By Kristy Lam Chi-sum & Oakes Lu Man-yan
email@example.com & firstname.lastname@example.org
WHEN the masks came off everyone’s face in late June this year in Hong Kong, it seemed that the attack of SARS was over. Yet, the worst was yet to come.
The high doses of steroids the SARS patients took during their SARS infection are believed to have caused the rare illness named avascular necrosis (AVN), which causes bone degeneration.
The exact number of AVN patients will remain unknown until a Hospital Authority magnetic resonance imaging (MRI) screening programme is completed. However, the authority estimated that about 100 patients recovering from SARS are now facing the risk of bone degeneration.
Even though the SARS can be cured, the devastating side effects of the medication treatment are still under great criticism.
Corticosteroid is another type of steroid commonly used in curing lethal diseases such as asthma and hemolytic anemia (a lack of red blood cells) . It also helps to improve the symptoms of system lupus erythematosus (inflammatory disease affecting most body parts) and rheumatoid arthritis (an inflammatory disease that affects joints) . But many patients complain about the side effects of the corticosteroid.
Usually, the majority who suffered from system lupus erythematosus are women. Mr Yau is the one among the minority. He has been suffered from system lupus erythematosus since 2000.
Though Mr Yau refused to give details about his health condition, his wife remembered well about the treatment his husband received in public hospitals.
“The doctor said that my husband had to take corticosteroid to stop the disease from spreading rapidly,” Mrs Yau recalled, “my relatives told me that corticosteroid would bring side effects, but there was no alternative at that time.”
Mrs Yau said that his husband regained appetite and got better at the beginning stage of the corticosteroid treatment but it did not last long.
“The health condition of my husband was deteriorating when the dosage increased. The medicine didn’t help at all while its side effects were overwhelming,” Mrs Yau said.
Eventually Mr Yau started to have illusions occasionally and he was unable to work anymore. Last year, he found out he suffered from bone degeneration and decided to quit the cortiscosteroid [i.e. corticosteroid] treatment secretly.
According to Mrs Yau, her husband has pain in his legs and hip when he walks. By the time Mr Yau stopped taking the corticosteroid, they went to Guangzhou to visit a Chinese medicine practitioner. Miraculously, things improved.
“After taking the Chinese medicine, my husband's health condition started to improve. Though the effect was rather slow, at least the situation didn't get worse anymore,” said Mrs Yau.
She complained that the doctors were supposed to explain the side effects of the medicine used to treat the patients beforehand. “If we had known the side effects of the corticosteroid clearly, my husband would not have dared to take the risk but try best to find alternatives.”
It might not bother us much because steroids are not a kind of common medicines we use in our daily lives. But there are some common medicines like aspirin and coughing syrup can be found in our own homes, and most of us still do not know the possible danger behind them.
The Hospital Authority’s Patients’ Charter states that patients’ rights include the right to know the names of any medication prescribed, and its normal actions and potential side effects given their conditions. According to a survey result, most patients lack the knowledge of the medicine taken.
The Society of Hospital Pharmacists of Hong Kong successfully interviewed 4,194 patients in ten hospitals during the period of December 2002 to January 2003. The result shows that 67 percent of patients said their doctors had reminded them to take medicine before or after a meal. Surprisingly, only 38 percent of patients know the use of the medicine and how it would affect their normal life. The study also found that 60 percent of them do not have the chance to choose what medicine to take in the treatment.
“Doctors have the responsibility to inform the patients of the use and side effects of the medicines but patients should take the initiative to ask about the medication they receive,” said Dr Marcel Koo, an associate professor of the Department of Pharmacology at the University of Hong Kong.
He also suggested that people should consult professional pharmacists before using nonprescription and over-the-counter (OTC) medicines.
When it comes to medication, some prefer the Chinese way. The downside of Western medicine drives patients to switch to Chinese medicine and it has become a trend.
Mok Sau-foon is a local believer in Chinese Medicine. “I suffered from menorrhagia when I was young. It's a kind of disease that will cause abnormal menstrual cycle. My period came three times a month at that time.”
She was sent to the public hospital where doctors there gave her some hormone pills. Her health situation did not improve much but the side effects were significant and serious.
“I had emotional problem at that time that I could get angry very easily. I was forgetful and always felt tired.” Ms Mok said, “I could not go to work at that time and I was lost. I just knew that I had to stop taking the pills.”
Doctors asked her to keep taking the medicine and be patient to see the result. It took four months to cure the menorrhagia and another six months to recover from the side effects.
“There are no medicines that have no side effects at all,” Dr Koo said. Chinese medicines, which do not contain chemicals like Western medicine, have less and milder side effects.
“For severe illness or disinfection, Western medicines are more effectual,” said Dr Koo.
In order to minimise the side effects, doctors will make suggestion for patients. “For example, aspirin may damage the liver, so doctors may ask the patients to take aspirin with antacids to protect the stomach.” he said.
But aspirin is dangerous to children under 16. It may induce Reye’s syndrome that will cause severe liver and brain damage. “Though the chance of having this side effect is quite low, it’s not worth taking such risks,” he said.
Paracetamol, which has similar function of aspirin, is more appropriate and safer for children, Dr Koo said.
He pointed that the doctors understood side effects’seriousness of one kind of medicine was directly proportionate to the dosage. Therefore they will sometimes ask the patients to take a combination of various medicines of small dosage instead of taking a large dosage of one particular medicine.
It is said that prevention is better than cure. No wonder there are many people trying to take tonic to keep them safe from sickness.
Cheung Chin-pang is a perfectly healthy man but he took pak-zhi (a kind of Chinese medicine which is helpful to ease your tiredness) and mushroom (yun-zhi) essence everyday. His wife said that these supplements are good for health and the mushroom essence helps to prevent cancer.
“I don’t know if it really helps but I believe it’s harmless to take the essence as it’s made of Chinese herbs! Everyone knows that there are no side effects in Chinese medicine.” He said.
Tang Siu-keung, a registered Chinese medicine practitioner who has been working in the industry for more than 20 years, insisted that no side effects would be caused by Chinese medicine.
“Supplements and tonics made of Chinese herbs surely have no side effects but their effectiveness has been exaggerated,” Mr Tang said.
Mok Sau-ching, an experienced Chinese medicine pharmacist echoed Mr Tang's opinion. “I have never heard of any case about side effects of Chinese medicine.”
She said most of the herbal tonics contain flour or additives because the nature of some of the Chinese medicine is not suitable to be turned into pills or syrup.
“The texture of ling-zhi makes it hard to grind,” said Mok, “we don’t know what would be put to make the ‘essence’ of it, anything but not harmful.”
She also revealed that it is normal for the factory to mix some other “things” with Chinese medicine to make protective drugs because of the high profits.
“Usually they use flour and add colouring to make the medicine look better,” she said. “Only the effect is exaggerated, but it does not cause any harm.”
The concept of “Chinese medicine is absolutely harmless” has almost become a theory to everyone.
According to the study of Peking University Health Centre from 1994 to 1999, Chinese medicine does cause side effects. Inappropriate use of it may be fatal.
“My colleague had bowel cancer a few years ago. It was so strange as she was actually a very healthy person and she never smokes! The doctors said perhaps she took too much herbal tonic. That’s why I refused to take any of them!”
Dr Koo pointed out most herbal tonics available in the market have not gone through official medicine supervision and the actual effect of the protective medicines has no scientific basis.
Edited by Karen Chong Kuk-heung