The medical student as ChatGPT
I am amused that people are slow to realise that large language models (ChatGPT etc) do not understand what they are saying, or that they make things up — that is, they hallucinate. Performance on “surface layer” testing does not equate to competence. Anybody who has taught medical students knows that humans are quite capable of exhibiting the same behaviour. It was one of the values of the old fashioned viva. You could demonstrate the large gulf between understanding (sense)on the one hand, and rote — and fluent rote at that — simulation on the other (garbage).
The medical educationalists, obsessed as they are with statistical reliability, never realised that the viva’s main function was for the benefit of teachers rather than learners. It is called feedback.
The medical student as ChatGPT
Horses for courses
Public schools exist to create the material they need for the class they want to build. When Eton needed soldiers, it was a very harsh environment; later, when it needed shysters and chancers, it adapted successfully to produce Boris Johnson and David Cameron. The girls’ estate is no different – and in the 50s and 60s it needed hostesses and broodmares. The last thing you would have wanted them to emerge with was a bunch of O-levels.
Merde!
She said…
Is France on the road to a Sixth Republic? | Financial Times
It was said of US President George HW Bush that he reminded every woman of her first husband. Macron reminds every French person of their boss: an educated know-it-all who looks down on his staff.
A long-handled personal earthmoving implement
We should all be asking more questions | Financial Times
As a beloved journalism handbook of mine puts it, you have to be able to “call a spade a spade, instead of bringing in someone from Harvard to solemnly declare it a long-handled personal earthmoving implement”.
And what about the reds?
Netherlands plots return to admission lotteries | Times Higher Education (THE)
Of course, I would say that wouldn’t I? I knew that lotteries had been used for medicine in the past in the Netherlands but….
The politics of admission are layered. Much media criticism has been levelled at University Medical Center Utrecht for an alleged bias towards blonde, white women. A spokeswoman said the institution was “constantly optimising [its] selection procedures, amongst others on the basis of research on bias”.
Supporters of lotteries say they could help the student body better represent Dutch society. “We do believe it would promote equity between students,” said Terri van der Velden, president of Interstedelijk Studenten Overleg (Intercity Student Consultation), the Netherlands’ largest national student organisation. “Our biggest fear with these selection instruments is that they’re chosen at random.”
TARA over TINA
I hadn’t come across the acronym TARA before, but it seems a hopeful thought for the New Year. Life is indeed more interesting with it set as the default.
TARA: There are real alternatives
TINA: There are no alternatives
(I have forgotten the source — apologies)
The crime-writing Belgian ‘sheriff’ fighting EU corruption – POLITICO
For him[Michel Claise], financial crime has destroyed fundamental aspects of society. “White-collar crime is the cancer of democracy,” Claise wrote in one of his books, “Le Forain” (The Showman).
And prison works for white collar crime.
Belgian justice is doing what at first sight the European Parliament hasn’t done,” the country’s Prime Minister Alexander De Croo told reporters in his first comments on the scandal on Tuesday. “The European Parliament has a lot of means to regulate itself. It turns out that this is largely a system of self-regulation based on voluntary efforts, which has clearly not been sufficient.
But that peacocking would be ironic to Claise, who complained in October that Belgium’s police are under-resourced, fighting a war against modern, high-tech corruption using “catapults.” Earlier in the year, he said the Belgian government was “ on Xanax rather than Viagra.” Now it’s the European Parliament he has found dozing on the job.
Not such a novel idea?
Pond Life: Princeton PhD inspires campus novel | Times Higher Education (THE)
When Jack Williams heard his PhD dissertation would likely be read by just a handful of people, he decided that a novel approach to expanding its reach was needed. Literally. “On average, only five people will read a doctoral thesis – and one of them is usually your housemate – so I thought it would be good if I could smuggle something of my ideas into a book,” said Dr Williams, whose debut novel, Pond Life, is published by RedDoor Press.
I had always thought fiction was an old form evident in many theses.
They just can’t help sharing it
Debt is the sexually transmitted disease of finance. People won’t discuss it in public.
Rich People’s Problems: My debt is becoming an albatross | Financial Times
I give you the tea bag and Tractatus!
A century ago Ludwig Wittgenstein changed philosophy for ever | The Economist
Of all the innovations that sprang from the trenches of the first world war—the zip, the tea bag, the tank—the “Tractatus Logico-Philosophicus” must be among the most elegant and humane.
That the book ever made it into print was miraculous. Before the war, as a student at Cambridge, Wittgenstein’s talent was clear to his contemporaries, who begged him to put his many thoughts into writing. He refused, fearing that an imperfect work of philosophy was worthless. His mentor, Bertrand Russell, made a habit of taking notes when the two spoke, lest his protégé’s genius be lost to memory. Wittgenstein himself had other preoccupations, principally suicide.
Now I don’t have to feel so guilty
Letter: Socialist historian foresaw Covid work habits in 1967 | Financial Times
Anyone who has read the socialist historian EP Thompson’s article “Time, Work-Discipline and Industrial Capitalism”, written in 1967 and collected in Customs in Common in 1993, will recognise his account of pre-industrial work habits in Pilita Clark’s article about modern workers’ reluctance to engage on Mondays (Business Life, May 17).
Thompson identifies a work pattern composed of “alternate bouts of intense labour and of idleness, wherever men were in control of their own working lives”. He remarks that the “pattern persists among some self-employed — artists, writers, small farmers, and perhaps also with students — today [1967], and provokes the question whether it is not a natural human work-rhythm”.
Michael Williams, Letchworth Garden City, Hertfordshire, UK.
No mothers’ milk here
Nestlé document says majority of its food portfolio is unhealthy | Financial Times
Nestlé document says majority of its food portfolio is unhealthy
An internal company presentation acknowledges more than 60% of products do not meet ‘recognised definition of health’.
No surprises here, then.
I think the quip was from the series Cardiac Arrest: the ITU used to be called the ICU (intensive care unit) until they realised nobody did.
In March, 2019, a doctor informed 78-year-old Ernest Quintana, an inpatient at a hospital in California, USA, that he was going to die. His ravaged lungs could not survive his latest exacerbation of chronic obstructive pulmonary disease, so he would be placed on a morphine drip until, in the next few days, he would inevitably perish. There was a twist. A robot had delivered the bombshell. There, on a portable machine bearing a video screen, crackled the pixelated image of a distant practitioner who had just used cutting-edge technology to give, of all things, a terminal diagnosis. The hospital insisted that earlier conversations with medical staff had occurred in person, but as Mr Quintana’s daughter put it: “I just don’t think that critically ill patients should see a screen”, she said. “It should be a human being with compassion.”
There was a touching obituary of Peter Sleight in the Lancet. Sleight was a Professor of Cardiovascular Medicine at Oxford and the obituary highlighted both his academic prowess and his clinical skills. Hard modalities of knowledge to combine in one person.
Throughout all this, at Oxford’s Radcliffe Infirmary and John Radcliffe Hospital, Sleight remained an expert bedside clinician, who revelled in distinguishing the subtleties of cardiac murmurs and timing the delays of opening snaps.
And then we learn
An avid traveller, Sleight was a visiting professor in several universities; the Oxford medical students’ Christmas pantomime portrayed him as the British Airways Professor of Cardiology. [emphasis added]
This theme must run and run, and student humour is often insightful (and on occasion, much worse). I worked somewhere where the nickname for the local airport was that of a fellow Gold Card professor. We often wondered what his tax status was.
A letter from Colin Mills (Basel) in last week’s Economist
Milk, beer and sweets were listed as “basic necessities” supplied by corner shops, which are thriving during the pandemic (“Turning a corner”, October 17th). Two of the three can hardly be considered necessities. Sweets are bad for you, and many people live perfectly happily without drinking milk.
The background is the observation that babies born by Caesarian have different gut flora than those born vaginally. The interest in gut flora is because many believe it relates causally to some diseases. How do you go about investigating such a problem?
Collectively, these seven women gave birth to five girls and two boys, all healthy. Each of the newborns was syringe-fed a dose of breast milk immediately after birth—a dose that had been inoculated with a few grams of faeces collected three weeks earlier from its mother. None of the babies showed any adverse reactions to this procedure. All then had their faeces analysed regularly during the following weeks. For comparison, the researchers collected faecal samples from 47 other infants, 29 of which had been born normally and 18 by Caesarean section. [emphasis added]
‘Statisticians have already overrun every branch of science with a rapidity of conquest rivalled only by Attila, Mohammed, and the Colorado beetle’
Maurice Kendall (1942): On the future of statistics. JRSA 105; 69-80.
Yes, that Maurice Kendall.
It seems to me that when it comes to statistics — and the powerful role of statistics in understanding both the natural and the unnatural world — that the old guys thought harder and deeper, understanding the world better than many of their more vocal successors. And that is without mentioning the barking of the medic-would-be-statistician brigade.
I think1 the words are mine:
Every time I hear the term line-manager used about an academic, retirement gets a day closer
But the great JK Galbraith (senior) had some words of his own on line-management (Galbraith, a famous Harvard Professor of Economics, was ambassador to India for JFK)
Galbraith proved up to the task, in part, as Bruce Riedel writes in “JFK’s Forgotten Crisis”, because he had access to the president and his aides. Most ambassadors report to the State Department, but the blunt Galbraith told the president that going through those channels was “like trying to fornicate through a mattress”.
- I think they are mine, but apologies if I have nicked them … ↩
Just three?
Doctors need three qualifications: to be able to lie and not get caught; to pretend to be honest; and to cause death without guilt.” So wrote Jean Froissart, a diarist of the Middle Ages, after an outbreak of bubonic plague in the 14th century. Fake news then meant rumours that the plague could be cured by sitting in a sewer, eating decade-old treacle or ingesting arsenic.
I thought the above quote was going to be from an exchange between James Hunt and Niki Lauda. But no, it was some advice from a mother to her son (Richard Seaman) on the choice of his bride.
At a party earlier that year he had met Erika Popp, the daughter of a director of BMW. When they decided to get married his mother disinherited him. Her final words to him were: ‘Dear boy, I would rather see you lying in your coffin than that you should contract this disastrous marriage.’
Seaman was dead six months later in a crash on the track so his mother did not have to wait long. Even the spectators got in the spirit of things:
During a race on the Pescara circuit in Italy in 1937, a driver crashed into a marker stone and collided with another car before spinning off into the crowd. Four spectators were killed at the scene, others had their legs severed and five died later from their injuries. ‘The race continued,’ Williams reports, ‘as races always did.’ After the 1955 Le Mans disaster, in which 83 people were killed by flying debris, crowd safety was vastly improved, but in Seaman’s day spectators died almost as often as drivers.
Now attitudes are different: even our attitude to the nuts and bolts:
The [F1]regulations cover everything from engine size to aerodynamic shape, and part of the game is to work out how much you can get away with while still obeying them. Some innovations are modest. Before it was banned in 2012, teams used helium rather than compressed air to power the guns used to remove wheel nuts during pit stops. The helium’s lower density made the guns spin faster, allowing them to get the nuts off fractionally quicker. The incremental gains add up. When the F1 championship began in the 1950s the average pit stop took 67 seconds. Nowadays a decent one takes around two seconds.
The power of incremental change.
Jon Day · Dear boy, I’d rather see you in your coffin: Paid to Race · LRB 16 July 2020
Surplus collagen
His younger co-workers, with their zippy metabolisms and surplus collagen, started referring to him as “the elder.”
A New Luxury Retreat Caters to Elderly Workers in Tech (Ages 30 and Up) – The New York Times
Poor Celine
The Economist heaps praise on Ireland’s ability to get its way:
Ireland has a good claim to be the world’s most diplomatically powerful country
We learn that Ireland beat off Canada to win a seat on the UN Security Council but that like Canada Ireland also has ‘a bigger, sometimes boorish, neighbour’.
Alongside more subtle overtures, the push for the Security Council seat [by Ireland] involved free tickets to Riverdance and a U2 gig. The best that Canada could muster was Celine Dion.
Charlemagne – How Ireland gets its way | Europe | The Economist
Whenever I have looked at the CVs of many young doctors or medical students I have often felt saddened at what I take to be the hurdles than many of them have had to jump through to get into medical school. I don’t mean the exams — although there is lots of empty signalling there too — but the enforced attempts to demonstrate you are a caring or committed to the NHS/ charity sector person. I had none of that; nor do I believe it counts for much when you actually become a doctor1. I think it enforces a certain conformity and limits the social breadth of intake to medical school.
However, I did do things work outside school before going to university, working in a variety of jobs from the age of 14 upwards: a greengrocer’s shop on Saturdays, a chip shop (4-11pm on Sundays), a pub (living in for a while ?), a few weeks on a pig-farm (awful) and my favourite, working at a couple of petrol stations (7am-10pm). These jobs were a great introduction to the black economy and how wonderfully inventive humanity — criminal humanity— can be. Naturally, I was not tempted?. Those in the know would even tell you about other types of fraud in different industries, and even that people actually got awarded PhDs by studying and documenting the sociology of these structures (Is that why you are going to uni, I was once asked).
On the theme of that newest of crime genres — cybercrime — there is a wonderful podcast reminding you that if much capitalism is criminal, there is criminal and there is criminal. But many of the iconic structures of modern capitalism — specialisation, outsourcing and the importance of the boundaries between firm and non-firm — are there. Well worth a listen.
- See below ↩ for a long aside on this point.
I think there is a danger in exaggerating the role of caring and compassion in medicine. I am not saying you do not need them, but rather that I think they are less important that the technical (or professional) skills that are essential for modern medical practice. I want to be treated by people who know how to assess a situation and who can judge with cold reason the results of administering or withholding an intervention. If doctors were once labelled priests with stethoscopes, I want less of the priest bit. Where I think there are faults is in the idea that you can contribute most to humanity by ‘just caring’. The Economist awhile back reported on an initiative from the Centre for Effective Altruism in Oxford. The project labelled the 80,000 hours initiative advises people on which careers they should choose in order to maximise their impact on the world. Impact should be judged not on how much a particular profession does, but on how much a person can do as an individual. Here is a quote relating to medicine:
Medicine is another obvious profession for do-gooders. It is not one, however, on which 80,000 Hours is very keen. Rich countries have plenty of doctors, and even the best clinicians can see only one patient at a time. So the impact that a single doctor will have is minimal. Gregory Lewis, a public-health researcher, estimates that adding an additional doctor to America’s labour supply would yield health benefits equivalent to only around four lives saved.
The typical medical student, however, should expect to save closer to no lives at all. Entrance to medical school is competitive. So a student who is accepted would not increase a given country’s total stock of doctors. Instead, she would merely be taking the place of someone who is slightly less qualified. Doctors, though, do make good money, especially in America. A plastic surgeon who donates half of her earnings to charity will probably have much bigger social impact on the margin than an emergency-room doctor who donates none.
Yes, the slightly less qualified makes me nervous.
Its natural, Jim. From an obituary of Julian Perry Robinson in Nature
Julian Perry Robinson (1941–2020)
In 1981, the US government publicly accused Soviet-backed forces in southeast Asia of waging toxin warfare and violating their legal obligations under the 1925 Geneva Protocol and 1972 Biological Weapons Convention. It alleged that aircraft dispersed ‘yellow rain’ containing mycotoxins that were “not indigenous to the region”. Julian Perry Robinson, working alongside biologist Matthew Meselson at Harvard University in Cambridge, Massachusetts, established that what actually fell was wild-honeybee faeces containing naturally occurring toxins. He died on 22 April, aged 78.
Just because your doctor has a name for your condition, doesn’t mean he knows what it is — Franz Kafka.
I hadn’t come across this quote by Franz Kafka before. It is of course true, but the converse is even more worrying. I like Sam Shuster’s aphorism better: the worst thing you can do is make a diagnosis (because it stops you thinking about what really is going on).
No, not post-covid nor even post-final Heineken or six-nation rugby 2020 ?, but rather the default drink of the networker. As Bronowski might have said of a golden period of 20th century physics: it was done as much in coffee houses an in laboratories. Is imbibing alone also subject to that other familiar disapprobation?
What began as an obscure berry from the highlands of Ethiopia is now, five centuries later, a ubiquitous global necessity. Coffee has changed the world along the way. A “wakefull and civill drink”, its pep as a stimulant awoke Europe from an alcoholic stupor and “improved useful knowledge very much”, as a 17th-century observer put it, helping fuel the ensuing scientific and financial revolutions. Coffeehouses, an idea that travelled with the refreshment from the Arab world, became information exchanges and centres of collaboration; coffee remains the default drink of personal networking to this day.
The value of wine exchanged yearly between consumers, connoisseurs and collectors—the secondary market—has quadrupled to $4bn since 2000, says Justin Gibbs of Liv-ex, a wine-trading platform. He reckons that just 15% of those buying wine on his website are doing so to drink it. The rest see it as a store of value.
Amateur buyers of fine Burgundy fear a speculative bubble – Smoking barrels
Annoying, isn’t it? But we all tend to a naive idea of value. Especially when we think about pricing drugs.
As a human being, and a citizen of this country, I deplore almost everything that’s going on in public life,” Mr Herron says. “As a novelist with a bent towards the satirical, it’s a gift.
Mick Herron quoted in the Economist.
Mick Herron’s novels are a satirical chronicle of modern Britain – Spy fiction
On shifting dullness
Henry characterise the less attractive teaching rounds as examples of shifting dullness
Henry Miller (apologies, a medic joke)