What do we do about credence goods in the marketplace of ideas?

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Background

A major theme of my master’s thesis1 was the idea that if we want to conceive of human research protocols through the framework of a marketplace, then human research protocols are something that economists would call “credence goods.”

Credence goods are products, like drug trials, whose quality is difficult for its consumers to judge.2 Markets for credence goods are marked by learning constraints and information asymmetry.3 That is to say, there are practical constraints that prevent most consumers from learning what they need to in order to make a good judgement about whether they want a product. So, while it might not be impossible for a person who wants to participate in a trial of a drug to get a medical degree to better evaluate it, it’s not reasonable to expect the market for drug trials to function properly if that’s the level at which one has to be educated in order to participate. Financial products are other examples of credence goods, and it is (generally) non-controversial that these need to be regulated in order for their markets to function.4

A popular metaphor and justification for freedom of expression is the “marketplace of ideas”—the notion that the truth will emerge from market-like competition in free, transparent, public discourse.5 Part of what makes this marketplace metaphor compelling is the idea that, over time, the best ideas will beat out their competition. The best response to bad speech is good speech. Consumers will, over time, identify and reward the best ideas, and the market itself will regulate what is expressed without the need for heavy-handed interference from the state.

Have news articles become credence goods in the marketplace of ideas?

This idea of a marketplace of ideas seems great, except that it is getting harder and harder to sift through the bad products in the news marketplace these days, and it’s taking more and more time and expertise to find the good ones. Sure, anyone with enough time and training and education can figure out when a particular news story is fabricated, but who has the time to do that?

Post-truth is the word of the year, according to Oxford Dictionaries. By some measurements, fake news stories have greater impact than legit ones:

Facebook engagements

Facebook engagements

Just today, we went from this tweet:

Original tweet

Original tweet

To this one:

It's a faaaake!

It’s a faaaake!

And before the day was even done, we came nearly full 360 back to this:

It's real!

It’s real!

For myself, I’m at the point where I don’t have the ability to figure out what’s going on anymore. I don’t even have the rubric of “common sense” to fall back on at this point. If you had shown me 4 years ago a news article that says Donald Trump is the President-Elect of the United States, I would have assumed that it came from a fake news site. There’s part of me that’s honestly still hoping this is all a prank.

Unintended consequences

As we all know, well-intended interventions into markets can have unintended consequences.6 So even though I’m frustrated by not knowing what is going on anymore, and I’m generally in favour of market regulation, I’m worried about what is going to happen next.

I don’t know what we should do, but I have a feeling that whatever backlash is coming against the “fake news,” it’s going to have exactly the opposite of its intended effect.

My fear is that any attempt to correct the trend of fake news is going to amount to censorship of the things that don’t get covered the way that they need to be through normal channels. (E.g. Youtube videos of police officers murdering racial minorities.)

tl;dr

The marketplace of ideas is having a market failure. How do we fix it without making things worse?

References

1. Carlisle B. A Critique of Phase IV Seeding Studies on the Basis of a Non-paternalistic Justification for Subject Protections in Human Research. McGill University Libraries; 2011.

2. London AJ, Kimmelman J, Emborg ME. Beyond access vs. protection in trials of innovative therapies. Science. 2010 May 14;328(5980):829-30.

3. Carpenter D. Confidence Games: How Does Regulation Constitute Markets? l. Government and markets: Toward a new theory of regulation. 2010:164.

4. Wikipedia contributors. “Credence good.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 2 Aug. 2016. Web. 2 Aug. 2016.

5. Wikipedia contributors. “Marketplace of ideas.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 12 Oct. 2016. Web. 12 Oct. 2016.

6. Wikipedia contributors. “Unintended consequences.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 18 Nov. 2016. Web. 18 Nov. 2016.

BibTeX

@online{bgcarlisle2016-4774,
    title = {What do we do about credence goods in the marketplace of ideas?},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2016-11-18,
    url = {http://www.bgcarlisle.com/blog/2016/11/18/what-do-we-do-about-credence-goods-in-the-marketplace-of-ideas/}
}

MLA

Carlisle, Benjamin Gregory. "What do we do about credence goods in the marketplace of ideas?" Web blog post. The Grey Literature. 18 Nov 2016. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2016/11/18/what-do-we-do-about-credence-goods-in-the-marketplace-of-ideas/>

APA

Carlisle, Benjamin Gregory. (2016, Nov 18). What do we do about credence goods in the marketplace of ideas? [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2016/11/18/what-do-we-do-about-credence-goods-in-the-marketplace-of-ideas/


A gift of the fae folk, I assume?

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What is this thing?

What is this thing?

I tried to go to the Snowden talk at McGill a couple weeks ago. The lineup was too crazy huge for us to get in, so we went to Thomson House, the McGill grad students’ pub, and hooked a laptop into a TV there to watch.

Seriously, what?

Seriously, what?

On the way back, in a pile of stones upturned by the construction between the Leacock and Brown buildings on the McGill campus, I found a little medallion marked with strange symbols. It has a pentagram on one side and Death on the other.

I don’t know what to make of it. I assume it was left for me by the fairy folk, and that it’s a good omen?

BibTeX

@online{bgcarlisle2016-4763,
    title = {A gift of the fae folk, I assume?},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2016-11-14,
    url = {http://www.bgcarlisle.com/blog/2016/11/14/a-gift-of-the-fae-folk-i-assume/}
}

MLA

Carlisle, Benjamin Gregory. "A gift of the fae folk, I assume?" Web blog post. The Grey Literature. 14 Nov 2016. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2016/11/14/a-gift-of-the-fae-folk-i-assume/>

APA

Carlisle, Benjamin Gregory. (2016, Nov 14). A gift of the fae folk, I assume? [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2016/11/14/a-gift-of-the-fae-folk-i-assume/


It’s Valentine’s Day! Time to review Bayes Theorem.

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Figure 1

Figure 1

It’s Valentine’s Day! Time to review your knowledge of Bayes Theorem. Here’s a fun exercise to do: Calculate the probability that a gay man is HIV-negative, given that he tells you he’s HIV-negative.

Definitions

First, let’s define our terms.

h: Does not have HIV
~h: Does have HIV
e: Says he does not have HIV
~e: Says he does have HIV

Goal

So let’s imagine that you’re a gay man, and you’re going to hook up with a guy for Valentine’s Day. You might be interested in calculating the following: P(h|e)

This expression, P(h|e) represents the probability that a gay man does not have HIV given that he says he does not have HIV.

Data

The base rate of HIV infection among gay men who have sex with men is 19%.1

Hence: P(~h) = 0.19; or P(h) = 0.81

See Figure 1 for a graphical representation. The entire square represents all gay men who have sex with men. The blue rectangle takes up 81% of the square, which is proportional to the CDC’s best estimate for the number of gay men who are actually HIV-negative.

From the same source, we can also determine that the probability that a person says he does not have HIV given that he does have HIV to be 44%.1

Hence: P(e|~h) = 0.44

In Figure 1, this is represented by the green rectangle. Given that a person is HIV-positive, there’s a 44% that they don’t know, and so they would likely say that they are “negative.”

The remainder, the yellow rectangle, is the proportion of gay men who are HIV-positive and who know that they are HIV-positive.

Assumptions

I am considering only the population of gay men who have sex with men.

Built into this is the assumption that men who have HIV and don’t know it would report themselves as HIV-negative, or that there wouldn’t be anyone who just says “I don’t know.”

I am also assuming here that 100% of gay men who don’t have HIV will say that they don’t have HIV. Put another way, there is a 0% chance that someone will say he has HIV if, in fact he does not have HIV. This is a simplification, It’s possible that someone is confused about his status, but very unlikely. Hence:

P(e|h) = 1; or P(~e|h) = 0

Bayes Theorem

To calculate our desired value, P(h|e), we should use Bayes Theorem.

P(h|e) = P(h) / ( P(h) + P(e|~h) * P(~h) / P(e|h) )

P(h|e) = 0.81 / ( 0.81 + 0.44 * 0.19 / 1 )

P(h|e) = 0.81 / ( 0.81 + 0.44 * 0.19 )

P(h|e) = 0.91

To illustrate this graphically, in Figure 1, this would represent the chance of your prospective hook-up being in the blue area, given that the only thing you know about him is that he’s either in the blue area or the green area.

Conclusion

Your risk of HIV exposure can be informed by your prospective sexual partner’s response to whether or not he is HIV-negative.

If a person tells you that he’s HIV-positive, he knows his status. No one goes around claiming to be HIV-positive unless they’ve been tested and got a positive result. The best evidence we have indicates that HIV-positive people with an undetectable viral load do not transmit HIV.2 So with a sexual partner who’s HIV-positive, you’re not getting any surprises.

If you don’t even ask about your prospective sex partner’s HIV status, you can be 81% certain that he’s HIV-negative, just because of the base rate of HIV prevalence. If you do ask and he tells you that he’s negative, that is a useful piece of information—it allows you to update your estimation of the probability that your prospective sexual partner is HIV-negative to 91%, but there’s still about a 1 in 10 chance that he’s HIV-positive, has no idea, and is not being treated for it.

Happy Valentine’s Day everyone!

References

  1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5937a2.htm?s_cid=mm5937a2_w
  2. Attia S et al. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 23(11): 1397–1404, 2009.

BibTeX

@online{bgcarlisle2016-4652,
    title = {It’s Valentine’s Day! Time to review Bayes Theorem.},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2016-02-14,
    url = {http://www.bgcarlisle.com/blog/2016/02/14/bayes/}
}

MLA

Carlisle, Benjamin Gregory. "It’s Valentine’s Day! Time to review Bayes Theorem." Web blog post. The Grey Literature. 14 Feb 2016. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2016/02/14/bayes/>

APA

Carlisle, Benjamin Gregory. (2016, Feb 14). It’s Valentine’s Day! Time to review Bayes Theorem. [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2016/02/14/bayes/


The answer to the question

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On October 9, inspired by the STREAM research group’s Forecasting Project, I posed a question to the Internet: “Do you know how the election is going to turn out?” I tweeted it at news anchors, MP’s, celebrities, academics, friends and family alike.

I’m very happy with the response! I got 87 predictions, and only 11 of them were what I would consider “spam.” I took those responses and analysed them to see if there were any variables that predicted better success in forecasting the result of the election.

The take-home message is: No. Nobody saw it coming. The polls had the general proportion of the vote pretty much correct, but since polls do not reflect the distribution of voters in individual ridings, the final seat count was very surprising. This may even suggest that the Liberals got the impetus for a majority result from the fact that everyone expected they would only narrowly eke out a victory over the incumbent Tories.

You can view the final report in web format or download it as a PDF.

BibTeX

@online{bgcarlisle2015-4616,
    title = {The answer to the question},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2015-10-25,
    url = {http://www.bgcarlisle.com/blog/2015/10/25/the-answer-to-the-question/}
}

MLA

Carlisle, Benjamin Gregory. "The answer to the question" Web blog post. The Grey Literature. 25 Oct 2015. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2015/10/25/the-answer-to-the-question/>

APA

Carlisle, Benjamin Gregory. (2015, Oct 25). The answer to the question [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2015/10/25/the-answer-to-the-question/


Can you predict the outcome of Canada’s 42nd federal election?

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The STREAM (Studies of Translation, Ethics and Medicine) research group at McGill University, of which I’m a part, has been working on a project for the last year or so in which we elicit forecasts of clinical trial results from experts in their field. We want to see how well-calibrated clinical trialists are, and to see which members of a team are better or worse at predicting trial outcomes like patient accrual, safety events and efficacy measures.

Inspired by this, I borrowed some of the code we have been using to get forecasts from clinical trial investigators, and have applied it to the case of Canada’s 42nd federal election, and now I’m asking for you to do your best to predict how many seats each party will get, and who will win in your riding.

Let’s see how well we, as a group, can predict the outcome, and see if there are regional or demographic predictors for who is better or worse at predicting election results. The more people who make predictions, the better the data set I’ll have at the end, so please submit a forecast, and ask your friends!

The link for the forecasting tool is here: http://www.bgcarlisle.com/elxn42/

Just to make it interesting: I will personally buy a beer for the forecaster who gives me the best prediction out of them all.* :)

* If you are younger than 18 years of age, you get a fancy coffee, not a beer. No purchase necessary, only one forecast per person. Forecaster must provide email with the prediction in order for me to contact him/her. In the case of a tie, one lucky beer-receiver will be chosen randomly. Having the beer together with me is conditional on the convenience of both parties (e.g. if you live in Vancouver or something, I’ll just figure out a way to buy you a beer remotely, since I’m in Montreal). You may consult any materials, sources, polls or whatever. This is a test of your prediction ability, not memory, after all. Prediction must be submitted by midnight on October 18, 2015.

BibTeX

@online{bgcarlisle2015-4597,
    title = {Can you predict the outcome of Canada’s 42nd federal election?},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2015-10-8,
    url = {http://www.bgcarlisle.com/blog/2015/10/08/can-you-predict-the-outcome-of-canadas-42nd-federal-election/}
}

MLA

Carlisle, Benjamin Gregory. "Can you predict the outcome of Canada’s 42nd federal election?" Web blog post. The Grey Literature. 08 Oct 2015. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2015/10/08/can-you-predict-the-outcome-of-canadas-42nd-federal-election/>

APA

Carlisle, Benjamin Gregory. (2015, Oct 08). Can you predict the outcome of Canada’s 42nd federal election? [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2015/10/08/can-you-predict-the-outcome-of-canadas-42nd-federal-election/


Gotcha! This is why piracy happens

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Stata

This summer, I took a two-week long course on systematic reviews and meta-analytic techniques for which there was some required software, in this case, Stata. As a McGill student, I was encouraged to buy the student version, which was about $50 for “Stata Small.” Not bad. I’ve paid more for textbooks. So I got out my credit card, bought the license, installed it on my computer, and ran the very first example command of the course. I immediately got a string of red letter error text.

The error message was telling me that my license did not allow me enough variables to complete the command. I checked the license, and it said I was allowed 120 variables. I checked the “Variable manager” in Stata, and I had only assigned 11 variables. (I checked the variable limit beforehand in fact, and made sure that none of the data sets that we’d be working with had more than 120 variables. None of them came close to that limit.)

So I emailed Stata technical support. It turns out that the meta-analysis package for Stata creates “hidden variables.” Lots of them, apparently. So many that the software cannot accomplish the most basic commands. Then they tried to up-sell me to “Stata SE.” For $100 more, they said, they would send me a license for Stata that would allow me to run the meta-analysis package—for realsies this time.

I asked for a refund and decided that if I really needed Stata, I would use the copy that’s installed on the lab computers. (Now I’m just using the meta package in R, which does everything Stata does, just with a bit more effort.)

For the record: I am perfectly fine with paying for good software. I am not okay with a one-time purchase turning me into a money-pump. I thought that the “small” student license would work. All their documentation suggested it would. If I had upgraded to “Stata SE,” would that have actually met my needs, or would they have forced me to upgrade again later, after I’d already made Stata a part of my workflow?

It probably would have been okay, but the “gotcha” after the fact soured me on the prospect of sending them more money, and provided all the incentive I need to find a way to not use Stata.

iTunes

A few years ago, I bought a number of pieces of classical music through the iTunes Store. I shopped around, compared different performances, and found recordings that I really liked. This was back when the iTunes store had DRM on their music.

I’ve recently switched to Linux, and now much of the music that I legally bought and paid for can’t be read by my computer. Apple does have a solution for me, of course! For about $25, I can subscribe to a service of theirs that will allow me to download a DRM-free version of the music that I already paid for.

This is why I won’t even consider buying television programmes through the iTunes Store: It’s not that I think that I will want to re-watch the shows over and over and I’m afraid of DRM screwing that up for me. It’s because I’ve had some nasty surprises from iTunes in the past, and I can borrow the DVD’s from the Public Library for free.

For the record: I do not mind paying for digital content. But I won’t send you money if I think there’s a “gotcha” coming after the fact.

I’m really trying my best

People who produce good software or music should be compensated for their work. I don’t mind pulling out my wallet to help make that happen. But I don’t want to feel like I’m being tricked, especially if I’m actually making an effort in good faith to actually pay for something.

Since DRM is almost always fairly easily circumvented, it only punishes those who pay for digital content. And this is why I’m sympathetic to those who pirate software, music, TV shows, etc.

BibTeX

@online{bgcarlisle2015-4459,
    title = {Gotcha! This is why piracy happens},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2015-05-22,
    url = {http://www.bgcarlisle.com/blog/2015/05/22/gotcha-this-is-why-piracy-happens/}
}

MLA

Carlisle, Benjamin Gregory. "Gotcha! This is why piracy happens" Web blog post. The Grey Literature. 22 May 2015. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2015/05/22/gotcha-this-is-why-piracy-happens/>

APA

Carlisle, Benjamin Gregory. (2015, May 22). Gotcha! This is why piracy happens [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2015/05/22/gotcha-this-is-why-piracy-happens/


Rethinking Research Ethics: The Case of Postmarketing Trials

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Good news!

Toward the end of the year in which I was working on my thesis, my supervisor had me write up a shorter version of my thesis for an attempt at publication. This was no small feat—imagine trying to compress a 90-page master’s thesis into 2 pages!

After my RA-ship ended, my supervisor, Jonathan Kimmelman, and Alex John London took the paper, made some substantial edits, and submitted it to a couple journals. The paper was accepted, and as of this week, it was published in Science.

So far, I have seen the following references in the media to the paper:

These are just news tickers and a press release from McGill, but my supervisor is hoping for the article to be picked up and actually commented on by others in the field of bioethics.

Needless to say, I’m thrilled. :D

BibTeX

@online{bgcarlisle2012-2878,
    title = {Rethinking Research Ethics: The Case of Postmarketing Trials},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-05-3,
    url = {http://www.bgcarlisle.com/blog/2012/05/03/rethinking-research-ethics-the-case-of-postmarketing-trials/}
}

MLA

Carlisle, Benjamin Gregory. "Rethinking Research Ethics: The Case of Postmarketing Trials" Web blog post. The Grey Literature. 03 May 2012. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2012/05/03/rethinking-research-ethics-the-case-of-postmarketing-trials/>

APA

Carlisle, Benjamin Gregory. (2012, May 03). Rethinking Research Ethics: The Case of Postmarketing Trials [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/05/03/rethinking-research-ethics-the-case-of-postmarketing-trials/


How seriously should I take my clinical evaluation?

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In nursing school at McGill, after every semester of clinical, there is a summary evaluation of my performance in the clinical setting. This evaluation includes a checklist of different things we’re graded on, divided into sections like “professionalism,” “technical skills,” “patient collaboration,” etc. Under each section, for every category, one receives a mark ranging from “unsatisfactory” to “meets expectations” and all the way up to “well above expectations.”

I have been sceptical about this mode of evaluation since last semester for a couple of reasons. First, I have a problem with the idea that one has to exceed expectations in order to receive full marks in a class. If I were to exceed expectations in certain ways, it would be very bad. Imagine if I took it upon myself to exceed expectations in the area of my technical skills and administer an IV medication. (This is something I have not been trained to do.) I would probably be expelled from the programme on the spot. But the biggest problem with this philosophy of evaluation is that you can’t, by definition, expect someone to exceed your expectations.

Setting that aside, my other major worry was that all the categories of evaluation were very subjective. I had no way to know if the marks I received were anything more than a reflexion of how much my clinical instructor liked me.

Fortunately, at the end of last semester, I noticed that there was one item on the checklist that was completely objective: The third box under “professionalism and responsibility” is an evaluation of punctuality—whether or not I showed up to clinical on time. This particular evaluation admits of absolutely no subjectivity or judgement on the part of the evaluator. It is something that I should be able to self-evaluate with complete accuracy, and there should be no variation between the mark I gave myself and the mark my teacher gave me. After all, my mark in this section should be a function of the time at which I arrived for clinical.

And so, I decided to do an experiment. I arrived at least a half hour early for every single clinical day this semester. There was not a single clinical day where I showed up on the floor and in uniform less than half an hour in advance of our starting-time. I didn’t do this in secret either. I made sure that my clinical teacher knew that I was there before she was, and that I was reviewing the chart before the day began.

My thinking was as follows: if I get anything less than “well above expectations” on my evaluation for that category, it means that there is some major disconnect between my actual performance and the grade I was assigned.

I received a mark of “meets expectations” from both my obstetric and paediatric teacher in that category. This was doubly shocking, because they had both explicitly commented on the fact that I was always early for clinical in the “comments” section.

I pointed this out to each of them in turn, and they were both very willing to change my mark. In the end, the difference between “meets expectations” and “well above expectations” doesn’t matter that much for this course. Clinical is pass/fail, and so if I had received a 100% in the course, I would get the same “satisfactory” mark on my transcript as if I had received a 65%.

That said, it’s hard for me to take evaluations seriously now. If even the grade I received for punctuality was coloured by the biases of my teachers, how much more were the grades I received in the more subjective categories affected by their prejudices?

BibTeX

@online{bgcarlisle2012-2811,
    title = {How seriously should I take my clinical evaluation?},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-04-13,
    url = {http://www.bgcarlisle.com/blog/2012/04/13/how-seriously-should-i-take-my-clinical-evaluation/}
}

MLA

Carlisle, Benjamin Gregory. "How seriously should I take my clinical evaluation?" Web blog post. The Grey Literature. 13 Apr 2012. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2012/04/13/how-seriously-should-i-take-my-clinical-evaluation/>

APA

Carlisle, Benjamin Gregory. (2012, Apr 13). How seriously should I take my clinical evaluation? [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/04/13/how-seriously-should-i-take-my-clinical-evaluation/


It’s midterm week and what is wrong with Google Docs?

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It’s midterm week right now, so I’m behind in my blogging. Apologies! I promise I’ll write a whole lot more when I get back.

Google Docs preferences

Google Docs preferences

In the meantime, here’s a little bug I’ve found in Google Docs, and it’s one that has come up recently, because I have been actively using this feature, and I’m not sure how it broke.

Google Docs has a great feature: automatic substitution. When you type “(c)” and then hit the spacebar, Google Docs immediately changes your “(c)” into a “©” like magic! There was one substitution I was using all the time, namely, the “–>” into “→” substitution.

I specifically remember having used it in January extensively in my notes.

If anyone has a tip or a clue as to how to fix this, that would be appreciated. Google’s documentation is lacking. I’ve done a few searches, and found nothing helpful.

Failure to replace

Failure to replace

I’ve checked my Google Docs preferences (see previous image) and the other substitutions work fine, but no matter what I do, I can’t get it to change my “–>” into a “→”.

BibTeX

@online{bgcarlisle2012-2710,
    title = {It’s midterm week and what is wrong with Google Docs?},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-02-15,
    url = {http://www.bgcarlisle.com/blog/2012/02/15/its-midterm-week-and-what-is-wrong-with-google-docs/}
}

MLA

Carlisle, Benjamin Gregory. "It’s midterm week and what is wrong with Google Docs?" Web blog post. The Grey Literature. 15 Feb 2012. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2012/02/15/its-midterm-week-and-what-is-wrong-with-google-docs/>

APA

Carlisle, Benjamin Gregory. (2012, Feb 15). It’s midterm week and what is wrong with Google Docs? [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/02/15/its-midterm-week-and-what-is-wrong-with-google-docs/


Sometimes trying to understand nursing can be realwise doubleplusungood

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Before I start on this rant, I want to clarify that I’m not suggesting that nursing be “medicalised,” or that the role of nursing be expanded to include diagnosis and treatment of illness. In fact, I think it’s a good thing that there is a discipline for caring for patients, namely nursing, and a separate one for diagnosis/treatment, namely medicine. These are different and complimentary roles, and I wouldn’t want to be burdened with the responsibility of diagnosing and treating the illness as a nurse. After all, if the nurse is busy doing diagnosis and treatment, who will be doing the nursing?

That said, I’m confused about something that’s come up a number of times in different contexts in nursing school—it’s the fact that nurses have to pretend that they don’t know what’s going on if anyone asks, but they are responsible for acting as if they do. A nurse is not allowed to diagnose an ear infection, a broken leg or a heart attack for example. If a nurse did that, she would be overstepping what she is licensed to do.

I think an example will help to clarify: It is well within a nurse’s responsibilities in certain contexts to triage patients in order of medical priority. Imagine a case in which three patients arrive at the emergency room to be assessed and prioritised by the intake nurse. One patient has the signs and symptoms of an ear infection. The second patient has an obviously broken leg. (Imagine the patient is in extreme pain and the leg is bent at a 90º angle half-way down the shin.) The third patient has all the tell-tale signs of a heart attack, like chest pain, distress, tingling down the left arm, light-headedness, etc.

In such a case, the nurse would be responsible for making sure that the third patient (the one with the heart attack) was given priority and taken to see a doctor immediately. The nurse would then refer the patient with the broken leg to radiology or something, and then a doctor would have the bone set and put in a cast. The first patient, the one with the ear infection, would have to wait until the others were treated before getting what she needs—probably just a prescription for antibiotics. If the nurse gets the order of priority wrong, she will be held responsible for the consequences.

The confusing part about this whole process is that a nurse has to simultaneously think about balancing the medical priority of the three patients while being careful to remain intentionally agnostic about what it is exactly that is afflicting each of the patients.

The nurse can’t just say, “You have an ear infection,” or “You have a broken bone.” Those are diagnoses. Doctors make diagnoses. Nurses can’t make diagnoses. But the nurse has to prioritise and execute her practice as if she did know that the one patient was having a heart attack and the other was having an ear infection.

This is of course, something of a simplification. In certain contexts, nurses can make what are called “nursing diagnoses.” Unfortunately, this concept doesn’t clarify anything for me. I asked a professor of mine to give me an example of one. She said that a nurse could pronounce a nursing diagnosis of “failure to oxygenate” in the circumstance that the patient was having difficulty breathing, complained of shortness of breath and had an O2-sat of 60% or something. The problem with the concept of a “nursing diagnosis” (at least for me) is that I would be more likely to call “failure to oxygenate” a “sign” (an externally observable indicator of the state of a person’s health) rather than a “diagnosis.”

But the point remains that after assessing a patient, if the patient asks, “Am I having a heart attack?” a nurse would have to respond with something like, “Due to the legal constraints on my licensure as a nurse, I can neither confirm nor deny that you are having a heart attack,” but at the same time, she would need to act as if she knew that the patient was having a heart attack and prioritise her care accordingly, on pain of legal repercussions.

I think I’ve heard of this before.

To know and not to know, to be conscious of complete truthfulness while telling carefully constructed lies, to hold simultaneously two opinions which cancelled out, knowing them to be contradictory and believing in both of them, to use logic against logic, to repudiate morality while laying claim to it, … to forget, whatever it was necessary to forget, then to draw it back into memory again at the moment when it was needed, and then promptly to forget it again, and above all, to apply the same process to the process itself—that was the ultimate subtlety; consciously to induce unconsciousness, and then, once again, to become unconscious of the act of hypnosis you had just performed. Even to understand the word ‘doublethink’ involved the use of doublethink.

(Orwell, George (1949). Nineteen Eighty-Four. Martin Secker & Warburg Ltd, London, part 1, chapter 3, pp 32)

Ahh, that’s what it is! Doublethink! Now I remember. This is, as they say, realwise doubleplusungood.

It might be crimethink to say this as a health care professional (am I allowed to call myself that yet?), but I guess I just have an intuition that the world won’t end if nurses are allowed to actually diagnose certain things under certain circumstances. I’m not saying that because I would want to change the role of nurses or to take territory away from doctors, but rather because I want to allow nurses to be able to execute their own practice—that of caring for the patient—without having to go through all that doublethink.

So, how does my claim that nurses should be able to diagnose certain things square with my original disclaimer that I don’t want to change the role of nurses? Here’s how I make it fit in my head: There are some things (like an obviously broken leg) that a nurse would be more than qualified to identify and yes, even diagnose without any further training. (There are other things that a nurse is not capable of diagnosing, and I’m not suggesting that nurses be trained to be able to diagnose cancer or anything so extreme as that.)

When would a nurse go about making a diagnosis? Only when it is necessary for her to do in the context of her role in providing care for the patient as a nurse.

For example, after an assessment, a nurse often needs to perform certain interventions as a part of her role. These may include referring to other practitioners, engaging in conversation, providing education, reflecting strengths, or assigning priority, as in the triage example above. For these interventions, it is often tricky to come up with a rational way to justify one’s actions without reference to the patient’s illness. I would much rather be able to say “the reason for this intervention is the patient’s infection” than “the reason for this intervention is something that I’m not legally allowed to say much about.”

BibTeX

@online{bgcarlisle2012-2664,
    title = {Sometimes trying to understand nursing can be realwise doubleplusungood},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-01-14,
    url = {http://www.bgcarlisle.com/blog/2012/01/14/sometimes-trying-to-understand-nursing-can-be-fullwise-doubleplusungood/}
}

MLA

Carlisle, Benjamin Gregory. "Sometimes trying to understand nursing can be realwise doubleplusungood" Web blog post. The Grey Literature. 14 Jan 2012. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2012/01/14/sometimes-trying-to-understand-nursing-can-be-fullwise-doubleplusungood/>

APA

Carlisle, Benjamin Gregory. (2012, Jan 14). Sometimes trying to understand nursing can be realwise doubleplusungood [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/01/14/sometimes-trying-to-understand-nursing-can-be-fullwise-doubleplusungood/


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