Crusading against evil since ...
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“How’s your head?” 
My least favorite question to answer since June of 2016.

It still hurts. 
Every day. 
Every day my brain reminds me that it’s not quite right. 
That it hasn’t gone back to “normal.” 
That it probably never will to some extent. 

But people don't want to hear that. 
People don’t want to hear your struggle. Everyone struggles. There's people who have it worse. 

But that does not mean your pain is not real. That does not mean your pain does not matter. 

‘Just try not to sound like you’re complaining,’ I tell myself every time I’m forced to answer that dreadful question. 

“It’s okay,” is the safest answer that comes out of my mouth. I always manage to say it with a smile, you know, to trick ‘em.

Those who know me read right through the lie. 
Those who don’t at least get the idea that we don’t have to go any further. 

“Glad you’re doing better,” they’ll say.

Ahhh yes, “better.”

Let’s analyze “better,” shall we?

Did I work out this morning? If so, I’ll probably have a headache by 7am. 
Did I sprint, elevate my heart rate too high or put my head below my chest/butt like a burpee? If so, that headache will last until I fall asleep. 

Sleep – the only true recovery for concussions and post-concussion symptoms.

Did I drive too far?
Listen to music too loud?
Read too much?
Did too many people try and talk to me at once? 
Have I stared at my computer for too long? 
My phone too long?
The TV too long? 
Did I focus during a conversation too hard?

Did I happen to do one or more of these in the same day…? 

*grabs an ice pack, shuts off all the lights and sounds, pulls out my emergency pill bottle, goes to sleep at 7pm two and a half years after I hit the fence.

Ahhh yes, “better” they say to me, as if walking, talking and smiling means people are pain-free. 

“Adjusting” I say to myself, as I continue working toward acceptance in my new “normal.” 
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7 days ago
As another person with post-concussion symptoms, I can empathize with this.
Central Pennsyltucky
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Creative arts and investing in systems

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Earlier in the week, a thinktank called “Onward UK” got some press for a report condemning the proliferation of “Mickey Mouse Degrees” in British universities. You might think (and indeed say, as I did) that a bucket shop policy institute consisting of a recently resigned special advisor and a “Senior Research Fellow” with a lobbyist day job has a bit of brass neck calling anyone else “Mickey Mouse”, and that’s why I’m not linking to the report (although I did finally crack and read it; it’s not terrible quality stuff, but as an example of the genre of policy entrepreneurship it’s an American trend that I don’t want to see embedding in British public life). Instead of getting into an empirical debate, I want to address what I see as a more interesting question; the whole way we think about our creative industries is fundamentally misconceived, because of a sort of methodological individualism that stops us seeing the system as a system.

In skeleton form, the argument is:

1. Lots of students choose to do degrees in creative arts subjects[1]

2a. Most of them don’t get high-paying jobs in the creating industries
2b. Many of them don’t get graduate-premium jobs at all

3. Because of the way the UK’s student debt write-off system works[2], this means that the provision of creative arts degrees gets a taxpayer subsidy

4. This is bad and should stop, either by regulating the provision of degrees or by futzing around with the loan/subsidy system to similar picking-winners effect.

It’s got a certain logic to it, but it suffers from what I’m going to call the “Park Problem”. I set it out (subject to a very compressed word limit) in City AM this week.

Basically, if any policy aimed at solving the alleged problem above would work, it would hit courses in media, film and creative arts at former polytechnics pretty hard. Specifically, you’d bet against the survival of “Communication Arts” at Sheffield Hallam University.

But … congratulations, Minister, you just zapped the course that brought us Nick Park, Aardman Animation, Wallis and Grommit and the media-industry cluster in Bristol.

The thing about the arts industries is that they’re very hits-driven; talking about what happens to the median person going into them is always going to massively underestimate the value of the system as a whole. They share this characteristic with pharmaceuticals and, famously, the oil industry (as the wildcatter proverb has it, “part of the cost of a gusher is the dry holes you drilled”). You can’t tell ex ante which spotty undergraduate is going to turn into a claymation genius and retrospectively justify the last decade of investment. Importantly, nor can they. As far as I can see, if you were to set it up without subsidy, you would most likely get too few people going into the creative arts, as they would rationally decide that they were more likely to be one of the ones that didn’t make it than one of the Nick Parks.

This is really not all that unorthodox; it’s just the application of venture capital thinking to what people are (wrongly in my opinion) analysing as a debt problem. The undergraduate education subsidy system ought to be thought of as one where the government makes loads and loads of smallish VC investments, effectively buying a roughly 30% shareholding for a five figure investment, with diversification across an entire undergraduate cohort every year. If you’re given that sort of an opportunity, then obviously you go for some moonshots, particularly when you’re the government of a country that famously does very well in creative industries compared to its peers[3].

But it’s actually possible to push this line of thinking somewhat further into a general point about arts funding, making use of the fact noted two paragraphs ago that not only is it impossible for an outsider to pick winners, it’s usually very difficult for the artists themselves. Where I think that leads to is the conclusion that when you’re looking at the rate of return on arts subsidies, there is no coherent way to measure ROI at any level more disaggregated than the entire system.

What I mean by this is that it’s not possible to isolate particular parts of the creative industry as “commercial” and look at their funding separately from the “artistic” bits. Some organisations might try to do this as a book-keeping exercise (and obviously, this isn’t a literal impossibility when it comes to things like an annual pantomime). But in fact, the avant-garde is a provider of raw and semi-finished material to the “commercial”. One of the outputs of “productions of Samuel Beckett” is “directors of Bond films”. More importantly than that, one of the important outputs of a thriving fringe theatre scene is an educated and critical audience, which is the hidden crucial competitive advantage that the British media industry enjoys over most of its competitors. There’s a reason why it was in the UK market that Simon Cowell managed, twice, to turn an incredibly generic talent-show concept into a format that conquered the world.

So not only is arts funding a hits-based business (in which part of the cost of the successes is the cost of the flops), it’s also a hits-based business in which it’s not really possible to measure the output, because a lot of the output is the production of intangible assets which only get converted into cash at a later date and with a connection that’s very hard to observe. I think that what this means is a) the overall ROI of creative arts funding is likely to be systematically underestimated by accounting systems which don’t take into account the production of intangible assets and which try to make a commercial/art split. And b) that the only reasonable way to allocate arts funding is by the judgement of informed creative peers.

[1] In general, one might see this as creating a rebuttable presumption that creative arts are succeeding in a marketplace which is competitive and internationally traded, and that this is good. The market for undergraduate education isn’t perfect of course; I have had numerous interesting arguments about whether the information asymmetries are really so great as to undermine this presumption but let’s set them to one side here.

[2] It basically replicates a really crude and badly designed graduate tax, but one which has the massive advantage over a proper graduate tax that it can be levied on foreign students from EEA countries.

[3] I have noted in the past that, whether or not China produces a hundred thousand graduate engineers every year, it remains the case that China has never produced a single decent television game show. Anyone remotely familiar with the concept of comparative advantage can draw the obvious conclusion with respect to whether the UK ought to be directing its talented young people into software engineering or into media studies.

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10 days ago
Another aspect of commercialization
Central Pennsyltucky
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Commercialization effects in universities

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Responding to students’ call for the sacking of John Finnis from Oxford University because of past homophobic writing, I tweeted yesterday that:

If I spend £30,000 on a car I don't expect the salesman to tell me my lifestyle is unacceptable. The idea that universities should be different is a hangover from the days before tuition fees.

This needs expanding. I was not justifying the students’ demand but merely getting at a point made by Fred Hirsch back in 1976. He called it the commercialization effect. If we pay for something we have different standards and expectations than we do if we get it for free*. Motivational crowding out happens. If I’m getting something for nothing I’ll be more tolerant of any, ahem, idiosyncrasies of its suppliers than I would be if I’m spending a fortune on it. You cannot create a market in something and then be surprised when customers exercise consumer sovereignty. Economic change causes cultural change. The cash nexus might well transform what used to be a learning experience into just another paid-for leisure activity – and people on cruises don’t expect to be “challenged” or offended by the waiters,

In this context, what’s surprising is just how tolerant students still are: as Will Davies has said, the idea that they are intolerant snowflakes is a figment of the right’s imagination. This, though, might not be an immutable fact. It might merely be an example of how culture is slow to change in response to economics. Tuition fees are a sufficiently recent innovation that they have not yet crowded out traditional academic social norms about free enquiry. But they might do so eventually.

In this context, there are many issues to consider. Let’s take five.

1. There is, as Aveek Bhattacharya pointed out, a commercial transaction in which people pay to be challenged and even offended – personal training. Isn’t this a parallel for university? Perhaps, but the trainer’s words of admonishment are a form of roleplay: a trainer who was (improbably) sincerely racist or homophobic wouldn’t get much custom. In this sense, there’s a distinction between lecturers using thought experiments (“what’s wrong with homophobia?”) and ones expressing sincere views hostile to some students. History-man-antony-sher-1

2. Teachers can compartmentalize. The great Andrew Glyn, for example, was never hostile to conservative students despite holding very different political views to them. Perhaps even homophobic teachers can do the same**. The converse is also true here. Lecturers with impeccably PC views in public have not always treated female students as they should: Howard Kirk wasn’t entirely a fictional character.

3. The idea that students should be challenged can easily have a class, race or gender bias in practice. Oxford vice-chancellor Louise Richardson has said that “education is not about being comfortable. I’m interested in making you uncomfortable’. But let’s face it, it is not white public schoolboys who generally feel most uncomfortable at her institution.

4. There are different ways of challenging students. Instinctively, I’m unhappier with homophobia or racism than I am with challenging political or religious views, because the former attack students’ sense of themselves whereas the latter do not or shouldn’t: your or religious political beliefs should not be constitutive of your identity in the way your race, sexuality or gender are. But is my instinct correct? Is this distinction tenable? Adam Wagner recently tweeted that he feels “almost physically hurt” when liberal ideas are challenged. That suggests it mightn’t be. But this opens a slippery slope I don’t like at all: if we’re intolerant of racism, why shouldn’t we be intolerant too of conservatism?

5. What type of market is that in higher education? Some interlocutors have suggested that if students don’t like homophobic lecturers they should leave. This seems silly to me. Education is a bundle of good and bad teachers, so walking out because of one bad egg is impractical, to say nothing of the difficulty of change courses. Voice is a perfectly reasonable alternative to exit.

There are no easy answers here. My point is that in introducing tuition fees, governments threatened to change the very nature of universities. Those who attack “snowflake” students and who assert traditional ideas of academic freedom are guilty of ignoring basic economic realities about motivational crowding out and the commercialization effect. It might be that the strongest, and under-appreciated, argument for abolishing tuition fees is that doing is a way to protect the traditional concept of the university.

* I mean at the point of use. Students have in the past paid for their education out of taxes on their enhanced earnings.

** Finnis is retired: I’m not much interested in his particular case.

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10 days ago
I paid my tuition so I deserve good grades
Central Pennsyltucky
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Falling down

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Of all the trauma alerts I get, the most frustrating has to be "FALL". These are usually elderly patients who fight gravity and lose, and their cases are seldom (if ever) satisfying. They typically are uninjured beyond bumps, bruises, and lacerations, though due to their age their recovery from such minor injuries can take several days or even longer. But if they do sustain serious injuries, they tend to be isolated to hip fractures, which I don't treat. The other types of falls (off a ladder, off a roof, off a bar stool etc) usually are from heights of 3-4 metres and are thus mostly uninjured (zzzzzzzz) or have broken ankles, which I still don't treat. All of this adds up to a very sullen me as I trot down to the trauma bay for yet another fall.

So when my pager alerted me to a fall recently (my third one of the day by 10 AM already), I got not a bit excited and tried my best to avoid the trauma bay entirely. I had only had one coffee by then, so I figured maybe the caffeine would elevate my heart rate even if the complexity of the trauma didn't. My Inner Pessimist, however, forced me to walk down to the trauma bay despite my efforts to ignore him.

The bustle when I got to the trauma bay confused me. Normally for low-level traumas the nurses and other staff sort of mill around chatting prior to the patient arriving, but in this case everyone was rushing around getting equipment. For a fall? What the hell is going on?

And about 30 seconds later, Xavier (not his real name™) arrived, and that question was quickly answered.

"Hey there Doc, this is Xavier. He fell off a cliff and . . ."

Wait, wait, wait. He fell off a what? Where the fuck is there a cliff around here??

"Yeah, you know the {Redacted} Cliffs."

Uh . . . no I really don't. I had no idea there were any cliffs in this area.

"Anyway, Xavier fell off a cliff about 30-40 metres. He woke up at the bottom and doesn't remember anything. 

No but seriously, where the hell is there a cliff?

"Ahem. Vitals have been stable though he's breathing a bit fast. He's complaining of pain all over his body."

Yeah, after falling 40 metres down a goddamned cliff I would be stunned if he weren't.

Normally the first thing I do is a full assessment, but my Inner Pessimist was insisting that I google where the fuck this cliff was. I resisted that urge and instead decided to, you know, examine my patient, an idea which seemed only slightly more important at the time. Xavier looked completely miserable. His blood pressure was fine but his heart rate was in the 140's. The most common reason for a high heart rate in trauma is bleeding, the second most common cause is bleeding, and third most common cause is fucking bleeding.  It could also be due to pain or heart injury or drugs, but bleeding is always my first concern. My concern was somewhat higher because his oxygen saturation was in the 80's (normal is 95-100%). 

On my initial head-to-toe assessment he was tender in his head cervical spine, thoracic spine, lumbar spine, chest, left hip, and left arm, though other than some rather crunchy ribs he had no obviously broken bones. His breath sounds were diminished on the left side, indicating that he likely had a pneumothorax (collapsed lung) under those fractured ribs. That concern was confirmed about 60 seconds later when I saw his chest X-ray.

His workup, which included X-rays and/or CT scans of pretty much every single body part (I think I skipped his thymus and right foot), showed that he was fucking broken. Think of a body part - go ahead, just think of one (other than the thymus and right foot, obviously). Yup, you got it, that was broken. He had fractures in his skull neck, upper back, lower back, ribs, hip, arm, and leg, along with his pneumothorax. He would need a chest tube for his lung, surgery for his hip, arm, and leg, and a neck brace and full back brace for his spine, which would not need surgery.

But the main question I had (other than "What cliff?") was, How the fuck do you fall off a cliff? And seriously, what goddamned cliff??

After several rounds of IV narcotics finally successfully controlled Xavier's pain (because of course he had a longstanding history of oral narcotic abuse), I got a chance to ask Xavier what happened. He very groggily told me that he was trying to show his in-laws the {Redacted} Cliffs while they were visiting that morning, and he simply got too close to the edge, lost his footing, and toppled.

This, I thought, is why I will never be out of a job.

As I contemplated the amount of human stupidity that it takes to get that close to the edge of a cliff (which, I learned later, has no guard rail on it), I looked at Xavier's blood work. While there was no major abnormality in either his blood counts or chemistry, his blood alcohol was about 3 times the legal limit to drive, which a quick calculation told me is approximately infinity times the amount of alcohol one should have in one's system while walking near a fucking cliff at 9 in the morning.

Xavier spent about two weeks with me before going home in a wheelchair, but it took me far less time than that to find out where these cliffs were. The moment I got in my car to go home the next morning I whipped out google and discovered that these cliffs are less than an hour's drive from the hospital. I briefly considered checking them out, but instead I decided to drive straight home and give my kids a big hug.

That seemed much more important. The cliffs can wait.
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12 days ago
I fell on my bike and wound up in a trauma unit.
Central Pennsyltucky
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Epiphany: Jesus wept

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Some Christians balk at this notion of God learning. An almighty and omniscient being, they say, doesn’t need to learn. But this is part of the story. The story tells us this happened too.
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15 days ago
Not all preaching
Central Pennsyltucky
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Jerry Falwell is a Poor Person

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If you’ve been awake anytime in the past 24 hours, you’ve probably heard about the interview Jerry Falwell, Jr. recently gave to The Washington Post about why he thinks supporting Trump is a moral decision. In that interview, Falwell says: “Why have Americans been able to do more to help people in need around the […]

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18 days ago
Title says it all.
Central Pennsyltucky
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