Transplant +198: Maintenance Rituximab on not Brexit day

So today, at the fourth time of asking, success! And no, I don’t mean Theresa May getting her dreadful EU withdrawal bill through parliament, which lost for a third time, by 58.

On not Brexit day, my neutrophils were above the 1.5 mark (at 1.66) needed for the hospital to give me my first maintenance rituximab. It was a remarkably straightforward process – a subcutaneous injection, taking 10 minutes to administer. The nurse asked me to keep talking to her through the process. I happily spouted nonsense about Brexit unicorns, Gnu, electric cars and the A380 (the aeroplane, not the road).

Brexit unicorns. Every bit as likely as an electric Caterham 7. But less real.
Brexit unicorns. Every bit as likely as an electric Caterham 7. But less real.

Other than feeling a little bit woozy (probably from the chlorphenamine pre-med – a pill normally used to reduce hay fever symptoms) I’m fine. I’ve been told to watch out for fatigue over the next few days. There’s also a risk that my neutrophil count could drop very low again, so any signs of a problem and I’ll be straight over to the hospital.

I think this will probably be the last blog entry I’ll be making about the stem cell transplant and its aftermath. Naturally, I shall celebrate my re-birthday every 12th September and there will be cake. No unicorns, by request. But I feel that today symbolically marks the end of this phase of my life. I’m not sorry to leave the SCT behind me, but there may be plenty of challenges ahead.

Transplant +189: The International Day of Happiness

I’m fairly sure that every day is an international day of something or other. I suspect that there are so many, there are diary clashes as well. Anyway, today is the international day of happiness, and coincidently, I’m happy.

Today was hospital day. After the scare of a few weeks ago, my neutrophil count has now climbed back up to 1.9. That’s just a smidge below the lower bound for normal people. I’m also just in the normal range for haemoglobin and platelets. This should mean that it will be fourth time lucky when I return for my maintenance Rituximab next Friday. So to celebrate it was coffee and cake at the Bottle Kiln, followed by a short run in Gnu to Carsington Water and Middleton Top.

Me, in Gnu, with Gnu's gnu, at Middleton Top Winding House
Me, in Gnu, with Gnu’s gnu, at Middleton Top Winding House.

I’m writing this at 4.30pm. Not even the worst UK Prime Minister of my lifetime ever could spoil my happiness for the rest of the day.

Surely?

Oh.

Smart metering – 1973 style

46 years on since this quirky piece from Tomorrow’s World,12 million or so first generation smart meters are installed. Second generation meters are supposed to be ubiquitous by the end of 2020. But by January of this year, just 250,000 had been installed. The £11bn project is running years late and at least £500m over budget. It seems unlikely this target will be met. The “and then a miracle happens” graphs in this House of Commons Library article bears this pessimistic view out.

The forty pence per year to read each meter in 1973 is around £4.80 in today’s money. Assuming that there are 48 million domestic meters, the programme will cost at least £240 per meter. Break-even in 50 years – if meters were still read 1973-style and they were capable of lasting anything like that long. But at least you won’t find Michael Rodd rummaging through your cupboards.

Note: For the computer history geeks, the ‘small computer’ shown in the clip is a Digital Equipment Corporation PDP-8.

When Brexit nonsense hits manufacturing reality

A Brexit manufacturing timeline.

May 2016

Professor Patrick Minford, of Economists for Brexit, says of manufacturing:

Over time, if we left the EU, it seems likely that we would mostly eliminate manufacturing, leaving mainly industries such as design, marketing and hi-tech. But this shouldn’t scare us.

Transitional arrangements should be made, lasting around 10 years, to help industries such as car manufacturing adjust.

June 2016

Mid-Derbyshire MP Pauline Latham, writing in the Derby Telegraph, explains why she wants to leave the EU:

At the weekend I made up my mind that Britain will be better off leaving the European Union. It is a decision that I have not arrived at easily, having been genuinely undecided since the referendum was announced.

Our manufacturing sector ranks number eight worldwide. The language we speak, English, is the international business language. Our judicial system is consistently rated as one of the least corrupt anywhere and our contract law is regarded across the world as the best for business. We have a long history of innovation, especially here in Derbyshire from even before the industrial revolution.

… Britain has a proud history and we want our children and grandchildren to enjoy the chances and opportunities we have had. I think this is possible outside of the EU and we should be confident that Britain can once again can stand by itself.

(This article has been removed since it was published, but fortunately I kept a copy).

March 2019

Johan van Zyl, head of Toyota’s European operations, speaking at the Geneva Motor Show to the BBC:

Mr van Zyl said it was vital that there was frictionless trade with the European Union.

He said Toyota would overcome any short-term problems at its Burnaston car plant near Derby, such as logistics, caused by leaving without a deal. But preparation for no-deal has been costly, he said, and in the long-term things could be “very difficult”.

Could work at Burnaston dry up after the current production cycle comes to an end? “The long-term effect could be that if it [Brexit] is very negative, that outcome is possible.”

Constantly improving competitiveness is vital, he said, adding: “But if the hurdles are becoming so high that you cannot achieve it then of course you can’t avoid it [hitting investment].”

Many people probably remember Minford’s comment about exiting the EU “mostly eliminating manufacturing”. It’s easier to forget that he was also arguing for a 10 year transition period prior to the referendum. One presumes he must be horrified by the negative consequences of a no-deal Brexit with no transition period. If so, he seems to be keeping very quiet about it.

As for my MP, Pauline Latham, she clearly forgot about a key reason why UK manufacturing was performing so well in 2016. The frictionless trade provided by the EU single market and customs union and required by Toyota to make sense of their investment here. Had that fact not slipped her mind, I’m sure she wouldn’t have advised her constituents to vote to leave. Surely? It wouldn’t have been rational, given the difficulty she found in making her decision.

We may be at the eleventh hour and 58th minute before Brexit, but if Latham is a genuine champion of manufacturing in Derby, she needs to take Minford’s advice. Rather than the no-deal desired by her ERG colleagues, she must vote for an extension to Article 50. That way, her government may stand an outside chance of obtaining Minford’s 10 year transition period.

Alternatively, she could recognise that she was poorly advised in June 2016 by the Brexiter elite. It would be the mark of a principled politician to acknowledge that, after all, EU membership provides the best chance of giving our children and grandchildren the opportunities we’ve enjoyed since 1973. Voting to revoke Article 50 would be a start to repairing the damage of the last two years.

The chickens are coming home to roost. Waiting for a disastrous Brexit.
The chickens are coming home to roost. Waiting for a disastrous Brexit.

The brain is (mostly) not a computer

I recently had my attention drawn to this essay from May 2016 – The Empty Brain – written by psychologist Robert Epstein (thanks Andrew). In it, Epstein argues that the dominant information processing (IP) model of the brain is wrong. He states that human brains do not use symbolic representations of the world and do not process information like a computer. Instead, the IP model is one chained to our current level of technological sophistication. It is just a metaphor, with no biological validity.

Epstein points out that no-one now believes that the human brain works like a hydraulic system. However, this was the dominant model of intelligence from 300 BCE to the 1300s. It was based on the technology of the times. Similarly, no-one now argues that the brain works like a telegraph. This model was popularised by physicist Hermann von Helmholtz in the mid 1800s. The IP model of the brain can be traced back to the mid 20th century. Epstein cites John von Neumann (mathematician) and George Miller (psychologist) as being particularly influential in its development. His conclusion is that it is as misguided as the hydraulic and telegraphy models of earlier times.

If Epstein is correct, his argument has significant implications for the world of artificial intelligence. If humans are not information processors, with algorithms, data, models, memories and so on, then how could computing technology be programmed to become artificially intelligent? Is it even possible with current computing architectures? (*) There has been no successful ‘human brain project’ so far using such a model. I’m convinced (as both a computer scientist and psychologist) that there never will be.

However, I disagree with what I interpret as Epstein’s (applied) behaviourist view of human intelligence. The argument that we act solely on combinations of stimuli reinforced by the rewards or punishment that follow has been thoroughly debunked (+). There is a difference between explaining something and explaining away something. The behaviourist obsession with explaining away rather than attempting explanations of mental events is a serious blind spot to progress. As serious as the obsession with the IP model, to the exclusion of other possibilities, exhibited by many cognitive scientists.

Living together in perfect harmony on my bookshelf - some of the many psychological traditions.
Living together in perfect harmony on my bookshelf – some of the many psychological traditions.

Just because we can’t currently say how the brain changes in response to learning something, or how we later re-use this knowledge, doesn’t mean that the task will always be impossible. It certainly doesn’t mean that our brains don’t have biological analogues of memories or rules. Declarative and procedural knowledge exists, even if there isn’t a specific collection of neurons assigned to each fact or process we know.

Furthermore, the limits of our current understanding of brain architecture doesn’t invalidate the IP paradigm per-se – at least for partly explaining human intelligence. We shouldn’t be surprised at this. After all, blood circulates around the body – and brain – using hydraulics. This earlier model of how the brain functions therefore isn’t completely invalid – at least, at a low-level. It may therefore turn out that the IP model of intelligence is at least partly correct too.

Epstein finishes his essay by saying asserting “We are organisms, not computers. Get over it.” He’s right – up to a point. But the explanations (or explaining away) he offers are partial at best. Psychologists from all traditions have something to add to the debate about human intelligence. Discarding one approach solely on the grounds that it can’t explain everything that makes up human intelligence is just silly. And that’s something which Epstein definitely needs to get over.

 

(*) I asked the same question at the end of Brainchildren – Exploding robots and AI. I’m still not ready to answer it!

(+) For example, see Dennett’s essay Skinner Skinned in Brainstorms.

Transplant +161: Bloody neutrophils

Bloody neutrophils. Bloody absence of neutrophils, actually.

I’ve been feeling really good for the last week or so. Gnu has emerged from hibernation and I’ve racked up a hundred or so very pleasant miles in him across Derbyshire. I’ve survived a third PT session in the gym which involved a punchbag. Very cathartic. I managed a six-mile walk around the tramway trail at Calke Abbey on Saturday without ill effects and, good Liberal Democrat that I am, I’ve been out delivering Focus leaflets. So the call I got yesterday morning from the hospital was unexpected.

Calke Abbey
Calke Abbey – a view from the old driveway.

The conversation went something like this.

“Hello Mr. Holyoake. Are you feeling well?”

“Yes, very. Thank you for asking.”

“I’m calling about your blood tests. Your neutrophil count is low, so you’re very vulnerable to infection at the moment. Are you sure you’re feeling well? If you are feeling even in the least bit unwell you need to come to the hospital immediately so we can get antibiotics into you.”

“I’m feeling fine. I feel better than I have done since the transplant. (Pauses, while making sweary noises in my head.) How low are they?”

“Well, they’re at … 0.14. We need to give you a course of GCSF injections immediately …”

Anything below 0.5 is considered severely neutropenic. No salad, blue cheese or pâté for me for the next few days! I’d hoped that I’d left such concerns behind after finishing with chemo last year, but it appears that my optimism was misplaced. The hospital (and other SCT survivors) have told me that it’s not unknown for this to happen. I know from past experience that the injections will sort the problem out, in the short-term at least. I’m slightly less panicked today than yesterday about what will hopefully be a minor setback.

However, there’s another wrinkle in this story. GCSF (Filgrastim) injections are (as far as I’m aware) the only way to get a haematology patient’s neutrophil count back up quickly, to protect us from life-threatening infections. (With a neutrophil count of 0.14, pretty much anything could be a life-threatening infection.)

Because of this, Filgrastim is on the WHO’s list of essential medicines. It should always be in stock.

The hospital pharmacy were only able to dispense three of the five injections I need. The other two will have to be collected separately on Friday afternoon. If the medicine supply chain is already struggling, it doesn’t fill me with confidence that it will work at all in the event of a catastrophic no-deal Brexit.

Are you listening, Pauline Latham MP, and all of your fellow travellers in the ERG? (I know the answer to that question – it’s no.)

Brexit stockpiling: I’ve got carrots and olives and I swear there’s no guns

Last week I was approached by Chris Doidge from BBC Radio Derby. He asked me if I wanted to be interviewed about my no-deal Brexit stockpiling plans. I agreed and we talked last Thursday. Unsurprisingly, the news surrounding the disastrous A52 redevelopment project meant that it wasn’t broadcast until yesterday morning. It’s available on BBC Sounds for around the next four weeks if you’d like to listen to what I said (1 hour 15 minutes in).

Faint praise for the interview included these gems from my daughters:

Listened expecting to cringe throughout but you don’t sound like you’ve totally lost touch with reality so congratulations.

So it’s a no to the underground bunker then?

The BBC later reported that Michael Gove had been warned – yet again – about the appalling consequences of a no-deal Brexit on food supplies. Then there’s also this – taken from the 31st January blog post of Riverford founder Guy Singh-Watson. I’m sure that no-one, whether they voted leave or remain, voted for food riots.

Riverford founder Guy Singh-Watson on the misery of planning for a no-deal Brexit
Riverford founder Guy Singh-Watson on the misery of planning for a no-deal Brexit and his concern over possible food riots.

I’d therefore argue that evidence from the experts suggests I continue to have a far more lucid grip on reality than that the Tory leader of Derbyshire County Council.

With Theresa May having disgracefully kicked the “meaningful” vote can down the road for at least a couple of weeks this afternoon, I’m going to continue stockpiling for the moment.

 

(*) Thank you to Jessica for providing the headline for this blog article – a very neat precis of what I said …