OK, so let's just imagine for a moment, that there were to be a big announcement on the news tonight. Imagine that the pharmaceutical companies finally held their hands up and admitted that steroid creams are addictive and cause serious long-term damage. Doctors and dermatologists around the world would all be informed and new guidelines put in place ensuring that steroid creams only be used for a period of five days to prevent addiction occurring. All OTC steroid creams are removed from sale.
"Hooray!" we may shout.
But what would be the implications? Would anything really change?
Moral Dilemma 1:
Well firstly, let's imagine the scenario of someone who suffers from eczema. They want a quick fix because they have a patch on their face and it looks unsightly. The doctor is at first reticent to prescribe a steroid, but succumbs to the patients demand, insisting that they follow the new 5 day guideline.
The patient uses the steroid cream but the eczema comes back after the 5 days. They return to the doctor, asking for a new prescription. The doctor refuses, because of the new guidelines. The patient now has a choice: Learn to live with the eczema and let it go away on its own, or get a steroid cream from a more disreputable source. Even now there are plenty of nasty people selling dangerous, illegal steroid creams. Would they see a sudden boom in trade? Obviously, the answer is to give the eczema a few weeks to go away on its own, but people are so obsessed with appearance today that many would opt for the more dangerous choice.
Moral Dilemma 2:
Now let us consider someone who has been using steroids for 20 years. My imaginary person is called John and he works full time in a public-facing role to support his family. He sees the announcement on the news and decides that he wants to quit steroid creams. The doctor warns him that quitting steroids will cause an intense rebound that will likely leave him incapacitated for the first 3 months, with total withdrawal taking as long as 3 years. John thinks that this will be difficult as he will not be able to get that much time off work, and he needs the money. What does the doctor do? Surely the doctor cannot force John into a painful withdrawal by withholding steroids.
Moral Dilemma 3:
What about the millions of people worldwide who regularly use steroid creams? Surely the doctors could not suddenly freeze all repeat prescriptions.Imagine the case of a dermatologist, who prescribes steroids to hundreds of his patients. Is he going to call them all in and refuse treatment, forcing them to go through withdrawal? How would a doctor, who has pledged to "do no harm" feel about prescribing a medication that he knows to be dangerous and addictive?
Legal Implications:
Admissions about the dangers of steroids would inevitably lead to lawsuits by disgruntled patients. Where does this leave doctors? Would graduates be reluctant to enter the medical profession? Who is more liable, Big Pharma or individual doctors?
Clearly, the truth about steroid creams is an inconvenient one. Steroid creams have been the mainstay of eczema treatment for over 50 years and are a billion dollar industry. If the truth about steroid creams was made public, the pharmaceutical companies know that they would be opening Pandora's Box.
I would love to read your thoughts on this debate. Does anyone have any ideas how these problems could be avoided? Please feel free to leave a comment below.
4 comments:
For a start, all new eczema patients should not be readily given steroids as the first line of treatment. Steroids given as a last resort should have the patient thoroughly educated and taught how to administer it over the 5 days or so treatment period. After 5 days patient must return to the doctor to be evaluated on further treatment balance of steriod cream returned for discarding (better still about only 5days use given).
I believe the steroid makers will be able to come up with something to help the TS withdrawal once they admit the dangers. Force the pharmaceutical to pay for damages for all patients who are suffering from TSW this should ease the patient's burden avoiding some of the dilemas in your 3 senarios.
More education is necessary for the medical practitioners, too. It really needs to start at the top. Apparently, doctors in India and Japan are paying more attention to the issue than those in the US/UK. I do think that the doctors' ignorance is a major part of the picture. Here is an article that discusses the need for an ethical approach to topical steroid use: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401837/
Thank you KLM for the excellent article. Until someone comes up with an alternative for those suffering from skin diseases, it will be hard to resist the overuse of TC. Various complimentary therapies should be clinically tested so that patients can actively participate in their treatment choices and not have to rely solely on TC.
Thanks for you insightful comments. I would also like to include some comments on the subject from members of the Itsan forum who were unable to post directly onto the blog.
Susan says:
In my opinion, the problem of topical steroids is much deeper and wider than just a drug problem. It’s a symptom that represents many of the problems that are widespread in the modern world. First of all, the food people eat is often not what our bodies are designed to eat. We eat factory-farmed, processed foods high in processed carbs, chemicals & sugar. This causes the body to create inflammation, which is actually one of the things our immune systems do to try to heal our bodies. Inflammation is at the base of most chronic diseases, including eczema & other skin ailments. A large percentage of people in the world today have diseases caused by inflammation. We need to change the food industry and educate ourselves to eat the food our bodies thrive on.
Once we are sick, instead of treating these ailments by discerning the root cause and correcting it, we suppress them with anti-inflammatory & other drugs, such as steroids. We go to doctors expecting immediate cures with drugs or, if drugs don’t work, surgery. We mostly don’t want our doctors to tell us to cure ourselves by changing our lifestyles, even though lifestyle-changes would lead to deeper and more long-term cures. Who wants to be told to exercise more, eat less or differently, sleep more, drink less, etc. We want drugs to handle every excess - pills to make us sleep when we’re so over-stimulated by electronics that our brains won’t turn off , aspirin to take away the headache caused by last night’s partying, antacids to relieve the pain of bad food, etc. We don’t pay attention to or respect the way nature designed our bodies to be treated.
In large part, I blame the modern approach to life in general. We’re constantly rushing around, “getting things done”. We want quick fixes and instant gratification. We don’t want to have to slow down to heal ourselves.
For all these reasons, I consider the food industry and the patients themselves (ourselves) to be as much at fault as the doctors & the pharmaceutical industry.
Blake says:
:) good read, I think that its all about educating and empowering the individual with the truth about steroid creams and from there it is up to them if they are willing to take the risk. It should be like cigarettes in that the side effects and dangers should be common knowledge and openly discussed and warnings on the package and from the doctors and pharmacists People deserve the truth and once they have that then they can make their own decisions and if anything happens they won't have anyone to blame apart from themselves and the doctors won't get the blame. It would be harder for kids as their parents would make the decision for them but as long as their parents are properly educated I would imagine it would be similar to a parent giving there kid some bad energy drink alcohol or any other drug they knew was bad for them. But at the moment there is no knowledge/warnings or anything much from the doctors or pharmacists and the system is corrupt not just with this medication but so many others. I always think of it as the sick care industry and not the health care industry because any industry is there to make money and the health/sick care industry makes money from people being sick not healthy and if we were all healthy then they wouldn't make money.
Thank you for your thoughts on this matter.
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