Minimum

What would happen?

First, the two examiners may start quarreling. That's the least of our interest.

More importantly, the two would end up setting the minimal standard as measuring the blood pressure - the only common factor agreed by the two.

What's wrong with this minimal standard? None, as long as you know how to use it.

Most examiners (who are, unfortunately, not properly trained) would take it as the criteria of passing a student. In other words, any candidate who does measure blood pressure in this station passes.

But, that's wrong. In the jargon of logic, the minimal standard should be a necessary criteria, but not a sufficient one, of passing. In other words, a candidate should always fail if he does not measure the blood pressure, but he should not automatically pass if he measures - unless he also makes sure the patient does rest enough and confirms the timing of blood pressure medicine, or he measures blood pressure from both arms and look for postural drop. If the minimal standard is not used in this way, it would inevitably end up having a set of stupid criteria and a bunch of dumb graduates.

PS. The whole situation is actually a variant application of the inverse marking scheme widely used for assessing practical procedures. Interested readers may like to a previous blog of mine. (See http://ccszeto.blogspot.com/2010/10/marking.html)

Standard

You may argue, "But, I'm not asking for eradicating the character of individual examiner - just that they should agree on certain minimum criteria of passing a candidate before they start the examination."

That sounds logical, eh?

In fact, KL, our star teacher, made the same suggestion - not only once but on a few separate occasions recently.

For this, I am worried.

Let me explain by a hypothetical example:

********************************

Suppose, in our examination, we put up a short case or practical station: Please measure the blood pressure of this patient. (Don't laugh because it appears too simple. I put this up for the benefit of readers without a medical background. And, after all, it is not that simple.)

Examiner #1 suggests: A candidate could pass if, in addition to measuring the blood pressure in the conventional manner, the candidate takes the effort of making sure the patient has rested for some time before the measurement, and when was the blood pressure medicine last taken.

Examiner #2 agrees. But, after a while, he suggests: A candidate should also pass if, in addition to measuring the blood pressure while the patient is lying flat, the candidate measures the blood pressure of both arms, and does check for postural change in blood pressure.

What do you think would happen ?

Different

You may ask, "But, we should have all our examiners using the same yardstick for scoring!"

Alas, I am horrified.

No, I am horrified not because the task would be difficult; it is actually impossible to have everyone the same because of human nature. I am not worried because whatever our education purists do, it would not happen.

(It is, however, catastrophic if it were going to happen in utopia or planets outside the solar system, because it means that we will find our intensive care physicians having the same personality as palliative care specialists, or neurologists the same as gastroenterologists.)

But, I am horrified because you put up such a suggestion, implying a subconscious desire to put an end on individualism and autonomy (which are the basis of freedom and democracy). In fact, the very character of our society that we should find precious is everyone is different.

The last practitioner of attempting to eradicate individual character had shot himself in Berlin some 66 years ago, I hope.

Discrepancy

The kappa is 0.455, indicating a moderate agreement.

You may say, "That's not acceptable. We should aim at something around 0.8 or above."

There are, however, two layers of consideration that may skip your eyes.

Let me bring you through the superficial one first.

***************************

The reality is simple: Not all examiners are the same.

If we take this as a de facto assumption, the inevitable consequence is we should deliberately increase the discrepancy of scoring for each and every pair of examiner. (And, I can assure you, it is one of the factors that determine how examiners pair up with each other.)

I can hear you gasp.

But true. It is logical to give an examiner who keeps giving a low score a partner from the other side of the spectrum.

Or, to put it simply, you may prefer to see two doves in the examination, but you have to consider other classmates who would then have to see a pair of hawks.

Calculation

Let's start with some basic mathematics:

The simplest way to assessing inter-observer agreement is to see how many exact agreements were observed. (For example, if we consider the two short case stations of our 130 students this year, we have 260 pairs of observations; amongst them 84 had identical scoring.)

The first problem is a certain degree of agreement could exist by chance. The real question is, therefore, how much better is the observed agreement better than that happens just by coincidence.

I shall leave the details of computation aside. The name for this measurement is, yes, as you know, kappa. The value could range from zero (entirely no agreement except that observed by chance) to one (absolute agreement).

But, the major weakness of kappa statistic is that it takes no account of the magnitude of disagreement (all are treated equally). The theory is simple: For example, if the scores of two examiners differ by one, it is perfectly OK; a discrepancy of three or more, on the other hand, does not seem satisfactory.

For simplicity, I shall assume the followings:

• 100% agreement is considered is the scores by two observers are the same, or differ by one point
• 50% agreement if the scores differ by two points
• 0% agreement if they differ by three points or more

With this "weighted" kappa statistics, how well do you think our examiners agree with each other? (In other words, what do you think is the kappa value?)

Let me tell you tomorrow.

Agree

Shortly after we said farewell to GY, we had our final examination.

I shall not elaborate the details of happenings here. Suffice to say there were no short of surprise in the examination every year – to the students as well as organizers all the same.

On Wednesday afternoon, after we had done with the clinical examination and were going through the individual scores again, one of our quick-eyed colleagues commented, “It seems not uncommon to have a pair of examiners giving substantially different scores to the same candidate.”

“Quite right,” one of the external examiners agreed, “In a scale of 20, a difference in score by 4 would seem deserving attention.”

“Don’t worry,” I tried to sooth the others (maybe not all that successfully), “The frequency and magnitude of discrepancy in scoring at hand is quite the same as what we observed over the previous years...”

Alas, while I was saying this, the other half of my cerebral cortex was going through some corresponding calculations – The subject could be explored in an entirely scientific manner.

I shall elaborate tomorrow.

Crisis

That evening, when LS was off work, my friend Warren gave her a ride.

The next morning, I met LS in the corridor. She appeared worried.

“What’s the matter?” I asked.

“Em… Do you think Warren has mid-life crisis?” LS whispered.

“What makes you think so?”

“You know, he bought a new car – I mean a second handed one. But it’s a Porsche!” Our professor of rheumatology said, “This is his third car – or actually the fourth one !?”

“Alas, I’m sure he just has too much money after the financial tsunami,” I smiled, “ Nonetheless, he may well have mid-life crisis – and, who doesn’t? At our stage, there seems very little chance, or, actually, need, for further promotion. Everything in life has been running in order – and, unfortunately, in the same order for quite some time. We all need some new stimuli.”

Maybe that’s also the (subconscious) reason why I put up this blog.

Audience

Shortly after I thought of the viva question, a few of us went out and had a farewell lunch with GY.

It was one of the best moments when we could chat on any irrelevant topic. During the meal, VW asked, “Szeto, have you checked how many audience you have for your blog?”

“Of course,” I smiled, “The temptation to check is irresistible! In fact, by looking at the number of page click each time after it is linked to the Facebook, I have a vague idea where my audience are coming from. I suppose you do the same?”

While the young professor of hepatology nodded, GY interjected, “You know, it’s sometimes annoying to find my name appearing in your blog – even though you always use acronyms.”

“Friend, do you know the principle of setting up cryptography for military use?” I asked.

“What do you mean ?” my cardiologist friend appeared puzzled.

“One of the principles is every name should be represented by more than one code…”

****************************

I must say it is always sad to see our friend leaving. On our way to the car park, LS asked the professor of cardiology, “So, how long have we been working together? Twenty years?”

“Not as much as that,” I sighed, “It’s merely eighteen years.”

And the famous saying of Chai Kau (柴九) came through the mind of all three of us.

Viva

(Email communications between our chairman's secretary and myself.)

**********************************

Dear Professors,

The final MB Viva examination will be held on May 19, 2011 afternoon. The chairman would like to enlist your inputs for questions (and answers) to be used in the Viva examination. Please kindly provide 1-2 questions each for distinction viva and pull up viva.

With best regards, et cetera.

**********************************

Dear XX,

Please be reminded that it is the tradition to let external examiners ask whatever they like in the distinction viva. Local examiner in the viva (usually the chairman) does not ask any question.

Sincerely,

Szeto

**********************************

A few emails followed, and, at the end, being an invertebrate (probably a mollusk), I conceded. I did not put up any question - but I suggested one for the distinction viva.

Here you go:

In your opinion, what is the most important advance in internal medicine over the past 10 years?

No model answer would be provided.

Distribute

During a casual dinner chat, my mother said, "I rang up M this afternoon."

M is the elder brother of my father. He is a Hong Kong citizen, but, after retirement, he moved back to the mainland and stayed with his family there.

"Do you know what's the first sentence he said in the phone?" My mother went on.

"Eh ...?"

"He asked when he would get the money!"

"What money?" I was surprised.

"That HK$6000 promised by our financial secretary !"

"Wa... haha..." I could not stop laughing, "What did you tell him?"

"I just said I have even no idea when I would get my HK$6000."

That's a fair comment. I considered for a while and said, "The bottleneck now is, of course, our thickheaded senior government officials have no idea how to give away the money. In fact, I always think it's not as difficult as they imagine."

"Eh... How?"

"Mail by cheque to all registered voters - to the address in the government's record. Of course they should give a certain period to allow everyone to update their address, and for all qualified voters to register if they have not done so already. If asked for a justification, the government could always say the money is a little token to encourage democracy !"

Explain

Following my recent grumble, you may notice there is actually a theme behind all this.

Let's go through the observations again:

1. Statistics is most often (mis)used to cover up data.
2. Ethical principles are largely used to justify unethical actions.

Yes, you are there: Good principles are often applied for sinister purpose. To go one step further, we should, and, usually only should, ring a bell and suspect something evil is behind the scene when the spokesman on the stage keeps emphasizing the good principles they are following.

For example, does the American government ever need to declare that they follow the law to arrest or kill anyone? Hardly - maybe only for Osama bin Laden. (Well, yes, for the invasion of Iraq.)

I won't cite examples from other countries.

Answer

That evening, I told Vivian the question on ethics in our final MB.

My wife was, understandably, surprised.

"How could anyone answer that?" She said.

"Well, I could - at least for two-third of it," I murmured, "But, the point is not whether a candidate knows the answer. In my opinion, it is not a question on ethics, but on how a student respond to a question that he or she knows nothing !"

"What ?" My wife was startled.

"That's true," I was affirmative, "It is a capability in its own right to answer a question that you have absolutely no idea what is being asked."

"Doesn't that simply mean going around and saying something non-specific and non-committing?"

"Of course not," I smiled, "To say the least, that's a very inferior way to tackle the problem. In contrast, a sophisticated student would analyze and appreciate the setting of that question."

"Well?"

"Well, the situation at hand is a short assay. In other words, no marks could be deduced even if you say something grossly wrong. More importantly, the examiner has no chance of responding by putting up follow up question. Therefore, one should actually use a shotgun approach and say a whole lot of specific statements - even though they may contradict with each other. Hopefully some of the answers would be correct and score some points."

Virtual

I must say I was horrified probably not for the same reason as yours.

It was not because the question was difficult. (Well, yes, it was.) To say the least, I am sure I know enough about utilitarianism and Kantianism - not from any teaching in medical ethics (which we had none when we were medical students), but from my private study on philosophy.

(I know virtue ethics as well when I look it up from Wikipedia - but I learnt that bit years back in Chinese and was not aware of the English name of this principle.)

And, also not because the score of our students would be low. After all, we draw curves and adjust for the performance of the whole class.

But, I was horrified because an assay question on ethics was put up at all - implying that our faculty did expect our graduates to know the stuff, and some of them really did.

Under what circumstances does a medical practitioner need to know these principles? No, not when he tries to be ethical. It's just the opposite: He only needs all these if his practice is unethical, and therefore he has to use all these dressings to cover up or justify his action.

As Zhuangzi (莊子) said: 聖人不死，大盜不止。《莊子·外篇·胠篋》

Or, to put it simply, it is not virtue ethics that we are teaching - it is virtual ethics.

Ethics

Shortly after my discussion with LS, I went to my division round. In the middle of it, my friend KM tapped me on the shoulder and whispered, "Who set the question of medical ethics for the final examination this year?"

I was surprise, "No idea. In fact I am not aware of anyone in our department who has an interest in setting up this kind of question."

After the round, I asked Maureen, our department secretary, to show me the written paper of this year. In fact, I glimpsed it through some days ago, and this time I just wished to confirm again - There was no question on medical ethics.

I wrote to KM and told him so.

In no time he replied, "It's all in the Facebook."

The question goes like this: Define utilitarianism, Kantianism, and Virtue ethics, and explain how each of the above school of thought can be applied into the following clinical example...

I was horrified and wrote back to my friend, "But, today is the surgical paper!"

Ethical

Lunched with LS. She was, as often, not very happy.

“What’s the matter this time?” I smiled.

“It’s that hopeless study again,” she frowned, presuming that I knew which study she was talking about (and yes, I did – after listening to it for half a million times). She continued, “The data are chaotic, and the result just does not turn out to be the way I want. I’ve tried no fewer than half a dozen of methods to analyze the data – so much so I am coming to the conclusion that my statistics is not very ethical!”

“You know, it is a self-conflicting idea to have an ethical statistical analysis,” I said.

“Alas, don’t go that far, my friend,” our professor of rheumatology protested.

“But yes,” I became slightly more serious, “The situation is just like cookery. If you have a good fresh piece of fish, you often don’t really need to cook – you can just slice it and serve as sashimi; elaborated cooking with seasoning and spices, however, is always necessary when the fish at hand is half rotten. Similarly, if everything of the study is in good order, you can usually describe and present and forget about complicated statistics – which is absolutely useful when the data are problematic.”

“But, isn’t statistics a technique designed to help us see things more clearly?” My friend asked.

“Yes, it was,” I murmured, “But, only was. There used to be an old saying: Language can express what you think, hide what you think, or replace the need of thinking altogether. If you follow Wittgenstein, statistics is a sophisticated form of language; it can present your data, but, more often than not, serves to hide your data, and, looking at the research of some epidemiologists, sometimes replace all data!”

Nothing

Shortly after our discussion on Fantasia and The Sorcerer's Apprentice, on our way back home, Vivian asked for my opinion of the quality of our graduates in the recent years.

“You know, the house officers nowadays just appear different from those brought up by the old school,” my wife sighed.

“Of course, because they are now educated by the new curriculum,” I said, “The original idea was to ease off the burden of hardcore book work so that students could divert their energy to more practical aspects of clinical medicine. But, it just doesn't work out as such. Our students do read much less textbooks, but, the unexplainable thing is, they are not less stressful or any more leisured to spend their time in the ward !”

“I suppose when they entered the medical school, they were the crème de la crème? In other words, it is you people who make them end up in this state of neither here nor there.” My wife pointed out coldly. I sudden found her sounded like the shoemaker in Hermann Hesse’s Beneath the Wheel.

“Quite right. In fact most of the students are bright enough to have minimal teaching,” I was forced to agree, “In fact, when we were medical students, our professors of anatomy and physiology each only taught us one word when the year started – Snell and Guyton respectively.”

“Isn’t it possible to have someone taking up the position and rectify all these?” My wife asked.

“Oh, no, thanks.” I put up a bitter smile, “No revolution again, please. Just like what I believe in the ruling of our city, the person responsible for the curriculum could only be successful if he intends to do nothing !”

Magic

(Cont'd)

For those not familiar with the little story The Sorcerer's Apprentice, it goes like this: Mickey Mouse was the apprentice of a sorcerer of mysterious power; while his master was away, this little servant attempts some of the magic tricks without knowing how to control them. The result was predictably catastrophic.

And I told my wife, "I see Chris Patten or the old colonial government the sorcerer, who run the city in a brilliant order, apparently by some black magic - free market or positive non-interventionism or whatever. Our SAR government is now for certain the little apprentice, who tries the same trick and, without knowing how the magic actually works, ends up in a chaos !"

Vivian just smiled. I could hear the comment You are too cynical from her throat.

"The worst bit is," I continued to murmur, "The little students of ours is a class lower than Mickey. When they see that the magic does not seem to work properly, they start altering the curse and bending the rules - only to find that they are jumping from the stove to the fire !"

"So, you don't think any one in this city could run it well, do you ?" My wife asked.

"Not CY to say the least." I sighed, "The only possibility is to find a man who has absolutely no interest to run the city as such - If he could stand the temptation and do nothing, I suspect there remains a chance that everything would be back in order!"

Fantasia

One evening, I was slightly surprised to find that Euterpe was absorbed in the music The Sorcerer's Apprentice.

"Oh, I showed her the clip of Fantasia 2000 from YouTube," my wife explained.

"Quite true," I nodded and murmured, agreed not only because that taught a little of the classic music for our princess, but the movie was memorably the one Vivian and I watched for our first dating.

"Right. You know, this piece is not only a good starter of classical music; it gives a lesson and shows that one has to shed his own sweat and tear and work hard, rather than taking shortcuts and rely on any black magic," my wife explained.

I was speechless, reflecting the story between Mickey and the sorcerer, and was forced to the conclusion that although two persons are seeing exactly the same thing, they would almost always arrive at two entirely different conclusions.

(to be cont'd)

Thank

(This is a retrospective entry.)

To all regular visitors of my blog,

There is an unexpected problem in the Google Blogger and the posting of new entry was not possible yesterday. My sincere thanks to those who noticed this.

Alas, I am even more thankful for those who appreciate why I thank rather than apologize, but most thankful for those who remember and appreciate the reason last time I did not put up a blog entry.

Szeto

Legacy

While I was thinking of those innovative medical degrees, a breaking news came up in my iPhone.

Osama bin Laden was dead.

You may ask what I was thinking of.

None, except the story of Sisyphus came through my mind, and I'm sure the Americans, or, actually, all man in collection, now have their stone on the top of the hill.

That's not only because there would certainly be successor (alas, maybe I should use plural) in Al Qaeda, and revenge of one kind or another is almost inevitable. More importantly, the pioneer of terrorism left a horrifying legacy: By 911, he set the example of starting a war - in an unconventional manner - against a superpower that seems unbeatable. For sure, there would be no short of adversaries, not necessarily from middle East but possibly every corner on earth, all hidden and waiting for a prime moment to give Uncle Sam a surprise punch on his face.

And, the worry is not only for the Americans. It applies equally well to all countries.

That is, in fact, a variation of the broken windows theory in criminology.

BAO

(Our luncheon discussion continued.)

"But, why's there an urgent need to set up a children's hospital rather than other sophisticated service in need - for example, the long-discussed center of excellence in neurology?" One of us asked.

"Didn't you read the morning paper? There is a huge need of paediatrics and neonatal service in order to meet the demand of our friends north to the Shenzhen River!" LW said.

"But, the bottleneck is not NNU," WY pointed out, "We do not have enough obstetricians and midwives."

"On that, I think the government should be more innovative," I smiled, "You know, graduates from some traditional medical schools, mostly in Ireland, in addition to having a degree of MBBS or MBChB, get an additional degree called BAO, which stands for stand for Baccalaureus in Arte Obstetricia."

There was a moment of silence, and then I added, "I believe the two medical schools here should be more proactive and try putting up a, say, two-year degree of "Bachelor of Obstetrics". Graduates of which could be called doctors but are only allowed to practice obstetrics, and they still need postgraduate examination by the College and so forth. It would ease off much of the manpower shortage of the field, and may well become a new and prolific industry in Hong Kong! After all, my suggestion is not that weird; our dentists are brought up similarly."

Monopoly

Met LW, WY and a few other colleagues during lunch. Our discussion somehow turned to the proposal of a children's hospital.

"It is coming soon. God knows what's left for the paediatricians in the peripheral hospital." The professor of neurology sighed.

"I suppose that's the way to focus and make better use of the resource?" One of us said.

"Yes, the resource is very focused," LW made a subconscious twist of his lips, "You know, the government actually assigned a substantial sum of money to conduct research in the hospital. But, the point is, only projects that are going to take place within the four walls of that hospital could apply."

"Alas, focus is the sugar-coated term for monopoly," someone over the other side of the table whispered.

"Not exactly. From a neuroanatomy point of view, you need two eyes to focus. If you have only one, you would actually fail to appreciate the depth of a problem." I whispered back.

Flaw

Of course the opinion of our chairman does not only apply to medical research, but probably all aspects of our life.

To go one step further, many of you may know my motto is Nothing flawless is natural or genuine (an insightful comment by Philo Vance, the legendary detective under S.S. van Dine). In other words, when serving as a reviewer, I am always eager to find out the problem of a paper - the more perfectly appeared a manuscript, the harder I search.

Alas, this is not a habit of mine alone. Most reviewers do the same, albeit often subconsciously. As an author, my usual strategy is to leave a simple obvious problem (for which the answer I prepared well in advance) in the manuscript I submit - so that the reviewer could point out (and feel satisfied, so that they would hopefully forget about other problems that I could not answer) and I could make a sensible response. Bingo !

PS. The same phenomenon actually happens in clinical examination. Examiners generally search for some loopholes in the candidates answer. A sophisticated student often leaves a point or two unclear in the answer, so that the examiners would dig deeper - only to find that the student actually knows a lot more.

Perfect

In the next day after I met WY, I attended the research day of my department.

The running was smooth under the organization of PS (although could hardly be regarded as exciting - which may not be something we want after all). To me, the only remarkable - in its literal sense - part was the slightly overrun plenary talk by our chairman.

Like all lectures that overrun, the message was simple: There is nothing perfect in the world - more so in the field of medical research.

The implication is obvious: One should never try to repeat a (laboratory) experiment until the result is water-proof, or to struggle with statistical analysis until every bit of the subgroup analysis agrees with each other, or to revise the manuscript until all details have been described and there is absolutely no misspelling and grammatical error.

(I have a particularly strong feeling to the last point: Neither William Shakespeare nor Winston Churchill committed no mistake in grammar, and the first edition of The Wealth of Nations - arguably the best academic publication in the field of social science - was full of problematic wordings and hiccups in spelling.)

After all, if the god did try to make a perfect world, it would not have taken only 6 days - and I am sure the product would not be you or me.

Cursory

While I was secretly happy for skipping the outside lecture, my friend WY popped in my office.

"What's up?" I asked.

"Just finished with the clinic - and I must say I am not at all happy." My friend frowned.

"Eh ...?"

"You know T, I suppose? He's going to join another specialty soon, but, for service need - as well as his general training - he is now attending our clinic." She sighed.

"Yes?" I put up an inviting smile.

"And, look what he does: He comes to the clinic slightly early, finishes with a good share of case, and leave an hour earlier than everyone else - because every patient was rushed through and not really being taken care of! I am sure he won't do the same to the patients in the clinic of his own specialty." My friend continued.

I nodded - as a gesture of being polite as well as understanding. On reflection I find it difficult to blame T because I am probably seeing my patients in an even more cursory manner - the only difference is I am equally quick for my renal patients.

That's something I should improve.

Long

I had a long and busy day after the meeting with KL. In that evening there was an invited lecture by our Society somewhere in Kowloon, but I decided to skip that and when home early to see to the homework of Euterpe.

The next morning, I asked BK and FP how they found the talk.

And, they both sighed.

FP said, "The speaker was gorgeous. His message could be finished in five minutes but he took nearly an hour to finish with the talk. In fact, he was so verbose that we could not have dinner long after 9 PM."

"Thank goodness I didn't go - saving me the opportunity to exercise my spicy and colourful vocabulary," I smiled. (A vivid incidence of a similar kind could be found in http://ccszeto.blogspot.com/2009/12/powerpoint.html)

Not only is a good speaker always keep the time well, but a real expert - even though he may not be good at presentation - should know how to summarize his work in a succinct manner.

For example, as to the question What man should or should not do, Georg Hegel answered in several thousands of pages - while the source of light simply gave Moses the Ten Commandments.

PS. Anyone who believe they could understand more than three lines of Hegel's writing should see a psychiatrist - it is delusional disorder until proven otherwise.

Learn

Don't get me wrong. By no means I tried to imply the method of doing research is mysterious and could not be mastered.

In fact, it is quite the opposite - I always hold the belief there is nothing that could not be learned.

But, I am also convinced there is nothing that could be taught.

(As what Hercule Poirot told Arthur Hastings in Murder on the Links, if you do not see the difference between the two, you see nothing.)

The common misconception by many so-called education specialist is that you can teach someone by giving them information. (The new generation educationalists use a different jargon: you can guarantee the teaching by satisfying the number of contact hours.) Their subconscious example is, you can force-feed any bird who says quack-quack to make a Peking duck full of fat.

But, our students are not poultry; they are cows and horses and donkeys - just see what they are expected to do after graduation.

And, you see where we are getting at? Being taught is a passive process, while learning is an active one. Teaching a class is something like feeding a herd of cows or sheep - you can put grass into their stomach, but they need rumination before the nutrient could be absorbed.

Teach

Shortly after I heard the opinion on globalization from two of my friends, I attended an urgent meeting – called by KL – to discuss the plan to have some of us spending a weekend in our sister university in the mainland and showing their postgraduate students how to conduct clinical research.

I must say this is not the first time I have such a request – or invitation if you like. Just two weeks ago, while I was in Singapore, Y asked me to do the same later this year in his institute.

In both cases, I put up a polite smile and (pretended to) accept. Frequent visitor may know, the eternal question of me is if there exists anything that actually could be taught.

Some of you may have heard of the famous saying of William Osler: He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.

But, the method of doing medical research is more than that: You can gradually accumulate experience and be a better investigator after you take part in it for long enough - even without studying any formal teaching of the so-called research method, but, you will not even be able to comprehend that kind of teaching if you have not started doing some research yourself.

Rather than learning medicine, the method of doing research is, in a sense, the same as learning the technique of stock trading: An ounce of practice is better than a ton of theory.

And, remind you, the experts who appear in TV or radio and give you all the numbers and advise are not the ones who make most money in the stock market.

International

Met L and S, two friends of mine, the day after Easter holiday. The latter was obviously tired.

“Hey man! What’s up?” I asked.

“Nothing,” S made a weak smile, “Just that I am coming to the conclusion that Thomas Friedman may be entirely wrong.”

“Don’t be obscure. What’s that all about?” I went on.

“You know, we are going to host an international conference.” He began.

“I’ve heard of that. I suppose that’s another piece of cake for you guys – after the experience of organizing no fewer than half a dozen of similar conferences.” I said.

“Alas, we all thought so – until yesterday when we had the meeting of the so-called organizing committee.” S sighed.

“What happened?” I was curious.

“Nothing – because no one is in charge and, worst of all, no one know who is in charge,” S was slightly excited, “You know, we are just a branch of that international organization. The headquarters is in Brussels. In order to streamline and orchestrate all the conferences within the organization, they hire a small group of experts – which stationed in Beijing. And, for this particular conference in Hong Kong, of course we have our own local organizing committee.”

“So…?” L interjected.

“So, the result is obvious. The three parties hardly ever meet and, whenever a problem appears, no one knows who is responsible to make the decision.” S continued, “The line of responsibility is similar to a Penrose stair paradox – There is always a level higher to seek permission, but, in reality, the matter is moving from one party to another without any progress.”

“In that case, Thomas Friedman was not incorrect,” L chuckled, “Just that you misunderstood him.”

“What?” I was surprised.

“The world is flat – but he didn’t say the world has no distance. For example, despite all the technical advances in virtual reality, you cannot kick the ass of someone across the Pacific Ocean.” My cynical friend finished while twisting his lips.

Artistic

While talking about the plot of Monster Inc 2, I could not refrain from thinking of the problem what are the objective criteria of being artistic - if there is any.

The usual advise is simple: Do a blinded assessment.

Oh, I don't imply we should close one of our eyes - if not both - and do the assessment; I mean we should not ask who the artist is before judging the value of a picture or a statue.

However, this is hardly practical. In real life we are often told of the information in advance and we just cannot remove that bit of memory when we judge a picture. Furthermore, many painters and sculptors have such a strong personality (not necessarily good ones !) that you won't miss unless you are an amateur.

My resolution is simple. Just ask the question: Can my four-year-old daughter make the same thing?

For example, our young professor of hepatology could paint, when he was a kid, as good as Adolph Reinhardt - I must say I could hardly consider either of them impressive. (See http://vwswong.blogspot.com/2009/07/outliers.html)

For the same reason, I find it difficult to accept some statues of animal heads or that photo of five naked persons being artistic.

Well, yes, that has nothing to do with the humanistic character of their maker, I know.

M2

You know what, there is a plan of producing the movie Monster Inc 2.

The plot is something like this:

After the iron curtain was torn down, Monster Inc was passed to a new generation of manager.

Of course, it is naive to believe you could rely on children's laugh as a source of energy - being scary is always the more secure method. But, this time, the successor of Mr. Waternoose does not frighten human.

He asks his subordinates to torture monster kids - poisoning some, beating up the others, and passively disappearing a few more.

Full of empathy, human beings obviously could not tolerate the scene they see and shed their tear, which is yet another source of energy in the monster world.

PS. One of the characters that takes up a major role in the movie is a monster kid who loves to make clumsy statue and take funny photos. I must say most people would find it difficult to call his products artistic until he is passively disappeared.