Photographs I'm Printing (6)

I have no idea what is burning. It looked good.

Big NHS Hospitals Are The Problem: Start Thinking About Solutions

Any disease from any vector depends for its lethality on the state of the patient's immune system. There's always someone who recovered from a disease that laid waste to the rest of the town. And someone who was unaffected. What made HIV so shocking was that it was the first virus that attacked the immune system: patients did not die from HIV, but from what they caught because HIV had weakened their immune system. At the moment the way SARS-Cov-2 works is not known. Like all diseases it hurts people with compromised immune systems, and it seems to do more damage to people with existing conditions that would have killed them in the next couple of years. Perhaps those conditions rob the body of its ability to fight the virus. Perhaps it weakens the body and the existing condition then finishes the patient.

Whatever the mechanism, the effect is the same. Hospitals are full of people with compromised immune systems and in poor shape. (Also expectant mothers and people who broke something in an accident - both those groups generally have sound immune systems.) So once SARS-Cov-2, or any other virus with similar characteristics, gets stuck into a hospital building, and in the staff, it kills people. Just like MRSA. Or a bad flu. Nothing new, but a lot more effective.

Many of the people with compromised immune systems and multiple conditions are old. There are a lot of old people in Western populations: a far greater proportion than at any time before. That makes SARS-Cov-2, and the ones that follow it, much more visible. When I was born, most men died before 70, and their wives survived not many years more. Now they live to eighty and beyond.

Western economies can afford to build large central multi-disciplinary hospitals. Such super-hospitals make qualified doctors, consultants, surgeons and other specialists highly productive. Because they make a small number of professionals highly productive, all the professionals are in the hospitals. Anyone needing more than simple care has to go to a hospital because that's where the productive professionals are. So all the vulnerable people wind up in hospital.

So a SARS-Cov-2 or similar virus turns a super-hospital into a killing house. Not because the virus is so awful, but because super-hospitals are where the NHS put its potential victims.

We have learned from the SARS-Cov-2 experience that the viability of the NHS depends on the parameters of the next virus. If the asymptomatic incubation time is too long, if the proportion of the population who are asymptomatic is too high, if the lethality (the ratio of death to infection) is too high, if it persists too long on the surfaces of hospitals and workplaces, then the hospitals become killing houses and have to be shut down.

Or the hospitals can be left open, and the rest of us shut down. Which is the choice Governments all over the world made in 2020.

Those governments thought super-hospitals were the solution. And so had to be "saved". Thus creating the insanity whereby to protect the resource that cures people, people have to be denied access to the resource that cures them.

In fact, super-hospitals are the problem.

People should not be turned away from A&E because of a virus that harms the patients two floors up in another annexe.

Put the children, child birth and maternity activity in a separate building. A&E can have its own building as well. Not annexes of a super-hospital, but in separate buildings, preferably in different postcodes. Under different organisations. I don't know enough about medicine to know what else could be hived off to stand on its own. Inevitably there will be a building for the care of people with compromised immune systems and complications: that will be the big one.

The super-hospital is now a liability, not an asset. It needs de-centralising.

Or it won't be there when we next need it. It will be closed.

Or we will be.

Photographs I'm Printing (5)

Wandsworth Town, 20/1/2013 - Apple iPhone 4S

Grey. White. Small patches of strong colour. Snow makes shapes out of everything. And when did Wandsworth Town ever look picturesque? 

The Raven Paradox

I cannot believe that anyone is still discussing this, but Sabine Hossenfelder did recently, as did UpAndAtom in mid-2019. Both present it as a serious issue for the idea of evidence and hence the scientific method.

The paradox is due to Carl Hempel, one of the many philosophers who circled round Rudolph Carnap and the Vienna School. They loved them some logic, and this really is.

Consider the hypothesis "All ravens are black". Evidence for this would be a black raven. A counter-example would be a white raven. So far so obvious. But "All ravens are black" is logically equivalent to "All non-black things are non-ravens". The evidence for that is a white tennis shoe and a red tomato. So on the principle that two logically equivalent statements should have the same evidence base, white tennis shoes are evidence for "All ravens are black". Which of course they aren't.

Which is supposed to be a paradox.

Which it is only if we stop to admire it for too long.

It isn't a paradox. It's a sign that our idea of what counts as evidence is nuanced enough to distinguish between statements that are equivalent in the predicate calculus. Nothing says that logical equivalence trumps all other forms of equivalence or lays waste to all other distinctions. Unless you're the kind of person who hung out with the guys at Carnap's Bar and Grill.

The Raven Paradox is a useful edge case: a theory of evidence should not fall foul of it.

Notice that to a falsificationist, there is no problem here. Confirmations don't count, only falsifications. White shoes do not refute the raven hypothesis, but falsificationists do not count the number of refutations, as inductivists do count confirmations. One refutation is too many, and a hundred confirmations are too few. (Ahem.) Notice also that the only things that falsify "All non-black things are non-ravens" are also ravens of any non-black colour. So the positive and its contra-positive have the same counter-examples. Just another logical superiority of falsificationism. But I digress.

Another approach is to notice that white shoes also confirm the claim that "All ravens are green", or indeed any other colour. We might say that if a piece of evidence confirms an hypothesis H(black) and also H(green), H(purple), H(puce) and so on, it is in some sense trivial with respect to that set of hypotheses. It's not what we are really looking for, which is that every time we see a raven, it is reassuringly black. This is an attempt to capture the necessary quality of relevance that evidence must have. It is not perfect, but it's a start. I'll leave the lads at Carnap's Bar and Grill to debate the details.

Instead of trying to resolve the paradox, we should ask: how did we get here? What are we assuming that creates the paradox? Is it true? What are the other assumptions we might have in their place? Who says that "equivalent with respect to the predicate calculus" is the relevant equivalence? Why not "equivalent with respect to the legal concept of material relevance"?

Which would send the ravens flying.

Photographs I'm Printing (4)

River Seine, Paris  27/9/2011 - Canon PowerShot A590 IS

Because the rippling water, the shades of the stone walls, the autumn trees, young folk hanging out, and a warm summer evening. There was a heatwave that week.

It's time for a while that I thought about things in which I do participate

There is one thing I have begun to realise.

How much of my comments and thoughts are about events in which I do not participate.

For some reason, commenting on things happening elsewhere to other people did not feel strange before. Everyone talks about the news.

Then The Quarantine happened. Governments did things that they have never done before, not even in wars, and some of them assumed powers that no-one should be allowed to keep. For a day. What is happening in America now is unbearable to watch. A once-great nation is breaking up before our eyes.

What is happening in the rest of the world is also incomprehensible, if you try to understand it as the rational reaction of governments to a virus. Understand it as the desperate reaction of exhausted politicians to one more pseudo-crisis being exploited by special interest groups, and hyped up by a media driven by sensation and producing anti-government propaganda, and it makes perfect sense. Now they have to back out of it while maintaining the pretence that it really was serious, without panicking a noisy chunk of the population who believe the hype and without alienating all the voters. That's quite an act.

And here I am, participating in the whole farce and I don't want to comment or think about it. Of course I have, because understanding what happened to cause the Quarantine is the single biggest test of an analyst's abilities. Now I have done it(*), while carrying on with the day job, standing in lines to collect my prescriptions, and trying to run a life, and now I'm done with it.

But right now, I have nowhere to go, and even if I did, I'm a little short on motivation.

We can fix that. There are at least another six weeks before my gym is allowed to open, and large companies will continue to be asked to keep their staff at home for at least another five months. So I have plenty of time to experiment with how I live and work at home.

Which is what I am going to think about now. It's time for a while that I thought about things in which I do participate.



(*) When Boris announced the Quarantine, all the academics and public health advisors said to themselves:

****, he's actually going to do it. He wasn't supposed to do it. Quarantining healthy people is so dumb even the WHO knows it's dumb. He was supposed not to do it, so that if things went bad, we could all say we advised him to do it, but he wouldn't listen, and look what happened, and how superior are we? Just like we always do. Of course he shouldn't have listened to us.

That's what happened. The experts overlooked how hyped-up the media were, and how tired the politicians were after Brexit, and years of appeasing the unappeasable activists. The disaster that has come on our country will not, however, make the media or the experts or the activists one whit more responsible. Repeat after me...

Experts. Huh. Look what happened the last time we listened to the experts! We got locked in to our homes for four months for no reason at all. **** the experts.

Photographs I'm Printing (3)

Chester Canal Basin - 14/6/2010 Sony Eriksson camera phone

What caught me was the smoothness of the water, that bright sunlight in the middle left edge, and the bright reflection at the front of the barge. It just said print me.