Medicines for children in Europe: from proposals to practicalities

A. Bush, M. Zach

To the Editors:

It is widely recognised that sick children are being offered a second-rate service, because in many cases medications being used in critically ill young people have not been tested at all in the very constituency they are meant to help 1. The many practical difficulties of clinical trials work in children have been reviewed, and welcome initiatives by the European Union (EU) among others have been put in place to try to address this. We now need to ensure that this leads to genuinely improved services for children. The two important questions are, what needs to be done, in order of priority; and how should our aims be achieved? The European Respiratory Society (ERS) has already been very active in both areas.

Clearly prioritisation is important; although we would like to inform all our decisions with good-quality randomised controlled trials in all the illnesses suffered by children at every age, in practice the scarcity of patients and the cost of trials means this will not happen for every treatment for each paediatric respiratory disease, at least in the short to medium term. Prioritisation needs to be in an open manner, free from the vested interests of the pharmaceutical industry, and with clear declarations of conflicts of interest from those debating the issues. The …

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