Achieving the digital detox.

Over the past few months, during my interaction with various people on Twitter and offline, I have been hearing about the information deluge that makes it impossible for them to acquire new skills. We indeed have limited 24 hours!

I wouldn’t be able to give a blow by blow account of how I manage things, but I have had to stick to certain good habits that have made things more comfortable for me. I will mention a few services below that make it incredibly easy to flow past the flood of distractions.

1) Mobile phone:

This is the biggest annoyance! I am off the social networks on the device barring Telegram. More on that later.

Twitter is accessed only on the browser. No dedicated applications exist. All notifications on the device are blocked except for text messages.

Telegram helps me to mute all conversations except people whom I deem essential. I have a lot of channels where I consume content passively. No mainstream social networks like Facebook or Instagram for me. They are antiquated because I cannot control them.

I also don’t have a fear of missing out. My associates either call me or text me if needed. Android has become better to manage notifications in recent times. I don’t have any experience with iOS, but I remain convinced that Apple iPhones are merely iPods with a calling facility.

2) Email.

I had mentioned this earlier too. I use Fastmail because I find there is inherent value in paying up for the email. I use a lot of aliases whenever I sign up for the service. It helps to signup with a unique email address. For example, for Dropbox, my alias will be dropbox (at) FastMail dot com (it is a hypothetical- just for illustration). Therefore, if any spam flows into my inbox, I know where is the leak from. All I have to do is to delete the alias.

This simple hack has served me well over six years, and I am happy to stay with this service. Mainstream email applications like Gmail or Yahoo are useless.

I have also created extensive rules which directs the email in the trash. It helps to clean up the clutter at the server itself without manual intervention. For example, all newsletters go to trash directly. Some of them are automatically marked as read and stay in the inbox- I scan through them when I get time. When they are marked as read, I don’t get a notification. Therefore, can easily stay focused on my work without being distracted by the flow in the inbox.

3) Password Manager

1Password is the password manager that is my life saver. It generates unique passwords for all the websites. It is a paid service, but good cloud sync helps me to sync it with my Android device as well. It eliminates the need to remember unique passwords.

4) The use of Telegram chat app

Telegram remains the only way to stay connected with any semblance of “social network”. I use a combination of groups and channels to stay informed. Channels work as public broadcasts. Any specific information I need is transmitted to it. I use bots (both paid and free) to achieve the effect.

For example, I use the IFTTT bot to work with the RSS feeds to populate the channels with the Pubmed content. If I need to track, say the latest publications in the development of MR-LINAC, I don’t have to visit the website manually. By use of booleans, I can filter the content, generate the specific RSS feeds which pipes it elegantly in the channel via IFTTT bot. Likewise, I use junction-connection bot and Feed-Reader bot for different purposes. I pool in information from all specific channels I need to follow into one omnibus channel so that I don’t have to deal with a multitude of channels. I do this by using junction-bot on Telegram.

Feed-Reader bot helps me to tap into various other social networks. For example, I have a specific channel devoted to cycling. All posts from multiple Instagram accounts flow in the channel. It helps me to keep track of the sectoral development. Likewise, I developed a channel for journalists on Telegram to keep track of telecom sector and clean energy. I also have a dedicated art channel that I helped to make for a friend. That collects all impressionist art, beautiful nature pictures and graffiti! None of the posts is done manually.

Focused groups require extensive group management. I recommend using Combot because it comes with a beautiful web-interface. Although the community bot management has introduced a paid plan, it is free for groups that have up to 100 members. The bot deletes specific stop words automatically along with other nifty features like muting users. The bot also keeps groups free of spam messages. Therefore, the groups stay efficient, productive and on course. It is unlike WhatsApp where users start spamming others without any rhyme or reason.

This above may sound onerous, but it helps to maximise the efficiency gains. As long as you are not distracted, it helps to keep focused on work.

In the busy schedules that we keep, always find time for solitude. That is the most critical period to stop and reflect on your goals.

Digital tools need a constant refinement. Hopefully, I will update this in the future.

(Images are for representational purpose only. This blog post is not intended for any commercial purpose).

Can you rely on Twitter?

Of late, my engagement with Twitter has decreased as my cynicism about social media has resurfaced. I have always held the belief that Twitter is, at first, a link-sharing service. The 140 characters and URL shortening services came out of that. However, they have actively tried to increase engagement.

It doesn’t happen like that. The rates of engagement (defined by clicking on the shared links) are abysmal. It means that anyone given the user is at the mercy of algorithms. Any change in that and the discoverability falls to zero.

The Twitter timeline is unsuitable for orderly consumption. I had mentioned before, and I reiterate- it depends on how algorithm ranks your association and engagement with other users. I have tried, with varying levels of success, to participate in the “live-tweeting”, but the heterogeneous nature of discussion doesn’t add structure.

I have bet my horses on Telegram instead. It is growing, without any direct marketing. The groups remain functional by use of bots which automate policing the channel. It ensures that no one misuses the allotted privileges to speak up. I have been managing a group recently which makes it easier for disparate users to discuss issues cohesively and understandably. Sharing links, inline players and in-app browser (or instant view) is a huge plus.

If the bottom line is efficiency, then yes, Telegram wins hands down. Twitter is becoming a mass of super-added mess. I use the offline Tweet clients because the web-version has a subpar experience. Besides, it tracks using cookies and other means.

I have tried (valiantly!) to convince users to switch gears. Staying online makes it worse for identity thefts. People implicitly trust social networks, but it is a decision that is fraught with danger.

Twitter is in search of a business model that would pay up for itself. As an ad-supported service, the users are the product. Despite the real-time insights, Twitter has been dumb enough not to be able to capitalise on the generated data. Either way, despite the promises of being able to provide a medium of discovery, the real fun happens in closed groups where we chat up, in detail, about issues that are close to heart.

The new promised updates to Twitter will still languish and leave you at the mercy of nameless, faceless algorithm. Think about it.

There’s still time to change gears.

Goals of research

There has been an outpouring of dollars in basic molecular research. Many clinicians have joined in with their labs to push for “clinically relevant research”. It is evident that there would be a lot of duplication and overlap between it.

For example, look at IDH gene in the pathogenesis of gliomas. We know it carries a prognostic significance. We also know about the molecular pathogenesis. How does duplicating the research across different labs helps us or makes us any wiser?

The answer lies in the pharmaceutical business goldmine. Loath to spend on basic research in molecular pathways, the research, instead has been farmed out to a network of labs. It is easy for anyone to form a company and then sell out by being acquired. It is excellent for research ecosystem as it brings about new innovative ideas, but there are some serious issues here.

Public funded research gets outpriced for the end users who have contributed in no small measure to the same. They need to become more aware of these repercussions. Shrinking federal grants for public funded research means that there is no adequate oversight and auditing of the labs that are doing the same thing. These are potentially very high stakes, and patent awards can make individuals pretty rich.

I agree that these are generalisations and that this opinion isn’t set in stone. I have based the above assertion on my reading of the situation as well as verbal accounts.

What is urgently required is a partnership at all levels. It is to focus on one idea that has the potential to work in brain tumours. Pool in resources, under legal agreements, to work on the different aspects of the same problem. The idea above is more akin to a hub-and-spoke model of research. The goal is the identify molecular pathway and understand its implications for radiation therapy.

Let’s say, hypothetically, IDH gliomagenesis is the new pathway discovered. One team to work at a molecular level to identify potential inhibitory points, other to identify molecules that bring about this change. Another side to study the effect of radiation therapy and the pathway. Aggregated results would avoid duplication and overlap and lead to faster translational outcomes.

The problem is that they end up leaving radiation as an after-thought. It should change.

Size does matter

The size of clinical trials has now become a raging issue. I came across it on Twitter, and I’d like to put in my perspective to it.

The Wall Street Journal article presents a reasonably nuanced view about the need for trials. What it leaves out in the process is that some diseases like those involving brain, because of their relative rarity, would always need a clinical trial. Likewise, for common cancers arising in breast and prostate, the opinion for long-term clinical trials is divided because it is a significant public health problem.

The treatment protocols for brain tumours like gliomas hasn’t changed much in the past 15+ years. For even rarer diseases like CNS lymphomas, the role of chemotherapy has expanded manifold. Patients present to different facilities with varying standard of care. Not everyone has access to the “research facilities”, and especially in developing countries, that conceptual framework is non-existent. The treatment protocols are often the trial and error in what “fits” in with the Indian subset of patients. It is true primarily because out of pocket expenditure is a significant public health issue.

Now comes the emerging role of “personalised medicine” where the opinion for big or small trials is even more sharply divided. What everyone secretly agrees but never speaks out in the open? It is more important to understand the need to publish negative trials. The focus of the oncological community is towards the big bang positive studies; especially for the “blockbuster” drugs. These are often intricately linked to prevailing stock prices. There are perverse incentives as well, not to take the financial risks. It is the pharma companies that decide on “treatment protocols” and the “standard of care” where conflicts of interest are given short shrift in the protocols. That is the reason why I insist on public funding of trials where a leeway has to be made to fail. Previously, I have also argued that “personalised medicine” is way too much in its infancy. We are only nibbling at the outliers and nowhere near the core of the problem.

It is also incredibly naive to assume that if a company is offering an “unrestricted educational grant”, it has no say in the outcomes. It gets them a seat on the board to be able to influence the reports indirectly.

So does size matter? More extensive trials, are time honed but require immense resources. I strongly feel that hair-splitting in current treatment options offers no means to an end. Instead of a clear focus on the outliers (like the drugs), protocols need to include radiation therapy as an inherent component of treatment.

Translational medicine needs to become the centre-stage, and public funding should avoid a substantial scale duplication of work. It comes with its caveats.

My Twitter journey so far

It is an honest confession about what I have been able to achieve and put it in perspective. Is the social microblogging website, beneficial?

  1. I have been lucky to come across many excellent individuals! Medical Physicists, Radiation Oncologists and the fraternity which gets together and deliberates on matters of mutual interest.
  2. I had to use a lot of muted words because most people don’t realise that Twitter is meant for “manufactured outrage”. It is lazy person’s means of “activism”.
  3. I follow many accounts, but some of them are muted because their tweets add no value to the discourse here.
  4. Some Twitter users are great. They read whats on their platter, but Twitter sorts out interaction based on algorithms. It means you are likely to miss out on a lot of important things. Your likes, re-tweets or other signals are factored in what you ultimately see. It isn’t educative nor informative.
  5. I participated in my first virtual conference for ESTRO. It was an enjoyable experience, and I have written and shared my ideas extensively. If you wish to factor in Twitter as part of an interactive platform, you need to have a coherent strategy. A generic hashtag adds little value to the overwhelming noise. I would, on any given day, have a Telegram channel, instead.
  6. I am dismayed by the constant barrage of advertisements by many organisations. It is good to promote diversity of thought; however, it is clear that these accounts have been outsourced to different agencies. It appears phoney; as if they are drunk of kool-aid. My bullshit filters typically go up at the very thought. I am not naming them, of course, but it gets my goat. Likewise, for a respected “physician-scientist”. It may be acceptable to make political statements, but it is like mixing wine with water. The result- academics+politics doesn’t make any sense.
  7. Gender politics on Twitter is too stupefying; I am gender neutral (if that is the term) and I prefer to see individuals as such. There is no meaning of gender for me (as far as academics is concerned). Using your Twitter account to wash your dirty linen in public (because you have a specific gender) is labelling your back with the tag of “stupid”. Ultimately, it is your choice as to what you wish to achieve with social media. I usually prefer to stick to a personal account on Twitter or better still; I prefer Telegram.
  8. The click-through rate for articles is abysmal. If you wish to see an improved version of click-throughs for the posted links, you will need to have a large number of followers.

Has there been any luck with getting people to switch over to Telegram? Nope. Nada. Zilch. It is because of my tacit understanding as follows- Twitter as a medium for beginners is intimidating. Many users prefer to stick with the known than to start with something new. It is not laziness, but everyone has a motive to be online using Twitter. Some wish to have a more significant exposure; some users want to interact with peers, some want to express outrage or crib about life’s not fair. There is no one reason. Telegram is much more personal compared to Twitter. I have a couple of groups and channels with me on Telegram. It is good to spend time by consuming content passively. Groups allow more fine-grained control and better-nuanced interaction. And the recent moves by Twitter to force users to access it through web-alone is a stupid move.

Twitter is a bitter-sweet experience. Yes, the constant stream can be tiring and distract you cognitively but it is fun in parts. On the flip side, you end up meeting amazing individuals and people from different departments across the world.

The myth about tissue donation

 

Many organisations are involved in raising awareness about brain tumours. It is essential because of the relative rarity of these diseases. One also requires in-depth research for finding the elusive “cure”.

A diagnosis of brain tumours often lurches sufferers from anxiety to nearly suicidal ideation that often makes them do desperate things. Alternative therapies, herbal remedies etc. become the order of the day, often aided and abetted by the Internet. The practitioners make tall claims which have no scientific logic.

The worst off are the snake oil businessmen, often under the guise of taking your tumour samples. Now, this is a very contentious issue, and I will try to make it as simple as possible.

Research involves tumour tissue to do molecular experimentation. It would unravel the molecular pathways that are involved in the final clinical presentation. Once you sign away the tumour tissue, you also sign away the rights for any “commercial exploitation”. The devil lies in the details. I feel you are unlikely to get your money’s worth for the tumour tissue you have donated. Any “blockbuster” drug that might come off it will be the sole property of the organisation that took the tissue in the first place.

Things, of course, are not so simple. It is a very generic statement, and I am sure exceptions to the rule apply.

So should you give away the tumour samples? Yes, by all means necessary. However, not to the organisations but to respectable Government institutions where the public funds’ research.

What will be the benefit of this move? Whatever new research yields the outcomes, it has to be placed in the public domain which would make it easier for scrutiny and more importantly, for reproducibility in other geographical regions. There is no point in locking up the innovation. If the organisation pledges to do the same, then all the better!

There’s one more major concern- data privacy. What would happen to the data if the organisation and the company behind it go bust? In case of Government organisations, the ultimate control will remain in public hands.

I strongly feel that calls for tissue donation need to be understood in the right context; before you sign away your rights for a great common good.

Twitter: Towards a slow spiral of death

Twitter is getting desperate after an increased focus and scrutiny of its actual number of users. While they use metrics like users who were online in the past month, Twitter knows that it is a sinking ship.

There was a lot of hoopla about Twitter making its first profit after consecutive losses. However, it seemed like a flash in the pan. It is yanking off the API’s (third party services which connect via desktop applications). It wants web-only services so that it can serve up “personalised” advertisements. The daily engagement with the service is declining.

It is a worrying trend. While the BTSM practitioners have linked and bonded over this microblogging service, it is easier to get lost in the din of rapid tweets which makes it impossible for any coherent discourse. I have seen posts from institutions- pictures shot from the OT about the cases that they have done. Why this kind of marketing?

The impact of social media ought to be real- like reaching out to potential donors, for example. However, that individual tweet is decidedly less likely to be seen by a specific person. Re-Tweets or Symplur impressions hardly have any bearing on the impact of “tweet”. It only states how many people could have possibly seen. Were they the correct target audience?

A vast majority of the population isn’t aware of nuances of Twitter which can be overwhelming. Mobile interface, like Telegram, needs to be explored in earnest. It should be linked to all the Telegram links (like URL’s). That is also a safe, secure service which doesn’t track you, unlike Twitter.