By Bryan Farha, Ed.D.
Oklahoma City University
The crises that Oklahomans have had to endure over the past few decades are mounting—from natural disasters like the tornado that just ripped part our treasured Moore community to shreds, to terrorist attacks such as the bombing of our Alfred P. Murrah Federal Building when it was bombed on April 19, 1995. I counseled rescue workers for this tragedy. I am certain that many from other states wonder how we can sustain ourselves in light of such gargantuan tragedies. There seems to be something special about the way we adapt and cope with extreme obstacles. Oklahomans have developed a type of resiliency that is hard to measure—but easy to observe. When I first began witnessing how we responded to monumental challenges—such as the 1995 bombing and the 1999 tornado that destroyed much of our Oklahoma City community, I noticed there was an immediate reaction questioning how such a tragedy can happen to our community. Obviously, this response is expected, but we’ve come a long way in twenty years. Now the immediate reaction, in the face of our current tragedy of tornados, is much clearer, decisive, and measured. We get a plan of action to locate missing children and others—then we begin rebuilding. We know what we’re doing in this great state. I saw this, when the tornado ripped through Moore, Oklahoma on May 20 2013.
However, after so many crises, how can we possibly endure tragedy after tragedy? Isn’t the natural inclination to collapse emotionally and physically? To give up? First, Oklahomans have a lasting bond that is difficult to break. We’ve been overcoming for a long time and, unfortunately, we’ve been forced to excel at it. With each tragedy, the bond becomes stronger. Strangers will risk their lives for other strangers without even a fleeting hesitation. A neighbor will put their life at risk in an attempt to rescue another’s child. Another way we survive is by allowing our children to express emotions after a tragedy. This is essential for the well-being of young children. Some parents are tempted to simply lecture to their kids in an attempt to “explain” such crises. More often, we teach our children to freely express themselves and speak as much as they wish about the often unanswerable questions surrounding such perplexing events. This puts our children on the path to recovery—even if we have difficulty answering their questions. We are aware that the traumatic feelings will never go away, however, so we seek not to eliminate the possibility of reliving the awful feelings, but to minimize their intensity and frequency. We know that total closure is unrealistic. Next, we further anchor the connection with our existing support groups of family and friends. Oklahomans know that attempting to handle tragedy alone is not a healthy approach—so we seek our loved ones to help get us through. The more people in our support network, the better. Then we learn to say goodbye to those we have lost. Realizing that life is ultimately transitory, we do the best we can at finally letting go—as difficult as this may seem. This is the only way we can truly look to a purposeful future. Lastly, acceptance is the key to enduring. In the face of apparently meaningless events, we somehow find a way to gain meaning from tragic experiences. Oklahomans accept that we live in a vulnerable place geographically. Moreover, we know with such geography come some very hard times. We’ve become good at repeating the cycle as often as necessary. We’re prepared and good at it. The sum total of all this is resiliency.
I’ve lived in Oklahoma my entire life—and I will never move away from this great state. This is home—tragedies and all.
Yet another high profile failed prediction for Sylvia Browne. She tells Amanda Berry’s mother in 2004 on the Montel Williams show, “she’s not alive honey.” This sent her mother into understandible tears, not realizing she was beginning unnecessary bereavement. I believe this should be a criminal action, but I suppose it was a choice to seek an alleged psychic.
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A Tale of Technology, Risks, and Unintended Consequences
Invited Post by John Nail, Ph.D.
Modern pharmaceutical drugs, along with other medical technologies, have doubled life expectancies during the past 100 years. There is a real possibility that the news media, politicians, lawyers and gullible jurors will put an end to these advances. The news media appears to enjoy reports of ‘dangerous products’ that the politicians embrace as it gives them a way of diverting attention from their own lack of competence. Trial lawyers earn their living by convincing gullible jurors that the ‘big companies’ are to blame for anything adverse that occurs when someone uses their product. Often, the result of the media and political orgy is that useful products are removed from the market. This is the story of a drug that was removed due to safety reasons and the possible unintended consequences of its removal. Before we proceed, we should note that 1) ALL technologies have unintended adverse consequences, 2) It is not possible to know what these consequences will be until large numbers of people start using (and abusing) the product, and 3) Decisions have unintended consequences, including often making a situation worse when trying to make it better.
Vioxx (generic name rofecoxib) was a prescription drug for the treatment of pain from osteoarthritis (this is the type of arthritis that occurs when bones are rubbing against each other). Vioxx was approved for use by the US Food and Drug Administration on May 20, 1999; it was discontinued on September 30, 2004, due to concerns regarding cardiovascular problems (heart attacks and strokes) in patients that used the drug.
A considerable amount of testing is required before the FDA will approve the use of a new prescription drug. One of the pre-approval tests involving Vioxx was the ‘VIGOR’ study – a double-blind test in which one group of participants (the study group) was given Vioxx and the other, (the control group) naproxen, a non-prescription pain reliever. This trial found that the Vioxx group members who had pre-existing heart attack risk factors were four times more likely to have a heart attack than were the participants of the naproxen group with pre-existing heart heart attack risk factors. One interpretation of this result is that Vioxx causes heart attacks in people with heart disease risk factors; the other interpretation is that naproxen prevents heart attacks in people with heart disease risk factors. We know that aspirin prevents heart attacks, so it is reasonable to assume that naproxen prevents heart attacks. Interestingly, there was no difference between the two groups in regards to deaths from heart attacks, nor was there a difference between heart attack rates between the two groups in people who did not have heart attack risk factors. Thus, if a person has heart attack risk factors and should be taking a ‘baby’ aspirin each day, that person’s chance of a heart attack is four times higher if the person is taking Vioxx instead of naproxen.
APPROVe was another Vioxx clinical study in which the ‘control’ group was given a placebo (sugar pill). During this study, it was found that, after 18 months, the participants who were being given Vioxx were almost twice as likely to have a heart attack than were the participants who were being given sugar pills. However, the heart attack deaths (mortalities) were equivalent between the two groups. Thus, as in the VIGOR study, the rate of heart attacks were greater in the Vioxx group, but the rate of heart attack deaths were identical between the two groups. The APPROVe results and the resulting media uproar resulted in Vioxx being withdrawn from sale.
Bextra and Celebrix were Vioxx’s competitors. Bextra was withdrawn due to increased heart attack and stroke risks in patients who were taking Bextra while recovering from heart surgery. Celebrix is still being marketed, however, it has a ‘black box warning’ that it should be used only as a last resort on patients who have heart disease or a risk of developing heart disease.
One of the arguments for why Vioxx and Bextra should no longer be sold was that “osteoarthritis patients have other options for relieving their pain” – these other options are over the counter pain relievers (aspirin, naproxen, acetaminophen, ibuprofen, etc.), and opioids such as codeine, demerol and morphine. While opioids are among the most effective of all pain relievers, they have unintended effects such as narcosis (sleep inducement) and physical and psychological addition. Rush Limbaugh allegedly became psychologically addicted to opioids.
Recently, a study determined that switching osteoarthritis patients from Vioxx or Bextra to opioids has resulted in a fourfold increase in falls and broken bones in elderly osteoarthritis patients. A quote from an article in The Journal of Higher Education that discussed this increase in falls and broken bones,
“Somebody should have thought more carefully about the elderly before making these recommendations” (switching elderly osteoarthritis patients from drugs such as Vioxx to drugs such as codeine to control their pain), says Bruce N. Cronstein, a professor of medicine at New York University’s Langone Medical Center. “Falls in an elderly population can be very dangerous, leading to long hospitalizations and even death.” ….”We don’t have wonderful alternatives for treating chronic pain”… Long treatment with aspirin or ibuprofen, for instance, often irritates and damages the digestive system…Falling down seems like one of the most obvious adverse effects, says Dr. Cronstein. “That’s not rocket science,” he notes. “The elderly are more frail. They have a host of factors that could lead to falls. If you add something that makes you a little unsteady, it increases the risk”
Thus, the choices for people with osteoarthritis are (and were) over the counter drugs such as aspirin and ibuprofen, that can cause digestive damage from long-term use, prescription narcotics that increase a person’s risk of falling by fourfold, or prescription drugs such as Vioxx that, in people with heart attack risks, increased their risk of heart attacks, however, these did not increase their risk of dying from a heart attack. The media and political storm that resulted in Vioxx and Bextra being removed from the market appears to have resulted in either more pain in osteoarthritis sufferers due to their not treating the pain, or the possibility / reality of digestive system damage, or increased use of opioid drugs which has produced an increase in falls and broken bones.
Elderly patients also don’t have the best of memories. This sometimes leads to accidental overdoes of opioid (and other drugs) due to a patient’s forgetting that they had already taken their pain pill for that day. It is also known that people often develop tolerances to opioid drugs, making these increasingly less effective.
I leave you with a comment uploaded to the discussion section from The Journal of Higher Education article:
‘“In addition to the danger of increased falls, the removal of Vioxx and Bextra from the market meant increased arthritis pain for millions of people (including me). The possibility of heart problems for some won out over the reality of pain for millions. I hope that not all medical decisions are made this way” John C.’
Unfortunately, this is how medical decisions are made during a media generated crisis. The next time that there is a media uproar about ‘dangerous medical products’, remember that the unintended consequences from the product’s alternatives may be worse than the product’s unintended consequences.
DR. NAIL is Chair of the Chemistry Department at Oklahoma City University