science – Go Retire Psychiatrist

Current Kratom and Psilocybin Legislative Action in Iowa

I just saw an excellent post from Dr. George Dawson, MD, DFAPA on Kratom. His emphasis that the risk for harm from this substance should be “…remembered at every policy debate.” I agree. This reminds me of what happened in the Iowa Legislature this term at the second funnel regarding substances with the potential for harms to users. Two drugs survived the second funnel: the Kratom bill House File 2133 and the Psilocybin bill House File 978, copied from the Iowa Capital Dispatch story published by Robin Opsahl, Brooklyn Draisey, and Cami Koons on March 20, 2026:

“Kratom:House File 2133 would designate kratom products – a substance currently legal for sale and possession in Iowa which produces a stimulant effect at low doses, and acts as a sedative at high doses – as a Schedule I hallucinogenic substance. People found in possession of kratom would be subject to a serious misdemeanor charge for their first offense, an aggravated misdemeanor for their second and a Class D felony charge for subsequent offenses. The bill passed the House and was placed on the unfinished business calendar in the Senate.

Psilocybin: The Senate Health and Human Services Committee amended and passed House File 978 Thursday, a bill that would allow for the legal, medical use of psilocybin in clinical environments with psychiatric support that have been approved by the state. Products with psilocybin, the psychoactive compound in “magic mushrooms,” and operators providing treatment involving psilocybin, would be regulated by the state through the Medical Cannabidiol Advisory Board, which would be expanded to include four members with expertise in psilocybin treatment. The program created through this legislation would be limited to individuals seeking treatment for post-traumatic stress disorder, but the board could seek legislative approval for using psilocybin in treatment for other mental health issues as more research becomes available.

I don’t know exactly what “unfinished business” means with respect to the Kratom bill. All I know at this stage is that it has not yet been signed into law by Governor Reynolds. I’ll have a couple of remarks about the Psilocybin bill later.

Kratom is currently legal in Iowa. A couple of years ago while we were driving on Highway 1 through Iowa City, I saw a big sign on a small store saying it was for sale. As of 12/02/2025, the FDA has issued an opinion:

“There are no prescription or over-the-counter drug products containing kratom or its known alkaloids that are legally on the market in the U.S. If a new drug application (NDA) is submitted for kratom (or one of its components) to treat a specific medical condition, FDA will review the scientific data to determine if a drug product containing kratom (or its components) is safe and effective to treat that specific medical condition. Consistent with FDA’s practice with unapproved substances, until the agency scientists can evaluate the safety and effectiveness of kratom (or its components) in the treatment of any medical conditions, FDA will continue to warn the public against the use of kratom for medical treatment. The agency will also continue to monitor emerging data trends to better understand the substance and its components.”

The web articles I found on Kratom indicate that it’s not controlled under the Controlled Substances Act, but the DEA says it’s a “drug of concern” and warns against its use according to a web article posted on March 11, 2026 by the National Institute on Drug Abuse (NIDA).

When I posted on my blog about Kratom after I saw the road sign advertising its sale at what appeared to be what we used to call a “head shop.” I tried to find more information about the substance. At that time, I found an article that saying when the DEA tried to place it on Schedule I in 2016, the American Kratom Association prevented it simply by protesting it (which may or may not be true). An historical overview of Kratom’s legal status in Iowa is here.

Kratom: Summary of State Laws

Kratom 101: What You Need to Know

As for the Iowa bill on Psilocybin, this post is getting a little long and I’ll try to keep my remarks brief. There was a news story about the bill which identified psilocybin as also being known as “magic mushrooms.” It also mentioned that it might be helpful for some people who struggle with PTSD and that last year, Governor Reynolds vetoed a bill that would have allowed distribution of the drug.

I found one of my old blog posts (“Maybe We Need a Dose of Humor) which was partly about psilocybin. I mentioned Dr. Henry Nasrallah’s article on how it might reduce the “visceral hatred” that is prominent in American politics:

In the current political zeitgeist, could psychedelics such as psilocybin reduce or even eliminate political extremism and visceral hatred on all sides? It would be remarkable research to carry out to heal a politically divided populace. The dogma of untreatable personality disorders or hopelessly entrenched political extremism is on the chopping block, and psychedelics offer hope to splinter those beliefs by concurrently remodeling brain tissue (neuroplasticity) and rectifying the mindset (psychoplasticity); September issue of Current Psychiatry, by the journal’s editor, Henry A. Nasrallah, MD (From neuroplasticity to psychoplasticity: Psilocybin may reverse personality disorders and political fanaticism. Current Psychiatry. 2022 September, 21(9): 4-6 | doi: 10.12788/cp.0283).

I found another one of my blog posts about psychedelic-assisted therapy from a couple of years ago.

The remarks from a former colleague were politely negative about the quality of the research in question in the Lykos study mentioned in my post which cited the Psychiatric Times article about the study. Dr. Jess G. Fiedorowicz, MD, PhD formerly was formerly on staff at University of Iowa Health Care. He’s now the Chief of Mental Health at The Ottawa Hospital where he’s also Professor and Senior Research Chair in Adult Psychiatry, Department of Psychiatry, University of Ottawa, Ontario. His remarks in the transcript are typical for his erudition and expertise as a clinician scientist.

And that segues into the University of Iowa Dept. of Psychiatry study on psilocybin for alcohol use disorder. There’s a podcast that mentions it with a link to an article. The department is currently recruiting according to clinicaltrials.gov:

“Psilocybin vs Ketamine for Alcohol Use Disorder: This study will collect data that measures the effects of a psychedelic intervention on patients struggling with alcohol use disorder (AUD). The study design will be a double blind, randomized, active-comparator trial with two study arms. Subjects randomized to Arm 1 (n=40) will receive individual psychotherapy sessions plus a 30 mg dose of psilocybin. Arm 2 subjects (n=40) will receive individual psychotherapy sessions and a 0.75 mg/kg dose of ketamine.”

However, the Iowa legislature’s bill supporting psilocybin is, for now, geared toward treatment of PTSD.

I think the Kratom bill goes in the right direction and I’m not so sure about the psilocybin bill.

Waiting for the Second Funnel in Iowa Legislature on Anti Vaccination Bills 2026

I’ve been trying to track the two anti-vaccination bills heading into the 2^nd funnel in Iowa and I guess I’ll just have to wait until tomorrow’s news reports.

One of them is HF 2171 which would eliminate Iowa’s requirement that children in grades K-12 receive vaccines before they can attend school. The other is SF 2095 (replaced by SF 2424, I believe) which would require postsecondary private schools to find clinical rotation training facilities for students in health care fields which would allow them to be exempt from any vaccine requirements.

I don’t expect either to survive the funnel, but I’m surprised that these bills were introduced at all given the risks of reducing the protection against communicable diseases as set by current public health policy.

I found a research paper on anti-vaccination legislation in mid-western states in which one of the authors, Filip Viskupič is a scholar who represents Iowa State University.

Reference:

Filip Viskupič, David L. Wiltse, Zachary Liebl, Tobias Kinslow,

The prevalence and nature of anti-vaccination legislation in ten midwestern states: Implications for public health and policy,

Vaccine,

Volume 79,

2026,

128452,

ISSN 0264-410X,

(https://www.sciencedirect.com/science/article/pii/S0264410X26002604)

Abstract: Legislative proposals that could lower vaccination rates pose a threat to public health in the United States. We tracked and analyzed anti-vaccination bills proposed in the legislatures of ten Midwestern states from 2013 to 2024. We used the LegiScan database to search for bills, and three researchers independently classified each identified bill. We classified 374 bills as anti-vaccination bills. The legislative sessions during 2021–2022 saw 222 anti-vaccination bills proposed, mostly concerning COVID-19 vaccination. During 2023–2024, 101 bills were proposed; however, these bills were broader in scope, covering vaccines beyond COVID-19. Most anti-vaccination bills were introduced by Republican lawmakers and only 9 had Democratic sponsorship or co-sponsorship, and only 22 were signed into law. Scholars should continue systematically tracking and analyzing anti-vaccination proposals and other bills impacting public health.

Keywords: Vaccine policy; Anti-vaccine; Health Policy; Health Politics

CDC ACIP Meeting Postponed for Today and Tomorrow

I missed the recent notice in the last couple of days that the CDC ACIP meeting was postponed for today and tomorrow. Me and more than a couple dozen people were kept waiting for a half hour before I got suspicious and looked it up. There’s a CIDRAP story posted yesterday that explains the “delay.”

There was a federal district judge ruling two days ago “…temporarily blocks every major vaccine policy change made by President Trump’s administration over the past year. The ruling came in response to the ongoing lawsuit filed by the American Academy of Pediatrics (AAP) and five other major medical organizations against Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.”

There is no message on the CDC ACIP webcast site about this and at the moment I’m writing this, there are still 41 people waiting for the YouTube webcast. I figured they were just getting coffee and bagels. There should have been an announcement by the CDC ACIP.

No wonder there was no agenda.

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.

Rash of Bigfoot Sightings in Ohio, So What About Iowa?

Actually, I should refer to the multiple sightings of Bigfoot as a flap. That’s proper terminology. The news story shows a video with the cryptid on it although I think it looks more like somebody smeared a chocolate bar on the camera lens.

There’s an organization called Bigfoot Society that is tracking the story. The Bigfoot Society Podcast by Jeremiah Byron of Earlham, Iowa posts weekly about Sasquatch sightings and lore. Here’s one about Iowa. There are a lot of ads periodically, so be patient.

There’s one thing I couldn’t find on the web and that’s the Iowa Bigfoot Information Center. There was a guy named Kevin Cook who was the head of it, but that was back in the late 1970s, which supposedly is when there were a lot of Bigfoot sightings. I found a really short article from September 24, 1978 published in the Des Moines Register about him.

I did a little digging and Kevin Cook partnered with another Bigfoot researcher named Clifford Labrecque to start the Iowa Bigfoot Information Center. Jeremiah Byron’s full YouTube presentation is sponsored by the Bigfoot Society Podcast and, unfortunately is available to members only. But there is a short teaser.

In the teaser, Byron interviews Kevin Cook and, although I can’t tell exactly how recent it is, I believe it was done shortly after Labrecque passed in 2021. The discussion mentions a prominent scientist, Dr. Jeff Meldrum, who has been interviewed on TV about Bigfoot. Unfortunately, he also passed in September of 2025. He was a full professor of Anatomy and Anthropology in the Dept of Biological Sciences at Idaho State University. He was a guest on some popular TV shows about Bigfoot (one of them misidentified him as being on faculty at Iowa State University). People are always getting Iowa mixed up with either Idaho or Ohio.

I’m reminded also of the Bigfoot Field Researchers Organization (BFRO), which keeps records of Bigfoot sighting around the country and they also sponsor annual Bigfoot hunts in Iowa. They had one last year, but I couldn’t find out how that went. There’s 2026 Iowa BFRO Expedition, which starts next month, April 30-May 3. Details are available below the announcement. Guns and dogs are not allowed.

Sena and I have done our own Bigfoot expeditions and one of them is below. No need to thank us; it’s our pleasure to contribute to the scientific endeavor.

CDC ACIP Meeting Scheduled for March 18, 19 2026

It’s been a while since the last CDC ACIP meeting. It’s scheduled for March 18, 2026, 8 AM to 5 PM EST and March 19, 2026, 8 AM to 5 PM EST, according the notice on the Federal Register.

There are over 1500 comments and the one I thought was the best was by the Vaccinate Your Family (VFY) organization, which you can read on their website.

According to the notice: “The agenda will include updates on ACIP Workgroups and discussions on COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. Recommendation votes may be scheduled for COVID-19 vaccine injuries and Long-COVID and ACIP recommendation methodology. 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.”

Clinical Problems in Consultation Psychiatry and The Break-Dancing Koala Bear

I ran across an old Clinical Problems in Consultation Psychiatry (CPCP) presentation by a couple of sharp medical students in 2014. They presented it at one of my morning consult rounds and it’s about Charles Bonnet Syndrome.

They did a very nice job and it compares fairly well with the University of Iowa Ophthalmology Dept summary. One of the authors of that summary is my retinal specialist, Dr. Ian Han, who did the surgery on my detached retina about 4 years ago. It also has a link to a great YouTube video of a woman who has Charles Bonnet Syndrome. It’s not a psychiatric disorder although ironically one of the treatments for it may sometimes be antipsychotic medications.

The other thing about this presentation is that the students’ fictional case description mentions that the patient had visions of “a break-dancing koala bear” among other things. I can’t remember whether I was the one who told them about a video on the internet that showed a break-dancing stuffed koala bear—or if it was the other way around! At any rate, I remember seeing it around that time, but of course I can’t find it now.

Do We Really Need Artificial Intelligence to Help People Who Are Demoralized?

I was just going through the many files on one of my old thumb drives that I still keep after I retired from consultation-liaison psychiatry over 5 years ago. I found a file that I must have typed from a source on how to help medically ill persons who are demoralized. Demoralization is not the same thing as depression or adjustment disorder. What I have copied from the original source is below, along with the reference.

Treating Demoralization

Ask first: “how are your spirits today?” Then ask “what is the most difficult thing for you now?”

Coherence Versus Confusion

1. How do you make sense of what you’re going through?

2. When you are uncertain how to make sense of it, how do you deal with feeling confused?

3. To whom do you turn for help when you feel confused?

4. (For religious patient) When you feel confused, do you have a sense that God has a way of making sense of it? Do you sense that God sees meaning in your suffering?

Communion Versus Isolation

1. Who really understands your situation?

2. When you have difficult days, with whom do you talk?

3. In whose presence do you feel a bodily sense of peace?

4. (For religious patients) Do you feel the presence of God? How? What does God know about your experience that other people may not understand?

Hope Versus Despair

1. From what sources do you draw hope?

2. On difficult days, what keeps you from giving up?

3. Who have you known in your life who would not be surprised to see you stay hopeful amid adversity? What did this person know about you that other people may not have known?

Purpose Versus Meaninglessness

1. What keeps you going on difficult days?

2. For whom, or for what, does it matter that you continue to live?

3. (For terminally ill patients) What do you hope to contribute in the time you have remaining?

4. (For religious patients) What does God hope you will do with your life in days to come?

Agency Versus Helplessness

1. What is your prioritized list of concerns? What concerns you most? What next most?

2. What most helps you to stand strong against the challenges of this illness?

3. What should I know about you as a person that lies beyond your illness?

4. How have you kept this illness from taking charge of your entire life?

Courage Versus Cowardice

1. Have there been moments when you felt tempted to give up but didn’t? How did you make a decision to persevere?

2. If you see someone else taking such a step even though feeling afraid, would you consider that an act of courage? (If so) Can you imagine viewing yourself as a courageous person? Is that a description of yourself that you would desire?

3. Can you imagine that others who witness how you cope with this illness might describe you as a courageous person?

Gratitude Versus Resentment

1. For what are you most deeply grateful?

2. Are there moments when you can still feel joy despite the sorrow you have been through?

3. If you could look back on this illness from some future time, what would you say that you took from the experience that added to your life?

Griffith, J. L. and L. Gaby (2010). “Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness.” Focus 8(1): 143-150.

There are a couple of resources I routinely used as a psychiatric consultant in the general hospital. One of them was the general outline of how to recognize and help someone who is demoralized (above). Another was a free online (non-AI) cognitive behavioral therapy resource that is still available called The MoodGym.

These are not the same thing as Artificial Intelligence (AI), which I think in some cases might be the wrong way to help someone with depression and anxiety that is more reactive to situational and medical stressors. AI can also be harmful to some people.

I have seen the brief psychotherapy guide above published and referenced in different articles on the web, one of them published as recently as 2025. Griffith and Gaby first published the guide to help those who are demoralized in 2005. It’s been around for 20 years and in my opinion is better than AI will ever be.

References:

James L. Griffith, Lynne Gaby,

Brief Psychotherapy at the Bedside: Countering Demoralization From Medical Illness,

Psychosomatics,

Volume 46, Issue 2,

2005,

Pages 109-116,

ISSN 0033-3182,

(https://www.sciencedirect.com/science/article/pii/S0033318205701006)

Abstract: Bedside psychotherapy with medically ill patients can help counter their demoralization, which is the despair, helplessness, and sense of isolation that many patients experience when affected by illness and its treatments. Demoralization can be usefully regarded as the compilation of different existential postures that position a patient to withdraw from the challenges of illness. A fruitful interviewing strategy is to discern which existential themes are of most concern, then to tailor questions and interventions to address those specific themes. Illustrative cases show how such focused interviewing can help patients cope assertively by mobilizing existential postures of resilience, such as hope, agency, and communion with others.

https://psychiatryonline.org/doi/full/10.1176/foc.8.1.foc143

Alyssa C. Smith, Jonathan S. Gerkin, Diana M. Robinson, Emily G. Holmes,

Consultation-Liaison Case Conference: Management of Demoralization in the Medical Setting,

Journal of the Academy of Consultation-Liaison Psychiatry,

Volume 67, Issue 1,

2026,

Pages 71-78,

ISSN 2667-2960,

(https://www.sciencedirect.com/science/article/pii/S2667296025005087)

Abstract: Demoralization has important implications for patients’ health, but consultation-liaison psychiatrists may be less familiar with diagnosis and management due to limited inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. We present the case of a multivisceral transplant patient who experienced demoralization due to complications from her posttransplant course. We discuss the diagnosis of demoralization, including differential diagnoses to consider, followed by a discussion of management of demoralization in the inpatient setting using acceptance and commitment therapy. We then discuss the consultation-liaison psychiatrist’s role in assisting with management of teams’ counter-transference to difficult patient cases, including the possibility of teams experiencing their own demoralization.

Keywords: demoralization; transplantation; transplant psychiatry; acceptance and commitment therapy; consultation-liaison psychiatry

Oppose Iowa Legislature Bill HF 2171 That Seeks to Eliminate Vaccine Requirements in Public Schools

I have been reading the public comments on the Iowa Legislature bill HF 2171 that, if passed, would eliminate the requirement for vaccines in public schools against many diseases such as poliomyelitis, diphtheria, pertussis, tetanus, rubeola, rubella, and varicella. People are overwhelmingly opposed to it and it’s beyond me how it got past the first funnel.

I’ve added some photos documenting the history of polio from the University of Iowa Health Care Medical Museum.

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.