Handing me a vial of an injectable medication, a guest
explained that he needed a refill. Its label was in Spanish, but technical
terms are recognizable in any language, so I had no trouble deciphering its
mixture of vitamins and minerals. And cortisone.
That was disturbing. The guest’s wife’s rheumatoid
arthritis occasionally flared up, and her doctor in Argentina wanted to make
sure this didn’t spoil their vacation.
Discovered in the 1940s,
cortisone seemed miraculous. Patients crippled with arthritis saw their pain
melt away. Ugly psoriatic plaques disappeared. Hay fever vanished. Eczema
victims who had been scratching for years stopped after a few doses of
cortisone.
A cure for cancer could not have produced more
excitement. The Nobel committee, which prefers to wait decades, rewarded
cortisone in 1950 - just as doctors were realizing that symptoms return with a
vengeance when the effect wears off, and repeated use produced disastrous
side-effects.
Creams are fairly safe, and cortisone taken internally
remains a life-saver for many serious diseases but a bad idea for ongoing
symptoms (generalized pain, itching, inflammation). Large amounts for a short
period are safe provided the problem is also short-lived. I give a huge dose
for poison ivy but stop after two weeks. By that time the poison ivy has run
its course.
A rare shot is probably OK for arthritis, but this
family’s G.P. used it generously, a common tactic because the short-term effect
is so good. There are no benign treatments for rheumatoid arthritis, but many
are safer than cortisone. I prescribed enough for one shot.
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