More Mall Walking for Everyone!

I don’t get out often to the mall to do mall walking, but I did today. I put on a little over 2.5 miles on my step counter. Mall walking is OK for exercise although I have to drive over there. Right next door to the entrance to the mall is the outdoor entrance to Planet Fitness, which is kind of ironic. But you have to pay a membership fee to use the facilities there. You can just walk through the mall for free and it opens an hour before the other shops just to accommodate mall walkers.

I think mall walking does wonders for my lower back. I see a lot of older people who look like they make mall walking regular exercise. They’re my age or older. Some of them have physical challenges that may be the reasons why they mall walk, that is, for conditioning. Their physicians might have even recommended it.

A minority of mall walkers I see are young, so this isn’t just for the elderly. Occasionally I’ll see a group who are challenged in various ways. Today it looked like the guy who was blind and using a cane was right out in front, actually leading the group.

Mall walking has advantages over, say, walking downtown. It beats getting clobbered by an exploding manhole lid, bit by a dog, or mugged.

There are some studies about mall walking, but the authors of a 2015 review mainly noted that there’s a need for more rigorous studies. Their conclusion sounds a little grumpy:

“We found the potential for mall walking programs to be implemented in various communities as a health promotion measure. However, the research on mall walking programs is limited and has weak study designs. More rigorous research is needed to define best practices for mall walking programs’ reach, effectiveness, adoption, implementation, and maintenance.”

Farren L, Belza B, Allen P, Brolliar S, Brown DR, Cormier ML, Janicek S, Jones DL, King DK, Marquez DX, Rosenberg DE. Mall Walking Program Environments, Features, and Participants: A Scoping Review. Prev Chronic Dis. 2015 Aug 13;12:E129. doi: 10.5888/pcd12.150027. PMID: 26270743; PMCID: PMC4552141.

Maybe the authors need to go for a walk.

It’s inspiring to see some of the mall walkers out there despite having major disability of one kind or another. I often see a lady who uses a wheeled walker and cannot hold her head up straight. When she sits down for a break, it looks like she’s collapsed. But she just gets up and at it again a few minutes later.

Mall walking may be understudied—but it’s also underestimated as a sign of resilience in anyone young or old.

University of Minnesota CIDRAP Story on CDC ACIP Meeting Next Week

The University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP) posted a news report about the upcoming CDC ACIP meeting next Wednesday. Apparently, so far the new advisory committee draft agenda does not include a vote on the Covid-19 vaccine.

The Short Story on Kiwi for Health

Sena was at the store yesterday and some guy (a total stranger) in a motorized scooter rode up to her and said, “I have trouble sleeping” and asked her where to find the kiwi fruit in the produce section. It didn’t faze her because this didn’t sound like a pickup line, you know like that joke on the TV commercial: “Why do iguanas reproduce only once a year? That’s because they have e-reptile dysfunction.”

Actually, the guy was looking for kiwi fruit because he had heard that it can help you sleep. So, she told him where it was. A little later, she saw him wandering around and asked him if he’d found the kiwi fruit. He hadn’t so she got a package for him.

It turns out there is a news article saying there are a few small studies indicating that eating a couple of kiwis (remember, this is about the fruit, not the birds) about an hour before you hit the sack can help you sleep. They have a lot of serotonin which your body turns into melatonin which can promote sleep.

You have to be careful about eating kiwis if you have a latex or fruit allergy because you could have a reaction. And if you have diabetes you need to be aware kiwis are high in sugar.

The thing is, you have to eat a couple of them about an hour before bedtime. Often enough I find that I’m napping in the evening in front of the TV long before then—but that’s probably because there’s usually nothing on but reruns and the usual commercials about cannabidiol (CBD) products, total body deodorants, and snake oil for e-reptile dysfunction.

In fact, there’s also some limited evidence that kiwi fruit can just help you feel better in general. It’s mainly about yellow kiwi fruit rather than the green ones. The yellow ones are called SunGold, and they have a lot of vitamin C. Actually, if you don’t like kiwi fruit, you can find other fruits and vegetables containing a lot of vitamin C, including strawberries and oranges—and broccoli. Go with kiwi fruit.

On the other hand, it looks like you might pay about 3x more for the yellow kiwi than the green.

Kiwi fruits are packed with vitamins. You can get 100% of vitamin C from SunGold and they have more than 20 vitamins and minerals. More than a million tons of kiwi fruit are produced every year. You can make kiwi pizza-if you’re on drugs!

And if you eat a couple of SunGold kiwis a day you could feel so good you might be more willing to contribute to the foundation for assisting iguanas with e-reptile dysfunction.

Center for Infectious Disease Research and Policy Outlook on Covid Data and New CDC ACIP Committee

I have a lot more faith in the infectious disease news from the University of Minnesota Center for Infectious Disease Research and Policy Outlook (CIDRAP) than most other news outlets. Their review of the so far 8 newly appointed CDC ACIP committee members is interesting. I plan to watch the upcoming June 25-27 CDC ACIP meeting.

They also provide updates on the CDC Covid-19 variant tracking data. While the LP.8.1 has been in the spotlight lately as the upcoming variant of note, the Nowcast estimates of the proportion of NB.1.8.1 are currently almost equal to LP.8.1. They report the NB.1.8.1 is minimally more immune evasive than LP.8.1. They are both descended from the JN.1 lineage. Overall, Covid-19 activity is low.

Can We Calm Down?

First of all, I want to make it clear that I am not now nor have I ever been pregnant. Now that I have your attention, I’ll add some context to that weird statement by saying how puzzled I am by all the controversy about whether or not there’s actually a federal recommendation against pregnant women getting the Covid-19 vaccine.

I admit, I actually did think about the movie “Signs” in which the lead character, Graham Hess, says “Everybody in this house needs to calm down and eat some fruit or something.” I think it fits.

I found a lot of news stories claiming that HHS and the CDC don’t recommend that pregnant women get the Covid-19 vaccine. What I actually found on the HHS web site says the opposite—the agency recommends it.

That seems to agree with the paper from the FDA leadership, published in the New England Journal of Medicine by Drs. Prasad and Makary (An Evidence-Based Approach to Covid-19 Vaccination. Authors: Vinay Prasad, M.D., M.P.H., and Martin A. Makary, M.D., M.P.H. Author Info & Affiliations). Published May 20, 2025. DOI: 10.1056/NEJMsb2506929.

“Moving forward, the FDA will adopt the following Covid-19 vaccination regulatory framework: On the basis of immunogenicity — proof that a vaccine can generate antibody titers in people — the FDA anticipates that it will be able to make favorable benefit–risk findings for adults over the age of 65 years and for all persons above the age of 6 months with one or more risk factors that put them at high risk for severe Covid-19 outcomes, as described by the CDC (Figure 2).”

Figure 2 is a table which lists many medical conditions that are indications for getting the Covid-19 vaccine. Pregnancy is one of them, based on the idea that it could increase the severity of Covid-19 disease.

On the other hand, when I looked at the health care provider page on the CDC website, the table showing the clinical indications for the Covid-19 vaccine sends a confusing message by showing pregnancy as a condition for which there is currently “No Guidance/Not Applicable.”

Just in case this web page gets updated, I took a screenshot of that part of the table:

But elsewhere on the CDC website are pages which clearly recommend that pregnant women get the Covid-19 vaccine.

I’m not making any political statements here. I’m just an old guy who clearly does have an indication for getting the Covid-19 vaccine and I recently did just that last month.

Dept of Health & Human Services to Reconstitute CDC Advisory Committee on Immunization Practices

HHS announced the removal and replacement of the current members of the CDC Advisory Committee on Immunization Practices in a press release today. The CDC ACIP meeting for vaccine recommendations is still scheduled for June 25-27. According to the Federal Register announcement under Supplementary Information:

“SUPPLEMENTARY INFORMATION:

Purpose: The Advisory Committee on Immunization Practices is charged with advising the Director, Centers for Disease Control and Prevention (CDC), on the use of immunizing agents. In addition, under 42 U.S.C. 1396s, the Committee is mandated to establish and periodically review and, as appropriate, revise the list of vaccines for administration to vaccine-eligible children through the Vaccines for Children program, along with schedules regarding dosing interval, dosage, and contraindications to administration of vaccines. Further, under applicable provisions of the Affordable Care Act and section 2713 of the Public Health Service Act, immunization recommendations of ACIP that have been adopted by the Director, CDC, and appear on CDC immunization schedules generally must be covered by applicable health plans.

Matters To Be Considered: The agenda will include discussions on anthrax vaccines, chikungunya vaccines, COVID-19 vaccines, cytomegalovirus (CMV) vaccine, Human papillomavirus (HPV) vaccine, influenza vaccines, Lyme disease vaccine, meningococcal vaccines, pneumococcal vaccines, Respiratory Syncytial Virus (RSV) vaccines for adults, and RSV vaccines for maternal and pediatric populations. Recommendation votes are scheduled for COVID-19 vaccines, HPV vaccine, influenza vaccines, meningococcal vaccine, RSV vaccines for adults, and RSV vaccine for maternal and pediatric populations. Vaccines for Children (VFC) votes are scheduled for COVID-19 vaccines, HPV vaccine, influenza vaccines, and RSV vaccines. 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. For more information on ACIP, please visit the ACIP website: https://www.cdc.gov/acip.“

The Wild West Sandbox of AI Enhancement in Psychiatry!

I always find Dr. Moffic’s articles in Psychiatric Times thought-provoking and his latest essay, “Enhancement Psychiatry” is fascinating, especially the part about Artificial Intelligence (AI). I liked the link to the video of Dr. John Luo’s take on AI in psychiatry. That was fascinating.

I have my own concerns about AI and dabbled with “talking” to it a couple of times. I still try to avoid it when I’m searching the web but it seems to creep in no matter how hard I try. I can’t unsee it now.

I think of AI enhancing psychiatry in terms of whether it can cut down on hassles like “pajama time” like taking our work home with us to finish clinic notes and the like. When AI is packaged as a scribe only, I’m a little more comfortable with that although I would get nervous if it listened to a conversation between me and a patient.

That’s because AI gets a lot of things wrong as a scribe. In that sense, it’s a lot like other software I’ve used as an aid to creating clinic notes. I made fun of it a couple of years ago in a blog post “The Dragon Breathes Fire Again.”

I get even more nervous when I read the news stories about AI making delusions and blithely blurting misinformation. It can lie, cheat, and hustle you although a lot of it is discovered in digital experimental environments called “sandboxes” which we hope can keep the mayhem contained.

That made me very eager to learn a little more about Yoshua Bengio’s LawZero and his plan to create the AI Scientist to counter what seems to be a developing career criminal type of AI in the wild west of computer wizardry. The LawZero thing was an idea by Isaac Asimov who wrote the book, “I, Robot,” which inspired the film of the same title in 2004.

However, as I read it, I had an emotional reaction akin to suspicion. Bengio sounds almost too good to be true. A broader web search turned up a 2009 essay by a guy I’ve never heard of named Peter W. Singer. It’s titled “Isaac Asimov’s Laws of Robotics Are Wrong.” I tried to pin down who he is by searching the web and the AI helper was noticeably absent. I couldn’t find out much about him that explained the level of energy in what he wrote.

Singer’s essay was published on the Brookings Institution website and I couldn’t really tell what political side of the fence that organization is on—not that I’m planning to take sides. His aim was to debunk the Laws of Robotics and I got about the same feeling from his essay as I got from Bengio’s.

Maybe I need a little more education about this whole AI enhancement issue. I wonder whether Bengio and Singer could hold a public debate about it? Maybe they would need a kind of sandbox for the event?

The FDA VRBPAC Meeting Today on Covid-19 Vaccines for 2025-26

The FDA VRBPAC meeting today on the Covid-19 vaccines for 2025-26 is so far leading me to believe that the best choice for the voting question-

Based on the evidence presented, please discuss considerations for the selection of JN.1 and/or a specific JN.1-lineage strain for COVID-19 vaccines (2025-2026 Formula) to be used in the U.S.

-might just be sticking with last year’s Covid-19 JN.1 lineage vaccine rather than targeting the newest LP.8.1 strain. The strains so far aren’t suggesting a seasonal pattern. Some strains only last for weeks and it seems getting or making a vaccine for a Covid-19 strain that disappears by the time the manufacturer rolls out a vaccine for it could turn out to be a waste of time.

Neverthe less, all three of the industry presenters are calling this a “seasonal” update to their Covid-19 vaccine products. They’re hedging their bets, so to speak, and would be ready to market a vaccine targeting LP.8.1 if the FDA decides to license the product.

I’ve held off getting the JN.1 vaccine so far in anticipation of today’s meeting, to see if there’s any reason not to get it based on today’s decision.

But the day is young. I’ll probably be making periodic updates to this post today. I think Dr. Jerry Weir’s slides are excellent, as usual.

“Voting Question
For the 2025-2026 Formula of COVID-19 vaccines in the U.S., does the committee recommend a monovalent JN.1-lineage vaccine composition?
Please vote “Yes” or “No” or “Abstain”

“Discussion Topic
Based on the evidence presented, please discuss considerations for the selection of
JN.1 and/or a specific JN.1-lineage strain for COVID-19 vaccines (2025-2026 Formula) to be used in the U.S.”

Update: Of course, the committee voted unanimously for the JN.1 lineage because there was no alternate choice. The only choice for the members was to vote for the JN.1-lineage or against it. Although I agree with the “vote,” I think they should have had the alternate of LP.8.1 available, otherwise why have a vote at all? I wonder what the FDA will do now.

FDA Vaccines and Related Biological Products Advisory Committee Meeting May 22, 2025

The meeting of the FDA VRBPAC on the composition of Covid-19 vaccines will be tomorrow, May 22, 2025 at 8:30 am-4:30 pm EST. Some materials have recently become available on the FDA website.

The briefing document indicates that there will be a discussion of the most recent Covid-19 variants and whether the current vaccine needs to be modified as the viral antigenic strain has mutated.

The World Health Organization has formed a new technical advisory group: “Technical Advisory Group on COVID19 Vaccine Composition (TAG-CO-VAC) to review and assess the public health implications of emerging SARS-CoV-2 variants of concern (VOCs) on the performance of COVID-19 vaccines and to provide recommendations to WHO on proposed modifications to COVID-19 vaccine antigen composition. Recently, the TAG-CO-VAC advised that a monovalent JN.1 or KP.2 vaccines remain as appropriate vaccine antigen, while a monovalent LP.8.1 is a suitable alternative vaccine antigen (Ref: https://www.who.int/news/item/15-05-2025-statement-on-the-antigen-composition-of-covid-19-vaccines) to be included in the composition of COVID-19 vaccines (2025-2026 Formula).”

The VRBPAC meeting topics:

“On May 22, 2025, VRBPAC will meet in open session to discuss and make recommendations on the selection of the 2025-2026 Formula for COVID-19 vaccines for use in the U.S. The committee will be asked to discuss available evidence on recent and currently circulating SARS-CoV-2 variants, including data from virus surveillance and genomic analyses, antigenic characterization analyses, vaccine effectiveness and clinical immunogenicity studies of current U.S.- authorized/approved COVID-19 vaccines and nonclinical immunogenicity studies of candidate vaccines expressing or containing updated Spike antigens.”

The attendees include:

The TAG-CO-VAC presenter:

Kanta Subbarao, M.B.B.S., M.P.H. Professor Department of Microbiology and Immunology Faculty of Medicine Laval University (Laval University is in Quebec City, Quebec, Canada).

There’s an Iowa City member on the committee roster:

Stanley M. Perlman, M.D., Ph.D. Expertise: Pediatrics, Infectious Diseases Term: 08/23/2022 – 01/31/2026 Professor University of Iowa Distinguished Chair Department of Microbiology and Immunology Carver College of Medicine University of Iowa, Iowa City, IA 52242.

And the acting chair of the meeting will once again be: Arnold Monto, M.D. Expertise: Epidemiology Term: 02/01/2022 – 01/31/2026 Thomas Francis Jr. Collegiate Professor Emeritus of Public Health and Epidemiology School of Public Health University of Michigan Ann Arbor, MI 48109.

Vaccine manufacturer presentations will be from Moderna, Pfizer, Novavax, and Sanofi.

FDA VRBPAC Meeting to Discuss Covid-19 Vaccines

The FDA VRBPAC meeting to discuss Covid–19 vaccines is scheduled for May 22, 2025, 8:30 a.m. – 4:30 p.m. ET. The committee will meet in open session to discuss and make recommendations on the selection of the 2025-2026 Formula for COVID-19 vaccines for use in the United States. The meeting presentations will be heard, viewed, captioned, and recorded through an online teleconferencing and/or video conferencing platform.

I couldn’t see any specifics about the forthcoming meeting. I assume there will be updates.