Covid-19 – Go Retire Psychiatrist

Iowa Bill HF2676 Which Would Allow OTC Ivermectin in Iowa On its Way to Governor Reynolds Desk

Late yesterday, there was a story published in the Iowa Capital Dispatch announcing that the MAHA bill HF2676 is on its way to Governor Reynolds for her signature. A part of that bill “…also would allow ivermectin, a drug used to treat parasitic infections that some have claimed can be used in preventing or treating symptoms of COVID-19, to be distributed over the counter by pharmacies.”

She will probably sign it, making Iowa one of a handful of states in the U.S. which allows human-grade ivermectin available over-the-counter in pharmacies. I think saying it would be OTC is partly a misnomer because it would actually be more like “behind the counter” as it’s not packaged to be sold that way, for example, in places like Walgreens.

The language of the bill is permissive, though, which means that pharmacists “may” (not “shall”) make ivermectin available OTC. I’m surprised that she’s quoted in the story saying the bill “takes common sense steps to improve health and well-being for Iowans of all ages.” Nothing further from the truth could be said regarding the ivermectin piece. There’s no good evidence that it’s effective for treating Covid-19 infection.

That said, I’m not sure how this bill once it’s signed into law would be enforceable. Pharmacists and/or other health professionals are not required to unilaterally or collaboratively set up a standing order making ivermectin available OTC. I think you’d still need to have a prescription if you need it to treat parasite infections.

If you drive up to the window and request human-grade ivermectin, the law would not prevent a pharmacist from asking you why you want it. I’m aware of off-label indications for medications. The American College of Medical Toxicology (ACMT) published a paper in 2022 cautioning against off-label prescribing of ivermectin for treatment of Covid-19. I agree with their statement that “clinicians, not courts should direct medical care.” By extension, I think that you could substitute the word “legislatures” for “courts.”

Calello DP, Kazzi Z, Stolbach A. American College of Medical Toxicology (ACMT) Cautions Against Off-Label Prescribing of Ivermectin for the Prevention or Treatment of COVID-19. J Med Toxicol. 2022 Jan;18(1):69-70. doi: 10.1007/s13181-021-00866-z. Epub 2022 Jan 10. PMID: 35006547; PMCID: PMC8744041.

I realize there’s a lot of off-label prescribing of drugs going on out there. Ozempic is one of them. I have not read the news article warning about “Ozempic penis.” I have read the FDA’s announcement about off label use of ivermectin.

The push for ivermectin off-label use for Covid-19 looks politically motivated, in my opinion. Governor Reynolds will likely sign into law HF 2676 including the small part about ivermectin which really doesn’t seem to belong in the bill. It’ll be a pyrrhic victory. I think it makes the legislators who supported it and the governor look bad. Further, I think it makes Iowa look bad. I doubt Iowa pharmacists, one of whom refused to fill a prescription for ivermectin for Covid-19 a few years ago, will have any trouble declining to provide ivermectin to anyone who wants to use it to treat Covid-19.

OK, on the lighter side I’m going to pour a little cold water on ivermectin regarding its use as an antiparasitic agent. Does it work for ticks? The reason I bring this up is that last week, my wife Sena did not use OFF! Deep Woods insect repellent before going out into the backyard garden which borders on a woodsy outlot. When she came inside, she asked me to take a look at the back of her neck because she felt something crawling on her. I plucked a tick from her hair and flushed it down the sink.

Then, this morning I noticed a CDC article published last week about visits to emergency rooms for tick bites being higher than usual. Ticks can make you really sick. They cause several diseases including something I didn’t know much about which is alpha-gal syndrome. That’s not a term invented to compete with the alpha male syndrome. The “gal” is short for galactose and if a tick infects you with it, you can get allergic to red meat (tick bite meat allergy). Then you’d have to avoid eating red meat.

So, is ivermectin effective against ticks? There was a study published 12 years ago that said it was not. On the other hand, there’s a story that says ivermectin is protective against ticks—in deer, not in humans. Don’t forget the OFF!

Sheele JM, Ford LR, Tse A, Chidester B, Byers PA, Sonenshine DE. The use of ivermectin to kill ixodes scapularis ticks feeding on humans. Wilderness Environ Med. 2014 Mar;25(1):29-34. doi: 10.1016/j.wem.2013.09.008. Epub 2014 Jan 9. PMID: 24411976.

The Question of Ethical Principles Regarding the Ivermectin Portion of Governor Reynolds MAHA Bill HF 2676

I think the Iowa legislature bill HF 2676 (Governor Reynolds’ MAHA bill) has just been sent back to the Senate, maybe based on fiscal issues, according to the most recent information I could find on the web. The ivermectin piece probably isn’t in a section that bears heavily on fiscal matters, so if the Senate approves it this time, it might either go back to the House for more debate about budgetary issues—or it might go to Governor Reynolds’ desk to sign (if it even has to be signed by the governor).

The ivermectin part of this bill would allow pharmacists to decide (it’s not mandatory; it’s permissive) on whether or not to offer ivermectin over-the-counter—for whatever reason a patient wants it, which could be for treating Covid-19 infection for which there’s no evidence of its effectiveness.

Because the language of the bill states that pharmacists would be immune from civil and criminal liability for bad outcomes from using ivermectin for treating Covid-19 infection, it would be up to individual pharmacists to choose whether or not to provide it for that purpose, based on their ethical principles to act out of their sense of clinical duty to ensure patient safety.

The ivermectin part of the bill is in Section VII and, in my opinion, should be removed.

Ivermectin Bill Looks Like It’s Dead-For Now

This is a quick followup on the progress of Governor Reynolds MAHA bill which included a piece endorsing making Ivermectin available over-the-counter in Iowa. I just read a story about what looks like the disappearance of the ivermectin from Reynold’s bill. The story, written by Laura Belin, comes from a webpage called Bleeding Heartland: An independent website about Iowa politics.

I don’t follow politics avidly (putting it mildly), but I think I understand a short paragraph from Ms. Belin’s article”:

“The Senate didn’t advance the governor’s bill. Instead, Senate Health and Human Services Committee chair Kara Warme introduced her own “health-related matters” bill, which got through committee and is eligible for floor debate. That legislation (Senate File 2367) incorporated the governor’s proposals on nutrition education, certificates of need for health care facilities, federal food assistance, and food dyes in schools, but left the ivermectin language on the cutting room floor.”

It looks like another anti-vaccine bill bit the dust—for now. I would cheer, but I know better. I expect somebody will resurrect it at some time in the future. I hope Dr. Austin Baeth is still around when it happens.

Iowa Legislature Ivermectin Bill A Game of “Captain, May I?”

I’ve been comparing the Iowa legislature bills on allowing ivermectin to be available over-the-counter in pharmacies. There were two of them and then there was one.

In the first bill, HF 2056, the language in it seemed to strongly direct pharmacists to make ivermectin available by using the word “shall”:

” The medical director of the department shall establish a standing order authorizing the dispensing of hydroxychloroquine and ivermectin by a pharmacist.

Notwithstanding any provision of law to the contrary, a pharmacist shall dispense hydroxychloroquine or ivermectin to a patient who is at least eighteen years of age, upon the request of a patient, pursuant to a standing order established by the medical director of the department in accordance with this section.”

The bill goes to say that “A pharmacist shall be immune from criminal and civil liability arising from any damages caused by the dispensing or use of…” these agents.

In Governor Reynolds version of the bill (included in HF 2676, successor to HSB 964), at least today, uses the word “may”:

“Sec. 17. NEW SECTION. 126.24 Ivermectin—prescription drug order not required.

A pharmacist or pharmacy may distribute ivermectin for human consumption as an over-the-counter medicine.
A pharmacist or pharmacy shall not be subject to professional discipline or civil or criminal penalties for the distribution of ivermectin pursuant to this section.”

I think the word “may” in Governor Reynolds’s bill implies a pharmacist can distribute ivermectin, but is not necessarily required to do so. In the HF 2056 bill (which died in the first funnel) the word “shall” implies the pharmacist must do so. Hydroxychloroquine is not mentioned in the governor’s version of the bill.

Although neither of these bills mentioned why the ivermectin bill is being introduced, I think it’s clear that some people think it could be an alternative to vaccines for Covid-19. Because research shows ivermectin is ineffective for treating Covid-19 and because they’re not FDA approved for that, I doubt any pharmacist would choose to do what the bill says.

This seems to be turning into a weird game of “Captain, May I?” I think the majority of pharmacists would rather not play.

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?

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.

CDC ACIP Highlights on Covid 19 Vaccine

There was a lot to digest in today’s CDC ACIP meeting on Covid-19 vaccines. I missed the morning sessions but managed to see a few of the afternoon presentations.

The presentation by Dr. Retsef Levi, PhD, MIT, ACIP Work Group Chair, the Covid -19 Vaccine Discussion Framing Work Group (WG) was basically pretty critical of the Covid-19 vaccines in general.

The opposing reply to this (favorable to vaccines) was put together by University of Iowa’s Dr. Stanley Perlman, Dr. H. Bernstein, and Dr. M. Miglis, Additional Workgroup Considerations in Covid-19 Vaccination Policy and Practice.

For a change, I listened to the Public Comment section. I usually have not paid attention to them because most of the speakers were opposed to vaccines. Today was different. All of them were strongly supportive of vaccines.

There is a bottom line to this. I watched the voting session, which was very interesting. There were 4 voting questions. I had to take pictures of them because they were not included in the on-line schedule. It was easily the most interesting session of the afternoon, at least for me.

Voting question 1: all but one member voted “yes,” the committee chair Kulldorff voted “no.”

Voting question 2: one member suggested striking this one, but they voted anyway. What’s worrisome is that it was split between the yes and no votes; only the chair, Kulldorff, could break it and he voted “no.” Looks like common sense won; otherwise it would have made access very difficult.

Voting question 3: The video lost audio for a long time, but eventually it turned out that the votes were “yes” unanimously on the assumption that pharmacists counted as “health care providers.”

Voting question 4: The votes were all “yes,” mainly because they decided that pharmacists could make this work. One member questioned the wording which suggested that you needed to talk to your doctor about getting the vaccine because of the wording “shared clinical decision-making.” They glossed over it.

It looks like access to the Covid-19 vaccine will remain mostly open for now.

Public Comments on Upcoming CDC ACIP Meeting Posted

I have just noticed that there are over 5,000 comments posted on the comments section of regulations.gov in the section entitled Meeting of the Advisory Committee on Immunization Practices-September 2025.

The link to the comment section is on the CDC ACIP meeting announcement web page, “Written Public Comments.”

This is the first time I’ve seen a written comment section like this for the meetings. I think it gives people a sense of what health care professionals and others think about how things are going with the current approach to preventive medicine at the CDC.

Upcoming CDC ACIP September Meeting on MMVR & Covid-19 Vaccines

The upcoming meeting on the MMVR and Covid-19 vaccines will include voting on the MMVR and Covid-19 vaccines. Usually, the committee posts the actual voting questions, which so far I have not seen on the meeting agenda. I’ll be looking for them in the next couple of days.

Here is the link to the Center for Infectious Disease and Policy (CIDRAP) at the University of Minnesota article which bears directly on the meeting topics.

CDC ACIP Meeting Agenda Posted

I just noticed that the CDC ACIP draft agenda for upcoming meeting on September 18th and 19th has been posted. There will be votes on the MMRV, Hepatitis B, and Covid-19 vaccines.