Archive for the ‘English’ Category

Current Reality of EBM

Thursday, February 15th, 2018

I’m troubled by the current reality of EBM We have correctly learned that reason can lead us astray, so we look to evidence We have correctly learned that most evidence is actually observational and hopelessly confounded, so we look to RCTs

We have correctly learned that RCTs can be crafted, misrepresented, accused of such, hotly debated amongst respected leaders (see #CastleAF, #Orbita, #Fame, #Affirm,etc ) and often later shown to be wrong, so we look to _validated_ RCTs.

But even as this journey into EBM began, we knew the sum total of available evidence only represented a sliver of what we do. If we correctly rely on validated RCTs, we are looking at a sliver of a sliver of a sliver.

When I walk into clinic *today* I’m fully aware that validated RCT data can advise on < 5% of what I’m asked. So I go back to using reason, while robotically touting the greatness and necessity of EBM. Cognitive dissonance abounds.

What Kids Enjoy In Life

Thursday, February 1st, 2018

For an assignment, I asked some of my terminal paediatric palliative care patients what they had enjoyed in life, and what gave it meaning. Kids can be so wise, y’know. Here are some of the responses (Thread).

First:

NONE said they wished they’d watched more TV
NONE said they should’ve spent more time on Face Book
NONE said they enjoyed fighting with others
NONE enjoyed hospital

MANY mentioned their pets:
‘I love Rufus, his funny bark makes me laugh.’
‘I love when Ginny snuggles up to me at night and purrs’
‘I was happiest riding Jake on the beach.’

MANY mentioned their parents, often expressing worry or concern:
‘Hope mum will be ok. She seems sad.’
‘Dad mustn’t worry. He’ll see me again soon.’
‘God will take care of my mum and dad when I’m gone’

ALL of them loved ice-cream.

ALL of them loved books or being told stories, especially by their parents:
‘Harry Potter made me feel brave.’
‘I love stories in space!’
‘I want to be a great detective like Sherlock Holmes when I’m better!’

Folks, read to your kids! They love it.

MANY wished they had spent less time worrying about what others thought of them, and valued people who just treated them ‘normally’.
‘My real friends didn’t care when my hair fell out.’
‘Jane came to visit after the surgery and didn’t even notice the scar!’

Many of them loved swimming, and the beach.
‘I made big sandcastles!’
‘Being in the sea with the waves was so exciting! My eyes didn’t even hurt!’

Almost ALL of them valued kindness above most other virtues:
‘My granny is so kind to me. She always makes me smile.’
‘Jonny gave me half his sandwich when I didn’t eat mine. That was nice.’
‘I like it when that kind nurse is here. She’s gentle. And it hurts less’

Almost ALL of them loved people who made them laugh:
‘That magician is so silly! His pants fell down and I couldn’t stop laughing!’
‘My daddy pulls funny faces which I just love!’
‘The boy in the next bed farted! Hahaha!’

Laughter relieves pain.

Kids love their toys, and their superheroes.
‘My Princess Sophia doll is my favourite!’
‘I love Batman!’ (All the boys love Batman)
‘I like cuddling my teddy’

Finally, they ALL valued time with their family. Nothing was more important.
‘Mum and dad are the best!’
‘My sister always hugs me tight’
‘No one loves me like mummy loves me!’

Take home message:
Be kind. Read more books. Spend time with your family. Crack jokes. Go to the beach. Hug your dog. Tell that special person you love them.

These are the things these kids wished they could’ve done more. The rest is details.

Oh… and eat ice-cream.

Davos

Saturday, January 27th, 2018

Where People Go To Get Better

Monday, January 22nd, 2018

"Where people go to get better" could be the best definition ever for the Ligne de vie… and it is pretty good news that it is obviously still missing ;-)

Picture by Panh Rithy (RPanh)

Austin Brexit

Tuesday, January 16th, 2018

The unfair advantage

Saturday, December 2nd, 2017

Yet another great post by Seth Godin (@ThisIsSethsBlog)


Here’s a sign I’ve never seen hanging in a corporate office, a mechanic’s garage or a politician’s headquarters:

WE HAVE AN UNFAIR ADVANTAGE:

We care more.


It’s easy to promise and difficult to do. But if you did it, it would work. More than any other skill or attitude, this is what keeps me (and people like me) coming back.

Should You Use Blockchain?

Wednesday, November 22nd, 2017

Almost everything on computers is perceptually slower than it was in 1983

Thursday, November 9th, 2017

A tweeted argument by @gravislizard on November 6, 2017

Almost everything on computers is perceptually slower than it was in 1983

Amber-screen library computer in 1998: type in two words and hit F3. search results appear instantly.
Now: type in two words, wait for an AJAX popup. get a throbber for five seconds. oops you pressed a key, your results are erased
One of the things that makes me steaming mad is how the entire field of web apps ignores 100% of learned lessons from desktop apps

Data in webpages in 2017 is distressingly fragile. go to google maps and try and find an action that *doesn’t* erase what you’re doing
Drag the map even a pixel? it erases all your results and closes the infobox you were looking at.

You have a list of interesting locations on the screen but you want to figure out how far they are from the center of town? you can’t.
You can open a new tab, do the search there, then flip back and forth manually in the browser. there’s no other way.
That is to say, once the data’s up on the screen, you *can’t add to it*. which is one of the core functions of computers, generally.
One of the primary reasons computers were *created* was to cross reference data. that is nearly impossible in most software now.

Maps are a particularly hot item for this. christ, what about looking at a map ISN’T about cross ref’ing data? it’s the WHOLE POINT
You have a start and a finish and need to integrate that with geography and roads. and gmaps, bing, etc. are all the worst choice for this.
You are, literally, better off taking a screenshot of the map, dropping it in ms paint and manually plotting there.
Gmaps wildly thrashes the map around every time you do anything. Any time you search, almost any time you click on anything it’s a bewildering whirl of colors and shapes that has gotten worse every six months for 15 years and in doing so it has made humans worse and worse and worse at doing things that computers were created to replace and improve
In 1998 if you were planning a trip you might have gotten out a paper road map and put marks on it for interesting locations along the way
With online maps you CAN do that, but the entire process is built assuming you already know everywhere you’re going
It APPEARS to be what you want – you can keep putting in locations and it’ll keep plotting them – but in truth it’s not at all
The process you WANT: pick your start and end. now start searching for places in between. Your start and end are saved.
When you find someplace interesting, add it to your list. Keep doing that, keep searching and adding.
Search far and wide. Search for cities and then click around inside them. Read reviews. Do street view.
When you’re all done, you go back to your plotted trip and start laying out the chosen locations and optimizing your path.
You can do this with a paper map. You can’t do this with gmaps. So you just don’t do it.
You do something halfass and unsatisfying instead, using multiple tabs or a text file you save addresses in or some shit

You don’t even realize why the process is frustrating because it’s just The Way It Is.
And everything on computers is like this. It’s just How It Is now. You can’t fail quickly and iterate.
On the library computer in 1998 I could retry searches over and over and over until I found what I was looking for because it was quick
Now I have to wait for a huge page to load, wait while the page elements shift all over, GOD FORBID i click on anything while its loading
how many times have i typed in a search box, seen what i wanted pop up as i was typing, go to click on it, then have it disappear

I make no secret of hating the mouse. I think it’s a crime. I think it’s stifling humanitys progress, a gimmick we can’t get over.
The mouse is the CueCat except it didn’t get ridiculed and reviled as it should have been. It’s inappropriate for almost everything we do.
There’s no reason for Twitter to use a mouse. There’s nothing mousey about this website, not a damn thing
Mice are for rapidly navigating through a complex and unstructured set of objects, like an app with dozens of options and input types

The Elephant In The Room

Friday, October 6th, 2017

This "Elephant in the room" is the perfect model to explain why the hierarchy is a wrong answer to complex issues. Imagine that all these "experts" will go and make their report to a minister who, while not having been confronted with field realities, will have to build a synthesis, then make a decision for the whole community.

AI Myths

Sunday, September 24th, 2017

Compete with Intelligence and Agility

Sunday, September 10th, 2017

In a recent article, Justin Bariso (@JustinJBariso) published a mail Elon Musk (@elonmusk) sent to Tesla employees a few years ago.

Subject: Communication Within Tesla

There are two schools of thought about how information should flow within companies. By far the most common way is chain of command, which means that you always flow communication through your manager. The problem with this approach is that, while it serves to enhance the power of the manager, it fails to serve the company.

Instead of a problem getting solved quickly, where a person in one dept talks to a person in another dept and makes the right thing happen, people are forced to talk to their manager who talks to their manager who talks to the manager in the other dept who talks to someone on his team. Then the info has to flow back the other way again. This is incredibly dumb. Any manager who allows this to happen, let alone encourages it, will soon find themselves working at another company. No kidding.

Anyone at Tesla can and should email/talk to anyone else according to what they think is the fastest way to solve a problem for the benefit of the whole company. You can talk to your manager’s manager without his permission, you can talk directly to a VP in another dept, you can talk to me, you can talk to anyone without anyone else’s permission. Moreover, you should consider yourself obligated to do so until the right thing happens. The point here is not random chitchat, but rather ensuring that we execute ultra-fast and well. We obviously cannot compete with the big car companies in size, so we must do so with intelligence and agility.

One final point is that managers should work hard to ensure that they are not creating silos within the company that create an us vs. them mentality or impede communication in any way. This is unfortunately a natural tendency and needs to be actively fought. How can it possibly help Tesla for depts to erect barriers between themselves or see their success as relative within the company instead of collective? We are all in the same boat. Always view yourself as working for the good of the company and never your dept.

Thanks,
Elon

Fluid reflections on keeping a solid center

Tuesday, September 5th, 2017

Nearly a year from now, Maria Popova (alias @brainpicker), published a list of 10 advices from 10 years of her famous web site Brain Pickings ; as she puts it:

I first set down some of these core beliefs, written largely as notes to myself that may or may not be useful to others.

I think that they may be useful… hope you agree… whatever, here they are:

  1. Allow yourself the uncomfortable luxury of changing your mind. Cultivate that capacity for "negative capability." We live in a culture where one of the greatest social disgraces is not having an opinion, so we often form our "opinions" based on superficial impressions or the borrowed ideas of others, without investing the time and thought that cultivating true conviction necessitates. We then go around asserting these donned opinions and clinging to them as anchors to our own reality. It’s enormously disorienting to simply say, "I don’t know." But it’s infinitely more rewarding to understand than to be right — even if that means changing your mind about a topic, an ideology, or, above all, yourself.
  2. Do nothing for prestige or status or money or approval alone. As Paul Graham observed, "prestige is like a powerful magnet that warps even your beliefs about what you enjoy. It causes you to work not on what you like, but what you’d like to like." Those extrinsic motivators are fine and can feel life-affirming in the moment, but they ultimately don’t make it thrilling to get up in the morning and gratifying to go to sleep at night — and, in fact, they can often distract and detract from the things that do offer those deeper rewards.
  3. Be generous. Be generous with your time and your resources and with giving credit and, especially, with your words. It’s so much easier to be a critic than a celebrator. Always remember there is a human being on the other end of every exchange and behind every cultural artifact being critiqued. To understand and be understood, those are among life’s greatest gifts, and every interaction is an opportunity to exchange them.
  4. Build pockets of stillness into your life. Meditate. Go for walks. Ride your bike going nowhere in particular. There is a creative purpose to daydreaming, even to boredom. The best ideas come to us when we stop actively trying to coax the muse into manifesting and let the fragments of experience float around our unconscious mind in order to click into new combinations. Without this essential stage of unconscious processing, the entire flow of the creative process is broken.

    Most important, sleep. Besides being the greatest creative aphrodisiac, sleep also affects our every waking moment, dictates our social rhythm, and even mediates our negative moods. Be as religious and disciplined about your sleep as you are about your work. We tend to wear our ability to get by on little sleep as some sort of badge of honor that validates our work ethic. But what it really is is a profound failure of self-respect and of priorities. What could possibly be more important than your health and your sanity, from which all else springs?

  5. When people tell you who they are, Maya Angelou famously advised, believe them. Just as important, however, when people try to tell you who you are, don’t believe them. You are the only custodian of your own integrity, and the assumptions made by those that misunderstand who you are and what you stand for reveal a great deal about them and absolutely nothing about you.
  6. Presence is far more intricate and rewarding an art than productivity. Ours is a culture that measures our worth as human beings by our efficiency, our earnings, our ability to perform this or that. The cult of productivity has its place, but worshipping at its altar daily robs us of the very capacity for joy and wonder that makes life worth living — for, as Annie Dillard memorably put it, "how we spend our days is, of course, how we spend our lives."
  7. "Expect anything worthwhile to take a long time." This is borrowed from the wise and wonderful Debbie Millman, for it’s hard to better capture something so fundamental yet so impatiently overlooked in our culture of immediacy. The myth of the overnight success is just that — a myth — as well as a reminder that our present definition of success needs serious retuning. As I’ve reflected elsewhere, the flower doesn’t go from bud to blossom in one spritely burst and yet, as a culture, we’re disinterested in the tedium of the blossoming. But that’s where all the real magic unfolds in the making of one’s character and destiny.
  8. Seek out what magnifies your spirit. Patti Smith, in discussing William Blake and her creative influences, talks about writers and artists who magnified her spirit — it’s a beautiful phrase and a beautiful notion. Who are the people, ideas, and books that magnify your spirit? Find them, hold on to them, and visit them often. Use them not only as a remedy once spiritual malaise has already infected your vitality but as a vaccine administered while you are healthy to protect your radiance.
  9. Don’t be afraid to be an idealist. There is much to be said for our responsibility as creators and consumers of that constant dynamic interaction we call culture — which side of the fault line between catering and creating are we to stand on? The commercial enterprise is conditioning us to believe that the road to success is paved with catering to existing demands — give the people cat GIFs, the narrative goes, because cat GIFs are what the people want. But E.B. White, one of our last great idealists, was eternally right when he asserted half a century ago that the role of the writer is "to lift people up, not lower them down" — a role each of us is called to with increasing urgency, whatever cog we may be in the machinery of society. Supply creates its own demand. Only by consistently supplying it can we hope to increase the demand for the substantive over the superficial — in our individual lives and in the collective dream called culture.
  10. Don’t just resist cynicism — fight it actively. Fight it in yourself, for this ungainly beast lays dormant in each of us, and counter it in those you love and engage with, by modeling its opposite. Cynicism often masquerades as nobler faculties and dispositions, but is categorically inferior. Unlike that great Rilkean life-expanding doubt, it is a contracting force. Unlike critical thinking, that pillar of reason and necessary counterpart to hope, it is inherently uncreative, unconstructive, and spiritually corrosive. Life, like the universe itself, tolerates no stasis — in the absence of growth, decay usurps the order. Like all forms of destruction, cynicism is infinitely easier and lazier than construction. There is nothing more difficult yet more gratifying in our society than living with sincerity and acting from a place of largehearted, constructive, rational faith in the human spirit, continually bending toward growth and betterment. This remains the most potent antidote to cynicism. Today, especially, it is an act of courage and resistance.

Perceptions of Probability

Saturday, August 26th, 2017

Great way to display the fuzzy perceptions of probability attached to natural language expressions.

From github.com/zonination

As the Mayor of Pittsburgh

Friday, June 2nd, 2017

This tweet made my day…

This other one too. As you can see, it was the first tweet ever from the CEO of Goldman Sachs.

Past, Present and Future of AI

Saturday, May 20th, 2017

Amazing panel, moderated by Diane Greene, at Google I/O ’17 about "Past, Present and Future of AI". Françoise Beaufays, Fei-Fei Li (@drfeifei), Fernanda Viégas (@viegasf) and Daphne Koller (@DaphneKoller) depict, in a truly insightful and "buzz free" way, what AI already can achieve and has the potential to become.

The whole panel is really worth watching. I selected some great sentences from Fei-Fei Li, mainly because they are less domain specific, hence easier to understand in isolation (at 8:18).


Around 2010, thanks to the convergence of the maturing of statistical Machine Learning tools, the convergence of big data brought to us by the Internet and by the sensors and the convergence of computing to more better hardware, these three pillars came together and lifted AI from the in vitro stage into what I call the in vivo stage. AI in vivo is where IA is making a real impact to the world.


It’s just the beginning. Every single industry that we see at Cloud Google is going to a transformation because of data, because of AI and Machine Learning and this is what I see as the historical moment… AI is going to impact and transform the field.


But I also do wanna say it’s just the beginning. The tools and the technologies we have developed in the field of AI are really the first few drops of water in a vast ocean of what AI can do. We cannot over promise but there should be tremendous excitement that we can do a lot of more work to make this AI in vivo happen.

Ransomware

Saturday, May 13th, 2017

A huge ransomware attack is currently having most MD in the UK going back to paper and pencil. There are good reasons to imagine that it will eventually get worse in the future ;-)

Maybe it is the proper time to (re)read "AI and the fridge".

As for Wannacrypt, if you want to patch an old machine (XP, Vista or 2003 server), use this link.

On Trump’s Mental State

Thursday, February 23rd, 2017


In a letter to the editor published on February 14, 2017 on the New York Times’ web site, an eminent psychiatrist demurs on Trump’s mental state:

Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.

Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.

Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).

Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.

His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.

ALLEN FRANCES

Coronado, Calif.


The writer, professor emeritus of psychiatry and behavioral sciences at Duke University Medical College, was chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV).

Flags, Countries & Stereotypes

Saturday, February 4th, 2017

Nice project by by Russian art director Kirill Zaytsev that smartly mixes country flags and stereotypes. Here are my favorites:

What patients should ask their physicians when ordered a new drug

Saturday, February 4th, 2017

Great list, from a paper by Ranit Mishori (@ranitmd), of questions to ask your physician to when ordered a new drug:

  • What is this medication, and why am I taking it?
  • Are there non-pharmacologic options to treat this condition?
  • How long do I need to be on it?
  • What are the benefits of continuing to take it?
  • What are the possible harms of using that medication?
  • Do any of my medications interact with any another?
  • Can I lower the doses of any of these medications?
  • Which of my medications are more likely to be nonbeneficial considering my age, my other medical conditions and my life expectancy?
  • Are there any medications I can get off completely?

Isabella Mocks Donald

Saturday, February 4th, 2017

Surrounded by female colleagues, Sweden’s deputy prime minister Isabella Lövin signs a climate bill in a way that clearly mocks a well known picture where Donald Trump, with all-male colleagues around, signed a decree barring US federal funding for foreign NGOs that support abortion.

No need to say that neither Trump, nor his fans, will get the point. But the real issue is actually not there. Let’s hope that those who can smile at this picture can detect others with a similar inner joy and build together a genuine meshed society.

I wish Isabella smiled.


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