Tuesday, 15 May 2012

NICE and the Prostate Drug Abiraterone

Originally NICE rejected the prostate drug Abiraterone as not being cost effective. It was originally £3000 and can extend life by over 3 months. I would totally agree with their decision and suggest that there is some evidence for no efficacious benefit at all.

Extending life by over 3 months is rather vague, as the life expectancy of those with prostate cancer will show some variation. The drug company will have found the studies that show the biggest possible effect size and this is a very small effect. So it is possible with larger studies over a longer period that the effect might be shown to be non-existent and a result of the variation in cancer life expectancy.

I know that as a patient terminally ill with prostate cancer you want to delay the end as long as you can but taking into consideration the quality of life and the limited extension of life this does not seem a worthwhile drug. I have seen someone have their life extended by 9 months by extensive, painful and debilitating anti-cancer treatment. To see them given false hopes only to eventually succumb. This is another of those false hopes.

NICE changed their view as the drug company cut the price tag from £3000 a month to something more affordable. But this still raises questions about how the drug company tries to set prices for new drugs without any sense of the market value and how the NHS can be pushed into signing deals with Big Pharma especially when public opinion is involved.


Sunday, 13 May 2012

E-learning thoughts

 I have been developing e-learning for a while, mostly following gut instinct rather than good practice but at last it is looking like a paradigm shifting technology in education. It is beginning to change the way we approach pedagogy and looking at how students learn.

When I first started it was all about getting materials online and the technologies and environments that you would use. We did not use the technology to improve teaching, it was just there as a fancy add-on, or an excuse to reduce contact hours. Now it presents a chance to finally escape the curse of lectures and the ideas of transmission in teaching, but there are threats to this opportunity.

Big information - like the textbook companies live off transmission teaching so they are not keen for us to change our approaches. Students also need to be convinced that this is a way forward. They prefer the idea of transmission because it takes the blame away from them. If they did not learn it is because the teacher did not transmit that knowledge properly, not that they did nothing for learning. This will get worse as they pay more and so teaching might become more defensive. It is important that it does not. We have to sell the positives of employability, skills for life and deep learning to students whose focus is becoming the certificates at the end. We can do this by making stronger links to employers and showing them what we are giving students, both by doing CPD and by making some of our resources open access. 

Doing this course has made me feel more positive about e-learning and what we can do. It has also reminded me that the impact of e-learning has not been what we expected ten years ago. But worthwhile transformations take time and we are following the Gartner curve about early over-optimism is replaced by a second peak of realistic application. 

The course has strengthened my view that the pedagogy is the most important aspect and that the bells and whistles of the technology are always secondary. It has also reminded me to think more outside the box. Do not teach the same way you teach face-to-face try new approaches and try edu-tainment. You need to bring the teaching alive. So Terry Pratchett might soon be making an appearance on my course reading lists and I might make the students watch Moneyball (Brad Pitt fans will be happy). 

One of my favourite papers on education is Fox's paper on different types of teacher. We often think of different learning styles but there are different teaching styles too. I like to think of myself as a pith helmeted explorer in the deep jungles of education trying to find the lost civilisations of  student learning. Maybe I should upgrade it to a more Indiana Jones style professor hunting for ancient treasure with a bit more dynamic style, maybe I am not thinking far enough outside the box. 

I think we perhaps should have looked more at Web2.0 and e-learning2.0 if the terms actually mean anything but I am not sure they are more than empty brands. 

It is becoming too hard to separate what we can do in education from government policy because the financial constraints are so tight. What I hope is that technology can help to reduce these constraints to give us more freedom in how we teach the students and better quality interactions. If the technology can reduce costs and improve sustainability, while also allowing us to provide an improved educational experience then everyone should be using e-learning. We have to be evangelical if we believe it is the right way to go. 

E-learning design is no harder that any learning design. The only difference is that in e-learning we actually do it, whilst in face-to-face we can usually muddle along doing what-ever we want to,within the very loose constraints of "learning objectives". You cannot do that in e-learning because the technology has to be in place, you have to relate the things you do to how and what the students are going to learn. Planning is absolutely essential and the most important part of building an e-learning course. You also have to accept that your plan is unlikely to work the first time. It is likely to need tinkering and you will find that something works and something might not. It has to be an evolving plan and so I would also try to avoid over-planning. There has to be a balance between design and application and we are all learning in an experiential way how to plan e-learning. Taking this course is only a first step. The next step is carrying out the plan. Then there is the crying when it all falls over and nothing works and the students hate it and then there is the new plan and the next version. Edison tried over 1000 materials before he found the right one for the light-bulb.

I have been off the blogs recently as I have spent the last three weeks stressing over a Blackboard test for the entire 2nd year in Life Sciences. That is 360 students in many different degree programmes. The statistics test combined all the different question types you can use. It has graphics, it had many alternative sets of data so that each student had a different test. In total there were 22 questions and over 2000 question variants across the 22 questions. The module leader was really concerned about how it would run but it all went smoothly even with two computers dying mid test! In the end 85% of the students passed (got more than 40%) 15% got more than 80%. The mean and median were 60%. So statistically it is ideal, it is what you want of an exam. Even better NO MARKING it was all marked instantly by blackboard. So it has been a positive experience in the end but a horrible one until then as making sure all the sums were right was a nightmare! This is what e-learning can do and when it works it is great.

Friday, 11 May 2012

Credentials and the future of universities

What employers want from universities is the credentials and they hope this relates to assessment. The problem is that most assessments do not test anything employers will find useful. Sitting for three hours regurgitating notes is not what employers want. So maybe this will lead to improvements in assessment which is the bit you will always have to pay for, and the bit universities will always want to keep control of.
As a thought if you are only doing the credentials and assessment, couldn't we have just one or two world-wide credential issuing/assessing bodies? After all there is no cap on numbers, as with the traditional university model. So this could mean full free-market competition leaving only the fittest. Would the research led universities want to bother? Would we all end up with a Pearson or McGraw-Hill degree?

Thursday, 10 May 2012

Why I would not invest a dime with Principalis Asset Management

This is precisely the half-witted nonsense that created the UK deficit in the first place. Oddly the deficit was not created by public sector pensions. It was created by bankers creating stupid financial instruments they were confident that government could not regulate, but which they (the financiers) failed to understand.

The nasty reality for the financial industry is that in western democracy those fools the plebs (non-bankers) get to vote, and even if the current government are not going to kick them where it hurts eventually the public will vote someone in who will. Then that really terrible thing happens called legislation which stops them continuing making money at the tax payer's expense. Nice friendly draconian legislation like that after the South Sea Bubble, the kind that disbands all public held companies and locks all the nice bankers in the jail for a few years. Anyway here is what the President of Principalis thinks,
My point is that the state as it currently exists in Western Europe cannot continue to exist - this is the end of the social welfare state.
The problem is that no-one in Western Europe wants to give up the social welfare state, so they have to find a way to fund its continuation and that means they can't deregulate the private sector.
Funny but deregulating the private financial sector was why we had the crisis, that had to be resolved by the intervention of the state through the central banks (the economic purists can say this is not the state as the central banks are independent, but who permits the printing of money? who send a monthly report to whom?).

So would you really put any money in a company which is lead by someone with this startling lack of vision? Someone who really knows how to annoy those with the legislative power? In a last ditch battle between politicians and financiers if it is a choice between the markets tanking or winning an election I know which way they will go. They do not want to be out of power and kicking a few billionaires and millionaires doesn't cost many votes. In the end the people hold them to account. It is either a friendly account at the ballot box, or if the financiers want to keep pushing it a less friendly one of the 1789 variety. If the financiers think this is not a possible outcome then lets look at history and politicians who found themselves in a financial crisis having to choose between their financier friends and holding on to power - Nero, King John, Philip IV, the French Revolutions, the Russian Revolutions ...