Category: science

Remembrance of Dr. William R. Yates MD

I was thinking about the Clinical Problems in Consultation Psychiatry (CPCP) learning sessions which was introduced to me by one of my first teachers in the University of Iowa Dept of Psychiatry, Dr. William R. (Bill) Yates.

I had originally been thinking of posting one of my own CPCPs that I presented in 2015. It was about the psychosocial adjustment of patients to ostomy.

I searched widely and in vain on the web for any recent information about what Dr. Yates was doing now. I was surprised and saddened to discover his obituary. He died on January 19, 2023 in Tulsa, Oklahoma.

As the obituary says:

He served on the faculty at the University of Iowa for Psychiatry and Family Medicine before becoming Professor and Chair of Psychiatry at the University of Oklahoma College of Medicine in Tulsa. After retiring, he continued to dedicate his time as a volunteer research psychiatrist at OU and the Laureate Institute for Brain Research where he also served on the board of directors. He authored over 100 scientific manuscripts that were published in peer-reviewed journals.

He was an energetic, a great teacher, had a great sense of humor, and was easy to get along with. He published in many scientific journals and taught many trainees. He was an avid bird watcher and his blog Brain Posts highlighting neuroscience research findings is still visible on the web.

He published the paper along with a chief resident on problem-based learning used on the psychiatry consult-liaison service in 1996, the year I graduated psychiatry residency and joined the faculty at The University of Iowa Hospitals & Clinics (Yates, W. R. and T. T. Gerdes (1996). “Problem-based learning in consultation psychiatry.” Gen Hosp Psychiatry 18(3): 139-144.) You can read the abstract for it along with a description of the CPCP at the link above which takes you to my April 19, 2019 blog post “Clinical Problems in Consultation Psychiatry.”

When he was the leader of the psychiatry consult service, we were still using paper charts and his staffing comments were always very brief and encapsulated the assessment and plan succinctly without wasted verbiage—contrasting with my long-winded note.

His remarks about his role at Laureate Institute for Brain Research is still accessible:

“I work part-time as a research psychiatrist for the assessment team at the Laureate Institute for Brain Research. We do research diagnostic assessments for a variety of imaging, genetic and biomarkers studies in mood, anxiety and other brain disorders. I also provide review and analysis of neuroscience research on my blog Brain Posts that can be found at www.brainposts.blogspot.com. You can follow me on Twitter @WRY999. I also use my blog and Twitter feed to share my bird photography images.”

I respected and admired Dr. Yates, as I’m sure many learners did. I will always remember Bill as a gifted scientist and teacher.

I think a fitting tribute would be to go ahead and post my CPCP on the psychosocial adjustment of patients with ostomy. One of the most interesting articles in the bibliography is how the mindfulness meditation approach to that adjustment can be very helpful. The website United Ostomy Association of America website is also informative.

The presentation is also limited to a dozen slides. I often encouraged learners to keep the number of slides to a managed number so the presentations wouldn’t run too long. I called my slide sets the Dirty Dozens.

Many thanks to Dr. William R. Yates and my condolences to his family.

Moderna Files for FDA Authorization of Updated Covid-19 Vaccine

The Moderna corporation announced in June 2023 that it filed for FDA authorization of its monovalent XBB. 1.5 vaccine.

Pfizer also announced the same message in August. It’s on page 4 of the Pfizer Earnings Call.

Shout Out to University of Iowa Hospitals Doctor Joseph Zabner!

Here’s a big shout out and congratulations to my former University Hospitals colleague Dr. Joseph Zabner who received the 2023 Distinguished Mentor Award.

Maybe an Iowa State Fair Contest Would Settle the Score in UFO Flap

I just saw the news story about the whistleblower David Grusch a couple days ago. Apparently, Mr. Grusch’s personal medical record was obtained through the state of Virginia’s Freedom of Information Act (FOIA) and released to the public. He was one of three people who testified recently at the House Oversight Committee hearing on Unidentified Anomalous Phenomena (UAP). He reported that the Department of Defense (DoD) had knowledge of extraterrestrial craft and “biologics” (extraterrestrial bodies?).

This reminds me of one of the final comments by one of the other three witnesses, which is worth framing as a quote:

“Don’t make the fish bigger than it was.” — retired Commander David Fravor of the U.S. Navy.

The current director of the DoD organization for UFOs, Sean Kirkpatrick, PhD, who heads the All-Domain Anomaly Resolution Office (AARO), expressed his objection in no uncertain terms to Mr. Grusch’s testimony, calling it insulting.

Anyway, I had to learn a little bit more about the FOIA, and found out that in addition to the federal government FOIA, each state has its own FOIA process. I looked up the Virginia state FOIA, and usually personal medical records are one of the exempted files. Apparently, they can still release them.

I think this might be an attempt to discredit Mr. Grusch. I’m puzzled by the release of his medical history. I don’t know anything about specific protections for retaliation against whistleblowers, but I would think exposing anyone’s medical record would count.

Not to spread any more conspiracy theories, but what if this whole thing is a well-orchestrated complex distraction from the general shambles of our political system? It would tend to discourage other whistleblowers from coming forward. Maybe that’s the intent.

If politicians and people in general were to make a concerted effort to treat each other with civility, respect, and a sense of humor, maybe these embarrassing sideshows could be minimized.

I don’t know if UAP involve advanced civilizations from across the galaxy and I doubt it. In fact, I tend to think a quote from Men in Black would fit:

“Human thought is so primitive it’s looked upon as an infectious disease in the better galaxies.”

I’m pretty sure most ETs have been steering clear of us for a long time.

How about this: the Iowa State Fair is on now, and it runs from August 10-20. I haven’t checked this out with anyone at the Fair, but if we could persuade David Grusch and Sean Kirkpatrick to settle their differences by competing in one or more of the contests coming up in the coming week, we might be able to get them to shake hands and have some laughs. Sena and I have never been to the Iowa State Fair, but if this event could be added, I think we could swing a trip there.

I see that the Cow Chip Throwing contest is scheduled for August 16 at 11 a.m. That would be a knee slapper.

It’s too late to arrange for them to compete in the Monster Arm Wrestling contest, which is this Sunday. Could a special event be scheduled later?

How about a cribbage game? The Cribbage Tournament is on August 20, starting at 10 a.m. with registration and the games start at 11 a.m.  Now that would be special since Sena and I are fans of the game. David and Sean would have to learn how to play cribbage ahead of time, and it’s not that hard.

There are other events, but the guys need to get ready and decide soon so they can enter. And they should notify me so that Sena and I can make the trip to Des Moines and catch the action.

Both winner and loser should get free corn dogs.

The Dragon Breathes Fire Again

Sena and I saw a news video about a technology called “DAX” which uses Artificial Intelligence (AI) the other day which promises to reduce or even eliminate pajama time for physicians trying to get their clinical note dictations done during the day instead of taking them home for several more hours of work.

The video was a demo of the technology, which looked like it recorded a clinical interview between the doctor and the news reporter. I didn’t see how exactly DAX was recording the interview without obvious audio equipment. Was it doing it through the smartphone speaker? This was very different from how I and many other clinicians dictated their notes using a headphone set at their desks in front of their desktop computers. It not only records but transcribes the interview.

Later, I discovered that DAX stands for Dragon Ambient Experience, made by Nuance which was acquired by Microsoft in 2022. I posted about Dragon products and their limitations last year. The product often produced hilarious mistakes during dictation which required careful editing. Sometimes more errors turned up after you completed it and these were visible in the patient’s medical record, which would then need to be corrected.

Several years ago, I remember talking to somebody from Dragon on the phone about the problems I was having. She was a little defensive when I told her I’d been having difficulty with Dragon for quite a while because it made so many mistakes.

A recent article on the web revealed that the errors continue with DAX. According to the article, “…it will make mistakes. Sometimes it might omit clinical facts; sometimes it may even hallucinate something.” I remember trying to communicate with the Google Bard AI, which seemed to do this pretty often. It made stuff up.

DAX is not cheap. The article reveals that one hospital pays $8,000-$10,000 per year per physician to use it. And skeptics worry that the system has too many bugs in it yet, which can lead to bias and inaccurate information which could negatively affect patient outcomes.

A recently published JAMA network article also urges caution in adoption of this sort of AI-assisted technology (Harris JE. An AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity. JAMA. Published online August 07, 2023. doi:10.1001/jama.2023.14525).

In this case, I think it’s appropriate to say “I told you so.”

New Dominant Covid-19 Variant EG.5

There is a new dominant Covid-19 variant called EG.5. It’s also called Eris. It’s descended from the XBB strains. It’s in the Omicron family and there is no indication it causes more severe disease and would be susceptible to current vaccines.

The Lesser-Known Quote by Wonko the Sane

A couple of days ago, Sena and I were playing cribbage and she thought she had a higher scoring hand than she actually did. She immediately realized it and scored it right. She commented that, at first, she thought she saw something she didn’t actually see. I quipped that “First you have to see it.” She thought that was pretty funny.

I actually said that because I remembered a quote from Wonko the Sane in Douglas Adam’s book “So Long and Thanks for All the Fish.” Wonko is a guy who lives “outside the asylum” because he saw the instructions on a box of toothpicks and thought it was so bizarre that he didn’t want to live in a society which needed that kind of instruction.

Now, you can find a lot of references on the web for the quote that arises from the toothpick instruction:

“It seemed to me, said Wonko the Sane, that any civilization that so far lost its head as to need to include a detailed set of instructions for use in a package of toothpicks, was no longer a civilization in which I could live and stay sane.” Douglas Adams, So Long, and Thanks for All the Fish.

You can even buy tee shirts printed with this quote. But that’s not the Wonko the Sane quote I was thinking of. In fact, I’m not the only one who thought of it and the first person I want to give credit to for calling attention to it is a WordPress blogger whose name seems not discoverable on his blog, but instead has the title Eppur Si Muove. It’s Latin and it means “…and yet it does move.” It’s attributed to Galileo who muttered it after being forced to recant his claim that the earth moves around the sun.

The quote is:

But the reason I call myself by my childhood name is to remind myself that a scientist must also be absolutely like a child. If he sees a thing, he must say that he sees it, whether it was what he thought he was going to see or not. See first, think later, then test. But always see first. Otherwise you will only see what you were expecting. Most scientists forget that…. So the other reason why I call myself Wonko the Sane is so that people will think that I am a fool. That allows me to say what I see when I see it. You can’t possibly be a scientist if you mind people thinking that you’re a fool. ~ Wonko the Sane, from So Long, and Thanks for All the Fish by Douglas Adams.

The blogger who wrote the post entitled it “Wonko the Sane—On Being a Scientist…”

Seeing what’s really there is very difficult to do. I’m fettered by expectations, desires, prior misinformation, and so on. Often, I see what I want to see rather than what’s there.

The toothpick quote gets more interpretations often by writers who sound like they trying to prove something. What’s even more interesting than them (and funnier) are the great number of actual instructions on how to use toothpicks, even how to do tricks with them.

What seems impossible to find are actual instructions for how to see.

Tickle Tickle Tickle!

I saw an interesting article about how lab rats react to researchers tickling them. I had no idea rats had a funny bone. They’ll even chase your hand to get tickled. When they’re tickled, they make laughing noises that are just under the threshold of human hearing, but the sounds can be heard when converted to our range of hearing. They like to be tickled on their bellies or backs.

What scientists have found is that an area in the brain called the periaqueductal gray (as medical students we had to learn about this area to pass anatomy class) that is associated with tickling and laughter. The upshot is that play is important for growing brains.

Many of us remember being tickled as children. We could get hysterical even if someone just approached us with hands outstretched, saying “kootchy kootchy koo.”

Something happens when we grow up and we lose that ticklish sensitivity. And you can’t tickle yourself to get that sensation.

Tickling sensitivity may go away, but a sense of humor usually doesn’t, at least for most of us. I can’t count the number of times Sena has caught me sort of stifling a chuckle over some funny thought that happens to cross my mind. I’m sure I look half-crazy. Sometimes I think I should come up with a semi-plausible explanation for this behavior (“Oh, I’m just being tickled by invisible extraterrestrials!”).

Scientists are still working on finding out why we’re ticklish. I don’t know exactly why we lose ticklishness as we grow up. But I don’t think building a tickling robot would fix it. It might be difficult to calibrate its finger strength, resulting in broken ribs and punctured lungs—at first. But those aren’t problems, just details to be worked out.

Tough TV Choices

I have a couple of choices for TV shows tonight. I could watch an X-Files rerun on the Comet network or the “season finale” of The Secret of Skinwalker Ranch.

Sena and I have been watching the X-Files reruns the last few nights. We didn’t know it was on until Sena happened to catch a couple of episodes. It comes on weeknights between 8-11 pm. They’re the early ones, which were pretty good.

We used to watch X-Files and munch popcorn a long time ago when the show was new. It was good entertainment.

On the other hand, it’s hard to know what to call The Secret of Skinwalker Ranch. Is it entertainment or investigative reporting? I don’t know how you can say it’s investigative in nature when mostly what you see are guys firing off dozens of hobby rockets to annoy the interdimensional entities who then lob UFOs back at them.

Calling a show a “season finale” doesn’t make me think about scientific TV programs.

I’m betting the skinwalker season finale will be an extravaganza of hobby rockets and dozens of Sasquatches flinging their hairy legs in the air in unison Rockette-style while munching on beef jerky.

I can’t afford to miss that. Sena will watch the X-Files on the TV downstairs.