Hospital Bias

Asking people about differences between private and public hospitals, you are most likely getting answers that the private hospitals deliver superior patient outcomes. Whereas private hospitals seem to have a positive stigma attached to them, public hospitals commonly have a negative stigma. Scientific evaluations are helpful to set the record straight again. The study published in “The Lancet Regional Health” in 2024 shows that in the simple descriptive statistics on several patient outcome indicators, this is what the data showed between 2026 and 2019. However, a more precise statistical analysis reveals that there is also a selective admission to the private and public hospitals in England. Using so-called instrumental variables approaches that account for the selection process between admission to the 2 types of hospitals (private versus public) most of the differences between the hospital types disappear. The underlying mechanism is a sorting of different patients into the private or public hospitals. Put in easy words, for a routine intervention people tend to chose the private hospital, but the more rare and difficult operations were more likely admitted to public hospitals. The number of co-morbidities (heart disease) is also of importance as they might negatively affect patient outcomes. Jumping to conclusions and reinforcing stigma about public or private provision of services hinders progress and an equitable provision of services.
The analysis of a potential selection bias can reveal the “creaming” effect of private provision of (health) services. Just caring for the “easy” or routine cases and avoiding the more difficult and costly cases has economic advantages, but for society as a whole the costs overall remain the same. A good public service in health is a definite asset.

(Image: Exposition Isa Genzken 2023 in Neue Nationalgalerie Berlin)

Transparent Publishing

New technology pushes transparency of publishing, journalism and science to new levels. Through the hyperlink structure of texts it is easy to link back to the sources of a text. What used to be long lists of references at the end of a text or in footnotes has become directly accessible through weblinks. Only paywalls may or may not restrict the fast and easy access to original sources. In writing online, this is a major additional feature of publishing in the last few years. Some online journals allow this for quite some time now, but there are lots of printed versions that stick to the read and be stuck approach of publishing.
In teaching I have been an advocate of “read the original sources” as the basic source of inspiration for authors. The transparency of the thought process and the evidence provided in whatever form should be traceable. In publishing this transparency allows to exclude the copying of thoughts or unreflected referencing.
However, the task to check for the validity of weblinks and the updating is an additional task. 500+ blog entries with an average number of 2 weblinks per blog entry makes this a job of its own. Testing of 1000 weblinks is something you need a software or plugin which alerts you to “broken links”. The maintenance of a webpage, therefore, increases substantially as the content increases. Reorganisations of webpages make the follow-up of links sometimes quite hard. Projects like the general archives of the web and webpages are very important to ensure the transparency of publishing in the short, medium and long run. The archives of today look more like machine rooms than the splendid archives or libraries of the past and present.

AI and PS

AI like in ChatGPT is guided by so-called prompts. After the entry of “what is AI” the machine returns a definition of itself. If you continue the chat with ChatGPT and enter: “Is it useful for public services” (PS), you receive an opinion of AI on its own usefulness (of course positive) and some examples in which AI in the public services have a good potential to improve the state of affairs. The AI ChatGPT is advocating AI for the PS for mainly 4 reasons: (1) efficiency purposes; (2) personalisation of services; (3) citizen engagement; (4) citizen satisfaction. (See image below). The perspective of employees of the public services is not really part of the answer by ChatGPT. This is a more ambiguous part of the answer and would probably need more space and additional explicit prompts to solicit an explicit answer on the issue. With all the know issues of concern of AI like gender bias or biased data as input, the introduction of AI in public services has to be accompanied by a thorough monitoring process. The legal limits to applications of AI are more severe in public services as the production of official documents is subject to additional security concerns.
This does certainly not preclude the use of AI in PS, but it requires more ample and rigorous testing of AI-applications in the PS. Such testing frameworks are still in development even in informatics as the sources of bias a manifold and sometimes tricky to detect even for experts in the field. Prior training with specific data sets (for example of thousands of possible prompts) has to be performed or sets of images for testing adapted to avoid bias. The task is big, but step by step building and testing promise useful results. It remains a challenge to find the right balance between the risks and the potentials of AI in PS.

Publishing2024

With new channels of publishing online the publishing world continues to change. Scientific research  moves also online and the reach of audiences has become a much more important factor in evaluation of success. Elite circles of in-groups publishing and quoting each other have a harder time to survive. It is a form of democratising the world of research which is by very large amounts financed by public budgets. Public radio and television now start to feel the heat as so-called influencers, some working independently, challenge the world of traditional journalism. The good news is that there are many more people active to produce news and entertainment and the two separate worlds become more and more integrated. Young people who have left the “official” media world, engage with their own peer groups and make their voices heard and more influential.  The quality of the provision of information is, however, a matter of concern. Audiences will have to check even more carefully than before which sources can be trusted. This is not an easy task. Speed of spreading information becomes an additional factor. It has always been like that, but the rhythm of a daily or weekly newspaper was very different from the publishing and consumption of news and information today.
The second factor that has drastically changed is the influence of “external” influences and information as well as disinformation campaigns that have an impact on “internal” reporting and commenting. What used to be the world of professional journalists has become an accessible possibility for many more than journalists. Publishing has become a very different world from the printing days and yet printing remains one important channel of publishing. (Link to own edited volumes of blog post for printing here).
Previously, we prepared the manuscript in paper, nowadays this seems to move online and the edited and sometimes corrected versions will be published in print later on. The challenge to science and journalism is ticking. Not accepting that there is a serious challenge is no solution either. (Image from Exposition “Books that made Europe”, 2016)

Books

Some say, a book is a book, is a book. This is to reiterate the lasting effect a printed volume might have. Many books are a form of a documentation of facts. Creative writing in whatever form finds most of the time some way into a format of a book. For centuries books have facilitated the diffusion of myths and stories throughout societies including translated versions of the content. 2 aspects are constituent here (1) form and (2) content. Annual book fairs receive most attention for new content within more or less the same rectangular format. There are, nevertheless, interesting variations of the form to be discovered as well. Traditionally book binding was the art that gave shapes to the content. Images in form of film are yet another representation of the book content. All this is “dealt” with at the Frankfurt book fair #fbm23, particularly in form of dealing in and with copyrights. New forms of delivery of content, online or as e-book, have added to the variety of books. Pay as you go or as abonnement with monthly delivery is the old and maybe fashionable new way to digest abundant content. People trust in books. The format as book in general seems to remain an authoritative form to present content, irrespective of the truthful or fictional kind of the content. The more we live in insecure circumstances, the more we tend to be willing to hold on to a pile of paper nicely woven or clued. It is still a very powerful tool to guide imagination for all ages. It allows us to learn at our own rhythm as far as we are willing to go. We are, or seem to be, in control of the process as well as the likely outcome. And yet, the spice of life is the surprise. Book it.

Polypharmacy

Each specialist treats a person or patient in her/his field of competence to the best of current knowledge. Well, marketing of pharmaceutical products is also a field of special competence. Medical doctors and pharmacists are largely competent intermediaries between the world of medical and pharmaceutical research, commercial interests and patients. As persons age, so-called multimorbidity is creeping into the daily life of many persons. After a certain age (75+), depending on country of residence to some extent, we all become patients. Although the basic problem has been known since the phenomenal rise of the pharmaceutical industry, little research is devoted to patients receiving multiple treatments with medical prescriptions from several specialists. In addition, we know there is a rather severe issue with compliance to prescriptions, for example, taking antibiotics for the whole prescribed period, to name just one. The interactions between several prescriptions and molecules administered to patients are very difficult to monitor and scientific tests of those are expensive and no pharmaceutical company really has an interest in such studies that might further add to the already long list of potential side effects. However, the study published by Daunt et al. (2023) reiterates the warnings that treatment of multimorbidity can have unwanted side-effects we do not really know about. General practitioners will have to take on the role for medical stewardship for their patients. Monitoring a patient’s digestion of a combination of medications becomes a prime role as of the age of 75, the paper specifies. Whereas a common believe tells us, taking more, will help more, the “daunting” truth might be, less can be more. (Source: Daunt, R., Curtin, D., & O’Mahony, D. (2023). Polypharmacy stewardship: A novel approach to tackle a major public health crisis. The Lancet Healthy Longevity. https://doi.org/10.1016/S2666-7568(23)00036-3.

Splendid Public Libraries to replace Cathedrals

Renovated public libraries are modern showcases of architecture and access to knowledge. Recently the best places add the platform function of people meeting people there not only taking out and bringing back books. The Stockholm city library is an impressive example of all functions.
The library figures also in the list of the 25 best public libraries in the world shown by flavorwire:  http://flavorwire.com/280318/the-25-most-beautiful-public-libraries-in-the-world  You can actually walk up the stairs and access books directly. In the annex building is the international collection with its multilingual treasure as well as the press and journal sections. Impressive is the wide spread audience rather than intellectuals only.
The place is a top place for adult education and lifelong and lifewide learning.