Category: current events

Politics on the Brain

I just discovered the news item about 5 Minnesota Senate Republicans who introduced a bill this month seeking to classify “Trump Derangement Syndrome” (TDS) as a mental illness. This is not a new idea, I think, and it targets Democrats as having the syndrome. There’s a big Wikipedia article about the history of the origin of it.

It reminded me of a Dr. Henry Nasrallah’s editorials about “neuropolitics” a term he used in an effort to understand how much politics can affect the human brain. He published a series of 3 articles in the journal Current Psychiatry. The one published in the October 2018 issue is entitled “Neuropolitics in the age of extremism: Brain regions involved in hatred.”

Dr. Nasrallah is a neuropsychiatrist who has an entertaining and thought-provoking writing style. I met him briefly when I was interviewing for psychiatry residency at the University of Cincinnati.

The political situation now is difficult and it makes me wonder even more if there is a problem with the human brain when it comes to politics.

Dr. Nasrallah article 1

Dr. Nasrallah article 2

Dr. Nasrallah article 3

Iowa Bills to Ban Vaccines and Require Vaccine Manufacturers to Waive Immunity Die

This week was what the Iowa Legislature calls funnel week. Today determined what bills stay alive and which one die.

The bills opposing vaccines died for this legislative session:

“mRNA vaccines: Senate File 360 proposed a ban on health care providers administering gene-based vaccines, like the COVID-19 vaccines developed by Pfizer and Moderna. Under the proposal, health care providers who administered vaccines that use nucleic acids like messenger RNA (mRNA) would face punishments of a misdemeanor charge and a fine of $500 for each violation.”

“Vaccine manufacturer immunity: House File 712 proposed requiring vaccine manufacturers waive their immunity from lawsuits over injuries that result from a “design defect” in a vaccine in order to distribute or administer the vaccine in Iowa. Under the 1986 National Childhood Vaccine Injury Act, there is a National Vaccine Injury Compensation Program providing no-fault compensation to individuals and families injured by childhood vaccines. While supporters of the bill said the current compensation program has problems, medical practitioners and advocates said allowing for lawsuits to be filed against manufacturers would prevent vaccines from being available in Iowa.”

Story published in Iowa Capital Dispatch, “Funnel week 2025: What bills are alive, dead at Iowa Statehouse after first deadline” by Robin Opsahl. March 7, 2025.

What Does “Design Defect” of a Vaccine Mean In the Iowa Bill to Require Vaccine Manufacturers to Waive Immunity from Lawsuits?

Beats me. Sorry, just kidding. I’m just a little bleary from looking at the web sites about the definition of “design defect” related to vaccines as it applies to the Iowa bill to make vaccine manufacturers waive their immunity from lawsuits about vaccine related injuries.

I am sympathetic to anyone who in fact has suffered a vaccine related injury.

That term “design defect” has been bugging me for days now and I just found out that this has been the subject of states vs federal legal wrangling for years. I’m not up to explaining all the legalese but there is a really tangled trail of cases in Georgia and Pennsylvania roughly around 15 years ago that ultimately led to a U.S. Supreme Court decision saying, essentially, the Vaccine Injury Compensation Program and the federal Childhood Vaccine Injury Act of the 1980s preempts all state level vaccine design defect claims.

I think that explains why the Iowa bill says that vaccine manufacturers have to waive their immunity from suits if they want Iowans to get their vaccines.

I can hear the groans and shouts of dissent even as I write this. Hey, you can’t make this up. Talk to your legislator or lawyer about it.

I’m not sure why Iowa would want to repeat the grind that Georgia and Pennsylvania went through which led to the conclusion that you can file vaccine design defect claims at the state level and not have to repeat history which would likely lead to any decisions made there being reversed in federal court.

And I’m not sure why any vaccine manufacturer would want to fight that battle in Iowa either. They might just steer around us and take their vaccines elsewhere.

The beginning of the Georgia story.

The end of the Georgia story.

The beginning and the end of the Pennsylvania story.

Vaccines aren’t perfect. They are neither 100% safe nor 100% effective. However, I support having vaccines available to help keep us healthy and the right to choose getting a vaccine. That’s why I don’t support a bill that I believe would make them less accessible.

New Wrinkle on Iowa Bill to Oppose mRNA Vaccines in Iowa

This is a follow up to yesterday’s post about the Iowa legislature’s proposition of a new law that would essentially ban mRNA vaccines in Iowa. I don’t understand the numbers and codes on the new sections, but the new one proposes that manufacturers of vaccines would have to waive immunity from lawsuits arising from “a design defect of the vaccine.”

I’m not sure if that’s addition to being charged with a simple misdemeanor, subject to a $500 fine for administering the vaccine. I oppose this one too because I think it would essentially make vaccines difficult to access and harder to persuade new medical staff to come to Iowa.

There’s going to be a meeting about the bill at 4:30 PM CST. I can’t remember if it’s at the state house or at the Exile Brewing Co. for sandwiches and Ruthie’s beer.

In any case, the comment section is overwhelmingly in opposition to the bill. I saw several comments mentioning that we already have the National Vaccine Injury Compensation Program (NVIP), which is designed to field requests for compensation to those who believe they’ve been injured by certain vaccines. I had not heard of it before. It’s administered by the federal government, Health Resources & Services Administration, which is under the Health and Human Resources department.

There is a nice easy to read summary about the complicated story of vaccine safety and liability at the Children’s Hospital of Philadelphia website. It was reviewed by Dr. Paul A. Offit, MD last year. He attends meeting of the Centers for Disease Control and Prevention, although I think he missed the one last month about the flu vaccine because it was cancelled.

If I see anything earth shaking about the meeting this afternoon on HF712, I’ll make an addendum to this post.

Proposed Bill Would Ban mRNA Vaccines in Iowa

Sena just alerted me to a bill in the Iowa legislature right now that proposes mRNA vaccines (like the Covid vaccine for example) be banned in Iowa. Part of it says that any person who provides or administers such a vaccine would be guilty of a simple misdemeanor and subject to a $500 fine. I do not support it although I also support the right of others to disagree.

The bill advanced out of subcommittee yesterday and I’m not sure how although, admittedly, I don’t know what exactly that means about its chance of being ultimately passed into law. There were hundreds of comments against it. It moves for further consideration to the Iowa Senate Health and Human Services Committee according to a story in the Daily Iowan.

This sent me to the web to find out what other silly laws Iowa has passed. A few of them are below:

“Any person who attempts to pass off margarine, oleo, or oleomargarine as real butter is guilty of a simple misdemeanor in Iowa. This one originated in 1943, but is still in force today.”

“In Marshalltown, horses are forbidden to eat fire hydrants.”

“It is illegal for a mustached man to kiss a woman in public.”

All of the above are on this Iowa State University web page.

The Connection Between Vitamin A and Measles Is Not Just About Carrots

The measles outbreak is big in the news and the issue of the role of Vitamin A in measles reminded me of something I saw back in the 1970s. I was working as a drafter and survey crew assistant for WHKS & Co (consulting engineers in Mason City, Iowa) at the time. As I was working on a drawing, a co-worker walked by my desk and I noticed her skin was the color of a carrot. She was orange. She explained that she and her husband had been taking high doses of beta-carotene, which is a precursor for Vitamin A. She and her husband both worked at WHKS & Co but I think he was home sick that day, from taking too much beta carotene.

So that segues into what I found out about the connection between measles and Vitamin A. The Centers for Disease Control and Prevention (CDC) has a web page on it and cites references for the role of Vitamin A. Vitamin A does not prevent measles. But in children who are severely ill and hospitalized from measles and under a physician’s supervision, age-specific doses of Vitamin A can be given for a limited period of time.

There are two references for the administration of Vitamin A in the context of kids with measles, available through weblinks from the CDC. One of them is the World Health Organization (WHO), which recommends Vitamin A for vitamin deficient children and because measles infection by itself can cause acute Vitamin A deficiency, resulting in xerophthalmia (severe dry eyes). This can lead to blindness.

Usually this is more of a problem in developing countries, but the WHO recommends it even for children in the US.

The other reference is Red Book. This is not the magazine for American women looking for tips on beauty. The Red Book is from the American Academy of Pediatrics and it notes the WHO recommendation to administer Vitamin A to patients “…regardless of their country of residence.”

The caveat is that you can get either not enough or too much of a good thing. Beta-carotene is a precursor to Vitamin A.  Vitamin A toxicity is bad.

And you could avoid all this because there is an effective vaccine for measles. Don’t take my word for it. Talk to your pediatrician.

New Consultation-Liaison Psychiatry Focused Practice Designation in Emergency Behavioral Certification in Emergency Rooms

I just found out about the American Board of Medical Specialties (ABMS) announcement of a new addition to the Consultation-Liaison Psychiatry subspecialty: Focused Practice Designation. It looks like it’s going to be administered by the American Board of Emergency Medicine (ABEM), possibly in collaboration with the American Board of Psychiatry & Neurology (ABPN).

I’m unsure of the nuts and bolts, but on the surface, it looks like it might be a promising way to address meeting the needs of the many patients who appear in hospital emergency rooms.

On the other hand, I’m unclear on whether this might also lead to the addition of yet another layer of medical and psychiatry board maintenance of certification exams and fees. It looks like some boards of medicine and surgery require those who want to pursue the Focused Practice Designation (FPD) specialization route sit for an initial certification exam which would be time-limited followed by something called “continuous certification” which is a form of maintenance of certification (MOC). This often entails periodic exams and fees which many physicians find burdensome and expensive, leading to petitions opposing MOC and finding alternatives to fulfill the continuing education needs in less costly and time-consuming ways. One notable alternative is the National Board of Physicians and Surgeons (NBAS).

I’m not sure why another layer of bureaucracy needs to be added to achieve the goal of ensuring that emergency room patients with mental health challenges have access to mental health professionals. In fact, there is an American Association for Emergency Psychiatry open to membership which includes psychiatrists, physician assistants, psychologists, nurses, social workers and other professionals. However, the goal behind the FPD route is to increase the presence of physicians in the emergency room. This creates a specific and arguably needed role for consultation-liaison (C-L) psychiatrists.

I get the impression the exact way this will be rolled out is under construction, so to speak. Although I can’t find language in the announcements for the new FPD specifically saying that there’s going to be another MOC for C-L psychiatrists, there doesn’t seem to be any language assuring there won’t be. The FPD web page for the American Board of Obstetrics & Gynecology (ABOG) makes it pretty clear—there’s a MOC for that.

Just because you don’t see anything currently on the ABEM and ABPN web sites about MOC being required for the FPD doesn’t mean that it won’t appear in the near future. For now, the ABMS table outlining the differences between the certification requirements for specialty/subspecialty designation and the FDP doesn’t specify extra certification for the FDP for C-L psychiatrists per se.

I’m hoping for the best for patients and doctors.

Girl Scout Cookies Are Safe!

We were out the other day and tried the new Girl Scout Thin Mint Frosties. Sena got chocolate and I got vanilla. We thought they were delicious. Wendy’s partnered with Girl Scouts of the USA to serve them up and it’s a great idea. They’re swirled and topped with a mint-flavored cookie crumble sauce.

We heard that the Girl Scouts would be out selling their famous cookies the same day at booths outside different stores across Iowa including Iowa City, but we couldn’t find them that day. Maybe it was because it was a little cold to be standing outside in a booth. Interestingly today, the girl scout didn’t know this whole idea was a collaboration between Wendy’s and the Girl Scouts of America.

We finally found a website that posted a schedule of when and where the cookies would be selling.

The weird thing is just before Sena left to get some Thin Mints cookies, we found a news story on the web which raised an alarm about whether or not they are poisonous (they’re not), if you can imagine that. People have been buying Girl Scout cookies for years and I’ve never heard of any problems.

So, it occurred to me that even though we’re not employees of the federal government, we could find 5 things to say relevant to the Department of Gustatory Explorations (DOGE) as part of our frivolous investigation of this issue. I think I’ve got that department name right.

  1. It turns out there’s a group called Moms Across America which has partnered with an outfit called GMOScience and they’re calling out Girls Scout of America for selling cookies with “toxic” metals and glyphosate (an herbicide). In their own small, unpublished, non-peer reviewed study, they tested some cookies and found they all had some traces of these substances. They tested cookies including Thin Mints in 3 states which included Iowa.
  2. Snopes investigated and found a number of facts, one of which is that “a child would have to eat 9,000 cookies in a day to approach harmful levels of pesticide or naturally occurring metals.”
  3. The FDA says you can safely eat the Thin Mints and any of the other kinds of Girl Scout cookies. On the other hand, I will not eat cookies containing coconut because it has the consistency of little pieces of cellophane, which I would chew endlessly without ever being able to bring myself to swallow them. This is a personal idiosyncrasy that has nothing intrinsically to do with any food containing coconut.
  4. Don Huber is a retired Purdue University professor of plant pathology who is part of the anti-GMO movement. He’s made many claims which have been criticized and refuted, even by Purdue University faculty members. One of them is that glyphosate causes a number of diseases including Alzheimer’s disease and he claims his ideas are supported by the research of a Maharishi movement expert in yogic flying. By the way there is a Maharishi International University (MIU) located in Fairfield, Iowa. You can learn transcendental meditation there and read about yogic flying (more like hopping) in an interesting 2016 NPR article but you won’t find anything in the curriculum per se on their website about levitation (but you will if you search for the term “yogic flying”). Consequently, you won’t learn dad jokes about this, including but not limited to “Help, I’ve levitated and I can’t get down!”
  5. The Girl Scout cookies and the Frosties taste great.

Well, I think that about wraps it up for DOGE.

Noteworthy Black Psychiatrists on the Last Day of Black History Month

I wanted to give a shout-out to Dr. H. Steven Moffic, MD for his article highlighting the career of a notable black psychiatrist, Dr. Alvin F. Poussaint, MD, who sadly died on February 24, 2025. I’m mortified that I hadn’t heard of him before now.

It reminded me of the time I mentioned another black psychiatrist I had never heard of either, Dr. Chester Middlebrook Pierce, MD, in a post about the book “Our Hidden Conversations” about a year ago.

I wondered if Dr. Pierce and Dr. Poussaint ever met. I looked this up but couldn’t find a definite link.

Dr. Moffic’s essay, in which he mentions antisemitism. also reminded me of an essay also published in Psychiatric Times in 2020 by Dr. Robert M. Kaplan, MD. The title is “Alois Maria Ott: I was Hitler’s Psychologist.”

It gives even more texture to Dr. Poussaint’s views on whether or when extreme racism should or should not be classified as a mental illness. My own residency training experience was marked by being assigned to a patient said to have schizophrenia—who angrily shouted when he saw me, “I don’t want no nigger doctor!” My faculty supervisor didn’t think I should be reassigned to an alternate patient, a decision I’m still ambivalent about.

FDA Announces Clozapine REMS Program Eliminated

As of February 24, 2025, the FDA has eliminated the Clozapine Risk Evaluation and Mitigation Strategy (REMS) program. See the FDA link for details. Below is the announcement.

“Latest Update

February 24, 2025 – Beginning today, FDA does not expect prescribers, pharmacies, and patients to participate in the risk evaluation and mitigation strategies (REMS) program for clozapine or to report results of absolute neutrophil count (ANC) blood tests before pharmacies dispense clozapine. FDA still recommends that prescribers monitor patients’ ANC according to the monitoring frequencies described in the prescribing information. Information about severe neutropenia will remain in the prescribing information for all clozapine medicines, including in the existing Boxed Warnings.    

Although the risk of severe neutropenia with clozapine still exists, FDA has determined that the REMS program for clozapine is no longer necessary to ensure the benefits of the medicine outweigh that risk. Eliminating the REMS is expected to decrease the burden on the health care delivery system and improve access to clozapine. FDA has notified the manufacturers that the clozapine REMS must be eliminated. FDA has instructed the clozapine manufacturers to formally submit a modification to eliminate the Clozapine REMS and to update the prescribing information, including removing mandatory reporting of ANC blood tests to the REMS program.  

In the coming months, FDA will work with the clozapine manufacturers to update the prescribing information and eliminate the Clozapine REMS.”–FDA