Opioid bill opponents line up | Jan. 6
Bill’s potential to harm patients
Legislators are proposing putting more restrictions on physicians’ ability to prescribe pain medications. Yes, the addiction problem is a serious one, and the law seems well-intentioned. Remember, however, that the road to hell is paved with good intentions, and the law of unintended consequences has not been repealed.
It may be apocryphal, but I was told in medical school that a large cohort of physicians were asked which drug they would choose if they could only have a single drug to use for the rest of their careers. The overwhelming choice was morphine, not an antibiotic or a cardiac medication. Apocryphal or not, this story teaches an important lesson. For a physician, the choice of a narcotic clearly demonstrates the primacy of pain relief in the hierarchy of care.
I do about 500 operations per year. Most of my postoperative patients receive a one-week supply of a narcotic combined with a non-narcotic (e.g., Percocet). A large percentage of those patients do not use it for a whole week. Some request another week’s worth. Pain varies with the procedure performed and variable individual needs. This cannot be legislated.
The three-day supply poses potential harm and suffering to patients, not to mention additional bureaucratic burdens on physicians. For example, a patient receives a three-day prescription and is still in pain when the prescription runs out on a weekend. The prescribing physician is not on call. The covering physician does not know the patient and may refuse or delay getting the prescription to the patient. To add to this problem, narcotics may not be prescribed over the telephone or electronically, and the covering physician must not only write a paper prescription but must find a way to get it to the patient, who then must make another trip to the pharmacy to get it filled.
If some physicians are overprescribing, then focus on that small group. I believe a computer program already exists for that purpose.
I fail to see how this proposed legislation will produce more good than harm.
John M. Clarke, M.D., St. Petersburg
Things are looking up
While many on the left argue that only the wealthiest 1 percent are benefiting from the new tax law and the economy in general, here are a few facts to consider:
• The U.S. labor force is 158 million, so the top 1 percent is less than 2 million people.
• There are 94 million Americans enrolled in their employer’s 401(k) plans.
• Contributions to 401(k) plans are currently capped at $18,000 per year, whether you earn $50,000 or $50 million per year.
• The stock markets were up 20 percent or more last year, benefiting every one of those 94 million participants and the additional millions who own stock directly or through an IRA.
President Donald Trump is certainly not responsible for the entire run-up in the market, but he deserves credit for restoring optimism in the economy. I would hope that the 92 million folks not in the 1 percent might be able to put aside their class envy for a while when they receive their year-end 401(k) statements in the next few weeks.
Peter Ford, St. Petersburg
Approve statewide diversion for youths Jan. 7, editorial
A second chance for youths
As stated in your editorial, diversion programs for youthful offenders are an answer. Maybe not "the" answer as you defined it, but certainly a contribution of immense importance.
I was honored to serve in the Early Delinquency Intervention Program for five years until it was dissolved by the Legislature over budget restrictions in 2006. Serving in both the residential and case management aspects of this program, I along with many other dedicated personnel strove to give children 15 years old and under "a chance." A youthful indiscretion should never stain one for life. The EDIP 2 program served Pinellas and Pasco counties and was a joint venture of Daniel Memorial out of Jacksonville and the Florida Sheriffs Youth Ranch campus in Safety Harbor.
Over the life of this program, which started in Jacksonville in 1992, three of four young people enrolled did not have another arrest for at least one year after completing the program, and our local program had a best 87 percent non-recidivism rate in fiscal year 2002-03. Money can be and should be allocated to expand such programs, as the Times opined.
Our children are certainly our future. At least with juvenile diversion opportunities, a good majority can say that they were given a chance and could see that loving people and the state cared about them.
I often wonder if one little iota of advice stuck with the hundreds of youngsters who crossed my path. The choice is ultimately theirs, but at least afford young people that chance.
Kenn Sidorewich, Oldsmar
Trump calls himself a ‘genius’ | Jan. 7
I’ve learned something since our president was inaugurated: It’s the Dunning-Kruger effect, which came out of the research of professor David Dunning and his then-graduate student Justin Kruger.
There are two sides to it. The first is that low-competency people tend to think they are more competent than they actually are. The other is that high-competency people tend to underestimate their actual competency.
Shakespeare stated it quite succinctly in As You Like It: "The fool doth think he is wise, but the wise man knows himself to be a fool."
Sorry to say, our president appears to suffer from this effect, and he definitely falls in the not very competent group. This is exemplified by his recent self-pronouncement that he is a genius.
Even conservative pundits have noticed. I seldom read George Will’s column because he writes with such contorted logic, but I did read the one in which he wrote that the president "does not know what it is to know something."
Anyway, I’m learning. The problem is, I do not like the teacher.
John McMichael, Tampa