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Steroids are frequently used in Hong Kong for their rapid action in inflammation and a sense of well-being generated in the patient. However, they are often used with little regard to safety. The hazards of systemic steroids are well known, but there are still patients who receive frequent weekly or even daily ; injections for allergic and musculoskeletal conditions. That incident, a few years ago, of systemic infection in a patient as a result of repeated steroid injections is still fresh in most doctors' memory. Topical steroids are not without risks. Long term steroid preparations inappropriately applied to the skin damage the structure of the skin, give rise to infection and mask the original diagnosis. Steroid eyedrops can cause cataract, open angle glaucoma, dendritic ulcers in herpes simplex eye infection, and bacterial and fungal eye infections2. It has been suggested that steroid eye preparations should not be used without specialist advice3. Polypharmacy is a universal problem. It is not uncommon to encounter a patient receiving five or six drugs for a single complaint, in which the pharmacological cocktail contains agents of opposing actions, of interacting potentials, of additive not synergistic, so likely toxic ; effects and of dubious therapeutic properties. The prescription of multiple drugs implies that the doctor is unsure of the diagnosis, unclear of the pharmacological actions of the drugs, or believes, most certainly simplistically, that more drugs will make the patient better quicker. One such cocktail for the reader to ponder is Ventolin syrup, Phensedyl linctus, Mucodyne syrup, Pholcodine linctus, Panadol elixir and Penbritin syrup prescribed for a five year old child with no history of asthma on the first day of a cough. Obviously such blunderbuss approach is to be discouraged. The harmful effects which can be caused to the patient are clear to see, let alone the costs incurred to the patient. One situation giving rise to polypharmacy is the need to treat undesirable side effects which have arisen from injudicious prescribing. Consider this menu for an elderly hypertensive bronchitic: Minocin, Mogadon, Stemetil, Inderal, Ventolin, Dyazide, Slow K, Pholcodine and Dorbanex. One wonders when and how the prescriber can get himself out of this vicious circle and sorafenib. The disordered linker region observed in both the Oct-1 and Pit-1 crystal structures supports previous hypotheses that a main function of the linker is simply to tether the POU-specific and POU homeodomains, effectively increasing the local concentrations of these two subdomains, thereby aiding high-affinity, site-specific DNA binding by the POU domain. The length of the linker region, which ranges in size from 15 to 56 amino acids, is likely to play an important role in enabling the POUspecific domain to assume various orientations relative to the POU homeodomain and, consequently, in determining the versatility with which POU domains can recognize various DNA elements. For instance, some class III POU domain proteins, which have a 17-amino-acid linker, can accommodate spacings of 0, 2, or 3 nucleotides between the DNA half-sites when the POU-specific and POU homeodomain are in one of the two possible orientations. This class of POU domain proteins can also bind with high affinity to sites where the relative orientation of the POU-specific and POU homeodomain is analogous to that of Oct-1 on its cognate DNA site Li et al. 1993; Certel et al. 1996; Malik et al. 1996 and serostim.

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