Burden of Proof

Sweet Jesus God, I don't know how much more of this I can take...

"Evidence Based Relationships"

WTF??

Cold Turkey 2010

With a tagline like "Wobble before you Gobble", how could I resist?  So, I signed up to do a 6k run from the State Capitol Building at 9am on Thanksgiving morning, which is also the day before I leave Salt Lake City to head home for Diardie's birthday and Christmas.  Can't wait.

Click Here to Donate

I am running in aid of the Huntsman Cancer Foundation and hope to raise the modest sum of $100.  I'm a long way off that yet.

For all their talk that "Philanthropy is an American thing; they just don't have the same tradition in Europe", they're a tough group to crack for raising a few bucks out of their own pockets. It's only 'philanthropy', apparently, if someone else (mega-rich) is paying (for everything)! Yet another small cultural difference, I suppose?

For Voley

(This is for Voley, coz Con's already seen it)

Bloom County house, Iowa City

Hiking and Running

Last weekend, I took myself off down to Moab - a four hour drive over mountains and through desert to the south east corner of Utah.  It was well worth the trip!  

the desert

Monitor and Merrimac

Moab is a small town in the middle of a red rock desert.  It looks a lot like a more up-market version of Radiator Springs (for those of you who've seen Cars).  There are loads of places to eat, drink, make merry and spend (lots of) your money on 'authentic American Indian' crafts and jewellery.

Hiking trail markers

Dead Horse Point

On Saturday, I wandered around town for a few hours and mostly just wasted time before I headed out to Dead Horse Point for a wee spot of hiking.  The Point is a rocky outcrop reached across a land bridge that is just 30 feet wide.  There are 2,000 foot drops the whole way round.

Dead Horse Point

Dead Horse Point

Legend has it that each year, cowboys would round up hundreds of wild mustangs from the mesa, corral them on the promontory, pick out the good ones and then release the others.  One year, for some reason (the story is unclear as to whether or not the corral was removed or left behind), the remaining horses stayed on the point and died of thirst within sight of the Colorado River, hence the name: Dead Horse Point.

Me on the Point

Dead Horse Point

Starting Line at
Dewey's Bridge

On Sunday, I left my exorbitantly overpriced motel before sunrise and joined a group of intrepid mental cases on the shuttle bus to Dewey's Bridge, about 30 miles north of Moab, on Highway 128, by the Colorado River.

Sunrise at Dewey's Bridge

We huddled around open fire braziers for an hour, watching the sun come up and paint the canyon walls red, before making our way back to the road and running 13.1 miles back to Sorrell River Ranch.  I was very proud of myself, finishing a half-marathon at 5,000 feet elevation in 2:10, especially considering (a) the altitude and (b) having to stop and take photos every couple of miles.

mile 8

mile 5

It was one of the most amazingly scenic half-marathons I have every done.  It was literally awesome - breath-takingly, awe-inspiringly beautiful.  There was also free beer at the finish line, yeay!  (Yes, really, free beer, on Sunday morning, in Utah... go figure!)

Balancing Rock

I got back to Moab around midday and stopped off for some lunch before heading out to Arches National Park.  I spent about an hour and a half driving around the park and stopping at various viewpoints until I got to Wolf Ridge Ranch.

Park Avenue

Petrified Sand Dunes

Then, I'll admit, I wussed out of the 2 hour hike up to Delicate Arch and drove up to the viewpoint which was about 1km from the Arch.  

Delicate Arch
(in the distance)

After that, I turned tail and drove back to Salt Lake City.  It was a bloody awful drive... took 5 hours, in the dark, over windy mountain roads, through rain storms.  Ugh! I was a ball of sweaty tension by the time I got home, but it was still the best weekend I've had since I've been here.

Me at Arches

Delicate Arch
(official photo)

Happy Columbus Day

Though, what's so happy about commemorating an event that possibly precipitated the genocide of countless indigenous peoples on this continent, I'm not so sure.

Also, Columbus never actually set foot on what is now the USofA, right?

Oh details, details.  Never mind.  It's not like it's a Federal holiday, or anything, so that's okay.

Oh, my poor head

That is all.

L'esprit de l'escalier

Actually, I don't think I disgraced myself too badly, but reading back over the transcription of today's disagreement with a professor from an ivy league school, I feel like there were some points that I should have elucidated more clearly, if only I'd known I'd want to raise them... I'm going to repeat most of the exchange here verbatim, but I reserve the right to edit minimally (i.e. no ums, ahs, or repeated you knows - his, not mine!, and no-one but me will be identified).  This took place about two and a half hours into a four hour session on 'Cost Effectiveness and Decision Analysis', so it will also give you a flavour of the hell I have been enduring for the past three weeks of sitting in on similar lectures and being told the same sort of thing.  It's a wonder I haven't broken before now!

Me: Can I ask, do you see these decision trees as being some sort of post hoc rationalisation, or would...

Him: Oh God, no! Heavens, no! No.

Me: So, you would expect somebody to sit down and...

Him: Yes

Me: ... work out all these sums...

Him: Yes

Me: ... and not be able to intuitively make a judgement on all these factors?

Him: Well, on every patient, one at a time? No.  Although there are people [that have] this notion that there will be a day, there might be a day when just as you can go to your electronic health record and get information about patients like this, you can tap into a program that will use a pre-constructed decision tree and give you a result, not that that's what you have to do, but it will give you the information in real-time.

Me: OK.  But, so what is the value then of having a profession that have learnt a practice, rather than going to a computer and putting in your own symptoms and then having a print-out saying 'this is the test you should take' or 'this is the treatment you should have'?

Him: [...] you know the mechanisms.  Why do certain tests work?  What do they do?  What are they measuring?  What's the '-iology'?  What's going on at a cellular level?  You want to know what's going on inside that black box, it's important.  That's one answer.  Another answer is that, and I said this earlier but I'm gonna say it again, the main advantage of doing decision analysis is not to get the number.  The main advantage is to sharpen your thinking.  So, yes...

Me: OK, but there's other ways to sharpen your thinking than being entirely 'systematic' and positivistic about your approach to problem solving, I would have thought.

Him: Say that again?

Me: There's other ways to sharpen your thinking and consider alternative options than taking one particular track.

Him: Well, I mean, if you want to think systematically and clearly about the circumstances under which getting the test, ordering the test is a good thing to do...

Me: But, systematic thinking does not necessarily mean that you have to be probabilistic in your approach.

Him: I suppose not, but it's one way to be systematic...

Me: So, it's one alternative.

Him: You could make decisions based on other criteria than expected outcomes, but eh, this is one way of doing it...

This brought the group off on a bit of a discussion for a few minutes, but about five minutes later, he starts lecturing again and pointedly comes back to me.  I apologise in advance for what you're about to have to skim over, but I had to listen to it several times (once live and then a few times for transcribing) and I have no sympathy for you and make no apologies for what I am about to subject you to, even if it is a bit like water boarding...

Him: (to me) But I think your question was 'why do you need to know what goes on inside the black box?', and the answer is probably, maybe you don't.  But, you know, it's usually a good idea to have some vague idea if you order a test why you're ordering that test, what a positive result means [...] I don't expect you to go home and do this; I expect you to be able to use the software and have an increased appreciation of what the software is doing, which may make you a more informed user of the software [...] If you just pick up the software package and plug in numbers, you might not know what some of those options mean.  You know, these days,  people buy software and they don't know what half the options do.  They might tinker with it but I'm trying to give you a sense of what you can do with the software.  There's a whole branch, sort of an extension, of decision analysis that I didn't get into called Markoff models, which are sort of decision trees that sort of recycle themselves.  That, you sort of have an event and then you go on, you make another decision and then you have another possibility of an event and things go on and on and on.  m.  There are other extensions that involve simulating individual patients, simulating the probability, basically rolling dice for each patient in a thousand patients to get a sense of what would happen in a thousand patients when you're developing strategies, em.  These are things that the software can do and you don't really need to know how it does it, you just need to know that it can do it and rolls up those kinds of analyses

Me: But then there's a whole other bunch of black boxing going on there about how the software is written and developed and how that program, what biases are built into the program.  So, there's black boxing no matter what you're doing...

Him: I don't want to be critical of your point, but there are people who do statistics and don't know what the hell they're doing...

I'll leave it at that.  As I re-wrote this, you have no idea how much I wish I could annotate and comment on several different things within his (interrupted) monologue.  I'll make do with a comment on how this ended.  He 'didn't want to be critical' of my point, the dirty liar!  He not only completely dodged a valid criticism (open the black box on medical decision making by piling it all into a black box of software-driven analysis tools?) by refusing to engage with the question, instead going off on a rant about how people misuse statistics (using a t-test when they should've used a chi-squared test, fr'instance) to redirect (misdirect?) attention from the point I raised.  If I were a stronger person, maybe I'd have pursued it, USPOS-style, but I felt that I had taken my share of class time and I was not feeling a ground-swell of support.  Tough room.

I did at least feel like I had stood my ground, somewhat admirably.  Next time, I won't be so nervous and the arguments will be better honed from the experience of sharpening them against such opposition.  There will be a next time.

It's not all work...

Part of the 'Fulbright Experience', apparently, is to engage in cross-cultural learning and experience. To that end, I took a day off from my packed schedule of stressing about cognitive dissonance and the eternal struggle between interpretivism and positivism, and went hiking.


Oh my sweet Lord Jesus - it was FAAAABULOUS!

We went up to the top of Snowbird (11,000 ft), partly along road, partly along trail, and the last mile runs along a narrow ridge with steep drops down to the valleys on either side. It's a moderately difficult climb in spots... let's just say that I won't be mocking people with hiking poles anymore! Some of it is rolls gently and some is very steep. It gets harder as you climb higher and the air thins out - by the time we were near the summit, I had to stop every 3 minutes to catch my breath - but what an excuse to look around and marvel at everything. The sky was a deep, deep blue; the aspens are mostly still green, but starting to turn yellow; some of the other trees have turned red and rust; the limestone outcroppings are dramatic against the red rock.  I loved every minute. We cheated a bit, and took the cable car back down to the bottom, where the Snowbird Oktoberfest was in full swing, so we had a beer and ate our hang sangers before heading from the hills.


At that height, the air is thinner and cleaner; you can see for miles in every direction. It certainly clears the perspective. Happy day.

And now I'm really confused

I'm afraid that I'm being assimilated. I really don't know if things are genuinely making more sense to me, or if it's just that my brain is capitulating more quickly than I would have given myself credit for. At the end of my first three-day brainwashing, I mean, QI course, I was eagerly nodding assent along with all the others.

Actually, I wasn't really. But I had come to a fairly frightening realisation (much of this thanks to the judicious use of IM technologies with my sanity-pillars at home) that in general, I'm on pretty much the same page as these guys. The difference is (if you'll allow me to continue torturing this analogy) that we're reading from different versions of a book that's been translated into different languages and then back into English via two other languages, so a lot of the words are very similar (sometimes even the same), but the meanings attached to those words often are not.

Let me use Google Translate as an example. If I start off with a sentence in English, translate it into German, then to Chinese and then back to English, I get a result something like this:
1. At what time does the train to London leave this platform?
2. Zu welcher Zeit fährt der Zug nach London verlassen Sie diese Plattform?
3. 什么时候到伦敦的火车你会离开这个平台？
4. When the train to London you will leave this platform?

Now, if I take the same first sentence, and this time translate it into Greek, then Hindi, and then back to English, I get this:
1. At what time does the train to London leave this platform?
2. Σε ποια χρονική στιγμή το τρένο για το Λονδίνο αφήσει αυτή την πλατφόρμα;
3. क्या समय ट्रेन लंदन के लिए इस मंच पर छोड़ दिया?
4. What time the train left for London on this forum?

Both of these final sentences started off with the same original sentiment, though neither of them ends up saying the same thing. They're both in different tenses, for a start! But this just goes to illustrate that even though they're trying to say the same thing, they've been filtered through a language sieve (and a whole bunch of other stuff that plays an analogous role here, but would take me forever to expound in this post, and I've got a meeting in 5 minutes...) to the point that they end up saying very different things and neither one is really in agreement with the other. Even though, they really are.

See why I'm confused?

So, my question is, have I just realised that we're really interested in the same things, but because we talk about them in different languages, using different conceptual frameworks and theoretical underpinnings, aiming for different audiences that we're doomed to talk in circles around one another, until we negotiate some shared meanings and develop a common understanding?

Or have I been assimilated?

Your Mother Knits Socks in Hell

That's right folks, I'm going to need an intervention, or as the lovely Carolin put it earlier, a positivist exorcism. She reckoned that Anita would be only too happy to help. Séamas could probably be called in for a spot of heavy lifting, if required.

Sweet Jesus, people... I've mentioned the sense of alienation and feeling like a complete outsider before, but I have just spent 3 hours undergoing the most immense cognitive dissonance I have ever experienced IN MY LIFE! (and I've had two kids, and all my illusions of being an Earth Mother shattered when the reality of children failed to meet my vaguely hippy expectations)

I've been listening to a very well-respected man lead a seminar on Quality Improvement and here are some of the more memorable quotes...

"he said 'in my experience'... pure subjective recall... he just made it up!"

"if you're an experienced practitioner, something happens in your brain, [sarcastically] you're touched by the hand of God... 'I know the right thing to do and this guarantees the best possible outcome'"

"If I know the algorithm and the seed point, I can tell you exactly what's going to happen"

I'm railing against it now, but this is only Day 1 of a three-day course. Next week, I'm sitting in on another two-day course and the following week, there's a full five days. I'm either going to end up as a drooling, gibbering vegetable (back to the cabbage analogy) or I'm going to crack under the pressure and start talking. Now, to be honest, I don't think that this is really the right time or place for me to present an alternative view, i.e. mine, but what if I can't help myself? They'll think I'm a cabbage and have me committed anyway.

More on this later. Perhaps.

-phic, -pher, -phy: on wearing hats and staying dressed

So, Carolin made an excellent point on my last post and it made me think a little harder about what I was saying. I realised that I am not really doing an ethnography, but rather I am using ethnographic methods (observation, shadowing, archival and document analysis, etc.) to draw out and develop an understanding of what I see happening. [Does this point up the difference between method and methodology?]

This fits well with the practice-based perspective on knowledge that I have been pursuing for some time now and also means that I do not need to exile myself any further. This practice perspective means that I can acknowledge that I interpret new experiences (including my research findings) through the lens(es) of my previous experiences and understandings of the world, rather than disregarding (or trying to discount) my conceptual underpinnings.

I still get to wear my hat but I wear it to set me apart from everyone else, so it's really not an ethnographer's hat. The up-side of all this is that I don't have to "strip down", which I'm sure is a great relief to everyone! (Especially me... it gets very cold here in winter!)

"... and then... Realisation!!"

Not that it's the funniest moment in a movie ever, or anything, but you know when there's a line of dialogue that just stays with you and seems to fit so many other situations... anyway, watch 'Shirley Valentine' and you'll realise that "realisation" must be said with a deeply mustachioed Greek accent and you'll laugh too...

Anyway, I've had a couple of epiphanies in the last week that I'm going to share. That might be a record. Both of my light-bulb moments relate to the sense of alienation I feel here and ways that I am trying to deal with it and make it work for me... building that outsider's perspective into the research, I suppose. Or at least, using it purposely and deliberately to stop myself from assimilating and losing sight of what makes me different in the first place.

The first is the understanding that as an ethnographer (a wanna-be, or for-real, let history judge that one) my job is not to make sense of what they do, rather it is to make sense of how they make sense of what they do. Is this mere pedantry? Maybe, but I see it as a subtle and important difference and I try to consciously remember it daily. I might buy myself a hat for the winter and call it my 'ethnographer's hat' so that every day when I put it on, I am also putting on a material reminder of what I am here to do.

If you think that was a bit up-it's-own-arse, then I suggest you stop reading now because the second is even more so! You have been warned. At a very basic level, I problematise concepts like 'knowledge', 'practice' and 'expertise', yet I am now working in an environment where these things are taken as given. This is presents difficulties for me because I see issues with what they're doing even if there are no immediate problems in practice. At a practical level, there doesn't appear to be a problem, so the issues that I have remain invisible and unacknowledged. Indeed, when issues do arise, they're put down to a "breakdown in communication" or a "communication gap", which does not recognise that what is at stake goes somewhat deeper than "you never said that" or "i didn't know/hear about that".

Eat the Cabbage

I used to blog fairly regularly and then I fell out of the habit. So now I have decided that it is time to start again.

'Researcher in Exile' is where I will keep some sort of open field journal relating to my research and my life. (In fact, I have lately found myself wondering if the two are actually different. The jury's still out on that one.) My exile is a strange and multi-faceted thing: self-imposed; a reward; a burden; physical; mental; conceptual; theoretical; practical; hypothetical; emotional; material.

I knew that I would face homesickness and that I would miss my family (and sometimes, being so far away causes me physical pain). What I did not expect to miss the people in my research network so much! At home, I would often go several weeks without physically seeing one of them, but we would be in regular contact by phone, skype or IM. I've still got that regular electronic contact with them. But now, I find myself surrounded by people who understand the world from a very different perspective to mine.

On the surface, there are only superficial differences between here and home. In fact, I quite like it here. On a conceptual level, however, I feel like I am marooned on an island with a village full of vegetarians, and I'm the cabbage! I want the cabbage to grow; they want to eat the cabbage.