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An intimate history of extreme weather Dr Daniel Hawcutt is a senior lecturer in paediatric clinical pharmacology at the University of Liverpool. He is one of only six trained paediatric clinical pharmacologists in the UK, and his research focuses on improving the understanding of how children handle medicines.

Daniel appeared on the University of Liverpool Podcast to discuss the relative lack of testing that has been completed in paediatric medicine, and how medical professionals might be able to get a clearer picture in the coming decades.

5 doses of reality about drugs for children

  1. The drugs in longest use are the ones we know least about
    This is largely due to a consent-based approach to research after the second world war. During this period, nothing could be done without your explicit consent – but who could consent for children? As a result, the younger population was often omitted from clinical trials.

    Daniel says: “For older drugs, we just don’t have a lot of the bedrock of basic research.”
  2. Making progress is slow and difficult
    The lack of research means that doctors struggle to know what the correct dose for a child should be for several common drugs – including salbutamol, tramadol, and codeine. Rituximab, which was developed to treat cancers, is another that causes confusion. The last time Daniel checked, there were no licensed paediatric indications for Rituximab in either the UK or United States.

    Are doctors under-dosing? Are they over-dosing, and potentially wasting significant sums of money that could be spent on drugs for other patients? “It’s very difficult to tease that apart,” says Daniel.
  3. Despite the lack of research-based knowledge, advances are being made
    Over the last few decades, medicine has undoubtedly had a significant impact on our overall health, says Daniel.

    He states that children have better outcomes; that more cancer patients are cured than ever before; and that fewer children die today from preventable disease than at any time in human history. But there is still a huge amount of research to conduct.

    He explains: “My concern is that we haven’t optimized it (treating children with drugs). And there will be some children who are losing out, and we don’t know it.”
  4. Children’s attitudes could help solve the problem
    Researching drugs to treat children is difficult for many reasons, including the fact children are predominantly healthy. However, a child’s inherent honesty can help clinicians learn more about appropriate drug usage in the young.

    “If they don’t like a medicine, they won’t take it,” says Dan. “If the medicine makes them feel poorly, they’ll tell somebody.”

    He adds: “I hear stories from colleagues treating people in their 80s, 90s, 100s… whose deference to doctors… provides different answers to questions. That’s luckily not the world we live in.”
  5. The law is moving in the right direction too
    Dan is hopeful that legislators are moving to ensure that paediatric drugs are just as effective as adult drugs. “People are starting to realise that children deserve medicines that are as evidence-based as adults.”

    He points to America’s Best Pharmaceuticals for Children Act, and the 2007 EU regulation on Clinical Trials in Children, as two particularly powerful pieces of legislation.

    Both force drug companies to describe the studies that could be done to determine the impact of their drugs on children, while also offering an extended licence to sell the drug if they deliver the studies themselves.

    “It’s not perfect,” says Dan, “but we do feel that we’re getting more and more clinical trials through.”

About this podcast

The University of Liverpool Podcast aims to bring listeners closer to some of the academic experts, authors and innovative thinkers from the University who, through their in-depth analyses, research and discoveries, are affecting positive change in the world today. Each episode features one or more of our academic experts discussing research in their specialist field. Subscribe to the University of Liverpool Podcast via iTunes, Tunein and Google Play Music (US and Canada only).

Interested in learning more about the University of Liverpool’s online public health programmes? Find out more about our APHEA-accredited online Master of Public Health (MPH), online MPH – International Public Health, online MPH – Management of Health Systems.

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