science – Page 8 – Go Retire Psychiatrist

Politics on the Brain

I just discovered the news item about 5 Minnesota Senate Republicans who introduced a bill this month seeking to classify “Trump Derangement Syndrome” (TDS) as a mental illness. This is not a new idea, I think, and it targets Democrats as having the syndrome. There’s a big Wikipedia article about the history of the origin of it.

It reminded me of a Dr. Henry Nasrallah’s editorials about “neuropolitics” a term he used in an effort to understand how much politics can affect the human brain. He published a series of 3 articles in the journal Current Psychiatry. The one published in the October 2018 issue is entitled “Neuropolitics in the age of extremism: Brain regions involved in hatred.”

Dr. Nasrallah is a neuropsychiatrist who has an entertaining and thought-provoking writing style. I met him briefly when I was interviewing for psychiatry residency at the University of Cincinnati.

The political situation now is difficult and it makes me wonder even more if there is a problem with the human brain when it comes to politics.

Dr. Nasrallah article 1

Dr. Nasrallah article 2

Dr. Nasrallah article 3

The Not So Skinny on Exercise Associated Muscle Cramps

I’m just about fully recovered by a sudden case of shin splints and calf cramps in both legs this past Monday. I did no running, just walked for a little over 4 miles between our house and the shopping mall.

I thought I was doing pretty well until I got about a half mile from home. I had to cross a relatively busy street that doesn’t have a traffic light control, just a sign that suggests drivers slow down and stop for pedestrians in the crosswalk. Many drivers breeze through at around 30 mph and so I generally wait until there’s no traffic or when cars slow down enough that I can’t see the driver’s maniacal grin.

As a few cars waited, I began to cross the street and about halfway over, I started to trot and immediately both my calves cramped up. It was painful and I just managed to limp over to the sidewalk. As I leaned over and tried to ease the cramps by grabbing my toes and bending them toward my shins, I wondered why that happened.

Part of the reason was this was the first long walk of the spring after a winter of being relatively sedentary, other than some routine exercises including stationary bicycle, step box, and stretching routines.

I’m used to shin splints, which I noticed before the leg cramps. But I’ve never had both calves cramp like that. I’d gotten enough fluids, I wasn’t dehydrated, and I wasn’t low on electrolytes. Then, I got curious about the interplay of all those and found out there’s a fair amount of controversy about the causes of what I found out was called exercise-associated muscle cramps (EAMC)

Shin splints are a minor annoyance and could be due to me just being an old guy overdoing it and wearing not the greatest shoes on a concrete trail. Resting a while is the main way to get past it. But because of the double whammy of bilateral shin splints and calf cramps, I hunted on the internet for studies of the causes of EAMC, specifically calf cramps.

I’m sure most readers are familiar with web resources like the Cleveland clinic, which provide general guidance. They usually recommend avoiding dehydration and staying up to speed on electrolytes. Rest is the main suggestion. Meditating over an oleomargarine figurine of Elvis Presley is not recommended but has not been sufficiently studied.

Anyway, I found an interesting web site which challenges the usual guidance about the causes of EAMC. One of the authors of an article (“What Are the True Causes of Cramps While Running?” by Phattarapon Atimetin, MD; published May 15, 2019 on the website samitivejhospitals.com website) disputing the cause of EAMC being dehydration or mineral deficits pointed out that these are less likely than something called “altered neuromuscular control,” which appears to be advanced by a scientist named M.P. Schwellnus. However, the author didn’t cite any references, so I had to hunt them down. I think I found the right articles.

I found one the author didn’t mention, which was a comprehensive review (note the publication date, a few months after Dr. Atimen’s article):

Maughan RJ, Shirreffs SM. Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining. Sports Med. 2019 Dec;49(Suppl 2):115-124. doi: 10.1007/s40279-019-01162-1. PMID: 31696455; PMCID: PMC6901412.

The authors’ bottom line is:

Exercise-associated muscle cramp is a relatively common occurrence in a range of sport and exercise activities. Onset is generally unpredictable, and the intensity and duration of muscle spasms are highly variable. Spontaneous muscle cramping in occupational settings involving hard physical effort suggests that high ambient temperature and large sweat losses accompanied by the ingestion of large volumes of plain water may be risk factors, and there is some evidence that the risk is reduced by the addition of salt to ingested fluids. Laboratory models of cramp involve either voluntary or electrically-evoked activation of muscle held in a shortened position. These studies have produced mixed results regarding the effects of disturbances of water and salt balance on the risk of cramping; however, they do suggest that, at least in this model, sensory organs in the muscle invoke abnormal reflex activity that results in sustained motor drive to the afflicted muscles. There may be different mechanisms at work in different situations, and there is no conclusive support for any of the proposed mechanisms. Preventive and treatment strategies are not uniformly effective.

They mention M.P. Schewllnus, but they don’t endorse the altered neuromuscular control theory or any other as being explanatory in every case of EAMC. The review was supported by the Gatorade Sports Science Institute (GSSI), which makes me wonder about it a little.

I’m not certain but I think the references for the studies Dr. Atimen mentioned are below:

Schwellnus MP. Cause of exercise associated muscle cramps (EAMC)–altered neuromuscular control, dehydration or electrolyte depletion? Br J Sports Med. 2009 Jun;43(6):401-8. doi: 10.1136/bjsm.2008.050401. Epub 2008 Nov 3. PMID: 18981039.

Braulick, K. W., Miller, K. C., Albrecht, J. M., Tucker, J. M., & Deal, J. E. (2013). Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency. British Journal of Sports Medicine, 47(11), 710-714.

Hoffman MD, Stuempfle KJ. Muscle Cramping During a 161-km Ultramarathon: Comparison of Characteristics of Those With and Without Cramping. Sports Med Open. 2015;1(1):24. doi: 10.1186/s40798-015-0019-7. Epub 2015 May 21. PMID: 26284165; PMCID: PMC4532703.

The reference below is more recent and the authors’ bottom line is below:

Kevin C. Miller, Brendon P. McDermott, Susan W. Yeargin, Aidan Fiol, Martin P. Schwellnus; An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps. J Athl Train 1 January 2022; 57 (1): 5–15. doi: https://doi.org/10.4085/1062-6050-0696.20

Advances in our understanding of EAMC pathogenesis have emerged in the last 100 years and suggested that alterations in neuromuscular excitability and, to a much lesser extent, dehydration and electrolyte losses are the predominant factors in their pathogenesis. Strong evidence supports EAMC treatments that include exercise cessation (rest) and gentle stretching until abatement, followed by techniques to address the underlying precipitating factors. However, little patient-oriented evidence exists regarding the best methods for EAMC prevention. Therefore, rather than providing generalized advice, we recommend clinicians take a multifaceted and targeted approach that incorporates an individual’s unique EAMC risk factors when trying to prevent EAMCs.

The review was not supported by Gatorade. It turns out the best management is rest and gentle stretching. If that doesn’t work, the advice is to seek advanced medical care. There is no evidence that meditating over an oleomargarine figurine of Elvis Presley is effective in any way—although, again, it has not been studied that I know of.

Rounding@Iowa Podcast: “Advances in the Treatment of Pancreatic Cancer”

This episode of Rounding@Iowa is about important medical advances in the treatment of pancreatic cancer. As you listen to Dr. Clancy interview Dr. Joseph Cullen about what’s new, you’ll hear a lot about high-dose intravenous Vitamin C. This can enhance treatment and improve response to chemotherapy and radiation therapy. Dr. Cullen’s most recent study about this technique showed the overall survival of patients with late-stage pancreatic cancer increased from 8 months to 16 months.

87: New Treatment Options for Menopause – Rounding@IOWA

Join Dr. Clancy and his guests, Drs. Evelyn Ross-Shapiro, Sarah Shaffer, and Emily Walsh, as they discuss the complex set of symptoms and treatment options for those with significant symptoms from menopause. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=81895 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Evelyn RossShapiro, MD, MPH Clinical Assistant Professor of Internal Medicine Clinic Director, LGBTQ Clinic University of Iowa Carver College of Medicine Sarah Shaffer, DO Clinical Associate Professor of Obstetrics and Gynecology Vice Chair for Education, Department of Obstetrics and Gynecology University of Iowa Carver College of Medicine Emily Walsh, PharmD, BCACP Clinical Pharmacy Specialist Iowa Health Care Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources:

Reference:

Kellie L. Bodeker, Brian J. Smith, Daniel J. Berg, Chandrikha Chandrasekharan, Saima Sharif, Naomi Fei, Sandy Vollstedt, Heather Brown, Meghan Chandler, Amanda Lorack, Stacy McMichael, Jared Wulfekuhle, Brett A. Wagner, Garry R. Buettner, Bryan G. Allen, Joseph M. Caster, Barbara Dion, Mandana Kamgar, John M. Buatti, Joseph J. Cullen,

A randomized trial of pharmacological ascorbate, gemcitabine, and nab-paclitaxel for metastatic pancreatic cancer,

Redox Biology,

Volume 77,

2024,

103375,

ISSN 2213-2317,

(https://www.sciencedirect.com/science/article/pii/S2213231724003537)

Abstract: Background

Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) have poor 5-year survival. Pharmacological ascorbate (P-AscH-, high dose, intravenous, vitamin C) has shown promise as an adjunct to chemotherapy. We hypothesized adding P-AscH- to gemcitabine and nab-paclitaxel would increase survival in patients with metastatic PDAC.

Methods

Patients diagnosed with stage IV pancreatic cancer randomized 1:1 to gemcitabine and nab-paclitaxel only (SOC, control) or to SOC with concomitant P-AscH−, 75 g three times weekly (ASC, investigational). The primary outcome was overall survival with secondary objectives of determining progression-free survival and adverse event incidence. Quality of life and patient reported outcomes for common oncologic symptoms were captured as an exploratory objective. Thirty-six participants were randomized; of this 34 received their assigned study treatment. All analyses were based on data frozen on December 11, 2023.

Results

Intravenous P-AscH- increased serum ascorbate levels from micromolar to millimolar levels. P-AscH- added to the gemcitabine + nab-paclitaxel (ASC) increased overall survival to 16 months compared to 8.3 months with gemcitabine + nab-paclitaxel (SOC) (HR = 0.46; 90 % CI 0.23, 0.92; p = 0.030). Median progression free survival was 6.2 (ASC) vs. 3.9 months (SOC) (HR = 0.43; 90 % CI 0.20, 0.92; p = 0.029). Adding P-AscH- did not negatively impact quality of life or increase the frequency or severity of adverse events.

Conclusions

P-AscH− infusions of 75 g three times weekly in patients with metastatic pancreatic cancer prolongs overall and progression free survival without detriment to quality of life or added toxicity (ClinicalTrials.gov number NCT02905578).

Keywords: Pancreatic neoplasms; Ascorbic acid; Controlled clinical trial; Gemcitabine; Nab-paclitaxel

Dr. Cullen mentions that patients contact him not infrequently to ask if taking high-dose oral Vitamin C will help them achieve similar results. Unfortunately, it will not. Giving it intravenously facilitates giving much higher doses. The study had a relatively small number of participants, which limited ascertainment of quality of life.

On the psychological side, there are ways to bolster the mental health challenges of those with pancreatic cancer, which typically has a grim outcome in terms of survival:

Spiegel D. Mind matters in cancer survival. Psychooncology. 2012 Jun;21(6):588-93. doi: 10.1002/pon.3067. Epub 2012 Mar 21. PMID: 22438289; PMCID: PMC3370072.

Further, Dr. William Breitbart, MD, Chair of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center was interviewed in 2021 and emphasized the need for bolstering mental health for those diagnosed with pancreatic cancer. According to Breitbart, “Pancreatic cancer triggers an inflammatory response in the body, which can lead to mood disorders,” Breitbart explains. Psychiatrists can prescribe certain antidepressant medications that directly target that inflammatory response.”

It Turns Out I Did Not Invent the Term “Zamboni Effect”

Today’s post connects weirdly with the one I wrote yesterday entitled “The Zamboni Effect,” in which I mistakenly believed I had invented the term “Zamboni Effect” based on my observation of what an ice resurfacing machine did to an ice rink in a local mall. It clarified the ice and also metaphorically, by extension, clarified relationships from the past viewed in the present—sort of.

As a reminder, the ice resurfacing machine was first invented in 1949 by a guy named Frank Zamboni. A lot of companies with different names make them nowadays but people still tend to call them all Zambonis.

Just for fun, I looked up the “Zamboni Effect” on the web today and it returned a few surprising results. Among the different meanings of the Zamboni Effect:

Zamboni Effect related to optimizing the ocular surface for surgery.
Zamboni Effect related to a scientist named Paolo Zamboni, who invented a controversial treatment for multiple sclerosis which later turned out to be ineffective.
Zamboni Effect related to something that happens in connection with dynamical nuclear spin polarization (whatever that is).

And for all I know, there may be other meanings for the Zamboni Effect that just never made it to the internet.

Iowa Bills to Ban Vaccines and Require Vaccine Manufacturers to Waive Immunity Die

This week was what the Iowa Legislature calls funnel week. Today determined what bills stay alive and which one die.

The bills opposing vaccines died for this legislative session:

“mRNA vaccines: Senate File 360 proposed a ban on health care providers administering gene-based vaccines, like the COVID-19 vaccines developed by Pfizer and Moderna. Under the proposal, health care providers who administered vaccines that use nucleic acids like messenger RNA (mRNA) would face punishments of a misdemeanor charge and a fine of $500 for each violation.”

“Vaccine manufacturer immunity: House File 712 proposed requiring vaccine manufacturers waive their immunity from lawsuits over injuries that result from a “design defect” in a vaccine in order to distribute or administer the vaccine in Iowa. Under the 1986 National Childhood Vaccine Injury Act, there is a National Vaccine Injury Compensation Program providing no-fault compensation to individuals and families injured by childhood vaccines. While supporters of the bill said the current compensation program has problems, medical practitioners and advocates said allowing for lawsuits to be filed against manufacturers would prevent vaccines from being available in Iowa.”

Story published in Iowa Capital Dispatch, “Funnel week 2025: What bills are alive, dead at Iowa Statehouse after first deadline” by Robin Opsahl. March 7, 2025.

What Does “Design Defect” of a Vaccine Mean In the Iowa Bill to Require Vaccine Manufacturers to Waive Immunity from Lawsuits?

Beats me. Sorry, just kidding. I’m just a little bleary from looking at the web sites about the definition of “design defect” related to vaccines as it applies to the Iowa bill to make vaccine manufacturers waive their immunity from lawsuits about vaccine related injuries.

I am sympathetic to anyone who in fact has suffered a vaccine related injury.

That term “design defect” has been bugging me for days now and I just found out that this has been the subject of states vs federal legal wrangling for years. I’m not up to explaining all the legalese but there is a really tangled trail of cases in Georgia and Pennsylvania roughly around 15 years ago that ultimately led to a U.S. Supreme Court decision saying, essentially, the Vaccine Injury Compensation Program and the federal Childhood Vaccine Injury Act of the 1980s preempts all state level vaccine design defect claims.

I think that explains why the Iowa bill says that vaccine manufacturers have to waive their immunity from suits if they want Iowans to get their vaccines.

I can hear the groans and shouts of dissent even as I write this. Hey, you can’t make this up. Talk to your legislator or lawyer about it.

I’m not sure why Iowa would want to repeat the grind that Georgia and Pennsylvania went through which led to the conclusion that you can file vaccine design defect claims at the state level and not have to repeat history which would likely lead to any decisions made there being reversed in federal court.

And I’m not sure why any vaccine manufacturer would want to fight that battle in Iowa either. They might just steer around us and take their vaccines elsewhere.

The beginning of the Georgia story.

The end of the Georgia story.

The beginning and the end of the Pennsylvania story.

Vaccines aren’t perfect. They are neither 100% safe nor 100% effective. However, I support having vaccines available to help keep us healthy and the right to choose getting a vaccine. That’s why I don’t support a bill that I believe would make them less accessible.

New Wrinkle on Iowa Bill to Oppose mRNA Vaccines in Iowa

This is a follow up to yesterday’s post about the Iowa legislature’s proposition of a new law that would essentially ban mRNA vaccines in Iowa. I don’t understand the numbers and codes on the new sections, but the new one proposes that manufacturers of vaccines would have to waive immunity from lawsuits arising from “a design defect of the vaccine.”

I’m not sure if that’s addition to being charged with a simple misdemeanor, subject to a $500 fine for administering the vaccine. I oppose this one too because I think it would essentially make vaccines difficult to access and harder to persuade new medical staff to come to Iowa.

There’s going to be a meeting about the bill at 4:30 PM CST. I can’t remember if it’s at the state house or at the Exile Brewing Co. for sandwiches and Ruthie’s beer.

In any case, the comment section is overwhelmingly in opposition to the bill. I saw several comments mentioning that we already have the National Vaccine Injury Compensation Program (NVIP), which is designed to field requests for compensation to those who believe they’ve been injured by certain vaccines. I had not heard of it before. It’s administered by the federal government, Health Resources & Services Administration, which is under the Health and Human Resources department.

There is a nice easy to read summary about the complicated story of vaccine safety and liability at the Children’s Hospital of Philadelphia website. It was reviewed by Dr. Paul A. Offit, MD last year. He attends meeting of the Centers for Disease Control and Prevention, although I think he missed the one last month about the flu vaccine because it was cancelled.

If I see anything earth shaking about the meeting this afternoon on HF712, I’ll make an addendum to this post.

Proposed Bill Would Ban mRNA Vaccines in Iowa

Sena just alerted me to a bill in the Iowa legislature right now that proposes mRNA vaccines (like the Covid vaccine for example) be banned in Iowa. Part of it says that any person who provides or administers such a vaccine would be guilty of a simple misdemeanor and subject to a $500 fine. I do not support it although I also support the right of others to disagree.

The bill advanced out of subcommittee yesterday and I’m not sure how although, admittedly, I don’t know what exactly that means about its chance of being ultimately passed into law. There were hundreds of comments against it. It moves for further consideration to the Iowa Senate Health and Human Services Committee according to a story in the Daily Iowan.

This sent me to the web to find out what other silly laws Iowa has passed. A few of them are below:

“Any person who attempts to pass off margarine, oleo, or oleomargarine as real butter is guilty of a simple misdemeanor in Iowa. This one originated in 1943, but is still in force today.”

“In Marshalltown, horses are forbidden to eat fire hydrants.”

“It is illegal for a mustached man to kiss a woman in public.”

All of the above are on this Iowa State University web page.

The Connection Between Vitamin A and Measles Is Not Just About Carrots

The measles outbreak is big in the news and the issue of the role of Vitamin A in measles reminded me of something I saw back in the 1970s. I was working as a drafter and survey crew assistant for WHKS & Co (consulting engineers in Mason City, Iowa) at the time. As I was working on a drawing, a co-worker walked by my desk and I noticed her skin was the color of a carrot. She was orange. She explained that she and her husband had been taking high doses of beta-carotene, which is a precursor for Vitamin A. She and her husband both worked at WHKS & Co but I think he was home sick that day, from taking too much beta carotene.

So that segues into what I found out about the connection between measles and Vitamin A. The Centers for Disease Control and Prevention (CDC) has a web page on it and cites references for the role of Vitamin A. Vitamin A does not prevent measles. But in children who are severely ill and hospitalized from measles and under a physician’s supervision, age-specific doses of Vitamin A can be given for a limited period of time.

There are two references for the administration of Vitamin A in the context of kids with measles, available through weblinks from the CDC. One of them is the World Health Organization (WHO), which recommends Vitamin A for vitamin deficient children and because measles infection by itself can cause acute Vitamin A deficiency, resulting in xerophthalmia (severe dry eyes). This can lead to blindness.

Usually this is more of a problem in developing countries, but the WHO recommends it even for children in the US.

The other reference is Red Book. This is not the magazine for American women looking for tips on beauty. The Red Book is from the American Academy of Pediatrics and it notes the WHO recommendation to administer Vitamin A to patients “…regardless of their country of residence.”

The caveat is that you can get either not enough or too much of a good thing. Beta-carotene is a precursor to Vitamin A. Vitamin A toxicity is bad.

And you could avoid all this because there is an effective vaccine for measles. Don’t take my word for it. Talk to your pediatrician.

Girl Scout Cookies Are Safe!

We were out the other day and tried the new Girl Scout Thin Mint Frosties. Sena got chocolate and I got vanilla. We thought they were delicious. Wendy’s partnered with Girl Scouts of the USA to serve them up and it’s a great idea. They’re swirled and topped with a mint-flavored cookie crumble sauce.

We heard that the Girl Scouts would be out selling their famous cookies the same day at booths outside different stores across Iowa including Iowa City, but we couldn’t find them that day. Maybe it was because it was a little cold to be standing outside in a booth. Interestingly today, the girl scout didn’t know this whole idea was a collaboration between Wendy’s and the Girl Scouts of America.

We finally found a website that posted a schedule of when and where the cookies would be selling.

The weird thing is just before Sena left to get some Thin Mints cookies, we found a news story on the web which raised an alarm about whether or not they are poisonous (they’re not), if you can imagine that. People have been buying Girl Scout cookies for years and I’ve never heard of any problems.

So, it occurred to me that even though we’re not employees of the federal government, we could find 5 things to say relevant to the Department of Gustatory Explorations (DOGE) as part of our frivolous investigation of this issue. I think I’ve got that department name right.

It turns out there’s a group called Moms Across America which has partnered with an outfit called GMOScience and they’re calling out Girls Scout of America for selling cookies with “toxic” metals and glyphosate (an herbicide). In their own small, unpublished, non-peer reviewed study, they tested some cookies and found they all had some traces of these substances. They tested cookies including Thin Mints in 3 states which included Iowa.
Snopes investigated and found a number of facts, one of which is that “a child would have to eat 9,000 cookies in a day to approach harmful levels of pesticide or naturally occurring metals.”
The FDA says you can safely eat the Thin Mints and any of the other kinds of Girl Scout cookies. On the other hand, I will not eat cookies containing coconut because it has the consistency of little pieces of cellophane, which I would chew endlessly without ever being able to bring myself to swallow them. This is a personal idiosyncrasy that has nothing intrinsically to do with any food containing coconut.
Don Huber is a retired Purdue University professor of plant pathology who is part of the anti-GMO movement. He’s made many claims which have been criticized and refuted, even by Purdue University faculty members. One of them is that glyphosate causes a number of diseases including Alzheimer’s disease and he claims his ideas are supported by the research of a Maharishi movement expert in yogic flying. By the way there is a Maharishi International University (MIU) located in Fairfield, Iowa. You can learn transcendental meditation there and read about yogic flying (more like hopping) in an interesting 2016 NPR article but you won’t find anything in the curriculum per se on their website about levitation (but you will if you search for the term “yogic flying”). Consequently, you won’t learn dad jokes about this, including but not limited to “Help, I’ve levitated and I can’t get down!”
The Girl Scout cookies and the Frosties taste great.

Well, I think that about wraps it up for DOGE.