Category: current events

The Intergalactic Angle on Your Point of View

I finally watched the movie “The Hitchhiker’s Guide to the Galaxy” the other night. It was released in 2005 and based on Douglas Adams’ book of the same title. In fact, he co-wrote the screenplay. A lot of it was not in the book. I thought a couple of scenes were noteworthy and pretty funny. I made connections to Dr. Martin Luther King, Jr. annual observance, which is this month.

One of them was the Point of View Gun. It’s probably unfortunate that the main prop was a gun, but hey, it was a ray gun. It didn’t kill anyone and in fact, it caused the person “shot” with it to be able to understand the perspective of another person. It was just temporary, but for a short while it enabled persons or extraterrestrials to understand another’s point of view. It was designed by the Intergalactic Consortium of Angry Housewives to influence their husbands to understand them better.

One of Dr. Martin Luther King’s main points was how important it is to try to understand and validate someone else’s point of view.

One drawback of the Point of View gun (besides the obvious associations with gun violence) was that the effect was specific to whoever was using it. So, when the ultra-maladjusted robot Marvin mowed down a gang of Vogons (hideous and cruel extraterrestrial bureaucrats who destroyed Earth in order to make room for an intergalactic bypass), they all collapsed from depression.

The other scene I thought was funny was the Vogon planet’s slap-happy encounter between the heroes and the creatures shaped like spatulas that popped out of the ground and smacked anyone in the face who had an idea.

I didn’t think the movie was nearly as good as Adams’ book. But I wonder if you could cross the spatula creatures with the Point of View gun that would take the perspective-taking power of the gun and give it to the spatula creatures who would slap you silly whenever you failed to even try to understand another’s point of view. I could use that kind of a slap sometimes.

It’s remarkable the connections you could make between Dr. Martin Luther King, Jr and The Hitchhiker’s Guide to the Galaxy.

CDC Weekly Update on Viral Respiratory Illness

As of December 8, 2023, the CDC reports:

  • “National test positivity, emergency department visits, and hospitalizations for influenza continue to increase. Influenza A(H1N1) is the predominant influenza virus circulating although influenza A(H3N2) and influenza B viruses are also being reported.
  • RSV-associated hospitalization rates remain elevated among young children and are increasing among older adults; of note, only 15.9% of adults 60+ report having received an RSV vaccine.
  • National vaccination coverage for COVID-19, influenza, and RSV vaccines increased slightly for children and adults compared to the previous week and remains low for both groups.”

However, the overall respiratory illness rates have gone from “moderate” to “low” in Iowa.

What’s Up with Intranasal Covid-19 Vaccines?

I saw the JAMA article on intranasal vaccines research for Covid-19. It starts off pretty supportive of the principle. However, at the bottom of the article, the outlook looks pretty stable for injectable vaccines for at least a good long while.

It’s an interesting read. Skip to the Many Questions section:

How these experimental mucosal vaccines stack up against mRNA vaccines, considered the standard of care, remains to be seen, Beigel noted. The NIAID intends to conduct phase 2 trials that would compare mucosal and mRNA vaccines head-to-head, “so you’d know for certain what you’re trading off,” he said.

Ideally, a mucosal vaccine would generate as good a systemic immune response as an mRNA vaccine as well as a robust mucosal immune response. But an excellent mucosal immune response might make up for a bit of a decline in the systemic immune response, Beigel explained. Perhaps a vaccine inhaled through the mouth and into the lungs could provide the best of both worlds—strong mucosal and systemic immunity—but there are no data yet to support that theory, he said.

“Everyone knows we need a better vaccine and would really like it if we could get something that interrupts transmission and stops even mild disease,” Beigel said. “Whether that’s attainable or not, we don’t know.”

I’m not knocking the concept by suggesting you read the Conflict of Interest Disclosures.

Reference:

Rubin R. Up the Nose and Down the Windpipe May Be the Path to New and Improved COVID-19 Vaccines. JAMA. Published online December 06, 2023. doi:10.1001/jama.2023.0644

This is National Influenza Vaccination Week!

This is National Influenza Vaccination Week (Dec. 4-8, 2023) and the CDC word is:

“National Influenza Vaccination Week (NIVW) is a critical opportunity to remind everyone 6 months and older that there’s still time to protect themselves and their loved ones from flu this flu season by getting their annual flu vaccine if they have not already. CDC data shows that flu vaccination coverage was lower last season, especially among certain higher risk groups, such as pregnant people and children. When you get a flu vaccine, you reduce your risk of illness, and flu-related hospitalization if you do get sick. This week is meant to remind people that there is still time to benefit from the first and most important action in preventing flu illness and potentially serious flu complications: get a flu vaccine today. Check out CDC’s NIVW toolkit for more shareable resources and content.”

It’s also big news that a recent CDC co-authored study showed strong evidence for flu vaccine effectiveness. Among the university medical centers participating in the study was the University of Iowa Hospitals.

CDC Update on Covid-19 Variant BA.2.86

I saw a news item headline which mentioned Covid-19 Variant. BA.2.86. The CDC website tracking respiratory variants has a definitive update as of November 27, 2023:

“What to know about BA.2.86

  • The virus that causes COVID-19 is constantly changing over time. Sometimes these changes allow new variants to spread more quickly or effectively. If that occurs, the new variant may become more common relative to other variants that are circulating.
  • Since CDC’s first post on BA.2.86 in August 2023, the proportion of infections caused by BA.2.86 has slowly increased. In the CDC Nowcast posted Nov. 27, 2023, BA.2.86 is projected to account for 5-15% of currently circulating variants.
  • CDC projects BA.2.86 and its offshoots like JN.1 will continue to increase as a proportion of SARS-CoV-2 genomic sequences.
  • At this time, BA.2.86 does not appear to be driving increases in infections or hospitalizations in the United States.
  • CDC contributed to and agrees with the World Health Organization’s recent risk assessment about BA.2.86 suggesting that the public health risk posed by this variant is low compared with other circulating variants, based on available limited evidence.
  • Updated COVID-19 vaccines are expected to increase protection against BA.2.86, as they do for other variants.
  • As mentioned in previous updates, COVID-19 tests and treatments are expected to be effective against this variant, including its offshoot JN.1.
  • It is not possible at this time to know whether BA.2.86 infection produces different symptoms from other variants. In general, symptoms of COVID-19 tend to be similar across variants. The types of symptoms and how severe they are usually depend more on a person’s immunity than which variant causes the infection.
  • Regardless of what variants happen, CDC will continue to track them, working closely with partners around the world to understand how they are spreading and how they respond to vaccines and treatments.”

When Should Psychiatrists Retire?

In answer to the question in the title, I’ll confess right away I don’t know the answer. The impetus for my writing this post is the Medscape article about an 84-year-old physician who was forced to take a cognitive test required by her employer as a way of gauging her ability to continue working as a doctor. She’s suing her employer on the grounds that requiring the cognitive test violated the American with Disabilities Act (ADA), the Age Discrimination in Employment Act, and two other laws in her state.

I didn’t retire based on any cognitive test. I recall my blog post “Gauging My Readiness for Retirement,” which I posted in 2019 prior to my actual retirement. In it I say:

I spent 4 years in medical school, 4 years in residency, and have worked for more than 23 years as a psychiatrist, mostly as a general hospital consultant. Nothing used to jazz me as much as running around the hospital, seeing patients in nearly all specialties, evaluating and helping treat many fascinating neuropsychiatric syndromes, teaching medical students and residents, and I even wrote a book.

On the other hand, I don’t want to hang on too long. When people ask me why I’m retiring so early (“You’re so young!”), I just tell them most physicians retire at my age, around 65. I also say that I want to leave at the top of my game—and not nudged out because I’m faltering.

In it, I mention a blog post written by a physician blogger, Dr. James Allen. The title is “When Physicians Reach Their ‘Use By Date.’ At the time I didn’t make a link to his post because the web site was not listed as secure.

Since that time, the web site has become secure, and you can read the post here. Dr. Allen lists anecdotes about physicians who ran close to or past their “use by” date.

Dr. Allen’s point is that we often don’t realize when we are past our “use by” date. That applies to a lot of professions, not just medicine.

There’s been a shortage of psychiatrists for a long time and it’s not getting better, the last I heard. All in all, I’m OK with the timing of my retirement.

I note for the record that I have not seen any mention in the news that the Rolling Stones have ever been required to take a cognitive test to continue working. I also want to point out that they are around 80 years old and their 2024 tour is sponsored by the AARP, the organization formerly known as the American Association of Retired Persons. I heard that the Rolling Stones new song, “Angry” is up for a Grammy.

I doubt anyone is angry about the obvious fact they’re not even thinking about retiring.

AARP Sponsors the Rolling Stones!

We have noticed that the AARP is sponsoring the Rolling Stones Hackney Diamonds Tour 2024. I don’t think it’s necessary to point out that, with all due respect, the Rolling Stones have long ago passed fossil status.

I guess that means it’s fitting that the AARP sponsor a rock music group the members of which are eligible to join the organization formerly known as Prince. Sorry, I meant to say formerly known as the American Association of Retired Persons.

Obviously, the Rolling Stones are not thinking about retirement. But unless they can come up with a plausible explanation for the name of the tour, Hackney Diamonds, they should probably not be eligible for the free tote bag the AARP offers to those who become members.

A hackney is a horse drawn carriage. A diamond is a precious stone. The Rolling Stones have thankfully clarified that, obviously, the Hackney Diamonds tour name comes from the well-known legend of the hackney cab driver who drove through the streets of a town called Hackney in London in the 17th century, tossing out diamonds to passersby if they could guess how many angels could dance on the head of a pin during a snowstorm in the Sahara Desert.

That’s about as clear as the explanation given by Keth Richards and Mick Jagger in an interview with Jimmy Fallon as reported in an article written by Tom Skinner in NME on September 7, 2023.

Anyway, the Rolling Stones have been a big deal for decades, of course and they get mentioned in a lot of different ways. For example, in the movie Men in Black 3, there’s a conversation between Agent J and young Agent K in a café which is prompted by the need to eat pie in order to clear their minds of the case they’re working on which is trying to stop the murderous bad guy, Boris the animal, from destroying Earth. Young Agent K stipulates the rule is to talk about anything about the case and to let the pie do its magic. You’ll never guess what they talk about but it goes like this:

“Young Agent K: You said we don’t talk, right? Go ahead, ask me any question. Anything you want, just as long as it doesn’t have to do with the case… just let her rip.

Agent J: What’s up with you and O?

Young Agent K: Me and O?

Agent J: Yeah, you and O.

Young Agent K: All right, all right… all right, this is it. A while back, I was assigned to keep tabs on a musician, Mick Jagger. He was in this British group, Rolling Stones…

Agent J: Rings a bell.

Young Agent K: We believed he’s on the planet to breed with Earth women, so I was in London and that’s when I met O. She’s smart, funny… great smile and we find ourselves in this pub, Whistler’s Bar, warm beer and the worst food you ever ate. We just played darts till the sun came up, neither of us wanted to leave…”

And I can remember that Microsoft used the Rolling Stones 1981 song, “Start Me Up” in their promotion of Windows 95 computer operating system. You remember that; it was a total loser which led to the evolutionary creation of a dozen operating systems, all of them laughably dysfunctional. I should know—I bought all of them.

So, the Rolling Stones turn up a lot in pop culture. Everybody knows that. That’s in part because of their stamina—and maybe doggedly persistent denial of aging leading to a refusal to ever retire, just drop on stage because their bones finally disintegrate.

So, returning to the question of why AARP (pronounced arf only with a p on the end) is sponsoring the Rolling Stones tour. I have no clear idea except that I think the organization wants to broaden appeal for the organization so that more dues paying young people join, adding money to help support those over 50 to maintain financial stability and security.

What I don’t understand is that, in part, this implies trying to work as advocates (read “lobby”) in Congress. All those old farts in Congress can do is argue and a some of them should seriously think about retiring. If they can’t command respect, they could at least get a free tote bag by joining AARP.

But the Rolling Stones don’t need free tote bags. They’ve earned their fossil status many times over. On the other hand, I have earned my certificate from the state legislature.

New CDC Campaign to Help Health Care Worker Burnout

The JAMA network published a brief report on the new CDC campaign to help health care workers reduce burnout and encourage well-being. An excerpt:

“Rather than focusing on what individual clinicians can do differently to improve their well-being, a new campaign by the National Institute for Occupational Safety and Health (NIOSH), part of the US Centers for Disease Control and Prevention, aims to reduce health care worker burnout by encouraging hospital leaders to implement organizational changes and offering them tools to do so.”