science – 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.

Cannabis Rescheduled from Schedule I to Schedule III Today

As of today, the US Dept. of Justice moved “…the classifications of products containing marijuana that are covered by the Food and Drug Administration or that have received a state medical-marijuana licence” from Schedule I to Schedule III.

This is not exactly the same as reclassifying all marijuana, although it looks like that is being considered as the next step. Marijuana itself is still illegal at the Federal level. And today’s current change in classification could also be legally challenged in the next 30 days.

It’s important to point out that today’s DOJ action is not the same as “full federal legislation” of marijuana. That would mean de-scheduling it altogether.

You can find out more about the legal consequences of today’s action at congress.gov. For example, “With respect to the manufacture, distribution, and possession of recreational marijuana, if marijuana were moved to Schedule III, such activities would remain illegal under federal law and potentially subject to federal prosecution regardless of their status under state law.”

Is Cannabis Reclassification Imminent?

I saw a couple of brief news alerts indicating that progress toward reclassification of marijuana from Schedule I to III could be happening as soon as today according to a Reuters report. I think that means we should pay attention to other stories and reports of cannabis use being associated with higher rates of psychosis in adolescents. That information is not new and it has been reported since at least since 2010.

The DEA is in charge of reclassification of substances.

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.

What’s Up with the Ivermectin Bill in Iowa?

I’m trying to find out what’s happening with Governor Reynolds’ MAHA bill (HF 2676) which includes allowing Iowa pharmacists to provide ivermectin without a prescription to those who prefer taking it, most likely for something else other than what’s indicated for, which is treating parasitic infections. The risk is that persons will try to use it to self-treat other diseases such as Covid 19 infections, for which there is no convincing evidence supporting ivermectin’s effectiveness.

There’s a list of bills signed into law by the governor as of April 16, 2026 which doesn’t include HF 2676. My understanding is that this year’s legislative session would be ending maybe as soon as tomorrow.

I found one source on the web which indicates the Iowa House passed it. It then went to the Senate, which passed the bill with the ivermectin part intact and it was returned to the House. It’s not clear whether Governor Reynolds actually needs to sign it into law.

My usual go-to news source for Iowa lawmaker news is the Iowa Capital Dispatch, but it doesn’t seem to have any recent updates on this bill.

The language of the bill regarding so-called over-the-counter ivermectin is permissive, meaning pharmacists may (not must) provide ivermectin, not making it mandatory for Iowa pharmacists to hand over ivermectin to anyone who requests it. And pharmacists would be exempt from “…professional discipline or civil or criminal penalties for distributing ivermectin…”

It doesn’t look like anyone considered what recourse patients might have if they suffer injury as a result of taking ivermectin for a non-FDA approved (off label) condition.

AI Chatbots and Psychiatry: Embrace or Dislodge?

I’ve just finished reading a couple of online articles about Chatbot use by patients who then present either to psychiatrists or psychotherapists (not that they can’t be one and the same!) and I’m a little puzzled. The title of my blog post came partly from what my wife, Sena, always says about Artificial Intelligence—which is that it needs to be dislodged.

The first article, “Clinician Competence in the Age of Chatbots,” is part of a Psychiatric Times series, “AI Chatbots: The Good, The Bad, and the Ugly.” It’s a collaboration between a psychiatrist who I admire (Dr. Allen Frances, MD) and Jill Noorily (described as someone “who lives and writes at the boundary between AI and the humanities).

I’m far from an expert on AI and I tend to be opposed to it most of the time. The article by Dr. Frances and Jill Noorily sounds almost supportive of Chatbots in psychotherapy.

The other article is entitled “Patients Bring ChatGPT to Psychiatry Visits, With Richard Miller, MD.” The tone of Dr. Miller is more along the lines of “dislodge AI” than that of the article by Dr. Frances and Noorily.

They were both published about the same time. The difference in tone between the two articles is definitely noticeable, at least to me. I’m also more like Dr. Miller than the authors of the articles in the Psychiatric Times series “AI Chatbots: The Good, The Bad, and the Ugly.”

Many of them are co-written by Dr. Allen Frances and other co-authors. The first one in the series was “Preliminary Report on Chatbot Iatrogenic Dangers,” posted on August 15, 2025 by Dr. Frances, MD and Luciana Ramos.

I quickly read through about 5 of the articles, getting a deeper sense of the conflicts I have about AI in general. The first one on iatrogenic dangers mentions the lawsuit brought by a woman whose son was the victim of a Chatbot who told him he should commit suicide—which he did.

So far, I think I have the same mindset about AI as Dr. Miller. Your thoughts?

Earth Day 2026!

Hey, Earth Day 2026 is on April 22, 2026! If any of you are like me (and who isn’t?), you might have trouble figuring out just what you can do that would be meaningful on Earth Day.

Well, here’s a link to Earth Day Tips which gives you 50 easy ways to participate. You could volunteer, take a quiz, go to the park, or even eat kale! Try not to stand under a tree in which a bald eagle is pooping.

You can find Earth Day events in your area at this website.

How About Some Good News?

How about some good news for a change? See the Daily Iowan report on research being done at The University of Iowa examining how transcranial magnetic stimulation can help clinical neuropsychiatric conditions such as depression and Alzheimer’s disease. There’s also a link to the open access study which gives more detail about the process.

Reference:

Li, Z., Trapp, N.T., Bruss, J. et al. Multimodal evidence for hippocampal engagement and modulation by functional connectivity-guided parietal TMS. Nat Commun (2026). https://doi.org/10.1038/s41467-026-70346-x

A Dose of the Mother

Sena had another dietary brainstorm and bought something called apple cider vinegar.

Warning: it contains a substance called “the mother.”

I’m not sure what the mother is, exactly, but I’m concerned that it might be something that would turn up as the main creature on a Svengoolie show movie. By the way, tonight it’s the 1977 release of “The Car.”

I was not sure whether I would want to consume anything that might contain vestiges (chunks?) of somebody’s mom. Hard to believe, this stuff has been around since 1912. What did the children think?

Actually, according to the first (and only) source I looked up on the web, the vinegar part got started by the Babylonians in 5000 B.C. Leave it to the Babylonians. You can mix it with moonshine to make werewolves. Think about that.

Sena thought I was going to look up scientific research about this. However, the claims that it makes mice smarter than humans is trivial. Just about every living creature is smarter than a human. Just read the news.

It turns out the mother is a mixture of acids that can make you hallucinate extraterrestrials and Bigfoot. You could use it as an underarm deodorant, but you might get sued by the maker of Lume deodorizer products.

There are a few tried and true effects of apple cider vinegar. You can soak your feet in it—if you don’t mind the incidental result nobody mentions, which is that your feet dissolve. You can get rid of fleas with it, but you might just want to visit a vet. And anything you can use as a weed killer should you make you think twice about drinking it. The bottle directs you to shake gently before using. You wouldn’t want to throw your hip out of joint.

Thank you for your time.

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.