That is the Question…
Published June 21, 2025
To begin, let me take you back to the 1940s. A woman crippled by rheumatoid arthritis, and has joints swollen and inflamed, is given a new drug. Within days, she’s walking again. The transformation is astonishing. The drug? A corticosteroid—specifically cortisone, a cousin of prednisone. Doctors and patients were stunned. The Nobel Prize was awarded. It felt like a miracle.
But like many miracles in medicine, the honeymoon didn’t last forever.
The Discovery and the Hype:
Corticosteroids were first isolated from the adrenal cortex by Edward Kendall and colleagues at the Mayo Clinic. By 1948, cortisone was being synthesized and administered to patients with autoimmune conditions. Prednisone, a synthetic cousin with a slightly altered molecular structure, came soon after and quickly became a mainstay due to its improved potency and pharmacokinetics.
Patients felt better—stronger, more mobile, less pain. Inflammation melted away. Doctors had, at last, a tool to tame the immune system, to cool the body’s internal fires. It was used in everything from arthritis to asthma, from lupus to skin conditions, and even for inflammatory bowel diseases like Crohn’s and ulcerative colitis. A miracle, right?
But as with any powerful tool, improper use leads to collateral damage.
The Costs of Long-Term Use
Over time, the darker side of corticosteroids emerged. Chronic use revealed a frightening array of side effects:
-Bone loss and osteoporosis
-Cataracts and glaucoma
-Weight gain, especially the classic “moon face” and abdominal fat
-Diabetes or worsened blood sugar control
-Increased infection risk
-Mood swings, insomnia, even psychosis
Essentially, steroids suppress the immune system and alter our body’s normal hormone regulation. That suppression is useful in autoimmune conditions, transplant rejection, or severe systemic inflammation. But in everyday infections—or worse, in viral illnesses like the common cold or flu—it’s a mistake.
How They Work: Power and Precision
Prednisone mimics cortisol, a natural hormone produced by our adrenal glands. Cortisol helps regulate metabolism, blood pressure, and the body’s stress response. But prednisone turns this up to 11.
It binds glucocorticoid receptors, blocking the production of inflammatory chemicals like prostaglandins, cytokines, and interleukins. It’s like throwing a heavy blanket over a fire—it suffocates the flames. But it also slows the fire department. Immune cells are suppressed, meaning infections can linger, worsen, or spread.
When Prednisone is Appropriate
There are conditions where prednisone is not just appropriate—it’s life-saving:
-Severe asthma or COPD exacerbations
-Autoimmune diseases (like lupus or vasculitis)
-Post-transplant immune suppression
-Severe allergic reactions
-Bad cases of poison ivy or other systemic allergic responses
In these cases, the benefit outweighs the risk. A short course, tapered properly, can rapidly reduce swelling, relieve symptoms, and allow healing to begin.
When It’s Misused (and Common Myths)
Now here’s where things get culturally curious.
In the U.S., there’s a tendency to reach for steroids too quickly—especially for upper respiratory infections. A patient has a cold and a lingering cough, and someone prescribes a “steroid pack.” It’s almost become a cultural reflex. In Canada, by contrast, this is much less common—and rightly so.
Why is this a problem? Because viruses like rhinovirus, influenza, and even COVID-19 rely on a healthy immune response for clearance. Suppress that response with steroids too early, and you can worsen the illness or prolong recovery. A 2019 Cochrane Review found no benefit—and some harm—from using corticosteroids in routine respiratory tract infections, including increased rates of secondary infections.
A meta-analysis in Chest (2020) reviewed over 6,500 patients and found that steroid use during viral pneumonia increased the risk of mortality and lengthened hospital stays—likely due to the immune suppression. This is not benign.
The myth of “the shot is better” also deserves to be addressed. Some patients (and providers) believe an intramuscular steroid shot is somehow safer or more effective than oral prednisone. In reality, IM steroids deliver the same drug—just over a longer time window. There’s no magic in the delivery route, and systemic side effects still occur. The idea that it’s somehow “cleaner” or “less risky” is not backed by science.
Steroid-Sparing Approaches: A Better Long-Term Plan
The good news is that inflammation can often be addressed without jumping straight to pharmacologic firepower.
-Healthy sleep patterns reduce cortisol dysregulation.
-Regular exercise lowers baseline inflammation and improves immune regulation.
-Weight loss, especially visceral fat, decreases inflammatory cytokines.
-Nutrition matters—with anti-inflammatory foods like turmeric (curcumin), ginger, fatty fish (omega-3s), green tea, and leafy greens all showing promise in reducing markers like hs-CRP.
Even biblical principles remind us of moderation and balance: “A heart at peace gives life to the body, but envy rots the bones.” (Proverbs 14:30). Chronic inflammation often stems not just from physical insult, but from lifestyle imbalance, chronic stress, and neglect of the temple God has given us.
Conclusion: Power with Prudence
Prednisone and other corticosteroids remain powerful allies in the medical toolkit. Used properly, they can relieve suffering and save lives. But they are not harmless. The risks of immune suppression, bone loss, infection, and blood sugar dysregulation must be taken seriously.
Avoid the temptation to see them as a cure-all, especially for viral infections or routine colds. Steroids should never be a shortcut for proper diagnosis, time, or supportive care.
Instead, let’s aim for health that’s built on stability—good sleep, nourishing food, movement, and peace. Let inflammation be a signal, not an enemy. And let medication be our servant, not our master.
1. Waljee et al., BMJ, 2017
2. Siemieniuk et al., Ann Intern Med, 2015
3. Cochrane Review, 2019
4. NIH COVID-19 Guidelines, 2023
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