On lowering the tone with a very clumsy pair of hands

by reestheskin on 28/08/2020

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Beautiful obituary of the wonderful classical guitarist and lutenist Julian Bream. Some of this story I knew already.

Almost as he started his long love affair with the guitar, Julian Bream was aware he was doing something disreputable. When he was caught as a teenager practising Bach in the Royal College of Music, he was warned not to bring that instrument into the building again. It lowered the tone.

Even the Army shared the snobbery

Signing on to do his National Service in an army band, he was told he could play piano and cello, fine, but the guitar only “occasionally”.

And it is not just rock musicians who sleep in the van before driving back up the M1 (note: an Austin, rather than a Transit)

Audiences clapped long and hard when he performed in the Wigmore Hall at 18, in 1951, but as he toured round Britain in the mid-1950s, sleeping in his Austin van to save on hotels, not many came to hear him.

Those from the home of the guitar were no less enthusiastic about this man from those Isles.

And from Spain, the spiritual and historical home of the guitar, came the loudest scorn of all. An Englishman playing a guitar, said one virtuoso, was a kind of blasphemy.

What I didn’t know was that he was essentially self-taught. This is common in rock, folk, and jazz and blues, but I assume rare in Classical music. Although Segovia was moderately well known, perhaps the lack of popularity of the guitar in the UK made this necessary. Readers of this rag will know that I am fascinated by autodidacts and what skills you can — and cannot —learn to a high level without formal instruction. My prejudice is also-taught: the energy needed to acquire mastery alone is worth so much more than the competence gained on the transactional shoulders of others. Passion and perspective are worth more than 50 IQ points, as they say.

There are limits, however. In this video he talks about his fingers and technique:

‘Unfortunately the Almighty bequeathed me with a very clumsy pair of hands… and very slow’ (link)

He had form on the lute as well, playing with the nails rather than the fingers, and again faced the distain of the ‘experts’.

Below, a video on why Bream thought of himself as a meat and potatoes Englishman.

The beginning is where its at.

by reestheskin on 12/06/2020

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The best way to foster mediocrity is to found a Center for Excellence.

This is a quote from a comment by DrOFnothing on a good article by Rich DeMillo a few years back. It reminds me of my observation than shiny new research buildings often mean that the quality (but maybe not the volume) of reseach will deteriorate. This is just intellectual regression to the mean. You get the funding for the new building based on the trajectory of those who were in the old building — but with a delay. Scale, consistency  and originality have a troubled relationship. Just compare the early flowerings of jazz-rock fusion (below)  with the technically masterful but ultimately sterile stuff that came later.

If I Sleep for an Hour, 30 People Will Die

by reestheskin on 11/06/2020

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Beautiful and moving video about the child forger Adolfo Kaminsky (via the NYT).

KISS: derm immunology

by reestheskin on 22/10/2018

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This was the ‘final’ video in the edderm101:core concepts video series (link to series).


Skin immunology (KISS!) from jonathan rees on Vimeo.

Ebbinghaus redux

by reestheskin on 19/03/2018

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Ebbinghaus link

John Perry Barlow RIP, lyricist for the Grateful Dead

by reestheskin on 06/03/2018

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He saw what other people had not yet seen, that this was a new space—one to which he quickly applied an existing term, cyberspace, and his own metaphor, the electronic frontier.

From the Economist’s obituary (the best writing in this world is about the dead..). He of the wonderful:

Governments of the Industrial World, you weary giants of flesh and steel, I come from Cyberspace, the new home of Mind. On behalf of the future, I ask you of the past to leave us alone. You are not welcome among us. You have no sovereignty where we gather…I declare the global social space we are building to be naturally independent of the tyrannies you seek to impose on us.

Then the thug with hoodie took over and the garden was enclosed.

It was Stewart Brand who made clear to me the link between the creation of the modern (computer — for that is what it is) age, and all that was good about the 1960s:

I think that hackers — dedicated, innovative, irreverent computer programmers — other most interesting and effective body of intellectuals since the framers of the US Constitution….. No other group that I know of has set out to liberate a technology and succeeded. They not only did so against the active disinterest of corporate America, their success forced corporate America to adopt their style in the end. The quietest of all the ‘60s subcultures has emerged as the most innovative and powerful. 

[Stewart Brand’s description nails it (previous link of mine)]

From Vanneavar Bush’s Endless Frontier to the Electronic Freedom Foundation.

And in memory here is the version of Dark Star (“The Finest Rock Improvisation Ever Recorded” – Robert Christgau). Listen to Lesh’s bass signalling the coming together at 1’15” onwards



Skincancer909 and skin cancer prevention

by reestheskin on 30/11/2017

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I hae been updating skincancer909. I am way behind schedule, but at last sorting out some of the typos and creating some more videos. Here is one of the ‘in one minute’ efforts. Enjoy. It will be finished soon. Honest.


Prevention in one minute from jonathan rees on Vimeo.

Look and listen

by reestheskin on 08/02/2017

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And just in case you like Iceland, Sigur Rós and drones, here is a video from Philip Bloom. Sit back.


How to use video. And how to talk

by reestheskin on 02/02/2017

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I read the book, ‘Ways of Seeing’ soon after it came out, but had never seen the videos. Spellbinding. Via here. It took me a while to appreciate it was the same mind that wrote ‘A fortunate man’ about, not primary care, but General Practice.

Blisters, molecular glues and pemphigus

by reestheskin on 04/10/2016

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Short video  on the above topic. There will be supporting material on my teaching page soon under the Skin Biology series (video 8). The Vimeo file is here.

Psoriasis in five minutes

by reestheskin on 04/07/2016

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I have been busy

Psoriasis in five minutes from jonathan rees on Vimeo.

Why is brown melanin blue!

by reestheskin on 17/06/2016

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Another (very) short video

Why is ‘brown’ melanin ‘blue’? from jonathan rees on Vimeo.

Why does psoriasis sometimes look white?

by reestheskin on 16/06/2016

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(Very) short video!

Why does psoriasis sometimes look white? from jonathan rees on Vimeo.

Video:The biology of the skin barrier and the eczema connection

by reestheskin on 15/06/2016

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A short video on epidermal biology with an emphasis on barrier function and irritant dermatitis.


The biology of the skin barrier: the eczema connection from jonathan rees on Vimeo.

Show me your phone

by reestheskin on 26/04/2016

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Via John Naughton

Skin biology 04. Urticaria : from nettle stings to autoimmunity

by reestheskin on 21/04/2016

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A short video on urticaria and the biology of the mast cells


Skin biology 03: skin pigmentation

by reestheskin on 16/04/2016

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Here is number 3. My favourite bit of skin biology.

Skin biology 02: from sunburn, to DNA and skin cancer.

by reestheskin on 15/04/2016

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Here is video number 2 in the ‘clinical’ skin biology series.

Skin biology 01: the basics

by reestheskin on 13/04/2016

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I have been busy producing and updating some videos. Here is the first in a series on skin biology.

Übung macht den Meister

by reestheskin on 17/11/2015

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This story is not just about physical infrastructure but also about expertise and the relation between expertise and ‘practice’. It is tempting to imagine that certification is about a moment in time, but this is not  how medicine or many other areas of high level skill  work.  The example of surgery is perhaps the easiest, but the same holds for specialties such as imaging, dermatology or histopathology, where perceptual skills are important. How may moles or melanomas you report a week is not the only determinant of competence, but it is a key variable  once you pass the novice stage. You know more than you can say, but you only know what you know if you keep doing it every day. The concert pianist still practises his scales every day. BTW, at last, in terms of safe health care, people are beginning to focus once again on diagnostic ability — or lack of it. You cannot control costs or think seriously about medical errors without an obsession about diagnosis and the system wide factors that undermine it (The National Academy of Sciences report is here).


by reestheskin on 04/11/2015

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A new welcome video for our Edinburgh Medical School dermatology module. Judging by the gesticulation, I must have some Italian blood in me (or so somebody tells me).

Light and dark: constraint, compliance, control, and contract

by reestheskin on 31/10/2015

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Several weeks ago, I visited our Vet School, based in Roslin, a few miles outside Edinburgh. It was a beautiful blue sky day, and I was in awe of the beauty of the building and the environment for their students my colleagues had created. Earlier this week, I was talking to a colleague from another College (as in, Faculty) about student learning and how to square ‘experience’ with ‘learning’ (actually, when I typed this first, I omitted the ‘l’ from learning…). This absolutely inspiring video says something about both, and the failure of constraint, compliance, control, and contract. (If this week’s THE is to be believed, automated staff surveillance will be thrown into the mix, too. See Peak indifference”: Cory Doctorow on surveillance in education. Who knows, next you will see popups all over your browser when you attempt to access your VLE because you haven’t given your course feedback responses…)


Could you live like this?

by reestheskin on 15/09/2015

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Oliver Sacks has died

by reestheskin on 01/09/2015

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Oliver Sacks has died. I haven’t read any of his books for a long time, but I loved ‘Awakenings’, and ‘The man who mistook his wife for  a hat’. I have never known what many brain people thought of him, but he was a link with the great age of medical description in my own subject in the 19th century. Others have said something similar before: you can learn more about the brain from n of 1 studies than from mega studies that are devoid of meaningful insight. To recognise the world, you have to imagine it first.

I wrote in an earlier post after reading some of his memoirs something about medical education:

When we choose students, so obsessed are we with the avoidance of risk, that we have forgotten that the best defence against whatever adversity the future might throw against us, is diversity.

I doubt if Sacks would have survived much of what we subject our students and you doctors to.

Much of what makes humans special is our visual system (as he says), but he had the wonderful voice to go with his approach, sounds that makes the telling of his stories all the more special.

How to approach a patient with a pigmented lesion?

by reestheskin on 30/08/2015

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This is up on my Vimeo page , as well. How to approach and think about pigmented lesions. #fOAmed.

The importance of forgetting and painful retrieval for learning

by reestheskin on 21/08/2015

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This is another useful talk from HILT. One problem that bugs me with both undergraduate teaching and learning, and clinical expertise when you are qualified, is the dynamic between measures of competence at a defined time point, and the influence of exposure on the pattern of competence over time. People often assert that because you have some skill at timepoint X, that somehow ‘clinical exposure’ will maintain that skill over time ( I am not talking about revalidation here, simply because most accept as currently construed revalidation is not credible). However, keeping knowledge accessible is not just a function of formal learning, but a function of how often you encounter particular clinical problems. The dynamics are worth thinking about. To maintain competence for rare disorders, you must  encounter them at a certain rate. However, it seems to me possible that ‘routine clinical practice’  may not allow enough encounters to allow this competence to be maintained at the rate that is required. [So, the rate required to maintain competence, is greater than the rate at which you might routinely encounter the problem]. This is of course why we might use simulation, or attend clinical meetings, or spend much of our life talking about ‘cases’. If you want high level competence, you have to control the ratio of mundane to advanced case-mix. This is one of the reasons you need a hierarchy, and why a consultant delivered service, is not compatible with high level clinical competence (yes, I am skipping over a formal proof, here!). Some of this is at least tangentially related to this video by Robert Bjork — he of desirable difficulty). It is not exactly the rugby training mantra of no gain without pain, but something cognate; and that our tacit  yesteryear views of competence are being destroyed.

Multimedia learning

by reestheskin on 11/08/2015

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This is a talk by Richard Mayer, one of the doyens of multimedia learning, at a HILT meeting. I find much of his work thought provoking and, at the very least, he makes me question much of what I do. But I have lots of questions: issues about transference and generalisability of the data; the applicability of the principles to advanced or at least non-novice learners (as he admits); and how this all interacts with Bjork’s desirable difficulty and motivation. A good intro to the topic is the book edited by him, The Cambridge Handbook of Multimedia Learning, although he has written stuff specifically for a medical audience too . My most insightful moment has been to realise that much as our students complain about lack of feedback, it is the lack of systematic student -> teacher feedback that limits what I do. The ‘curse of knowledge’ looms large, but I am deeply antagonistic to the idea that you cannot substantially improve teaching at both the macro and the micro levels. And without being ‘trendy’.

The Greek crisis and medical migration

by reestheskin on 02/07/2015

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BTW: German and most European hospitals tend to look cleaner than UK ones. And they wear white coats.

We all have the Blues.

by reestheskin on 16/05/2015

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BB King has died. What a life.

“I was a regular hand when I was seven. I picked cotton. I drove tractors. Children grew up not thinking that this is what they must do. We thought this was the thing to do to help your family,” he said.

When the weather was bad and he couldn’t work in the cotton fields, he walked 10 miles to a one-room school before dropping out in the 10th grade.

I saw him just once, on a double bill with Miles Davis in Vienna, sometime in 86/87. Just listen: one note fills.

How getting your work bounced is the best thing to happen (sometimes)

by reestheskin on 07/05/2015

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I like this because it shows how discovery should and can work, and how it all relies on a generosity of spirit (just as a reader must give an author some slack). Also because several years after, I was first shown a browser when I was visiting NIH, and I just didn’t ‘get it’. (music is a bit loud, but persist…)