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”:

  1. ” 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.

  1. A pharmacist or pharmacy may distribute ivermectin for human consumption as an over-the-counter medicine.
  2. 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.

Iowa Legislature Offering Cheese and Crackers on the Bill of Fare

I heard a song entitled “Cheese and Crackers” on the Big Mo Blues Show last night. I’ve heard a few times over the years, but I never looked up what it meant until today.

The song was originally written by a rockabilly singer named Hayden Thompson, although I’ve only heard it sung by blues artist Roscoe Gordon. According to a Reddit social media thread, “Cheese and Crackers” was the B side of a record by Thompson and the A side was “Shoobie Oobie.” Thompson couldn’t find anyone to arrange the “Cheese and Crackers” lyrics at a recording studio and left in a huff, leaving the lyrics on the piano.

Roscoe found it and put it in an R&B arrangement. Billboard magazine called it the strangest new release of the week. The song is about a guy repeatedly being offered cheese and crackers although he doesn’t like or want them. According to a Wikipedia article, the term “cheese and crackers” is a kind of mild swear word chilled down from “Jesus Christ.”

That’s funny, because that’s how I feel about all the anti-vaccine bills coming out of the Iowa Legislature this year. One of them is SF 2095, which seeks to penalize private postsecondary colleges and universities if they don’t accommodate students who want to be exempt from all vaccines for any reason and to find clinical training programs who will accept them. An excerpt from the bill:

“A postsecondary school offering a degree requiring a clinical rotation shall, upon request of a student enrolled in the degree program, identify a clinical rotation placement where the student will be permitted an exemption from any vaccination requirements imposed by the placement location during the duration of the student’s clinical rotation.

A postsecondary school not in compliance shall not qualify as an eligible institution for the purposes of Iowa tuition grant.”

The other punishment could be a fine. Unless I’m looking on the web in the wrong place, I don’t find any such facility anywhere in Iowa. That would mean the postsecondary private school would be punished for something it can’t control. I’m pretty sure that would be called unjust—or maybe tricky if the goal is to coerce clinical training program leaders to loosen up their vaccine exemption policies. Right now, the only exemptions are religion or medical.

This sounds like the Iowa legislature is offering us cheese and crackers. No thank you.

Update to the Anti-Vaccine Bills in Iowa Legislature

This is just a quick update to the Iowa legislature anti-vaccine bills as far as which ones have passed what is called the first funnel. Here’s a link to the definition of a funnel.

Which bills got past the first funnel:

SF 2095: This bill is about private colleges or universities that would be punished if they don’t make accommodations for students in health care education program who want to avoid getting vaccines.

HF 2171: This bill would remove the requirement for children in primary and secondary schools to get vaccinations. I think this bill is dangerous and unnecessarily puts children at risk for infectious diseases including diphtheria, pertussis, tetanus, poliomyelitis, rubeola, rubella, and varicella.

Which bill didn’t get past the first funnel:

HF 2287: This was the bill that sought to make vaccine manufacturers who want to sell their products in Iowa give up their immunity from lawsuits under the Childhood Vaccine Injury Act.

I couldn’t find out where the ivermectin over-the-counter bills (HF 2056 and HSB 694) were in the funnel as of today.

That make 5 bills in the Iowa legislature that are anti-vaccine-5 bills too many.

Iowa Legislature Bills I Could Live Without

I should stop reading the news. I’ve just found a couple of other Iowa Legislature bills that are anti-vaccine.

One of them is the HF 2287 I mentioned yesterday that would make vaccine manufacturers steer clear of Iowa altogether.

Another two I just discovered today:

HF 2171: This one which seeks to make vaccines for school age children voluntary. No child in elementary or secondary school in Iowa would have to be vaccinated against diphtheria, pertussis, tetanus, poliomyelitis, rubeola, rubella, and varicella. This is not safe for anyone.

SF 2095: This one seeks to exempt students from vaccines in medical, nursing, or other health care-related degree programs.

There’s a news article about SF 2095 which makes it clear what it is about. I don’t understand why a person studying medicine or any other health care-related degree program would not need to get vaccinated against communicable diseases. This bill would require private schools to provide some other alternative training program instead of those that require vaccinations. If they don’t, they’d be penalized, either by losing access to the Iowa Tuition Grant Program—or getting fined. None of that makes sense to me. If you’re in training to be a doctor, you should get vaccinated. If you don’t understand why vaccinations are vital to practicing medicine, you shouldn’t be in medicine.

If I sound like a curmudgeon about all this, so be it. I’m a retired doctor and I graduated from the University of Iowa College of Medicine in 1992. I spent my career practicing consultation-liaison psychiatry, so I was always at the interface between medicine and psychiatry. It was always a challenge for me to balance the art and science of medicine. And I didn’t always do it very well.

But I’m puzzled by what looks like an awkward imbalance in the view of medicine today. I’m a little cranky about it, and I like to think my age entitles me to react that way sometimes. I could add a quote from William Osler here, but I’m more prone to jokes as a I get older, probably because I know I’m no wiser than anyone else.

Did you hear Chuck Norris got the Covid vaccine? The vaccine is now immune to everything.

Iowa Vaccines and Legislature Proposed Bill Deja Vu

I see we have yet another bill introduced in the Iowa legislature seeking to make vaccine manufacturers liable for “design defects” resulting in injuries related to vaccines. This feels like déjà vu. Last year HF 712 targeted the Covid 19 vaccine. The bill died in the funnel. This year, the same sponsors introduced HF 2287—which is a similar bill that would target all vaccines.

One news story indicated that the sponsors were open to adding an amendment that would allow vaccine manufacturers to distribute vaccines in Iowa as long as patients sign a form that waives their right to sue the manufacturer as long as they are informed of the risks. I’m not sure how the forms would be made available to the public.

I thought patients, under the National Childhood Vaccine Injury Act of 1986, already have access to the Vaccine Injury Compensation Program (NVICP). Even if they don’t get compensated through that program, they can still sue the manufacturers.  I thought the “design defect” issue had been dealt with.

This new bill broadens the products in that it looks like it includes all vaccines, even those children typically get. There are already many parties have gone on record opposing HF 2287, including but not limited to:

Pharmaceutical Research and Manufacturers of America

Iowa Medical Society

Iowa Pharmacy Association

Iowa Association of Rural Health Clinics

Iowa Public Health Association

Iowa Chapter-American Academy of Pediatrics

I think vaccine manufacturers will avoid Iowa if this bill becomes law. It could lead to an uptick in the communicable diseases burden, as though we need any more of that.

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?

What Wildlife Does Not Know About Nature Valley Snack Bars

We finally finished up the batch of Nature Valley Chocolate Peppermint Wafer bars. The label says says they are “naturally flavored with other natural flavor.” The comical TV commercials in the last couple of years show cute woodland creatures like squirrels bitterly complaining about the dirty nuts they have to put up with compared to the Nature Valley bars with “chocolatey stuff.”

We think the commercials are funny, but the animals are apparently unaware of the dark underbelly of Nature Valley snacks. The product label clearly lets you know about the “bioengineered” material in the snack bar, which only piques your wonder about what that’s supposed to mean. You can read more about it on the FDA and USDA websites.

And then there’s the flak about the lawsuit back in 2018 which led to General Mills dropping the claim that Nature Valley products were “100% Natural” and settling a lawsuit filed by consumer groups that the products contained trace amounts of the chemical “glyphosate” which is in a common weedkiller called Roundup. The amounts were well below the allowable safe benchmarks.

You know that reminds me of that flap a year ago when a consumer group filed a lawsuit against The Girl Scouts about selling their cookies which were alleged to contain the same pesticide. I scanned the web and it looks like the lawsuit was voluntarily dropped by the main plaintiff although it may still be alive and kicking because there are others who are still part of the litigation. There’s zero evidence supporting their claim.

And then there was the Listeria recall back in 2016 related to specific Nature Valley bars. Do squirrels need to worry about Listeria? Probably not, because they can’t read even though they can talk and play clever tricks on humans.

Our only complaint about the Nature Valley wafer chocolate peppermint bars is that they lack any detectable taste. I used to eat Nature Valley granola bars every day as part of my nutritious lunch and aside from the growth of bilateral 18-inch-long antennae on my forehead, I didn’t notice any problems.

Verdict on Kale Salad

Well, Sena served the cranberry kale salad today, along with a hearty vegetable soup. If I had not known that the kale was in the salad, I would not have noticed anything unusual about it.

In fact, the salad was pretty good, although truth be known, the kale was mixed together with so many other veggies and Dijon salad dressing, I wouldn’t have known it was in there.

So, I’m obligated to share the article about kale I read yesterday when I was complaining about kale salad. It’s chock full of vitamins but has hardly any calories.

And it doesn’t turn you into an extraterrestrial.

Man, that kale was good!

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.

Thoughts on Martin Luther King, Jr. Day

Today being Martin Luther King Day, I’m reminiscing a little about my short time as a student at Huston-Tillotson College (one of this country’s HBCUs, Huston-Tillotson University since 2005) in Austin, Texas. It’s always a good idea to thank your teachers. I never took a degree there, choosing to transfer credit to Iowa State University toward my Bachelor’s, later earning my medical degree at The University of Iowa.

However, I was a reporter for the college newspaper, The Ramshorn Journal. That’s where the featured image comes from.

Although I didn’t come of age at HT, I can see that a few of my most enduring habits of thought and my goals spring from those two years at this small, mostly African-American enrollment college. I learned about tenacity to principle and practice from a visiting professor, Dr Melvin P. Sikes, in Sociology (from the University of Texas) who paced back and forth across the Agard-Lovinggood auditorium stage in a lemon-yellow leisure suit as he ranted about the importance of bringing about change.

He was a scholar yet decried the pursuit of the mere trappings of scholarship, exhorting us to work directly for change where it was needed most. He didn’t assign term papers, but sent me and another freshman to the Austin Police Department. The goal evidently was to make them nervous by our requests for the uniform police report, which our professor suspected might reveal a tendency to arrest blacks more frequently than whites.

He wasn’t satisfied with merely studying society’s institutions; he worked to change them for the better. Although I was probably just as nervous as the cops were, the lesson about the importance of applying principles of change directly to society eventually stuck. I remembered it every time I encountered push-back from change-resistant hospital administrations.

As a clinician-educator I have a passion for both science and humanistic approaches in the practice of psychiatry. Dr. James Means struggled to teach us mathematics, the language of science. He was a dyspeptic man, who once observed that he treated us better than we treated ourselves. Looking back on it, I can see he was right.


Dr. Lamar Kirven (or Major Kirven because he was in the military) also modeled passion. He taught black history and he was always excited about it. When he scrawled something on the blackboard, you couldn’t read it but you knew what he meant.

And there was Dr. Hector Grant, chaplain and professor of religious studies, and devoted to his native Jamaica. He once said to me, “Not everyone can be a Baptist preacher.” He tried to explain that my loss of a debate to someone who won simply by not allowing me a word in edgewise was sometimes an unavoidable result of competing with an opponent who is simply bombastic.

Dr. Porter taught English Literature and writing. She also tried to teach me about Rosicrucian philosophy for which she held a singular passion. Not everyone can be a Rosicrucian philosopher. But it prepared the way for me to accept the importance of spirituality in medicine.

I didn’t know it back in the seventies, but my teachers at HT would be my heroes. We need heroes like that in our medical schools, guiding the next generation of doctors. We need them in a variety of leadership roles in our society. Most of my former HT heroes are not living in the world now. But I can still hear their voices.