HEALTH / Common Remedies: Steroids

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LIKE characters in a traditional western, medical drugs can be categorised as 'good' or 'bad'. Antibiotics and heart drugs are good; tranquillisers, oral contraceptives, and steroids are bad - or at least are perceived by most people as having such dangerous side-effects that they are best avoided. Steroids may literally be life-saving in conditions such as asthma and ulcerative colitis, yet some patients prescribed them are so terrified by their reputation that they don't take them, or take less than the prescribed dose.

'Steroid' is a technical term in chemistry for a type of complex molecule, and many hormones (oestrogen and testosterone for example) are steroids. The anabolic steroids used illegally by sportsmen mimic the action of male sex hormones. Steroid drugs, as the term is commonly used, are synthetic equivalents to hydrocortisone, a hormone made in the adrenal glands buried deep inside the abdomen. Natural hydrocortisone helps the body cope with physical and emotional stress. Someone whose adrenal glands have been destroyed by disease needs daily doses of hydrocortisone to stay alive.

The main action of steroid drugs is to suppress inflammation. If the intestines, the skin, the joints, or any other part of the body become hot, red, swollen and painful, then treatment with steroids (either applied directly or taken by mouth to reach the bloodstream) will - almost miraculously - restore normal colour, temperature, and blood flow. The effect is, indeed, so miraculous that when steroids first became available as drugs they were given in huge doses to people with conditions such as rheumatoid arthritis, producing apparent cures - until the side-effects became apparent.

No one given large doses of steroids can avoid the side-effects. As inevitably as they suppress inflammation, they raise the blood pressure, increase weight, redden the complexion, increase body hair, and thin and weaken the bones. They increase susceptibility to stomach ulcers and diabetes and all kinds of infections. Occasionally they cause serious mental disturbances.

This is such a catalogue of disaster that high doses of steroids are given only in life- threatening circumstances or in conditions such as temporal arteritis, where steroids are given to prevent blindness.

Attempts to develop steroid drugs that have less severe side-effects have been only partially successful. If the steroids can be delivered directly to the target, the dose needed is much reduced, and people with asthma who take their steroids by inhalation have far fewer problems with side-effects. Low strength steroid creams are so safe that in most countries they can be bought over the counter without a prescription.

Nevertheless, for many people with chronic diseases, especially those due to disturbances of the immune system, long-term steroid treatment is essential. Steroids are given to patients having organ transplants and they are used in the treatment of some kinds of cancer. In all these conditions the dose will be kept as low as possible, but side- effects do usually develop. Much of the 'bad' reputation of steroids dates back to a time when they were given in larger doses; but they are the outstanding example of the need to balance risks against benefits.