Iowa – Go Retire Psychiatrist

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.

Update to the Anti-Vaccine Bills in Iowa Legislature

This is just a quick update to the Iowa legislature anti-vaccine bills as far as which ones have passed what is called the first funnel. Here’s a link to the definition of a funnel.

Which bills got past the first funnel:

SF 2095: This bill is about private colleges or universities that would be punished if they don’t make accommodations for students in health care education program who want to avoid getting vaccines.

HF 2171: This bill would remove the requirement for children in primary and secondary schools to get vaccinations. I think this bill is dangerous and unnecessarily puts children at risk for infectious diseases including diphtheria, pertussis, tetanus, poliomyelitis, rubeola, rubella, and varicella.

Which bill didn’t get past the first funnel:

HF 2287: This was the bill that sought to make vaccine manufacturers who want to sell their products in Iowa give up their immunity from lawsuits under the Childhood Vaccine Injury Act.

I couldn’t find out where the ivermectin over-the-counter bills (HF 2056 and HSB 694) were in the funnel as of today.

That make 5 bills in the Iowa legislature that are anti-vaccine-5 bills too many.

Iowa Legislature Bills I Could Live Without

I should stop reading the news. I’ve just found a couple of other Iowa Legislature bills that are anti-vaccine.

One of them is the HF 2287 I mentioned yesterday that would make vaccine manufacturers steer clear of Iowa altogether.

Another two I just discovered today:

HF 2171: This one which seeks to make vaccines for school age children voluntary. No child in elementary or secondary school in Iowa would have to be vaccinated against diphtheria, pertussis, tetanus, poliomyelitis, rubeola, rubella, and varicella. This is not safe for anyone.

SF 2095: This one seeks to exempt students from vaccines in medical, nursing, or other health care-related degree programs.

There’s a news article about SF 2095 which makes it clear what it is about. I don’t understand why a person studying medicine or any other health care-related degree program would not need to get vaccinated against communicable diseases. This bill would require private schools to provide some other alternative training program instead of those that require vaccinations. If they don’t, they’d be penalized, either by losing access to the Iowa Tuition Grant Program—or getting fined. None of that makes sense to me. If you’re in training to be a doctor, you should get vaccinated. If you don’t understand why vaccinations are vital to practicing medicine, you shouldn’t be in medicine.

If I sound like a curmudgeon about all this, so be it. I’m a retired doctor and I graduated from the University of Iowa College of Medicine in 1992. I spent my career practicing consultation-liaison psychiatry, so I was always at the interface between medicine and psychiatry. It was always a challenge for me to balance the art and science of medicine. And I didn’t always do it very well.

But I’m puzzled by what looks like an awkward imbalance in the view of medicine today. I’m a little cranky about it, and I like to think my age entitles me to react that way sometimes. I could add a quote from William Osler here, but I’m more prone to jokes as a I get older, probably because I know I’m no wiser than anyone else.

Did you hear Chuck Norris got the Covid vaccine? The vaccine is now immune to everything.

Iowa Vaccines and Legislature Proposed Bill Deja Vu

I see we have yet another bill introduced in the Iowa legislature seeking to make vaccine manufacturers liable for “design defects” resulting in injuries related to vaccines. This feels like déjà vu. Last year HF 712 targeted the Covid 19 vaccine. The bill died in the funnel. This year, the same sponsors introduced HF 2287—which is a similar bill that would target all vaccines.

One news story indicated that the sponsors were open to adding an amendment that would allow vaccine manufacturers to distribute vaccines in Iowa as long as patients sign a form that waives their right to sue the manufacturer as long as they are informed of the risks. I’m not sure how the forms would be made available to the public.

I thought patients, under the National Childhood Vaccine Injury Act of 1986, already have access to the Vaccine Injury Compensation Program (NVICP). Even if they don’t get compensated through that program, they can still sue the manufacturers. I thought the “design defect” issue had been dealt with.

This new bill broadens the products in that it looks like it includes all vaccines, even those children typically get. There are already many parties have gone on record opposing HF 2287, including but not limited to:

Pharmaceutical Research and Manufacturers of America

Iowa Medical Society

Iowa Pharmacy Association

Iowa Association of Rural Health Clinics

Iowa Public Health Association

Iowa Chapter-American Academy of Pediatrics

I think vaccine manufacturers will avoid Iowa if this bill becomes law. It could lead to an uptick in the communicable diseases burden, as though we need any more of that.

Pelicans on Parade!

The weather was superb yesterday and we visited our favorite walking trail out at Terry Trueblood Recreation Area—along with a lot of people who had the same idea. It was around 60 degrees and not a cloud in the azure blue sky.

The highlight was the big flocks of white birds with black markings under the wings sailing over Sand Lake. Observers we encountered had different opinions about what species they were.

At first, I thought they were pelicans, which are frequent visitors at the park. On the other hand, a few thought they were storks and for a while I took their side. The further we walked and the more video I got, and the more people we talked with, the less sure we were about these very large white birds. Many people were very sure they were pelicans.

After we got home, I looked on the internet for education about how to tell the difference between storks and pelicans—and was convinced that the birds we saw were pelicans. I was able to enlarge a picture I pulled from one of my video clips which showed clearly the large bill.

I guess this is a good place for Dixon Lanier Merritt’s 1910 limerick about the pelican:

“A wonderful bird is the Pelican.

His beak can hold more than his belly can.

He can hold in his beak

Enough food for a week!

But I’m darned if I know how the hellican!”

Despite the tall tales about storks bearing babies, the fact is their beaks are narrow.

So, this actually takes me back to the one person on our walk who was convinced that the large, wheeling birds were storks. She joked around about the idea a little and asked Sena if she knew the story about how Dumbo was born. It just so happened was lost on us because we’d never seen the 1941 Disney film Dumbo and it turns out that a stork brought Dumbo to the train dragging a car full of elephants, one of which was Mrs. Dumbo.

And there’s a very complicated explanation of the stork myth about them delivering babies to mothers—although not in their beaks but in a bundle.

Aside from the pelicans, we saw many signs of spring, including buds on the trees, the ice melting on Sand Lake, and people gazing at the sky-waiting for spring.

Update to the Iowa Legislature Bill to Make Ivermectin Available Over the Counter

Pursuant to my previous post about the debate in the Iowa Legislature over a proposed bill to make Ivermectin available over-the-counter (OTC) in Iowa, it looks as though hydroxychloroquine was recently dropped from the bill. Although few people say it out loud, in my opinion, it’s no secret that the main reason for the bill is to make ivermectin available to those who want to use it to treat Covid-19, despite there being no convincing evidence that it’s effective for that.

However, yet another bill was introduced by the governor which has its own ivermectin promotion section; so, there are now two ivermectin bills. They look the same.

The Iowa Board of Pharmacy is opposed to them because the language obliges them to comply with dispensing ivermectin to patients even if it might potentially harm them.

Although the bill removes penalties for dispensing ivermectin, there seem to be no specific penalties to pharmacists for refusing to do so. About 3 years ago, a pharmacist refused to fill a prescription for ivermectin that was intended for treatment of Covid-19.

A similar bill in Utah was not passed about 4 days ago. Supporters of the bill appeared to be engaging in passing misinformation about ivermectin for Covid-19, claiming there was “plenty of data” supporting its effectiveness for it. In fact, the FDA has not approved its use for treatment of Covid-19.

I wonder if there might be a justification for a kind of civil disobedience by pharmacists by refusing to give OTC ivermectin to patients. The other question is what does the Iowa Board of Medicine think about this? Is it right to leave physicians out of the loop in this situation?

It seems ironic that a legislator who is an internist, Dr. Austin Baeth, is on the right side of this debate by opposing the bills, yet the state medical board seems to be silent. Would it be appropriate for the state medical board to take a public position about this issue as the pharmacy board has?

The Extraterrestrial and Mutilated Soybean Hybridization Program in Iowa

After watching a number of TV shows about extraterrestrials (ETs), I had this vivid dream about ETs invading Iowa.

Apparently, I had somehow driven out on some highway that was not clearly marked, maybe Highway 20 which the National Weather Service always mentions as a sort of boundary line between a howling, disastrous tornadimohurricannibalistic storm and utter tranquility a few miles north of us.

I got out of the car and noticed up in the sky a gigantimonguous craft shaped like a triquetra. It was eerily silent as it passed just inches above my head and it glowed multiple colors like the NBC peacock.

Suddenly, 3 beings who resembled the 3 stooges (except their heads were tiny) floated out of the craft and took me hostage. They kept arguing amongst themselves about how they were going to exsanguinate me and then fuse me with a soybean plant they had previously mutilated. Apparently, they had tipped a few cows in the process and slipped in the pasture, falling into an area full of cow pies.

I told them they smelled bad and suggested they try Mando, the deodorant that is nothing like the scented stuff which, if you apply it, is exactly like turning up your car radio when the engine rattles—hey, it just masks the problem.

I guess that hurt their feelings and they told me they were going to stick some kind of implant in my nose so they could track me because they could hear my nose whistle and find me anywhere. I told them I’m allergic to ET implants and I would just sneeze it out. I had them there.

Then they tried to communicate with me telepathically but I knew how to counter that trick. I just thought really hard about good barbecued ribs, which made them hungry. They asked me where they could find a decent rib joint and I told them how to get to Jimmy Jack’s Rib Shack in Iowa City.

So we head on over there and I help them order. They weren’t sure what to drink, so I suggested water because I saw this trick in the movie, Signs. It didn’t work as I expected and they just acted like they were drunk.

Then, of all things, they wanted to go to Area 51, and we just zipped over there. On the way, they picked up Bob Lazar who drew pictures of them. He asked me why they had barbecue sauce all over their faces and I just told him they had bad manners.

Finally, I woke up and I swear I’m going to limit how much kale I eat next time.

Another Silly Bill in the Iowa Legislature

I saw a story in the Iowa Capital Dispatch by Robin Opsahl today that there’s a bill in the Iowa legislature which seeks to make the drugs ivermectin and hydroxychloroquine over-the-counter (OTC) in Iowa. It doesn’t actually specify the reason why but it’s probably because some Iowans want the drugs available to treat Covid-19. I think the motivation sounds similar to the bills introduced in March of 2025 which were designed to make it illegal to get mRNA vaccines for Covid-19 in Iowa. They both died in funnel week last year.

The bill was discussed yesterday and, while there were 3 commenters in favor of it, there are several reasons to be suspicious of whether it would be a good thing for Iowans. Both ivermectin and hydroxychloroquine were studied for evidence of efficacy for Covid-19 and the studies failed to show that.

The FDA has made it clear that it doesn’t recommend either ivermectin or hydroxychloroquine for treatment of Covid-19.

However, the Iowa bill HF 2056 seeks to make both available OTC and require pharmacies not only make it available but protect the pharmacist from legal or criminal liability for any harms that might result from its use.

While you can find news stories saying simply that 4 states (Tennessee, Idaho, Arkansas, and Idaho) have adopted similar laws, there is at least one recent follow up news story indicating that the pharmacists still have some reservations.

A Boise, Idaho pharmacist says he’ll dispense ivermectin to callers—as long as they have a doctor’s note. Most callers don’t have a parasitic infection. The pharmacist points out that, while the Idaho law says he can dispense ivermectin without a prescription, the FDA hasn’t approved it to be used this way. “It’s not designed or packaged for retail sale,” according to the pharmacist. It’s not made for OTC use.

There’s also a hitch when it comes to health insurance coverage for OTC drugs, implying you might have to pay out of pocket. Arkansas and Tennessee pharmacists say that, despite the law change allowing OTC sale of ivermectin in their states, they won’t sell it that way.

I hope their example will be followed by the other states who seem to be going the same way as Iowa. On the other hand, I’m pretty sure there might be plenty of conscientious objectors in Iowa who might slow down the legal push to get either hydroxychloroquine or ivermectin OTC.

Just because lawmakers put in a lot of language in a bill in an effort to persuade pharmacists that they won’t get sued or go to jail if they always give the customers what they want doesn’t mean they’ll obey a law based on misinformation and which makes them disobey their principles. I don’t understand how the legislative machinery works but I’m hoping the fate for this bill will be the same as what happened to those from last year.

What Questions Should We Ask on MLK Day?

I ran across this quote from Dr. Martin Luther King, Jr. in my notes:

“Human progress is neither automatic nor inevitable… Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals.”

― Martin Luther King Jr.

This week we’ll be getting the two biographies of Martin Luther King, Jr. One of them is a biography published a couple of years ago by Jonathan Eig, titled “King: A Life.” The other is an autobiography, “The Autobiography of Martin Luther King, Jr.”

This morning, I was focused on puzzling over Eig’s book, in which there is a focus of how depression affected Dr. King. Gradually, I found out more about his struggles with mental health than I ever knew, and people were aware of them many years before Eig.

Dr. King never shared his emotional problems with anyone while he was alive in order to avoid the stigma in those times. Initially I asked “Why?” type questions. Why does anyone dig into a person’s private health information? That’s called PHI for short and it’s not supposed to be readily available to just anybody. Health professionals know that.

And then I remembered something I learned gradually over the course of my career as a psychiatrist. It’s hard to frame useful answers to “Why?” questions. It’s often more helpful to ask “What?” questions, mainly because they lead to actionable replies about things we might need to change.

What did I do as a teacher before I retired from consultation-liaison psychiatry in order to train those who would improve on what I did?

I shared with my students what I thought would be most helpful to them in their careers going forward:

The shortage of psychiatrists in general, and of C-L psychiatrists specifically, still leads me to believe that George Henry was right when he said:

“Relegating this work entirely to specialists is futile for it is doubtful whether there will ever be a sufficient number of psychiatrists to respond to all the requests for consultations. There is, therefore, no alternative to educating other physicians in the elements of psychiatric methods.”– George W. Henry, MD, 1929 (Henry, G.W., SOME MODERN ASPECTS OF PSYCHIATRY IN GENERAL HOSPITAL PRACTICE. Am J Psychiatry, 1929. 86(3): p.481-499.)

There was so much in Henry’s paper published in 1929 that still sounds current today. I can paraphrase the high points:

Practice humility and patience
Avoid psychiatric jargon
Stick close to facts; don’t get bogged down in theories
Prevent harm to patients from unnecessary medical and surgical treatment, e.g. somatization
“The psychiatrist deals with a larger field of medical practice and he must consider all of the facts.”

The psychiatrist should “…make regular visits to the wards…continue the instruction and organize the psychiatric work of internes…attend staff conferences so that there might be a mutual exchange of medical experience”
Focus on “…the less obvious disorders which so frequently complicate general medical and surgical practice…” rather than chronic, severe mental illness

The advantages of an integrated C-L Psychiatrist service (here I mean integrating medicine and psychiatry; mind and body) are that it increases detection of all mental disorders although that requires increasing the manpower on the service because of the consequent higher volume demand in addition to other requests, including but not limited to unnecessary consultation requests.

Further, what still astonishes me is the study which found that among consultee top priorities was an understanding of the core question (Lavakumar, M. et al Parameters of Consultee Satisfaction With Inpatient Academic Psychiatric Consultation Services: A Multicenter Study. Psychosomatics (2015). The irony is that the consultees frequently do not frame specific questions (Zigun, J.R. The psychiatric consultation checklist: A structured form to improve the clarity of psychiatric consultation requests. General Hospital Psychiatry 12(1), 36-44; (1990).

Moreover, it is sometimes necessary to give consultees bad news. A consultant should be able to tell a colleague what he or she may not what to hear. This principle is applicable across many disciplines and contexts. And it is best delivered with civility.

A former president of the ACLP said:

“A consultation service is a rescue squad. At worst, consultation work is nothing more than a brief foray into the territory of another service…the actual intervention is left to the consultee. Like a volunteer firefighter, a consultant puts out the blaze and then returns home… (However), a liaison service requires manpower, money, and motivation. Sufficient personnel are necessary to allow the psychiatric consultant time to perform services other than simply interviewing troublesome patients in the area assigned to him.”—Dr. Thomas Hackett.

I don’t think it’s too much to expect things to improve. Speaking of improvement, Stephen Covey called it “sharpening the saw,” one of the 7 habits of highly effective people. For this, The University of Iowa Hospitals and Clinics C-L Psychiatry has the Clinical Problems in Consultation Psychiatry or CPCP. This was started by Dr. Bill Yates in the 1990s, and it was originally called Problem-based Learning. “PBL…emphasis on the development of problem-solving skills, small group dynamics, and self-directed methods of education…most common types of problem categories identified for the conference were pharmacology of psychiatric and medical drugs (28%), mental status effects of medical illnesses (28%), consultation psychiatry process issues (20%), and diagnostic issues (13%) …PBL conference was ranked the highest of all the psychiatry resident educational formats.”

Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.
- Covey, S. R. (1990). The seven habits of highly effective people: restoring the character ethic. New York, Simon and Schuster.

What did I do when burnout made me a less effective teacher? In 2012 I started getting feedback from colleagues and trainees indicating they noticed I was edgy, even angry, and it was time for a change.

After reflecting on the feedback from my colleagues and students, I enrolled in our university’s 8 week group Mindfulness-Based Stress Reduction (MBSR) program. Our teacher debunked myths about mindfulness, one of which is that it involves tuning out stress by relaxing. In reality, mindfulness actually entails tuning in to what hurts as well as what soothes.

Maybe we should ask what helped Dr. Martin Luther King, Jr. persevere in spite of the inner turmoil and external pressure.

Fractured Numismatics

I saw this article on the web about certain coins (state quarters) that might be worth a lot of money. I just raided our piggy bank for pennies and other chicken feed a couple of months ago and knew we had some quartesr.

As it turns out we have a couple of the year 2000 S. Carolina quarters; one was a P and the other a D.

“2000 South Carolina quarter

The 2000 South Carolina quarter was one of the first State quarters to be released. It may have extra value if it has extra strikes during the minting process instead of one strike.

A 2000-P 25C South Carolina (Regular Strike) had an auction record of over $3,000, according to the PCGS, valued due to its MS69 grade. Very few coins in this condition exist.

Estimated worth: $500-$2,500”

I peered at them with a magnifying glass but couldn’t really tell if it was valuable. We looked for a coin shop on line to see if we could get some assistance with grading the coins. There’s a coin and gun shop right here in town. Apparently, coin shops often deal in guns as well. The neighborhood looked a little rough.

So, I checked on the internet on a couple of coin collectors web sites and found an interesting YouTube on S. Carolina state quarters alone. There was a quarter worth about $3,500.