Over my cornflakes this morning, I read Ben Hoyle’s interview with Tim Cook, CEO of Apple, in The Times Magazine.

This was one of those interviews which is sort of interesting but doesn’t really say much. Though I was quite taken with this description of Apple’s canteen where the cutlery is hidden from view in an illuminating example of form over function:

You can’t tell what the chefs are cooking because there are no menus on display (the options are on your phone if you’re an employee). You don’t seem to be able to pay cash for anything and there are no sauce sachets or eating utensils to be seen unless you know where to look (they’re with the other unsightly essentials like bottled drinks and napkins, sunk out of sight in smooth, curved central islands reminiscent of giant iPods).

What really struck me about this interview was the weird cognitive dissonance in the tenth paragraph. In this paragraph, Hoyle points out that:

Apple’s App Store is “curated” to the extent that you (and your children) won’t find hate speech or pornography on there.

That is, Apple – for better or worse – prioritises its values over the freedom of its customers to easily use the platform for activities which meet with disapproval from Apple. I wish this (puritanical?) attitude had been used to challenge in this bit of the same paragraph:

Apple has regarded privacy as “a basic human right” for a long time and “built the company around” that belief. The sprawling, intimate personal data profiles that companies like Facebook and Google compile “shouldn’t exist”, Cook thinks.

Cook claims that Apple is built around privacy. Yet, while Apple is happy preventing access to hate speech on the App Store, it actively promotes the Facebook app despite it asking for user permission to build data profiles which Cook says are antithetical to everything Apple stands for.

This seems a really odd moral position to me: if your company is reputedly built around one “basic human right”, why allow apps which violate that fundamental belief and ban apps which contravene less dearly held standards? The answer seems fairly obvious to me: the Facebook and Google apps are among the most popular, and are core to the iPhone experience. But can you really claim something is a cornerstone value if you ignore it to sell more phones?

I was also a bit riled up by this ludicrous comparison:

On cybersecurity … the company also protects its FaceTime and Messages apps with end-to-end encryption unlike, say, Google’s standard Gmail.

Why compare a closed messaging system, where end-to-end encryption is easy, with an open standard like email? That reads like a line supplied by Apple. It should have been challenged by asking if Apple’s iCloud email service protects messages with end-to-end encryption, which of course it does not.

There are a lot of things that Apple does extraordinarily well. It is evidently one of the corporate success stories of our time and has inspired phenomenol brand loyalty among a huge population of users. But it isn’t perfect.

Much of the media, and Hoyle’s article is no exception, seems far too credulous when it comes to Apple. Coverage of Apple would be much more satisfying if it showed a degree of balance or at least an attempt at challenging some of the more outlandish media lines rather than simply repeating them verbatim.

The picture of Tim Cook at the top of this post was uploaded to Flickr by Fabio Bini, and is used here under its Creative Commons licence.

The Economist’s data team has today published a blog post called “How much would you pay to keep using Google?” Unusually for The Economist, the headline isn’t really an accurate representation of the contents, which actually discuss research findings related to the amount people would have to be paid to give up using search engines in general.

But the original question got me thinking. A couple of years ago, I’d have responded with a fairly substantial sum. These days, I’m not so sure. I wonder what that says about the state of the company?

Google used to be the only decent search engine. That is no longer true. A couple of years ago, I decided to see if it was possible to go all-in on Bing. Ironically, this was somewhat inspired by Matt Cutts, formerly of Google, who gives himself 28-day challenges to test assumptions and better himself. Surely, I reasoned, it can’t be as bad as people make out, nor as bad in daily use as an occasional search to try it out makes it seem. I switched my default search engine to Bing in Chrome and on my mobile.

And do you know what? The vast majority of the time, it is perfectly competent. On very rare occasions when I’m struggling to find something I also try searching on Google: I’d say 75% of the time, I also fail to find what I’m looking for there. I’d also say, without any proper data to back up the assertion, that Bing’s results seem less replete with spammy useless links than Google’s. And Bing’s rewards scheme buys me an occasional coffee. I don’t think I’d pay for Google search.

But of course, Google provides more than just search. Would I pay for other components of their offer?

Would I pay for Gmail? There are perfectly decent alternatives to Gmail, and I rarely use my actual Gmail address but forward stuff to it from elsewhere, so redirecting future mail wouldn’t be a problem. Moving the archive would be a pain. I’d probably pay a small fee—a pound a month?—just to avoid the hassle.

One service I would definitely pay for is Google Maps. I use Google Maps every day and have not found anything that can even begin to compete. Back in December, Justin O’Beirne wrote a great essay on Google Maps’s moat—the content and time barrier which keeps it well ahead of competitors. On these terms, I guess Google Maps is probably the most “valuable” bit of Google to me.

Google Drive is great, but OneDrive is pretty great too. Chrome is my current default browser, but I’d happily switch to Firefox. Google Calendar is actually quite irritating (especially since ‘quick add’ was removed) and I use it only because it’s handy. I like my Android phone, but I’d get by on iOS. I’d be sad to lose my Chromebook, but Windows laptops aren’t quite the horror shows they used to be.

I enjoy watching occasional Youtube videos, but I wouldn’t really miss them if I couldn’t watch them any more. I use Google Photos, but I also upload all of my photos to other cloud services, at least in part because I don’t trust Google not to shut down Photos when it turns its attention elsewhere (à la Google Reader or Google Notebook, both of which closed while I was an active user).

More recent Google developments (Home, Assistant, Allo, Duo, Now) have totally passed me by.

Jeff Jarvis used to talk about “livin’ la vida Google” to describe his complete immersion in the Google universe. A couple of years ago, I’d have put myself in a similar category, but no longer. I am only one person, and I’ve no idea how ‘typical’ I am in this context, but I wonder if my change in behaviour represents a wider portentous shift for Google’s fortunes?

The photo at the top was posted on Flickr by Sigurd Magnusson, and is reproduced here under its Creative Commons licence.

I usually try to avoid ‘grumpy’ columns in magazines. As a general rule, they are not very interesting and are not nearly as funny as the author intends. Turning a ‘moan’ into interesting writing is a tricky skill to pull off.

All of that aside: In 1843 magazine, Adrian Wooldridge recently wrote about irritating announcements on public transport:

Some companies seem to revel in redundancy. In the railway world Amtrak is the champion of verbosity. Recorded announce­ments on its trains proclaim the arrival of each station with a peroration ending in a request to “please take this time to look about you and collect your bags”, as though the majority of passengers were otherwise likely to canter off the train in a spiritual ecstasy, leaving their material possessions in their wake.

This complaint touched a nerve. When I was commuting to London on a weekly basis a few years ago, there was one particular train guard whose name became lodged in my memory, so annoying were his announcements. His tone tended to convey a weary sense of superiority: it was with some mild irritation that he reminded passengers to check that their tickets were valid for this particular service, as though only a moron could be confused. He spoke extremely slowly, as though he had been told in training not to speak too fast and had overcorrected. And, most irritatingly of all, he seeemed intent on lengthening every announcement to the greatest possible extent by including superfluous words.

Peterborough would never be the ‘next stop’; it would inevitably be ‘the next station stop at which our service will be calling this morning’. Passengers should not merely content themselves with ‘reading the displayed safety instructions’; rather they should ‘be sure to fully familiarise themselves with the safety information cards displayed on the walls of the vestibules at the end of every carriage on board this service’. Customers should not simply ‘have tickets ready for inspection’; they should ‘be aware that a full ticket check will now take place in all coaches, starting from Coach B at the front of the train, and ensure that they have all tickets, travel documents and railcards to hand both at their seat and when moving around the train.’

The verbosity was almost too much to bear. So while I disagree with Adrian’s preference for not knowing the names of service workers and wearing headphones through safety demonstrations on aircraft, I find it hard not to have a little sympathy with his complaints about excessively loquacious train guards.

As an aside, on a recent train journey, the guard issued the typical reminder that passengers should “take all of their personal belongings with them”. Somebody loudly responded that this wasn’t practical, as most of their personal belongings were at home rather than on a train. I’ll laughed quite loudly, despite myself.

The image at the top is of a Virgin train at Brighton station. The full version was posted on Flickr by Matt Davis, and I’ve reproduced a cropped version here under its Creative Commons Licence.

The latest thing at Caffè Nero… and very refreshing it is, too.

I recently finished reading Don Bartlett’s translation of A Death in the Family, which is the first volume of Karl Ove Knausgård’s radically honest autobiography. It took me a long time to get through this book (around three months) because I found it so intense that I had to read sections at a time, interspersed with other books. Nonetheless, I thought it was a masterpiece.

Roughly halfway through, Knausgård writes:

There is no one who does not understand their own world. Someone who understands very little, a child, for example, simply moves in a more restricted world than someone who understands a lot. However, an insight into the limits of understanding has always been part of understanding a lot: the recognition that the world outside, all those things we don’t understand, not only exists but is also always greater than the world inside.

This caused me to reflect for quite a long time and stimulated a couple of thoughts to jot down here.

The description of people understanding their own world and being restricted to the world they understand is fascinating. I think there are lessons in that formulation for public health. People frequently make choices which are, by any objective measure, bad for them: smoking, refusing vaccinations, drinking a G&T while blogging. But taking action which is objectively harmful isn’t necessarily irrational, and we often forget that.

If someone’s understanding of their world is that vaccinations cause harm to children, then refusing vaccination is a rational choice in line with their understanding. Their understanding is wrong, but they are acting rationally within the limited world in which they move. If we are to effectively influence the behaviour, then we need to inhabit the world to understand the rationality of the choices people are making. Unpicking the reasons for the incorrect understanding and setting about correcting it is likely to lead to greater success than lecturing people.

At work, there is a sign in the lift which reads “Could you have taken the stairs?”. The answer for me is invariably “no”—I only take the lift when I’m unable to take the stairs—and every time I see the poster I get mildly annoyed at its accusatory tone. It also seems unlikely that it changes anybody’s behaviour, given that it is only seen after someone has decided not to take the stairs. It’s a poster that doesn’t have any effect on anyone’s understanding, nor does it expand anyone’s worldview.

I realise this is a fairly incoherent ramble (see also the reference to drinking and blogging), but I suppose my point is that public health interventions should try to be less preachy and more practical.

In professional life, it isn’t uncommon to hear people imploring other people to ask questions if they don’t understand something. “There are no stupid questions” and “If you’re thinking it, someone else is thinking it too” are commonly heard refrains. And yet, professionals often remain frightened to ask questions which they think might reveal a degree of ignorance.

A few years ago, after a particularly tense meeting which had featured the world “I really don’t understand what you’re talking about”, a former supervisor gave me a one-to-one aside of valuable advice which they said it had taken many years to learn: “If someone is coming to talk to me and is so poor at pitching what they say that I can’t follow it, it is my professional responsibility to politely challenge that by asking them to explain themselves. It solidifies my reputation as someone who is engaged, intelligent and listens to what people say.”

This made me pay much more attention to my own and others’ reactions to people asking questions. The first thing I noticed was the frequency with which, when challenged, people often weren’t able to explain their waffle. This is useful because it helps people to make a value judgement about the rest of what someone is trying to tell them. The second thing I noticed was that when people could explain, they were usually happy to do so, and altered the rest of their ‘pitch’ to a more appropriate level. The third thing I noticed was that my respect for the person who asked the question generally increased.

This completely changed my perspective, and I now regularly ask questions which I’d previously have thought might make me look stupid. This took an effort at first, of course, but now comes naturally. Sometimes the questions I ask are bloody stupid and I should know better—but rarely, and when it does happen, it at least gives people a laugh. I don’t know if it’s bolstered my reputation, but it has certainly meant that there are lots of things I now understand that would have otherwise passed me by.

“An insight into the limits of understanding has always been part of understanding a lot”.

I took the photo at the top of this post at Charles de Gaulle airport. It is a chandelier, which has absolutely no relevance to the content of the post. I just thought it was quite pretty.

A couple of years ago, I wrote a post for the Fuse Open Science Blog about the system failures which lead to patients ‘inappropriately’ presenting at A&E, and how this is often blamed on patients who are expected to self-triage with a high degree of accuracy. I’ve thought of this today because it popped up in my Facebook ‘memories’.

This has prompted a couple of completely disconnected thoughts.

My first thought is that what I wrote then remains true today, and has become even more relevant with ever-increasing pressure on NHS Trusts. Effective triage of patients to the ‘correct’ NHS services is a nut that remains stubbornly uncracked.

More money has been ploughed into putting GPs in A&E departments, despite mixed evidence on cost and patient throughput. Some companies are experimenting with triage chatbots for the NHS which feels to me like an unlikely solution to the problem of sorting acutely unwell patients. The NHS Choose Well campaign keeps steaming ahead at various levels of the NHS as though doing more of the same will result in a completely different outcome.

Anecdotally, clinical colleagues tell me that last winter was ‘better’ than others in recent years, in as much as A&Es were over-filled with patients who should be there rather than patients who shouldn’t be there. Of course, that means departments are more pressured. Perhaps the fear of long waits and ‘chaos’ puts off ‘inappropriate’ attendees. I’m certain that it puts off some ‘appropriate’ attendees and that this will, at least in a very small way, have contributed to excess winter deaths for 2017/18.

My second—unrelated—thought is that I have absolutely no memory of writing or publishing that Fuse article. I mean, I know I wrote it, but I have no memory of constructing it, or of looking up the stuff about Joseph Hodgson and drawing a parallel between misuse of historical charitable hospitals and the modern NHS.

I’m always bad at remembering things I’ve worked on in the past, but to have such a complete absence of any memory for something I wrote (and clearly put thought into) only 24 months ago is remarkable even for me.

I can only assume I was knackered when I wrote it… which would also explain the slightly crap call-back pun in the last line. I can see what I was trying to do, but reading it now, I think it slightly missed the mark.

The picture at the top is a cropped and edited version of a photo published on Flickr by gwire. I’m using it under its Creative Commons licence.

Taken by Wendy.

Last week, I read this remarkable story about a new cruise ship by Oli Franklin-Wallis in Wired, and have been thinking about it ever since:

Symphony of the Seas – which, on its maiden voyage from Barcelona in March 2018 became the largest passenger ship ever built – is about five times the size of the Titanic. At 362 metres long, you could balance it on its stern and its bow would tower over all but two of Europe’s tallest skyscrapers. Owned and operated by Miami-based cruise line Royal Caribbean, it can carry nearly 9,000 people and contains more than 40 restaurants and bars; 23 pools, jacuzzis and water slides; two West End-sized theatres; an ice rink; a surf simulator; two climbing walls; a zip line; a fairground carousel; a mini-golf course; a ten-storey fun slide; laser tag; a spa; a gym; a casino; plus dozens more shopping and entertainment opportunities.

Cruise ships mean two things to me.

Earlier this year, I went on a ‘mini-cruise’ from Newcastle to Amsterdam aboard a DFDS ship. The journey was an overnight 15 hour or so thing, so certainly not equivalent in any way to spending weeks at sea on the world’s biggest cruise ship. The rationale for this was that I fancied a last-minute break and couldn’t find a cheap flight from Newcastle, so went on a cheap boat instead, spent a day in Amsterdam, and took a cheap flight from there. This worked remarkably well, and I’d do it again.

This was the first time I’d been on an overnight boat since our annual family camping trips to France when I was a child. Prior to going, I’d sort of thought in the back of my mind that I might be the sort of person who might one day enjoy a proper cruise. This experience put me off.

The ship was lovely, and I was particularly impressed by the cabin. I had expected a pokey bunk-bedded hovel but was actually rewarded with a fairly large space which looked not unlike a Travelodge room, with an en-suite bathroom. The food on board was also much higher quality than I would have expected. But I am somebody who likes to wander—and even with only 15 hours on the ship, I was itching to get off and explore. Exploring the ship felt a bit constrained.

It was silly of me not to realise this in the first place. Wendy and I ruled out going to an idyllic holiday resort last summer for the sole reason that it was located on a main road along which walking was not advised, so we couldn’t ‘go for a wander’ without catching a bus or taxi somewhere first. I hadn’t really clocked that ‘going for a wander’ wasn’t really a go-er on a ship.

While the Symphony of the Seas is ridiculously bigger than the ship I was on (it’s more than twice as long and can take four times as many passengers across twice as many decks), I still think I’d feel ‘cooped up’ pretty quickly. So I don’t think I’ll be going cruising anytime soon.

My other relationship with ships is professional. One of the more esoteric parts of my role as a Consultant in Health Protection is that I am the designated Medical Officer for a number of ports. This gives me certain legal responsibilities relating to ships and the health of their crew—most of which are thankfully delegated to people much more expert than me. But just imagine how complex an outbreak of norovirus or Legionnaire’s disease could get on a ship as huge as Symphony of the Seas. I was fascinated to read in Oli’s article about some of the steps taken to mitigate the risks:

“The level of hygiene is extreme,” Yrjovuori announced, as we passed a hand-washing station. Though ship-wide outbreaks of sickness make the news at least once a year, the total number of passengers who fall ill is a fraction of one per cent. But close quarters enable outbreaks, so sanitation regulations at sea are stringent. Every part of the ship, from lift buttons to the casino’s chips, are sanitised daily; interior materials have to stand up to the high level of chlorination from the constant cleaning. Rubbish is frozen in vast storage containers to slow bacteria growth and is only removed in port.

Fascinating stuff… perhaps we could even try and replicate some of it on land!

The pictures in this post are my own from the above-described ‘mini-cruise’ adventure. The pictures in the Wired article are a great advert for the power of print, looking far more arresting as double-page spreads than as on-screen images.

Spring is definitely on the way once the cattle return to the Town Moor… and they’ve been here for a little while now!