Clinical Trials Neglect Kids
April 30, 2008
Clinical trials on new drugs or treatments do a poor job of planning for results from kids. That’s the news from Ian Sinha of the University of Liverpool and his colleagues, who looked at what clinical trials measure for kids. If a study doesn’t measure the right things, then the results don’t tell you much.
For instance, imagine that you want to lose weight, and you decide to judge your progress by measuring how many earthworms slither across your sidewalk on one afternoon. It’s the wrong measurement, and it won’t tell you anything about your weight. Similarly, clinical trials must measure the right things in kids to find out how a drug might help or hurt them.
In A Systematic Review of Studies That Aim to Determine Which Outcomes to Measure in Clinical Trials in Children, which was published in PLoS Medicine, Sinha and his colleagues conclude:
Very few studies address the appropriate choice of outcomes for clinical research with children….
If the studies don’t ask the right questions about kids, no one can know if a drug really works right for a kid. Moreover, few clinical trials even look at kids—as described in Few Kid-Tested Drugs. So parents must take some responsibility for evaluating—in the best ways that they can—when and if their child needs a particular drug. I know that’s not the desired situation, but it is what we face.
Scrutinize Medical Scans
April 29, 2008
Does your kid need every scan that a physician recommends? Maybe, and maybe not. Jean Mitchell, PhD, of Georgetown University, reported in Medical Care that physicians use medical imaging more than ever—some uses increasing by 400 percent in just a few years. In the same journal, Vivian Ho, PhD, of Baylor College of Medicine pointed out that the increases really picked up with physicians sending patients to facilities owned by the physician or at least where the physician would make some money from the scan. In short, a physician who can make money from medical imaging is more likely to suggest that patients get imaged.
Clearly, this news is not just about kids. But kids tend to be more sensitive to imaging than adults. So before you let anyone scan your child, make sure that there’s a good reason for it. If the scan being considered is a CT scan, visit Image Gently to learn more about them.
Of course, medical imaging saves lives of adults and kids. Still, there’s no reason for a kid to ever get a medical procedure that is not necessary. You might think that a physician should decide what’s necessary, but parents need to participate in the decision, too.
Sexual Harassment Beats Up Bullying
April 28, 2008
Being sexually harassed as a child is worse than being bullied, at least in terms of its effects on a kid’s health. James E. Gruber of the University of Michigan-Dearborn and Susan Fineran of the University of Southern Maine looked at more than 500 middle and high school students, and found that these kids were bullied more than they were sexually harassed. The sexual harassment, though, did the most harm to their health.
As published in Gruber and Fineran’s article, Comparing the Impact of Bullying and Sexual Harassment Victimization on the Mental and Physical Health of Adolescents, which appeared first online at Sex Roles, more than half of the kids had been bullied and about one-third had been sexually harassed during their current school year. Somewhat surprisingly, the bulling and sexual harassing happened about equally to boys and girls. For kids who were gay, lesbian, bisexual or questioning their sexuality, nearly 80 percent of them had been bullied and more than 70 percent of them had been sexually harassed.
When the authors looked at self esteem, mental health, physical health, trauma symptoms, and substance abuse, all of these health issues correlated with bullying and sexual harassment. Overall, though, the sexual harassment did the most health damage to both boys and girls.
As the authors conclude in their article:
All students need to benefit from a safe school environment and the mental and physical health implications from sexual harassment and bullying behaviors need to be considered. Keeping schools safe in the twenty-first century is a worthy goal but continuing to focus on boys’ behavior and bullying violence in schools, rather than on all students’ negative experiences with sexual harassment detracts from our ability to provide a healthy environment for all children.
Broader Diagnosis Explains Part of Autism Increase
April 25, 2008
Is autism really on the rise or is the diagnosis just changing? Autism is the fastest-growing developmental disability, according to the Autism Society of America. Moreover, the Autism and Developmental Disabilities Monitoring Network of the U.S. Centers for Disease Control and Prevention (CDC) says that about 1 child in 150 has autism in the United States. Nonetheless, the CDC also notes:
It is clear that more children than ever before are being classified as having autism spectrum disorders (ASDs). But, it is unclear how much of this increase is due to changes in how we identify and classify ASDs in people, and how much is due to a true increase in prevalence.
Professor Dorothy Bishop of the University of Oxford recently looked for one possible piece of this puzzle. She and her colleagues studied adults who had been diagnosed with severe language disorders when they were kids, and asked: Using today’s standards, would these people have been diagnosed with autism spectrum disorders? As published in Developmental Medicine & Child Neurology (see Autism and diagnostic substitution: evidence from a study of adults with a history of developmental language disorder), the researchers concluded:
Some children who would nowadays be diagnosed unambiguously with autistic disorder had been diagnosed with developmental language disorder in the past.
Nonetheless, this does not answer all of the questions about rates of autism. As Bishop says:
We can’t say that genuine cases of autism are not on the increase as the numbers in our study are very small. However, this is the only study to date where direct evidence has been found of people who would have had a different diagnosis today than they were given 15 or 20 years ago.
It certainly appears that changes in diagnostic criteria play some part in the apparent increases in autism.
Few Kid-Tested Drugs
April 24, 2008
Do you give your kids safe medicines? It can be difficult to know, because few drugs are approved for kids. In fact, only about one-third of the available medicines have been approved by the U.S. Food and Drug Administration (FDA) for kids.
Let’s clarify just what that means. First, a drug is not necessarily dangerous for kids just because the FDA has not approved it for use in kids. It probably means that no one ever ran a clinical trial to test how kids react to this drug. Still, physicians know that many drugs get used in kids all the time, despite not being officially approved for kids. Part of the problem, probably, arises from difficulties in enrolling kids in clinical trials. How many parents want to enter their kid in a drug test?
The details aside, what should a parent do? Any time that a physician prescribes something for your child, you should ask: Has this drug been approved for use in children? If the answer is “No”—and it will be in many cases, just because of the few kid-approved drugs—then you should ask your physician to explain why this drug will be fine for your kid.
