Lessons in communicating uncertainty & complexity

Over the last year or so, I have really enjoyed reading whatever article Ed Yong has written for The Atlantic. It’s not just the degree of care that he puts into writing his articles, it’s also the fact the he is very good at explaining complex problems in simple terms.

His latest article is entitled The 3 Simple Rules That Underscore the Danger of Delta. It boils down the interaction between vaccines and the virus into 3 simple rules as follows:

  1. The vaccines are still beating the variants
  2. The variants are pummelling unvaccinated people
  3. The longer Principle No. 2 continues, the less likely No. 1 will hold

More than these simple rules, however, is the way these ideas are put forth. I particularly like how he balances complexity vs clarity. Another writer who does this extremely well is Zeynep Tufekci. As someone in a similar position (but with a far smaller audience), I’m trying my best to learn how to communicate uncertainty & complexity from writers like Yong & Tufekci.

I hope The Atlantic will forgive me in quoting one paragraph from the article in its entirety. It describes our problems dealing with low-probability events that have far-reaching consequences.

The discussion about vaccine-beating variants echoes the early debates about whether SARS-CoV-2 would go pandemic. “We don’t think too well as a society about low-probability events that have far-reaching consequences,” Majumder told me. “We need to prepare for a future where we are doing vaccine rollout again, and we need to figure out how to do that better.” In the meantime, even highly vaccinated nations should continue investing in other measures that can control COVID-19 but have been inadequately used—improved ventilation, widespread rapid tests, smarter contact tracing, better masks, places in which sick people can isolate, and policies like paid sick leave. Such measures will also reduce the spread of the virus among unvaccinated communities, creating fewer opportunities for an immune-escape variant to arise. “I find myself the broken record who always emphasizes all the other tools we have,” van Kerkhove said. “It’s not vaccines only. We’re not using what we have at hand.”

It goes without saying, but we really need to do something about this.

Town & Gown 10k

A few weeks ago—in a moment of madness—I signed myself up for the Town & Gown 10k run here in Oxford.

I am not a runner. For the record, my normal definition of a jog/run is ‘ambling along taking pictures of interesting things’.

I also know that I will never run a marathon or even a half marathon, for the following reason: the numbers are wrong! Instead of running 40km for a marathon, and 20km for a half marathon, you have to run (approximately) 42km and 21km, respectively. Now, before you sharpen your pitchforks, I know there are historical reasons for it. They probably even make sense in some weird historical way. All I’m saying is, the numbers are inelegant, mmmkayyy?

Anyway, back to the run itself which took place last Sunday, the 27th of June 2021.

Due to restrictions imposed by the virus-that-shall-not-be-named, the runners were split into different groups, or waves, based on starting times. I was assigned to wave 1a by virtue of my excellent performance in previous runs expected finishing time of 2 hours.

At 8.30am on Sunday, I therefore made my way to the warmup area, past a speed limit sign that read 5mph. Well, no danger of me exceeding that, I thought!

The warmup itself was brief but fun. Apart from the usual stretching routine, the event host (who apparently is a Bollywood dance instructor) also led us on a Bhangra-inspired warmup routine:

After that, it was a short walk to the starting line. The runners were released in pulses of 10 people to avoid overcrowding. And so began my first 10k run…

The run itself was nice, taking us along closed roads past many beautiful buildings in Oxford. I ran the first 5km diligently, but then did my usual stuff of stopping to take pictures along the way. What can I say, old habits die hard.

Prior to this event, the longest run I’ve ever participated in was a 5km one, but I’ve done 7km runs before in my own capacity. So when I saw the sign below, the following words from Samwise Gamgee somehow crossed my mind:

If I take another step, it’ll be the farthest away from home I’ve ever been.

Samwise “Sam” Gamgee

Ignoring my tingling Hobbit senses, I shouldered on and eventually finished the run in 71 minutes, enough to earn me 1,876th place out of 2,045 people who actually finished the race.

(bows down for applause)

Below is a picture of me at the run:

Wait, sorry, that was from the week before. Dang it!

Here’s the correct picture:

Epilogue

Naturally, one might ask if I plan to take part in further runs. The answer is: probably not. Like I said, I’m not a runner, and my feet actually hurt like hell after the run. Having run through the Oxford city centre, I think it helps to have a really nice setting around you to take your mind off the actual pain of running. But it can’t beat the simple pleasure of jogging/walking in the park next to my house, taking pictures of wonderful things that catch my eye (like the snail above).

Thus endeth my first, and likely my last, 10km run.

Thank you for reading.

Balancing rights & responsibilities

My friend Dr Khor Swee Kheng convinced me to turn one of my previous blog posts into a proper newspaper column, so I did. Below is the article entitled ‘Balancing rights & responsibilities‘, first published in The Star on Wednesday, 23 June 2021:

Balancing rights & responsibilities

The rights and responsibilities of medical students appear straightforward and uncontroversial, but this issue recently surfaced after Universiti Malaya stopped a medical student from taking the second year exams because this student was unvaccinated.

Some reports indicate that this student had previously refused a Covid-19 vaccine for unclear reasons. Fortunately, this student is an extreme outlier and does not represent the vast majority of medical students and doctors.

The exact circumstances of this case do not matter for the purposes of our article, as we want to ask a much broader question with ethical and policy implications: Should a university be allowed to bar a medical student from taking an exam if he or she refuses the Covid-19 jab for no valid reason (such as a history of severe allergies)?

Indeed, this question raises a variety of subsequent questions, like “Should patients be allowed to decline a doctor if the doctor is unvaccinated?” or “Should the Malaysian Medical Council deregister a doctor who is clearly anti-vaccination?”

Let’s answer the original (and simpler) question, as a basis for answering the subsequent (and more complex) questions.

We both agree that Faculties of Medicine in any university can, should and must bar a medical student from exams if they refuse the Covid-19 vaccine.

Highly respected fraternity

There are several reasons why we hold medical students (and doctors) to a higher standard compared to other professions.

One, society is sensitive to a doctor’s influence (for both right and wrong reasons), and this influence must be used in positive and responsible ways.

Two, doctors are frequently the leading proponents of science, evidence and rationality, and they must maintain their leadership in the face of anti-science and anti-truth movements around the world.

Three, medicine is a profession with strict ethical codes and professional standards, and doctors must uphold these codes and standards.

Today’s medical students are tomorrow’s doctors, so they too, must also be held to these higher standards.

To be absolutely clear, we believe that it is equally important to inform and educate people into getting vaccinated, rather than coerce them.

Education, knowledge and information are not mutually exclusive from our hard stance on exam bans for medical students who refuse vaccinations.

We are also firm believers in the benefits of vaccination and call on everyone to register for vaccinations as early as possible.

We are not saying that doctors are the most important members of society – indeed, nurses, pharmacists, paramedics, allied health professionals, technicians and hospital cleaners are arguably more important than doctors, even in a small hospital.

However, for reasons both good and bad, doctors are seen in a different light and therefore have greater responsibilities to society.

Attitude matters

Being a good doctor is not just about securing good grades.

A doctor’s attitude (towards knowledge, his profession and with other people) is far more important than merely good grades.

For example, let’s imagine a doctor who doesn’t believe in the importance of hand hygiene and handwashing.

That disbelief could be a deeply held personal conviction, but is contradictory to science, evidence and professional standards.

Handwashing can be substituted with vaccines or safe childbirth practices, as examples where a doctor’s personal beliefs must be consistent with prevailing science, evidence and professional standards.

In other words, the doctor’s right to personal beliefs must be balanced with his responsibility to follow the science, evidence and professional standards.

A second example is the doctor who refuses to attend to a medical emergency because it will disrupt his sleep.

It may seem preposterous, but this doctor argues that his right to rest overcomes his responsibility to save a life.

Society does not accept this, and indeed the doctor can be sued for criminal negligence.

In other words, the doctor’s right to rest must be balanced with his responsibility to save lives.

The bigger question is, where does the right of a medical student (or a doctor) stop and his responsibilities begin?

Aren’t we impinging on that person’s right to become a doctor simply because his or her beliefs aren’t aligned with those of modern medicine?

Well, society “impinges” on an individual’s professional rights all the time, because professional rights are never absolute and the public interest is more important than personal interest.

For example, anyone can say they want to be a lawyer, accountant, car mechanic, taxi driver or hawker, but societies have agreed that governments can enforce licences, laws, regulations and standards to ensure that society is protected from any incompetence or malice.

In the case of medical students, their right and privilege to practise medicine clearly must be balanced with their responsibilities to look after their patients.

Protection for all

During the Covid-19 pandemic, it is reasonable to expect that healthcare professionals looking after the most vulnerable members of society should be vaccinated.

Vaccines protect them and their patients.

Medical students should also be vaccinated as their clinical training involves direct interactions with patients.

Indeed, some have advocated for medical students to be considered frontliners and to receive the first vaccines.

But what if a doctor refuses to be vaccinated?

It is important to start by understanding the reason(s) for his refusal, and to manage all the reasonable reasons.

But after that, compassion and understanding must have limits, especially when public interest is at stake.

If push comes to shove, Malaysia should consider making it mandatory for all healthcare professionals (HCPs) to be vaccinated to continue delivering clinical services (unless there are valid reasons not to be vaccinated).

This will protect the HCPs, provide psychological comfort that their colleagues are all similarly vaccinated, protect their patients, and perhaps acts as a litmus test to identify HCPs that have unusual beliefs.

However, this is controversial and may have unintended consequences.

Therefore, it is a nuclear option to be deployed only as an extreme last resort.

Nonetheless, it should remain a viable policy option.

To return to the original question concerning rights and responsibilities of medical students (and doctors), we can conclude by saying that any nobleness in being a doctor comes from the emphasis on our public responsibilities over our personal rights.

People who choose to become doctors must perhaps make more than the usual personal sacrifices to help their patients heal.

In the case of medical students who refuse vaccinations for non-valid reasons, they might be better off looking for a new profession.

Museum of Natural History & Pitt Rivers Museum

The Oxford University Museum of Natural History, not to be confused with the Natural History Museum in London, first opened its doors in 1860 and has delighted nerds (like me) ever since. Even before it was opened, it had hosted what subsequently became known as the Great Debate, in which Samuel Wilberforce, Bishop of Oxford, matched wits with Thomas Huxley on the topic of Charles Darwin’s theory of evolution by natural selection.

These days, the approach from the lawn is marred somewhat by barriers erected due to ongoing construction work at the site of Reuben College, the latest addition to this collegiate university. However, one can still see some Megalosaurus footprints on the front lawn, made from casts of fossilised prints discovered at Ardley Quarry, Oxfordshire in 1997.

This museum is probably my second favourite place in the city (after Blackwell’s). Pre-pandemic, I’d sometimes drop by for a short while to take a look at the dinosaurs, have a light lunch, and read at the cafe upstairs.

Like I said, I’m a nerd.

These photos were taken recently when I brought my family along for a visit. We also made our way into the adjacent Pitt Rivers Museum, although the kids were understandably less excited about all the stuff there compared to the dinosaurs skeletons found next door.

A bit about the photos themselves…

After importing them into the Photos app on my MacBook Pro, I decided to be lazy and simply applied the ‘Vivid Warm’ filter instead of making individual edits. I’m still getting used to this new workflow, having used Adobe Lightroom for quite a while, but so far so good.

Enjoy the pictures!

Dua Dekad

The following article first appeared on Berita MCOBA, the official publication of the Malay College Old Boys Association (MCOBA), on 16 June 2021. I’m re-posting it here for my own records.

2021 was supposed to be the year we, the Class of 2001, marked our twentieth year since leaving MCKK. So, like any self-respecting organisation, we drew up our to-do list:

  • Vanity/commemoration project chosen? Yes!
  • T-Shirt designs discussed on WhatsApp? Of course.
  • Appropriate hashtag selected for maximum social media impact? #DuaDekad…BOOM!
  • Money raised to finance all the above? Guys, err…guys? Wait, where’d everyone go?

Unsurprisingly, all our plans went out the window because of the pandemic. To make matters worse, we lost one of our brothers through illness early this year. Al-Fatihah buat Mohd Zulfadhli Faiq bin Baharuddin, semoga ditempatkan di kalangan para solihin.

Having said that, every obstacle can also be an opportunity.

Sure, a virus pretty much shut down civilisation for the 2020/2021 season. But you know what else is like a virus? An idea. According to the famous philosopher Leonardo DiCaprio:

An idea is like a virus. Resilient. Highly contagious. And even the smallest seed of an idea can grow. It can grow to define or destroy you.

So, what exactly is this idea? It’s the notion that one has a bigger role to play in society, a bigger responsibility than just to get good grades, secure a high-paying job, marry a pretty lady, and focus on making money.

Keluar membimbing negara
Maju terus mara

As Form 1 students at the Prep School, we were taught John F. Kennedy’s words: Ask not what your country can do for you—ask what you can do for your country.

With that idea in mind, since the start of the pandemic, our boys have been actively supporting the nation’s frontliners and healthcare facilities.

Initially, this mostly took the form of food packet distribution at the COVID-19 Integrated Quarantine and Treatment Centre (PKRC) 2.0 at the Malaysia Agro Exposition Park Serdang (MAEPS). But in April 2021 when case numbers were rising rapidly and there was a need for manpower at the COVID-19 Assessment Centre (CAC) at Stadium Malawati, Shah Alam, our boys volunteered to help under the auspices of the IMAM Response & Relief Team (IMARET).

Chief of them all is Dr Ahmad Munawwar Helmi; no, this is not even a figure of speech, he literally is the IMARET COVID-19 Taskforce Coordinator! Working tirelessly throughout the pandemic, his efforts have been crucial in giving physical, mental, and emotional support to the nation’s frontliners. +10 points to Ahmad House!

Captain Syed Fayez Idid, a pilot who is ‘on leave’ because of the pandemic, was one of the earliest to join Munawwar at the CAC. In his capacity as team leader, he helped to train new volunteers on top of maintaining the smooth running of the CAC.

Captain Amirul Hijjas raised some money, got his mother to cook some food, and personally drove (by car, not aeroplane) to the CAC to distribute lunch to the frontliners. Some of us, like Hazrul and Azri, took leave from work and donned personal protective equipments (PPE) for the first time in our lives while volunteering at the CAC. Others like Amir chose to contribute lunch packs to the frontliners. Behind the scenes, the rest of the batch conducted their own fundraising initiatives to support all this volunteer work.

For those who aren’t aware, volunteering at the CAC is not an easy task. It can involve lots of time and effort and carries significant risk particularly if you haven’t yourself been vaccinated.

Sure, in the grand scheme of things, these are miniscule contributions compared to the actual effort of fighting COVID-19 by our frontliners. But anyone who has ever done volunteer work knows this: it is not a zero-sum game, every little bit helps!

Therein also lies the beauty of charity.

What do I mean by this? Well, has it ever occurred to you that we only truly keep what we give to charity? Our wealth, our time, our families…none of these will accompany us to the grave EXCEPT for what we have used or given to help others.

Reputation-wise, MCKK is not known for its academic prowess (I hear ‘Intergom’ is the place to be these days). But if I were writing one of those Facebook posts about ’The Importance of Your SPM Results’ for the benefit of our SPM 2020 & 2021 juniors, here’s what I would say to them:

“Your worth is not determined by fast cars, good grades, or the amount of money in your Bitcoin wallet. Whatever your results are, think about how you are going to contribute to society.”

Towards the end of the musical Hamilton, the protagonist Alexander Hamilton asks:

What is a legacy? It’s planting seeds in a garden you never get to see.

So for our #DuaDekad anniversary, we hope to inspire others to volunteer their time, money, and effort to charity. Let this be our legacy, inshaAllah.

Fiat Sapientia Virtus