The Canadian Paediatric Society’s (CPS) Drug Therapy and Hazardous Substances Committee has a broad health care mandate, one that sometimes seems underappreciated by the practice community. Interest in pharmacotherapy for children can be traced back to The Boke of Children, written by Thomas Phayre in 1546. However, we often assume that children are less in need of drug treatment than adult patients. In parallel, in paediatric practice, there has been a disproportionate emphasis on the adverse effects of drugs and chemicals, perhaps reflecting the prominence of North American poison control centres. The CPS has made a concerted effort to strike an appropriate balance between therapeutics and toxicology with its Drug Therapy and Hazardous Substances Committee, and has consistently emphasized the important role of pharmacotherapy in exemplary child care, including both the prevention and treatment of disease.
Over the past 30 years, it has been especially important for the committee to promote better research on drug therapy for children. With the growth of evidence-based practice, it is increasingly difficult to accept the lack of sound science supporting much of what is done in paediatric therapeutics. For at least three decades, strong voices within the CPS have called for more comprehensive drug investigations aimed at determining the efficacy and safety of drugs for Canadian children. Recently, the research focus has also emphasized studies of quality of life for children receiving long term therapy.
The committee recognizes the need for applied research that builds carefully on the excellent knowledge base gained through basic pharmacology or in studies of adult patients. The committee also encourages the involvement of Canadian paediatricians in the population health sciences relevant to optimal drug therapy, including pharmacoepidemiology, pharmacoeconomics, social and behavioural sciences, and drug informatics.
Representative issues currently under consideration by the committee include the following:
optimal treatment of nausea and vomiting in pregnancy,
the use of cisapride in neonates,
the use of leukotriene inhibitors in asthma,
the place of alternative medicines in paediatrics,
new treatments for methanol and ethylene glycol poisoning,
use of short acting nifedipine in children,
tobacco abuse as problem in paediatric public health,
hazards of over-the-counter cough and cold remedies,
folic acid supplementation and neural tube defects,
Canadian policy on paediatric drug labeling, and
acetaminophen and ibuprofen for pain and fever.
Clearly, no amount of information about drug actions in children will be useful unless evidence is translated into action in clinical care settings and health policy. The committee is eager to support better educational methodologies to disseminate drug information and to create decision-making aids suitable for use by those committed to improved care. Major tools for disseminating improved prescribing information for children are available in the form of rapidly developing electronic medical information systems.
In 1998, the committee finds itself in a heady environment. After 25 years of relative neglect, the medical practice community, governments, insurers and consumer advocacy groups are suddenly supporting improved prescribing information for children. A major stimulus of renewed interest has been the 1997 American legislation that mandates improved paediatric labeling for the 80% of drug products currently on the market that have not been adequately studied in children. Taking cues from the United States and from the International Conference on Harmonization, which will consider paediatric drug issues later this year, it seems highly likely that the Canadian government will move to support an improved research infrastructure for paediatric drug investigation. The committee looks forward to an opportunity to lead, with the CPS, during this exciting period for drug investigation, a period that will lead to improved disease prevention and treatment.
The committee has been a staunch advocate for the rights of Canadian children to safe and efficacious drug therapy. We look forward to a day when most care of children will be truly designated ‘evidence-based’.