I Just Heard the Song “Florida Man” on the Big Mo Blues Show

I heard the song “Florida Man” by Selwyn Birchwood on the Big Mo Blues Show on KCCK radio tonight. I updated my post “Gators OMG” by adding the YouTube video to it.

Thoughts on UFOs and UAPs

I was either too sleepy the other night or briefly abducted by extraterrestrials to stay up for the new spin-off TV show, Beyond Skinwalker Ranch. They hired new actors—I mean researchers. The original show, The Secret of Skinwalker Ranch, is actually interesting and I usually watch it. The actors are always firing off rockets into the sky to provoke either the extraterrestrials or the skinwalkers.

One of the cast members is an actual scientist. He’s Dr. Travis Taylor, PhD, an astrophysicist. He’s in charge of firing off those rockets. There’s a Wikipedia article on him. He has several degrees and has written many books. He’s a pretty good actor.

The other night, the show hosted a guest who was the guy who came up with the alternative name for UFOs: Unidentified Aerial Phenomena (UAP). I can’t remember his name but he was used as bait to attract attention from the ranch, which is sometimes conceptualized as being a kind of mysterious living entity, capable of ignoring humans and not creating any weirdness—and at other times causing major atmospheric disturbances and UAP activity that makes everybody on the show say things like: “We’ve got to get Travis’s eyes on this piece of dead animal skin—it’s just crazy!”

I’m not sure how any of the cast can keep themselves from laughing. On the other hand, they’ve managed to involve the Utah state attorney general. He has the same tailor as Johnny Cash, apparently. He supports the actors and seems to know better than to try and upstage any of them. He wants to know what’s flying in the air in his state. Judging from the number of sick and dead mutilated animals strewn around the 512-acre property, my guess is that it’s mainly buzzards.

The show might talk to the guy who recently identified himself as an ex-intelligence official and whistleblower who reports that the federal government is hiding numerous UAPs, many of which have no doubt been crashed on Earth by drunken extraterrestrials, none of whom have ever taken a defensive driving course and are doing hard time in underground prisons in Utah for operating UAPs while under the influence of the Pan Galactic Gargle Blaster, an alcoholic beverage described by researcher Douglas Adams in The Hitchhiker’s Guide to the Galaxy. Try to say that sentence in one breath, I double-dog dare you.

I think the producers of the skinwalker show should consider hiring another actor, Nick Pope, the retired employee of the British Ministry of Defense. He investigated UAPs when they were still called UFOs, which of course made him a laughingstock, but that all changed when the name was changed to UAP. He is now a famous member of the Ancient Aliens team and the only one sane enough to persuade people from actually breaking down the gates of Area 51 during the Storm Area 51 crisis in 2019. He also has a Wikipedia entry. He has never publicly denied successfully completing treatment for Pan Galactic Gargle Blaster use.

Unless the new Beyond Skinwalker Ranch spinoff moves to an earlier time slot, I’ll just have to wait for the reruns. It’s probably not as funny as the original and certainly won’t equal the uproariously hilarious Mountain Monsters (which we can no longer watch because it left cable TV). Only a parody like that can top the current UAP TV program fare.

Sena Films Turkeys Brunching!

Sena caught a couple of turkeys on video, brunching in our backyard garden. They eat seeds and bugs—and probably mulberries dropped by drunken squirrels and other hungry birds. They look pretty nervous. They always look that way but they were probably hearing a dog barking at the time.

In the late morning light, they look like they’re wearing metallic armor. At times, they look entitled and imperious.

We have yet to see any baby turkeys.

Squirrel Feasting on Mulberries!

The other day we saw a squirrel racing all over a tree in our back yard. At first, we didn’t know what kind of tree it was, but it was obvious the squirrel knew it could get a tasty meal from it.

The tree was full of fruit and, after a web search, we think it’s a mulberry tree. Lots of creatures eat mulberries including squirrels. That probably also explains why we see so many bird species flying in and out of that tree.

My Two Cents on the Involuntary Treatment of Tuberculosis and Psychiatric Illness

By now many of us have seen the news headline about the person in Washington state who was arrested and sent to jail for noncompliance with a court order for treatment of tuberculosis. This led to my searching the literature about the connection between court-ordered treatment for psychiatric illness and court-ordered treatment for tuberculosis in Iowa. I’m not assuming that the person who is the subject of the news story has psychiatric illness.

I’m a retired consultation-liaison psychiatrist and the issue of how to respond to patients who refuse treatment for tuberculosis arose maybe once in my career. When the Covid-19 pandemic began a few years ago, I thought of the Iowa code regarding involuntary quarantine of patients infected with Covid-19 infection. I thought it was a situation similar to that of persons infected with tuberculosis. That was an issue for the hospital critical incident management team to deal with.

I found an article relevant to both internal medicine and psychiatry. It is entitled “Can Psychiatry Learn from Tuberculosis Treatment?” It was written by E. Fuller Torrey, MD and Judy Miller, BA and published in Psychiatric Services in 1999. The authors point to the directly observed therapy (DOT) programs in place in several states, including Iowa. Such programs can include positive reinforcement incentives such as fast-food vouchers and food supplements, movie passes and more. They credit the New York experience using DOT with reducing the tuberculosis rate by 55%.

Torrey and Miller point out that many psychiatric treatment programs didn’t offer as many incentives as DOT programs for treatment of tuberculosis. They also say that a “credible threat of involuntary treatment, essential for the success of DOT” often is absent from psychiatric programs.

I was puzzled by their view because of what I saw from our own integrated multidisciplinary program of assertive community treatment (IMPACT) at The University of Iowa Hospitals & Clinics, which started well before they wrote the article. My impression is that it has been very successful. The Iowa Code covers the role of involuntary psychiatric hospitalization in the event of noncompliance as a result of uncontrolled psychiatric symptoms leading to danger to self or others or inability to provide for basic self-care needs.

On the other hand, because of my background in consultation-liaison psychiatry, I wondered about how we might treat someone with both tuberculosis and severe psychiatric illness, the latter of which could make treatment of the former difficult or even impossible.

We can use long-acting injectable antipsychotics to treat those with chronic schizophrenia. They’re not uniformly effective, but they play an important role in acute and maintenance therapy.

But I also forgot about how tuberculosis treatment could be administered to those unwilling to take it voluntarily. I rediscovered that tuberculosis treatment can be given by injection, if necessary, although it’s usually intended for treatment-resistant disease. On the other hand, scientists created a long-acting injectable drug for tuberculosis which was effective in animal studies and which could be a delivery system for non-adherent patients.

And I thought about who would be the responsible authority for administering tuberculosis medications on an involuntary basis. It’s not psychiatrists. It turns out that in most states, including Iowa, the local public health officer is in charge. The CDC has a web page outlining suggested provisions for state tuberculosis prevention and treatment.

Patients with tuberculosis who refuse treatment can be confined to a facility, although it’s not always clear what that facility ought to be. Certainly, I would be concerned about whether a jail would be the best choice.

I don’t have a clear answer for an alternative to incarceration. Would a hospital be better? General hospitals are not secure and there would not be an ideal way to prevent the patient from simply walking away from a general hospital ward. If the patient has a comorbid severe psychiatric illness that interferes with the ability to cooperate with tuberculosis treatment, then maybe a locked combined medical-psychiatric unit (MPU) would be the better choice. Arguably, while an MPU might not be the best use of this scare resource, it’s probably more likely to have a negative pressure isolation room for a patient with both tuberculosis and psychiatric illness. I co-attended with internal medicine staff on The University of Iowa Hospital’s MPU for many years. There are rigorous criteria for establishing such units. The best expert in integrated health care systems I know of would be a former teacher and colleague of mine, Roger Kathol, MD. He is currently the head of Cartesian Solutions.

I’m aware that just because someone refuses treatment for tuberculosis doesn’t necessarily mean a psychiatric illness is present. The critical issue then could become whether or not the patient has the decisional capacity to refuse medical treatment. The usual procedure for checking that would include assessing understanding, appreciation, reasoning, and the ability to make a choice. You don’t necessarily need a psychiatrist to do that. Further, there are nuances and recent changes in the decisional capacity assessment that can make the process more complicated. The New York Times article published in early May of this year, entitled, “A Story of Dementia: The Mother Who Changed,” makes that point based on a real-life case in Iowa, involving psychiatrists at The University of Iowa.

It occurs to me, though, that just because a person is able to pass a decisional capacity assessment doesn’t necessarily make a decision to refuse tuberculosis treatment OK. Letting someone expose others to infection when effective treatment is available doesn’t sound reasonable or safe.

That’s my two cents.

Quenard F, Fournier PE, Drancourt M, Brouqui P. Role of second-line injectable antituberculosis drugs in the treatment of MDR/XDR tuberculosis. Int J Antimicrob Agents. 2017 Aug;50(2):252-254. doi: 10.1016/j.ijantimicag.2017.01.042. Epub 2017 Jun 5. PMID: 28595939.

Most Birds Forget They Ever Met

Some birds pair for life, like swans and bald eagles. Most backyard birds pair up for a season. Mourning doves sometimes mate for life, but their name doesn’t relate to grief when they lose a mate. Their instinct is to procreate and ensure the survival of the species.

They forget each other after every season. But when you just watch them, it’s easy to imagine they’re in love.

Rain Blesses Our Garden Including Evening Primrose

We were very happy when we finally got a little rain the other day. It really brightened up the garden. Sena got some evening primrose. This happens to be one of my favorite flowers. It was one of the many flowers she planted in her big garden at our first house.

The evening primrose I see on the web are mostly the yellow variety. The variety we’ve had is a pale pink color. We were surprised to see that some people warn against planting this in your yard. It’s considered invasive, but we didn’t have any problem with that years ago.

Some say that evening primrose is not intended for human or animal consumption. The Mayo Clinic web page says that, while it’s probably safe to take in pill form in small amounts for a limited period of time, the evidence for its effectiveness for the medical conditions people usually take it for is inconclusive at best. And you shouldn’t use it if you have a bleeding disorder, epilepsy, or schizophrenia.

My very limited web search revealed the rationale for avoiding taking evening primrose if you have schizophrenia was that it might raise the risk for seizures. I saw one Cochrane Database Review from over 20 years ago which said it had no effect on fish oil supplements for schizophrenia. One article from the 1980s suggested that evening primrose oil might increase the risk for seizures in patients with schizophrenia.

The bottom line is you should not ingest it but simply admire its beauty.

First Time for Iced Coffee!

Sena brought home a carton of iced coffee this afternoon. This is our first time trying it. It’s a vanilla flavor brew. It’s pretty good! I always thought coffee had to be hot to be good. And I’ve always taken it black. We both like the vanilla flavor.

A 2012 article on The Daily Meal says New Yorkers drink the most iced coffee. It’s been growing in popularity since 2010.

CDC Updated Recommendations for Covid-19 Vaccine Use

The Centers for Disease Control (CDC) held a Clinician Outreach and Communication Activity (COCA) meeting to discuss updated recommendations for Covid-19 vaccine use on May 11, 2023. You can view the YouTube recording of the meeting and view presentation slides at this link. The meeting was designed for clinicians.

FDA Meeting June 15, 2023 on Strain Selection for Periodic Covid-19 Vaccine

The FDA Vaccines and Related Biological Products Advisory Committee will meet June 15, 2023 from 8:30 a.m.-5:00 p.m. ET “to discuss and make recommendations on the selection of strain(s) to be included in the periodic updated COVID-19 vaccines for the 2023-2024 vaccination campaign. This discussion will include consideration of the vaccine composition for fall to winter, 2023-2024.”

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