Terminology is a big problem in dermatology, and not just for dermatologists or other doctors. Years ago, many doctors avoided referring to basal cell carcinomas (BCC) as cancers. The reasons are obvious: whilst they are invasive and are carcinomas, their behaviour puts them in a class of their own. Once you say carcinoma to many patients, the baggage is so large, that you must then give a mini lecture explaining the inadequacy of generic terminology. And you then worry whether they believe you entirely. When the newspapers run the summer stories, what sort of cancer are they talking about: BCC or melanoma? Anyway, my point is that diagnosis is both positive and negative. Negative, in the sense that you have to explain what any entity is not.
I was reminded of this when I say a patient from East Asia for whom English was perhaps a second or third language. She had, what was for her, a frightening pigmented lesion. Fortunately it was medically banal and harmless. I gave the ‘positive name’, and then outlined the list of ‘negatives’: it wasn’t this, it wasn’t that etc. Suddenly, her eyes lit up, and a smile crossed her face. ‘I’m safe’ she said. Yes.
“Being in the hospital is horrible. They woke me up at 4:00 am once to ask whether I was sleeping well.”
Via Philip Greenspun, describing a friend with a terminal disease, and why he wanted to avoid chemo.
“This is a terrific essay. The keystone of science’s power and the continued survival of a civilisation based on — and at the mercy of — science, is contained in the following:
‘As Jacob Bronowski (1956) said – in science truth is all-of-a-piece: either we are truthful always and about everything; or else the dishonesty ramifies, the rot spreads, and rapidly we are being honest about nothing.’
External audit, as we have seen over the last quarter century in many human domains, does not work. All too often it is merely a tool for rendering deceit invisible. Integrity is not a bolt on for our survival, but a bit of our biological machinery that is struggling against the loss of the ‘personal’.
If we look back to the writings of Merton, Lewis Thomas, Peter Medawar, John Ziman, and the like, it is clear we lack a coherent and deep view of what has happened to modern science and — because science is integral to the modern world — our civilisation. This essay sets the tone for what must follow.”
10 similarities between Higher Education and the Catholic Church on the eve of the Reformation?
Ivan Illich might be concerned with at least one half of this comparison. But it is difficult to read it without feeling a little twinge of guilt. Short of original sin, of course. Donald Clark, in fine icon smashing form.
“Johnson deftly states, “the curse of this age of microspecialization and the proliferation of ‘’omics’ is to separate the ridiculome from the relevantome.””
From a review of George Johnson’s ‘The Cancer Chronicles’ in Science.
“Taxpayers have spent billions of pounds in interest costs through the private finance initiative to enable tens of billions of pounds to be taken off the government balance sheet – money that should have been spent on the schools and hospitals. When in opposition, the present government acknowledged the issues and committed itself to clarity and openness in presentation. But it seems the exigencies of office have proved too demanding. Why lose weight when you can reset the scales?”
John Kay on ‘fiddling’ (aka lying) by HMG
“(Robert) Hughes was not afraid of occupying the radical centre, a space which has become somewhat under populated of late, and fighting all comers. He became one of the world’s great art critics without even bothering to complete his own university education, and had no respect for academics who baffled their students (and themselves) with the jargon of ‘theory’. He was hardly alone in noticing the appalling prose that slopped like effluent out of the post-modern university, but he described it better than most. ‘With certain outstanding exceptions like Edward Saïd, Simon Schama or Robert Darnton, relatively few people who are actually writing first-rate history, biography or cultural criticism in America have professional tenure, though many writers are attached to universities as decorative hermits or trophies in those therapeutic diversions known as Creative Writing courses.’ And then with typical erudition and style he tells us that in a denunciation of art schools in 1914 the Dadaist Arthur Craven had said ‘I am astonished that some crook has not had the idea of opening a writing school.’”
This of course just doesn’t apply to art, but to too much of the academy. Most of us just can’t agree on the extent.
“Kevin O’Rourke refers to the “cocooned elites in Brussels”, which gets to the heart of the matter. The dignity of office can be a terrible thing for intellectual clarity: you can spend years standing behind a lectern or sitting around a conference table drinking bottled water, delivering the same sententious remarks again and again, and never have anyone point out how utterly wrong you have been at every stage of the game. Those of us on the outside need to do whatever we can to break through that cocoon — and ridicule is surely one useful technique.”
This is not confined to Brussels. I seemed to remember some comment about the dangers of academics suffering ‘Kissengeritis’ — they end up a hopeless amalgam of academic and politician. The antithesis of science is not art, but politics. Just look at all these ‘professors’ peddling NHS nonsense and defending the indefensible.
“On this note, he quotes mathematician and family friend Jacques Hadamard, apparently complaining about a student who asked for a thesis topic, “Can you imagine that? If he has no topic of his own, he should not even think of a Ph.D.!””
Which brings to mind David Hubel’s practice of trying to persuade students not to do a PhD — he only wanted the ones who ‘really’ wanted it, rather than those who were just judged able.
From a book review of Fractalist in Science
Derek Bok states that some of those who were found guilty of criminal acts in the recent waves of corporate malfeasance in the US, scored very well on their ethics modules at Harvard. It is easy (and facile) to imagine that somehow doing a ‘course’ on a particular topic will produce a change in behaviour that is permanent and withstands countervailing forces (culture eats strategy,and culture eats morality etc, I hear you say). Those in universities should of course know better — producing changes in behaviour in response to an environmental stimulus is a paraphrase of one definition of learning. But the message doesn’t get through, largely because the academy has increasingly chosen to turn its professional tools away from examination of its own purpose. It is deemed rude to ask for evidence when everybody knows the sun goes round the earth.
Nor, if we are to believe Timothy Wilson, should we go in with the ‘null’ hypothesis that courses wishing to eradicate ‘isms’ may only be beneficial. The evidence points in a different direction: they make some people’s behaviour worse. I sometimes wonder if anybody is really too worried about whether these interventions work — they just want to tick boxes to comply with yet more rituals of verification (to use Michael Power’s phrase from the Audit Society).
Anyway these ramblings were by way of introduction for what is for me one of the clearest expositions of morality and the human condition. I have no idea why I cannot keep it out of my mind but maybe putting it down in writing might help. It comes from a short article by Jacob Bronowski, in a posthumous collection of his essays, ‘A sense of the future’. The article is “A moral for an age of plenty” and it includes an account of the death of the physicist Louis Slotin.
Louis Slotin was a physicist in his mid thirties, working at Los Alamos in 1946. Bronowski described him so: ‘Slotin was good with his hands; he liked using his head; he was bright and a little daring — in short, he was like any other man anywhere who is happy in his work’. Just so.
Slotin was moving bits of plutonium closer together, but for obvious reasons, not too close. And as experts are tempted to do, he was using a screwdriver. His hand slipped. The monitors went through the roof. He immediately pulled the pieces of plutonium apart, and asked everybody to mark their precise positions at the time of the accident. The former meant he would die (9 days later, as it turned out); the latter allowed him to prognosticate on what would happen to the others (they survived).
There are two things that make up morality. One is the sense that other people matter: the send of common loyalty….The other is a clear judgement of what is at stake: a cold knowledge, without a trace of deception, of precisely what will happen to oneself and to others if one plays the hero or the coward. This is the highest morality: to combine human love with an unflinching, a scientific judgement.
I actually think we are more lacking in the second than the former. Worse still, we are less tolerant of evidence than we once were: we prefer to wallow smugly in our self-congratulatory goodness. We have been here before. Medicine only became useful when physicians learned this lesson.
[ And yes, people remarked that Slotin hadn’t followed protocol…]
With these ideas in mind, we’re excited to announce the launch of HarvardXPLUS: new higher-touch versions of select popular online courses. With limited enrollment and smaller cohorts, HarvardXPLUS will allow you to engage even more with your fellow learners, and with Harvard faculty and teaching fellows.
The program also includes a new HarvardXPLUS credential that will clearly represent your commitment and hard work in completing these courses, as well as a deeper level of engagement and mastery of defined learning objectives.
At some stage these courses are going to surpass residential quality courses in many universities. The convergence will continue, although hopefully not of language (higher-touch anyone?)
‘This makes clear that one consequence (and one suspects one purpose) of TEF is to facilitate the division into institutional sheep and goats, followed by starvation of the goats.’
I didn’t know.
Two Stanford graduate students, Jerry Yang and David Filo, saw opportunity. Working from a trailer on campus, they began compiling websites into a list, organized by topic. They eventually named it Yahoo, an acronym for ‘Yet Another Hierarchical Officious Oracle.
I now have a new term for ‘learning outcomes’. Yahoo. Although ‘hideous’ competes with hierarchical
“The entire system of learning at Oxford, so far as I can recall, consisted of the combination of mnemonics, composition and argumentation. Reading lists were prodigious: often 20 or 30 items − both entire volumes and journal articles – so redundancy was a given: hours needed to be spent in the library to extract the pith from acres of paper. I took two courses (as modules were then called) every term, and the coursework requirement was an essay of 3,000 words per week for each of them; the sheer amount I had to write gave me the core facility needed for an entire adult working life as a professional writer.
The argumentation was, of course, astonishingly thorough when compared with the meagre “contact hours” most contemporary students are mandated: a full hour vis-à-vis, usually one-to-one, reading out your essay and then picking it apart.”
I learned a new acronym, too: BDDM (bi-directional digitial media). Ugly, but not silly
A nice story in Nature about two giants: Jerome Bruner and the Turing award winner, Alan Kay.
Jerry made seminal contributions to an astonishing number of fields — each a stop on the road to finding out what makes us human. Beginning in the 1960s, computer simulations became the model of the human mind in cognitive psychology, with researchers trying to simulate how humans solve problems, form concepts, comprehend language and learn. But reducing humans to computers was antithetical to Jerry’s humanistic perspective.
Given this, it was surprising that computer scientist Alan Kay, the designer of what became the Macintosh graphical user interface, turned up more than 30 years ago on Bruner’s Manhattan doorstep with a gift of a Macintosh computer. Jerry’s ideas of representing information through actions, icons and symbols, central to his theory of cognitive development, had inspired Kay to get users (even children) to act (through a computer mouse) on icons, enabling the use of an abstract set of symbols (computer program). This was the foundation for what became the Macintosh interface.
One other line in the obiuaryt by Patricia Marks Greenfield stood out:
In 1972, Bruner sailed his boat across the Atlantic to take up the first Watts Professorship of Psychology at the University of Oxford, UK.
I guess the removal expenses were as stingy then as now.
“I have never kept count of the many inventions I made but it must run into the hundreds. Most of them were trivial, such as a wax pencil that would write clearly on cold wet glassware straight from a refrigerator. It was published as one of my first letters to Nature in 1945.”
“A Rough Ride to the Future” by James Lovelock. Blake said it: it is all about ‘minute particulars’. Of a piece.
For many, assessments are a lighthouse in the fog of education—a clear guide by which to make safe decisions. But in reality, assessments create the fog.
Dan Schwartz here
If you are interested in making undergraduate medical education work, you have to be interested in scale. We have to think about scale in at least two ways.
First, within certain limits it is possible to invest more if you teach bigger numbers. If you want to produce high class online material, it will cost a lot. If you want to find out what works, larger numbers of ‘trials’ will help. If you want to produce meaningful online material, rather than just some dismal Powerpoints, it is only cost effective if class sizes are large. For many disciplines in many medical schools, there is simply not enough critical mass to produce great content. Or at least there isn’t, if teaching always plays second fiddle to research and clinical service.
The other side of the coin is simply that bedside teaching does not scale. The larger the group, the worse the teaching; and patient resource is limiting. There are of course plenty of patients, but medical schools are modelled around where the resource was fifty years ago, rather than where it is now. They are reluctant to change because the ‘start up’ costs are large, and because schools are fixated on short term rather than long term educational goals. In the old bedside model, the ready availability of suitable patients was a large (hidden) subsidy. As it disappears, people are waking up to how expensive it will be to replace. Many of these costs will be direct costs to universities, rather than hospitals, simply because the political realities in the UK mean than hospitals are simply unable to find the finance to change the way they work. Most of the money that is said to support student teaching is siphoned off to support clinical service. It is just that nobody wants to call it fraud.
From a student perspective these issues matter enormously. Student experience is often poor, and the sense of ‘place’ lacking in many, if not most, UK medical schools. The (justified) disenchantment felt by junior doctors at the hands of the NHS employers and so-called educational establishment, will spread to our undergraduates (more than it has already).
There is a quote from Clay Shirky that is germane here*.
You have to find some way to protect your own users from scale. This doesn’t mean the scale of the whole system can’t grow. But you can’t try to make the system large by taking individual conversations and blowing them up like a balloon; human interaction, many to many interaction, doesn’t blow up like a balloon. It either dissipates, or turns into broadcast, or collapses. So plan for dealing with scale in advance, because it’s going to happen anyway.
*I got this via Mike Caulfield’s blog post here
Amongst the conclusions or findings were:
I do not think this is inevitable with online courses or teaching online, rather it represents a failure to understand that the ‘L’ in LMS is usually subservient to the ‘M’. I suspect many of these points apply to online material as part of residential courses, too. Getting the online bit right requires large investment of academic staff time. I do not see how you can do it well without increasing costs — at least in the short term.
Mike Caulfied has some useful points to make on this report here
A physicist who chose physics over Wall Street in 1990 was making a sacrifice that a physicist in 1960 wasn’t.
Very thoughtful essay by Paul Graham. Bad news for the academy.
Seen it before, but always makes me smile. And think.
The ratio of expertise or expense between what you currently spend on the students already registered with you, versus that which you spend attracting new students, is a statement of ethical values (or lack of them). The same goes for the staff who work for you already. Your current students may get a bunch of ugly Powerpoints with no design support; the potential students get professional videos.
There is an interview in EdSurge with Dan Schwartz, the Dean of the Stanford School of Education. He talks about many interesting ideas elsewhere, but in this interview he says some fairly standard things about universities versus industry.
‘As an academic: I’m a great starter, and I can prove that something works. But my desire to ever have a 1–800-Call-Dan hotline for people who want to know how to use my inventions is like…zero.
Now, if its software, I could put it up on the Internet and let people use it. But I can’t market it, and I can’t keep maintaining the code. And I need to get a business plan, but I don’t know how to do that. ‘
This is very much about universities being the sort of place you start things, not where you finish them. I agree. Indeed one of the problems I see is that people want research to increasingly resemble product development. This will make all the figures look great (‘D’ is more expensive), but eventually will bankrupt universities.
Medical schools have taken on all sorts of activities that are critical to the practice of medicine, it is just that some or many of them should be done elsewhere. Please invent new statistical methodologies, or ways of measuring disease, but let others outwith medical schools apply them in the ‘D’ of the R + D. Economists use the census, but they do not do the legwork themselves.
But this got me thinking (not surprising given the theme of his article) about the one area where business or product development is central to a university’s activity: teaching delivery and learning (ugly phrases all, I know, but they are placeholders for more). And I do not believe we are good at doing this. We are good starters, but developing coherent programmes that dovetail into a particular niche, is not something we do well — certainly not in undergraduate medicine. The most obvious reasons for this deficiency are:
I am not convinced people get this, or realise the time for fiddling or small tweaks has long gone.
The structural framework of many university activities, especially advanced research, are well suited to their goals, and few institutions are as efficient at the business of genuine invention (leave aside, that universities are getting worse at this — this is only in part their fault). But if I look at the modern medical school we are not good finishers in our central ask, and we need to be.
‘We also identified a significant increase over time in the percentage of people who incurred catastrophic health expenditures (greater than 30 percent of the household income) in the Czech Republic, Italy, and Spain…
These findings indicate the substantial weakening of financial protection for people ages fifty and older in European health systems after the Great Recession.’
From ‘The Great Recession And Increased Cost Sharing In European Health Systems’, published in Health Affairs.
What continues to surprise me is how long it takes to appreciate the catastrophe that has been allowed to unfold, without any good reason.