biomedical research from its systemic flaws. Bruce Alberts et and a comment from an economic perspective (Malthus all over again). As the author says ‘Get it? It’s as if the Pope and three leading cardinals held a press conference predicting the collapse of the Catholic church. These people know what they are talking about and we need to listen.’

The Heart of research is Sick, by Peter Lawrence, and The mismeasurement of science, by Peter Lawrence in which he recalls the classic Leo Szilard parable about how to kill genuine discovery. Can you imagine Szilard in the academy?

It’s that time of year isn’t it?

Students are the coin of the realm.

David Patterson.

There is a moving and well written Perspective in this week’s NEJM, written by an Australian physician, Ranjana Srivastava. It is about the premature death of a close colleague. It contains an interesting account of a conversation with a medical student. The student tells the author how deeply she misses the deceased colleague. 

“The other students are saying I must get over it or I’ll never become a real doctor. They say real doctors don’t cry. This has forced me to think about what specialty I might pursue where I don’t have to deal with loss.” I stare at her incredulously. Fighting back tears, she ventures, “Do you think I should see a psychiatrist?”

“What for?”

“To learn how to experience loss properly. I really want to be a good doctor,” she says. “I want to be strong to help others.”

My incredulity is replaced by alarm that we impart such pernicious messages to impressionable future doctors.

Amen. [link for this post]

Worth a glance #2

by reestheskin on 12/01/2015

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‘A Better Way Out’, Marcia Angell’s spirited review of Atul Gawande’s ‘Being Mortal’. Essential reading for all med students and doctors, and an indictment of much modern medicine and medical education. It will happen to you, and me— possibly sooner for the latter.

The MOOC Misstep and the Open Education Infrastructure, David Wiley (via Stephen Downes).

Occupy Your Brain: On Power, Knowledge, and the Re-Occupation
of Common Sense. Carol Black. A terrific read, aimed largely at school rather than universities.

Why lectures are dead (or soon will be) By Tony Bates. In talking about attempts to improve lectures he uses the phrase : ‘Nevertheless, all this is just lipstick on a pig.’ A new one on me, but I like it.

‘Health policy is in tatters. Markets haven’t worked, inspection hasn’t worked, demand management has failed, morale at an all-time low and workforce planning botched. The sky is dark with chickens coming home to roost. The NHS is now all about muddling through’. Roy Lilley calls it right. But what is a young graduate or student to do? [link for this post]

Welfare for the rich corporations: pharma threaten NHS with lawsuits

by reestheskin on 08/01/2015

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So, let me get this right. The NHS wants to stop buying certain drugs from pharma, because they think the benefits do not merit the expense. Now, I regularly buy goods from Waitrose. On review, and after discussing the benefits of the various items with my family, I decide to stop buying the goods. (I had never entered into any long term contract). They just don’t seem worth it anymore. Waitose are not impressed, and say that they spent a lot of money stocking their shelves with said items, together with the 40% of their costs they spend on advertising and wining and dining doctors. They want a judicial review to force me to keep buying their goods. More of Galbraith’s ‘Welfare for the rich’, with tax payers subsidising businesses that can’t innovate in the marketplace. FT report here

On this day, in Edinburgh, student executed for blasphemy

by reestheskin on 08/01/2015

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From Wikipedia: Thomas Aikenhead (c. March 1676 – 8 January 1697)[1] was a Scottish student from Edinburgh, who was prosecuted and executed at the age of 20[2] on a charge of blasphemy. (Please note the year, not jus the date…)

Great comment in the Guardian from as ever the irrepressible Ross Anderson  on an article by Athene Donald. Reality is in the first sentence. [link for this post]7

There’s only one way to do great science, and that’s to hire the brightest people you can find and let them do whatever turns them on. That’s how Bell Labs operated, and it’s how universities like Cambridge used to operate (and still try to). Smart firms like Microsoft and Google try to emulate it in their own research operations.

The UK is screwing up because of increasing micromanagement; because ministers like to stand up and make “announcements”. So Osborne wants a big research centre near Manchester? This is surely unconnected with the fact that he’s an MP for Cheshire; and of course no-one would be so crass as to suggest that Willetts gave Oxford £20m for research in quantum computing because he’s an alumnus. However, as Athene says, the mechanisms used to distribute the research budget should have the confidence of academics. Walport doesn’t.

Were I the legislator, I’d shift some of the funding from places to people. Every year, the thousand research students who produced the best theses would get five years’ postdoctoral funding to go and do their research wherever they wanted. They’d vote with their feet, and ministers would see pretty quickly whether Oxford or Manchester was hot or not.

At present, the Royal Society awards less than 100 junior research fellowships a year, which let lucky young scientists do just that. The EU adds a few more Marie Curie fellowships. These young postdocs are among the most productive we have, because they’re doing what interests them, and they’re much better placed to judge what’s a good investment of effort than decrepit old senior professors (let alone ministers). What’s needed is to scale this up. At steady state, 5000 postdocs at £35k each plus the same again for overheads would be £350m a year or 7.5% of the science budget. What’s more I’d expand it into the arts, humanities and social sciences too.

This would force vice-chancellors to focus on providing an environment in which people can do great research, rather than sucking up to ministers and lobbying for more pork. This should be the natural drift of policy for conservative or liberal ministers, as it would align incentives somewhat better than at present.

I find Anderson disturbing — not because he is wrong— but because he is right about so many things.

The point of a lecture isn’t to teach. It’s to reify, rehearse, assemble and celebrate.

Stephen Downes


“Despite my lofty dreams and expectations, practicing primary care pediatrics was nothing like I hoped it would be.  My days were filled with opportunities to meet and grow with patients and families, but my tidbits of time were sliced into 15-minute increments.  As my practice size increased, I was persistently pressured to add extra patients over my lunch hours before the day started, and into time slots already booked with other patients.  The need to move increasingly efficiently sparked anxiety within me  — I was halfway through greeting one patient before I was also surreptitiously listening for the opening and closing of the next exam room door to signal that another patient was waiting.

The physical and emotional work of completing a visit every 15 minutes repeatedly refreshing my smile before I burst into the next room began to make me feel like a machine.  As a robot in the factory of medicine.” Via Kevin MD.

[link for this post]

Worth a glance

by reestheskin on 03/01/2015

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The REFormation and all that, Derek Sayer.

Thomas Piketty and Rejecting Honours.

Learning is effortful, and other sound advice by Daniel Lemire.

MOOCs redux. Audrey Watters dissects.

“In a blog post this year, Knewton CEO Jose Ferreira insisted that learning styles exist because “to me, it’s pretty obvious.” This is a perfect example of how buzzwords dovetail so neatly with believability. Even though there is no evidence that learning styles are real, the phrase is repeated so often, some people are certain that they must. So much of education technology works this way. Blended learning, personalized learning, learning styles – they must be good because, after all, “to me, it’s pretty obvious.” A company releases a number, wraps it in a PR message, and as long as it fits the story we want to tell, it becomes the truth, widely repeated but never widely challenged.” Audrey Watters

‘At medical school I was taught by Dr. Nimmo, an elderly Edinburgh physician who wore a pinstripe suit, carried a heavy gold watch, and whose combed white hair was held in place with pomade. If he realized that a patient was hard of hearing he’d take his stethoscope from his jacket pocket and ceremoniously place the earpieces into their ears. Taking the other end in his hands, he’d speak slowly and clearly into it as if into a microphone. The focus and amplification of the stethoscope meant that he didn’t have to shout loudly, and the privacy of the patient on the open ward was preserved. For the most part his patients found the role reversal hilarious; occasionally the medical students did too. I remember him turning to one student who was sniggering a little too conspicuously. “There’s nothing funny about trying to communicate properly,” he said. “Use whatever means you can to understand and be understood.”’

From a review by Gavin Francis in the NYRB of  ‘I can hear you whisper: an intimate journey through the science of sound and language’, by Lydia Denworth.