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.
I learned a new slang word from Houston White, the guy who makes that specialty coffee in Minneapolis I blogged about yesterday: Brown Sugar Banana (I’m not a fan, but I admire him just the same). The word is “dope.” That used to be an insult or an illicit drug when I was growing up. Now it means “very good.”
I guess writing, at least for me, is dope.
The further I get in time away from the day I retired from practicing consultation psychiatry, the more I reflect about how I became a psychiatrist. I’m a first-generation doctor in my family, so what follows is one way to write about it.
What has helped me get through life was this writing habit along with a sense of humor. When I was little, I wrote short stories for my mother. I was the “number one son” in the words of my father, which meant only that I was the first born. My younger brother came second only in order of birth. He was the track star. I was the paperboy. Our parents separated early on. Sena and I have been married for 47 years.
I have been writing my whole life. I used a very old typewriter. I wrote poetry for a while, eons ago. Like many aspiring writers, I tried to sell them to publishers. The only publisher I remember ever responding sent me a hand-scrawled note on a small sheet of paper. He told this really short, nearly incoherent story about his son, who had apparently died shortly before. His son had a “tough road.” It wasn’t clear exactly how he died, but I remember wondering whether it was suicide. It was very sad.
In the 1970s, while I was a student at one of the Historically Black Colleges and Universities (Huston-Tillotson College, now a university) in Austin, Texas, I submitted a poem to the school’s annual contest and for entry into the college’s collection, called Habari Gabani (which means “what’s going on” in Swahili). It was rejected. Years later, I finally was able to track down a digital copy of Habari Gani.
Habari Gani from Huston-Tillotson College
Eventually, thank goodness for everyone’s sake, I gave up writing poetry. It was as bad as Vogon poetry. You’ll have to read Douglas Adam’s book “A Hitchhiker’s Guide to the Galaxy,” for background on that. The Vogons were extraterrestrials who destroyed Earth in order to build an intergalactic bypass for a hyperspace expressway. Vogon poetry is frightfully bad; it’s the waterboarding torture of literature.
I wrote a short Halloween story for my hometown newspaper contest once. It got honorable mention, but I can’t recall what it was about, thank goodness.
I wrote a feature story in a journalism class taught by a nice old guy who made a long speech to the class about the unfortunate tendency for young writers to use flowery, polysyllabic words in their prose. He made it clear that journalists shouldn’t write like that. Although I didn’t consciously do the opposite to annoy him, I did it anyway. I even tossed the word “Brobdingnagian” in it, which might have referred to some high bluffs somewhere in Iowa. Despite being infested with Vogonisms, my teacher tolerated it, sparing my feelings. I must have passed the course although how I did it remains a mystery.
I wrote and co-edited a book with the chairman of the University of Iowa Healthcare Dept of Psychiatry, Dr. Robert G. Robinson, MD. It was “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry”. There were several contributors. Many of them were my colleagues. It was published in 2010, and prior to that, I’d written an unpublished manual that I wrote for the residents.
Handbooks of CL PsychiatryHandbook of Psychosomatic Medicine
There wasn’t any humor in either book, because they were supposed to be evidence of scholarly productivity from a clinical track academic psychiatrist. But I used humor and non-scientific verbiage in my lectures, albeit sparingly. I remember one visiting scientist remarked after one of my Grand Rounds presentations, “You are so—poetic” and I detected a faint disparaging note in his tone…probably a reaction to a latent Vogonism. It’s not impossible to monkey-wrench those into a PowerPoint slide or two.
I used to write a former blog called The Practical Psychosomaticist, later changed to The Practical CL Psychiatrist when The Academy of Psychosomatic Medicine changed their name back to The Academy of Consult-Liaison Psychiatry back in 2017. I wrote The Practical CL Psychiatrist for a little over 7 years. I stopped, but then missed blogging so much I went back to it in 2019 after only 8 months. I guess I was in withdrawal from writing.
I have to admit that I’ve been mis-hearing some of the lyrics of one of my favorite songs, “Lean on Me” for the past fifty-odd years since Bill Withers wrote it. It stayed on the top of the charts for more than 3 weeks back in 1972. That was a special time in my life; and not an easy one.
Back then, you couldn’t just look up song lyrics or anything else for that matter on the world wide web. It didn’t exist yet. I’ve always been prone to mondegreens and I finally found out that I was hearing something different in the verse:
“Please swallow your pride
if I have things (faith?) you need to borrow
For no one can fill
those of your needs
That you won’t let show”
Just to let you know, I found lyrics in one YouTube that substituted the word “faith” for “things”. Think about that one. I don’t know how to settle it, so if anybody knows which word is right, please comment. Anyway, it’s a little embarrassing and revelatory that I heard “…if I have pain…” instead of “…if I have things (or faith)…” And I never really heard “…That you won’t let show.”
Yet I lived it.
Years later, after I’d finished college, medical school, residency in psychiatry, and had taught residents and medical students at the University of Iowa for a number of years, one of my colleagues, Scott, a brilliant psychologist and writer, stopped by my office one day. This was years ago.
His name is Scott and he suggested that it would be nice to get together sometime soon to catch up. I deferred and I remembered he replied while looking off down the hallway, “I’m 70.” I wonder if he meant he didn’t know how much more time he had left.
Scott and I had taken similar paths in the middle of our careers at Iowa. I wanted to try private practice and left for Madison, Wisconsin. Scott got the same idea and left for a position in Hershey, Pennsylvania. We both regretted it and soon after returned to Iowa. I swallowed my pride and came back because I loved teaching. I think he returned for the same reason. We were both grateful that the UIHC Psychiatry Dept. Chair, Bob Robinson, welcomed both us of back.
Jim’s teaching awardsBooks by Scott and Jim
I touched base with Scott a little while ago. We’re both retired. I was trying to find out how to contact Bob about messages I was getting from the publisher of our consult psychiatry handbook. Neither Scott or I could find out what was going on with Bob, who retired several years ago and moved back East. It turned out he had died. Sometimes we all have sorrow.
Scott is my friend, and I leaned on him a long time ago. I’m unsure if I let it show. I’m 70 and I’m grateful to him.
On that note, I’m finding out that I can’t walk all the way to the mall and back anymore. On the other hand, I can walk about half that distance. It’s about a mile and a half out to the Clear Creek Trail and back. There’s a lot of uphill and downhill stretches along the way. I can manage that.
And Sena bought me a couple of pairs of new shoes that I’m breaking in that will probably be easier on my feet and my calves. They’re Skecher slip-ons, not to be confused with the no hands slip-ins. I’m used to slip-ons. I tried one pair out today, in fact. Before I left, I took a few pictures of Sena’s new garden. As usual, she’s planting new flowers. The dogwood tree looks great. She’s even excited about the wild phlox. I can’t keep track of everything else out there. She makes the beauty out there.
And I lean on her for that.
dogwood treewild phloxeven more flowersflowersmore flowersnew shoes1new shoes2
Today is designated Earth Day although there is such a thing as Earth Month. Among the several trees Sena planted in our back yard trees are a few that we hope exemplify the Earth Day theme, which is Our Power, Our Planet.
One of them is a dogwood, which we’re hoping will bloom soon. Dogwoods represent joy and rebirth. There are a couple of crab apple trees, a red jewel and a perfect purple. Crab apple trees represent love and all are very special to Sena and me.
Love, joy, and rebirth. They can all be linked to power, which can be the power of will. The will to respect the planet also implies respecting each other. Practicing humility can be a kind of power.
The power to be still and listen to each other can make us more open to change.
On that note, because I can’t go for long without joking around, I should retell the story about me and the walking dead meditation. About 13 years ago, I had an even more serious case of not listening to others than I do now, if you can believe that. It eventually led to my choosing to take the Mindfulness Based Stress Reduction (MBSR) class ( see this current University of Iowa mindfulness essay). I wrote an essay for the Gold Foundation and it’s still available (I updated the links):
How I left the walking dead for the walking dead meditation (August 13, 2014)
About a year or so later, I bought Jon Kabat-Zinn’s book on Mindfulness-Based Stress Reduction (MBSR), Full Catastrophe Living, because I was dimly aware of the burden of stress weighing on me as a consulting psychiatrist in an academic medical center. I didn’t get much out of Kabat-Zinn’s book on my first read. But then 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.
Until then, I’d barely noticed the problem. Like most physicians, I had driven on autopilot from medical school onward. I had called myself “passionate” and “direct.” I had argued there were plenty of problems with the “system” that would frustrate any doctor. I had thought to myself that something had to change, but I never thought it was me.
After reflecting on the feedback from my colleagues and students, I enrolled in our university’s 8 week group MBSRprogram. 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. I was glad to learn that mindfulness is not about passivity.
But I kept thinking of Kabat-Zinn’s book, in which he described a form of meditation called “crazy walking.” It involved class members all walking very quickly, sometimes with their eyes closed, even backwards, and crashing into each other like billiard balls. I hoped our instructor would not make me “crazy walk” because it sounded so—crazy. I dreaded crazy walking so intensely that I considered not attending the 6-hour retreat where it might occur.
We didn’t do crazy walking. Instead, we did what’s called the “walking meditation.” Imagine a very slow and deliberate gait, paying minute attention to each footfall—so much so that we were often off balance, close to crashing into each other like billiard balls.
I prefer to call this exercise the “walking dead meditation” because it bore a strong resemblance to the way zombies move. One member of the class mentioned it when we were finally permitted to speak (except for the last 20 minutes or so, the retreat had to be conducted in utter silence). It turned out we had all noticed the same thing!
Before MBSR, I was like the walking dead. I was on autopilot — going through the motions, resisting inevitable frustrations, avoiding unstoppable feelings, always lost in the story of injustices perpetrated by others and the health care system.
In practicing mindfulness, I began noticing when my brow and my gut were knotted, and why. Just paying attention helped me change from simply reacting to pressures to responding more skillfully, including the systems challenges which contribute to burnout. About halfway through the program, I noticed that the metaphor connecting flexibility in floor yoga to flexibility in solving real life problems worked.
Others noticed the change in me. My professional and personal relationships became less strained. My students learned from my un-mindfulness as well as my mindfulness, a contrast that would not have existed without MBSR.
As my instructor had forewarned, it was easy for me to say I didn’t have time to practice meditation. I had to make the time for it, and I value the practice so much that I’ll keep on making the time. I will probably never again do the walking dead meditation.
Today we gather to reward a sort of irony. We reward this quality of humanism by giving special recognition to those who might wonder why we make this special effort. Those we honor in this fashion are often abashed and puzzled. They often don’t appear to be making any special effort at being compassionate, respectful, honest, and empathic. And rewards in society are frequently reserved for those who appear to be intensely competitive, even driven.
There is an irony inherent in giving special recognition to those who are not seeking self-aggrandizement. For these, altruism is its own reward. This is often learned only after many years—but our honorees are young. They learned the reward of giving, of service, of sacrifice. The irony is that after one has given up the self in order to give back to others (family, patients, society), after all the ultimate reward—some duty for one to accept thanks in a tangible way remains.
One may ask, why do this? One answer might be that we water what we want to grow. We say to the honorees that we know that what we cherish and respect here today—was not natural for you. You are always giving up something to gain and regain this measure of equanimity, altruism, trust. You mourn the loss privately and no one can deny that to grieve is to suffer.
But what others see is how well you choose.
Leonard Tow awardGetting the pinOn my lapel; in my heart
I’m still practicing mindfulness-more or less. Nobody’s perfect. We hope the dogwood tree blooms soon.
There’s a CDC ACIP Meeting scheduled to start at 8:00 AM EST today (caught me off guard). The slides are here.
Noteworthy: Dr. Denise Jamieson, MD, MPH is chair of the CMV Working Group. She is Vice President for Medical Affairs and the Tyrone D. Artz Dean, Roy J. and Lucille A. Carver College of Medicine at University of Iowa. In the Q&A session following the Covid-19 vaccine presentation, Dr. Jamieson expressed a preference for a universal recommendation (citing implementation and uptake challenges, which other attendees mentioned as well) for the Covid-19 vaccine as opposed to a risk-based or permissive recommendation. See slide labeled “Discussion” below:
There was no vote scheduled for today’s meeting on the Covid-19 vaccine.
The presentation by Moderna on the new Covid-19 vaccine, mRNA-1283, was helpful. I gather there will be an FDA meeting about it in June.
First of all, if you looked up Saint therapy for depression, you might have accidentally found information on Saint Dymphna, the Catholic patron saint of those living with mental illness.
Actually, SAINT stands for Stanford accelerated intelligent neuromodulation therapy. It’s a personalized protocol for using transcranial magnetic stimulation (TMS) to treat severe depression. The University of Iowa is the first academic center to offer it in the Midwest.
This is a big step forward from the days many years ago when we were starting use right unilateral electrode placement for applying electroconvulsive therapy (ECT) to treat depression because it was thought to lead to fewer cognitive problems post-treatment.
SAINT is a game changer according to Dr. Nicholas Trapp, MD, assistant professor of psychiatry, who describes it as a method to pinpoint the best location in each patient’s brain to target with TMS to treat major depressive disorder. The procedure is quick and recovery from depression can be sustained for months.
Kudos to The University of Iowa. And maybe thanks to Saint Dymphna.
Okay, so here’s my pitch on how potential donors can support programs at The University of Iowa. Today the One Day for Iowa fund drive kicks off, and it ends at 11:59 PM today on March 26, 2025.
I got a soft spot in my heart for The University of Iowa College of Medicine and University of Iowa Health Care (UIHC), even though my undergraduate Bachelor’s degree was from Iowa State University.
You can find in the UIHC Medical Museum a description of the historical development of the medical school. Following the Flexner Report in 1909 which found fault with all U.S. medical schools including Iowa’s, there was a drive to avoid “inbreeding,” meaning hiring of one’s own graduates. Nowadays, there are legislative efforts to keep as many as we can of Iowa’s best and brightest.
I had my regular visit to the dentist at The University of Iowa Health Care (UIHC) today, and it was a good thing I did. For the past couple of weeks or so I’ve had cold and hot sensitivity in a couple of teeth. No surprise, the dentist found 3 teeth that needed a little work.
The dental hygienist also suggested I try using a tongue cleaner and gave me a free one. I’d never heard of a tongue cleaner before. The package advertisement (in English, French, and Spanish) says it’s for combatting bad breath, although the dental hygienist assured me in 6 different languages that she didn’t detect that problem in me.
I was there for my annual teeth cleaning but now I had 3 teeth needing work. Luckily, the dentist had an appointment in the early afternoon. It was a 3 hour wait, but I thought it was better to get it done sooner rather than later. Anticipating a visit with a dentist is sometimes almost as bad as getting in the chair and exercising my ability to refrain from flinching as the high-speed instruments whine in my ear while the dentist and the assistant do their level best to see that I gag several times in at least 9 different languages, including Klingon.
It’s hard to explain why I was having tooth sensitivity because, according to the dentist, the damage was not that severe. It wasn’t until I wandered around the hospital while waiting for the 2nd appointment that I realized I had never visited the Medical Museum on the 8th floor. And that’s where I found a possible explanation that made more sense than the modern one. It’s probably toothworms.
No kidding, back in the 18th century, a lot of people thought worms caused tooth decay by eating them from the inside out. There was also a College of Dentistry display in the Medical Museum featuring a typical dentist chair and samples of rusty tools, which made wonder if I should put off the filling work until, say, after my next ten reincarnations.
There’s a human skeleton in the museum which is affectionately called Gertie. The historical note on Gertie is very interesting in that it was thought to be a male when Ottumwa Regional Health Center donated it to UIHC in 2013. It turns out he is actually a she and the “…two symmetrical holes in the upper jaw are the result of large dental abscesses.” Just what I wanted to learn on a day when I’m anticipating dental work.
Anyway, my teeth got repaired. I would say that the UIHC dental clinic has come a long way from 1904. You don’t turn and spit in a bowl anymore. They just siphon the toothworms out with a suction wand nowadays.
The University of Iowa Stead Family Children’s Hospital Neonatal Intensive Care Unit was recently recognized by the American Academy of Pediatrics (AAP) as one of only two such units in the U.S. having the highest levels of neonatal care.
It reminds me of the Iowa Hawkeye football games where, at the end of the first quarter, all the players and football fans wave from the field to the pediatric patients and their families watching the game from UI Stead Family Children’s Hospital. It’s called the Wave, one of the best traditions in college sports.
Well, the AAP waves to Stead Family Children’s Hospital NICU.
Last year, I wanted to present this Distinguished Education Lecture by Dr. Russell Ledet, MD, PhD, given during Martin Luther King Jr. Celebration of Human Rights week. It took a while for my message to the University of Iowa to get through channels, but I want to thank Audra M. King, the Administrative Services Coordinator for the Office of Student Affairs and Curriculum in the University of Iowa Carver College of Medicine for her help in getting it into a YouTube format that allows the general public to see and hear Dr. Ledet’s presentation.
I wrote a post in February last year about how impressed I am with Dr. Ledet as a leader. Now you can hear him tell his own inspirational story.
Go Retire Psychiatrist 