health care – Go Retire Psychiatrist

CDC ACIP Meeting Postponed for Today and Tomorrow

I missed the recent notice in the last couple of days that the CDC ACIP meeting was postponed for today and tomorrow. Me and more than a couple dozen people were kept waiting for a half hour before I got suspicious and looked it up. There’s a CIDRAP story posted yesterday that explains the “delay.”

There was a federal district judge ruling two days ago “…temporarily blocks every major vaccine policy change made by President Trump’s administration over the past year. The ruling came in response to the ongoing lawsuit filed by the American Academy of Pediatrics (AAP) and five other major medical organizations against Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.”

There is no message on the CDC ACIP webcast site about this and at the moment I’m writing this, there are still 41 people waiting for the YouTube webcast. I figured they were just getting coffee and bagels. There should have been an announcement by the CDC ACIP.

No wonder there was no agenda.

Ivermectin Bill Looks Like It’s Dead-For Now

This is a quick followup on the progress of Governor Reynolds MAHA bill which included a piece endorsing making Ivermectin available over-the-counter in Iowa. I just read a story about what looks like the disappearance of the ivermectin from Reynold’s bill. The story, written by Laura Belin, comes from a webpage called Bleeding Heartland: An independent website about Iowa politics.

I don’t follow politics avidly (putting it mildly), but I think I understand a short paragraph from Ms. Belin’s article”:

“The Senate didn’t advance the governor’s bill. Instead, Senate Health and Human Services Committee chair Kara Warme introduced her own “health-related matters” bill, which got through committee and is eligible for floor debate. That legislation (Senate File 2367) incorporated the governor’s proposals on nutrition education, certificates of need for health care facilities, federal food assistance, and food dyes in schools, but left the ivermectin language on the cutting room floor.”

It looks like another anti-vaccine bill bit the dust—for now. I would cheer, but I know better. I expect somebody will resurrect it at some time in the future. I hope Dr. Austin Baeth is still around when it happens.

CDC ACIP Meeting Scheduled for March 18, 19 2026

It’s been a while since the last CDC ACIP meeting. It’s scheduled for March 18, 2026, 8 AM to 5 PM EST and March 19, 2026, 8 AM to 5 PM EST, according the notice on the Federal Register.

There are over 1500 comments and the one I thought was the best was by the Vaccinate Your Family (VFY) organization, which you can read on their website.

According to the notice: “The agenda will include updates on ACIP Workgroups and discussions on COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. Recommendation votes may be scheduled for COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. Agenda items are subject to change as priorities dictate. For more information on the meeting agenda, visit https://www.cdc.gov/acip/meetings/index.html.

Meeting Information: The meeting will be webcast live via the World Wide Web.”

Iowa Ivermectin Bill Heads to the Senate

I see the Iowa House passed HF 2676 including the ivermectin section which would make the anti-parasite drug available over-the-counter (OTC) in Iowa, despite arguments against it about the medical indications for the drug, which don’t include treatment of cancer and Covid-19 infection. There’s a high probability that some people might use it to treat those conditions. It now goes to the Senate.

It’s worth pointing out that a stand-alone version of this bill died in the first funnel. The text of this alternative bill, which is sponsored by Governor Reynolds, is distinctly different from the first one. It uses permissive language saying a pharmacist “may” (instead of “shall”) make this prescription drug used to treat parasite infections in humans and animals available OTC to those who want it for what some might call off-label use.

Recall the original version of this bill said the “medical director” of a pharmacy should write a “standing order” for ivermectin to be available “OTC.” This probably blurs what’s actually implied, which is that someone with “prescriptive authority” write the standing order, such as a physician.

This is clarified in the laws recently passed in June of 2025 in the Louisiana legislature stating that “pharmacists can dispense ivermectin to adults pursuant to a standing order issued by a health care professional with prescriptive authority. When administering ivermectin to a patient, the rule requires pharmacists to provide information on indications and contraindications. A screening risk assessment tool is also required. Pharmacists may charge an administrative fee for these services.”

It looks like Iowa might be taking a slightly different approach. By the state making ivermectin OTC in the first place, the “standing order” piece is bypassed to avoid the apparent contradiction of ivermectin (a prescription drug) having both OTC and prescription features.

But it gets more complicated than that because Iowa has authorized a collaborative drug therapy management arrangement by which a licensed prescriber may allow an authorized pharmacist to prescribe certain drugs. Further, even though states can’t override FDA classification of a drug, they can decide on whether a drug needs a prescription or not. Would it make sense to ask what reason would there be for legislators to seek non-prescription status for a drug—other than expedience?

Under this bill, a pharmacist can’t be sued or be held criminally liable if patients suffer injury or even death by taking ivermectin for an indication which doesn’t make sense to medical science. By contrast, if someone suffers an adverse effect from a vaccine, patients and families have access to the Vaccine Injury Compensation Program and if that’s not effective, they can file lawsuits in state and federal courts. If this sounds unfair, there’s a reason for that which people might not discover until it’s too late. A strong mitigating factor is the pharmacist’s ethical standards.

The FDA has provided guidance about unapproved (off-label) use of FDA-approved drugs. It’s possible to use an approved drug for an unapproved use. However, the major reason why a physician might consider doing this is usually because an approved drug is not available to treat a patient’s condition.

In this case, ivermectin is approved for treatment of parasitic infections and there’s no credible scientific evidence it’s effective for treatment of Covid-19 or certain types of cancers. Off label use is not illegal in the U.S. Insurance may or may not cover the cost. There are a number of drugs used off-label, including the popular drug Ozempic, approved for diabetes and used off-label for weight loss.

I hope the Senate considers the potential for medical trouble with HF 2676.

Clinical Problems in Consultation Psychiatry and The Break-Dancing Koala Bear

I ran across an old Clinical Problems in Consultation Psychiatry (CPCP) presentation by a couple of sharp medical students in 2014. They presented it at one of my morning consult rounds and it’s about Charles Bonnet Syndrome.

They did a very nice job and it compares fairly well with the University of Iowa Ophthalmology Dept summary. One of the authors of that summary is my retinal specialist, Dr. Ian Han, who did the surgery on my detached retina about 4 years ago. It also has a link to a great YouTube video of a woman who has Charles Bonnet Syndrome. It’s not a psychiatric disorder although ironically one of the treatments for it may sometimes be antipsychotic medications.

The other thing about this presentation is that the students’ fictional case description mentions that the patient had visions of “a break-dancing koala bear” among other things. I can’t remember whether I was the one who told them about a video on the internet that showed a break-dancing stuffed koala bear—or if it was the other way around! At any rate, I remember seeing it around that time, but of course I can’t find it now.

Do We Really Need Artificial Intelligence to Help People Who Are Demoralized?

I was just going through the many files on one of my old thumb drives that I still keep after I retired from consultation-liaison psychiatry over 5 years ago. I found a file that I must have typed from a source on how to help medically ill persons who are demoralized. Demoralization is not the same thing as depression or adjustment disorder. What I have copied from the original source is below, along with the reference.

Treating Demoralization

Ask first: “how are your spirits today?” Then ask “what is the most difficult thing for you now?”

Coherence Versus Confusion

1. How do you make sense of what you’re going through?

2. When you are uncertain how to make sense of it, how do you deal with feeling confused?

3. To whom do you turn for help when you feel confused?

4. (For religious patient) When you feel confused, do you have a sense that God has a way of making sense of it? Do you sense that God sees meaning in your suffering?

Communion Versus Isolation

1. Who really understands your situation?

2. When you have difficult days, with whom do you talk?

3. In whose presence do you feel a bodily sense of peace?

4. (For religious patients) Do you feel the presence of God? How? What does God know about your experience that other people may not understand?

Hope Versus Despair

1. From what sources do you draw hope?

2. On difficult days, what keeps you from giving up?

3. Who have you known in your life who would not be surprised to see you stay hopeful amid adversity? What did this person know about you that other people may not have known?

Purpose Versus Meaninglessness

1. What keeps you going on difficult days?

2. For whom, or for what, does it matter that you continue to live?

3. (For terminally ill patients) What do you hope to contribute in the time you have remaining?

4. (For religious patients) What does God hope you will do with your life in days to come?

Agency Versus Helplessness

1. What is your prioritized list of concerns? What concerns you most? What next most?

2. What most helps you to stand strong against the challenges of this illness?

3. What should I know about you as a person that lies beyond your illness?

4. How have you kept this illness from taking charge of your entire life?

Courage Versus Cowardice

1. Have there been moments when you felt tempted to give up but didn’t? How did you make a decision to persevere?

2. If you see someone else taking such a step even though feeling afraid, would you consider that an act of courage? (If so) Can you imagine viewing yourself as a courageous person? Is that a description of yourself that you would desire?

3. Can you imagine that others who witness how you cope with this illness might describe you as a courageous person?

Gratitude Versus Resentment

1. For what are you most deeply grateful?

2. Are there moments when you can still feel joy despite the sorrow you have been through?

3. If you could look back on this illness from some future time, what would you say that you took from the experience that added to your life?

Griffith, J. L. and L. Gaby (2010). “Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness.” Focus 8(1): 143-150.

There are a couple of resources I routinely used as a psychiatric consultant in the general hospital. One of them was the general outline of how to recognize and help someone who is demoralized (above). Another was a free online (non-AI) cognitive behavioral therapy resource that is still available called The MoodGym.

These are not the same thing as Artificial Intelligence (AI), which I think in some cases might be the wrong way to help someone with depression and anxiety that is more reactive to situational and medical stressors. AI can also be harmful to some people.

I have seen the brief psychotherapy guide above published and referenced in different articles on the web, one of them published as recently as 2025. Griffith and Gaby first published the guide to help those who are demoralized in 2005. It’s been around for 20 years and in my opinion is better than AI will ever be.

References:

James L. Griffith, Lynne Gaby,

Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness,

Psychosomatics,

Volume 46, Issue 2,

2005,

Pages 109-116,

ISSN 0033-3182,

(https://www.sciencedirect.com/science/article/pii/S0033318205701006)

Abstract: Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.

https://psychiatryonline.org/doi/full/10.1176/foc.8.1.foc143

Alyssa C. Smith, Jonathan S. Gerkin, Diana M. Robinson, Emily G. Holmes,

Consultation-Liaison Case Conference: Management of Demoralization in the Medical Setting,

Journal of the Academy of Consultation-Liaison Psychiatry,

Volume 67, Issue 1,

2026,

Pages 71-78,

ISSN 2667-2960,

(https://www.sciencedirect.com/science/article/pii/S2667296025005087)

Abstract: Demoralization has important implications for patients’ health, but consultation-liaison psychiatrists may be less familiar with diagnosis and management due to limited inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. We present the case of a multivisceral transplant patient who experienced demoralization due to complications from her posttransplant course. We discuss the diagnosis of demoralization, including differential diagnoses to consider, followed by a discussion of management of demoralization in the inpatient setting using acceptance and commitment therapy. We then discuss the consultation-liaison psychiatrist’s role in assisting with management of teams’ counter-transference to difficult patient cases, including the possibility of teams experiencing their own demoralization.

Keywords: demoralization; transplantation; transplant psychiatry; acceptance and commitment therapy; consultation-liaison psychiatry

Oppose Iowa Legislature Bill HF 2171 That Seeks to Eliminate Vaccine Requirements in Public Schools

I have been reading the public comments on the Iowa Legislature bill HF 2171 that, if passed, would eliminate the requirement for vaccines in public schools against many diseases such as poliomyelitis, diphtheria, pertussis, tetanus, rubeola, rubella, and varicella. People are overwhelmingly opposed to it and it’s beyond me how it got past the first funnel.

I’ve added some photos documenting the history of polio from the University of Iowa Health Care Medical Museum.

Iowa Legislature Ivermectin Bill A Game of “Captain, May I?”

I’ve been comparing the Iowa legislature bills on allowing ivermectin to be available over-the-counter in pharmacies. There were two of them and then there was one.

In the first bill, HF 2056, the language in it seemed to strongly direct pharmacists to make ivermectin available by using the word “shall”:

” The medical director of the department shall establish a standing order authorizing the dispensing of hydroxychloroquine and ivermectin by a pharmacist.

Notwithstanding any provision of law to the contrary, a pharmacist shall dispense hydroxychloroquine or ivermectin to a patient who is at least eighteen years of age, upon the request of a patient, pursuant to a standing order established by the medical director of the department in accordance with this section.”

The bill goes to say that “A pharmacist shall be immune from criminal and civil liability arising from any damages caused by the dispensing or use of…” these agents.

In Governor Reynolds version of the bill (included in HF 2676, successor to HSB 964), at least today, uses the word “may”:

“Sec. 17. NEW SECTION. 126.24 Ivermectin—prescription drug order not required.

A pharmacist or pharmacy may distribute ivermectin for human consumption as an over-the-counter medicine.
A pharmacist or pharmacy shall not be subject to professional discipline or civil or criminal penalties for the distribution of ivermectin pursuant to this section.”

I think the word “may” in Governor Reynolds’s bill implies a pharmacist can distribute ivermectin, but is not necessarily required to do so. In the HF 2056 bill (which died in the first funnel) the word “shall” implies the pharmacist must do so. Hydroxychloroquine is not mentioned in the governor’s version of the bill.

Although neither of these bills mentioned why the ivermectin bill is being introduced, I think it’s clear that some people think it could be an alternative to vaccines for Covid-19. Because research shows ivermectin is ineffective for treating Covid-19 and because they’re not FDA approved for that, I doubt any pharmacist would choose to do what the bill says.

This seems to be turning into a weird game of “Captain, May I?” I think the majority of pharmacists would rather not play.

Iowa Legislature Offering Cheese and Crackers on the Bill of Fare

I heard a song entitled “Cheese and Crackers” on the Big Mo Blues Show last night. I’ve heard a few times over the years, but I never looked up what it meant until today.

The song was originally written by a rockabilly singer named Hayden Thompson, although I’ve only heard it sung by blues artist Roscoe Gordon. According to a Reddit social media thread, “Cheese and Crackers” was the B side of a record by Thompson and the A side was “Shoobie Oobie.” Thompson couldn’t find anyone to arrange the “Cheese and Crackers” lyrics at a recording studio and left in a huff, leaving the lyrics on the piano.

Roscoe found it and put it in an R&B arrangement. Billboard magazine called it the strangest new release of the week. The song is about a guy repeatedly being offered cheese and crackers although he doesn’t like or want them. According to a Wikipedia article, the term “cheese and crackers” is a kind of mild swear word chilled down from “Jesus Christ.”

That’s funny, because that’s how I feel about all the anti-vaccine bills coming out of the Iowa Legislature this year. One of them is SF 2095, which seeks to penalize private postsecondary colleges and universities if they don’t accommodate students who want to be exempt from all vaccines for any reason and to find clinical training programs who will accept them. An excerpt from the bill:

“A postsecondary school offering a degree requiring a clinical rotation shall, upon request of a student enrolled in the degree program, identify a clinical rotation placement where the student will be permitted an exemption from any vaccination requirements imposed by the placement location during the duration of the student’s clinical rotation.

A postsecondary school not in compliance shall not qualify as an eligible institution for the purposes of Iowa tuition grant.”

The other punishment could be a fine. Unless I’m looking on the web in the wrong place, I don’t find any such facility anywhere in Iowa. That would mean the postsecondary private school would be punished for something it can’t control. I’m pretty sure that would be called unjust—or maybe tricky if the goal is to coerce clinical training program leaders to loosen up their vaccine exemption policies. Right now, the only exemptions are religion or medical.

This sounds like the Iowa legislature is offering us cheese and crackers. No thank you.