Medicine – it's not kids' stuff

By Zhou Ping Source:Global Times Published: 2013-1-15 15:53:00


Medicines designed to treat children's coughs and colds on the shelf in a pharmacy. Photo: CFP
Medicines designed to treat children's coughs and colds on the shelf in a pharmacy. Photo: CFP

Wu Xiaoman is the mother of a 17-month-old boy and she is unhappy. She is unhappy with the fact that her son has been unwell. But more unhappy that the drugs prescribed to help ease the boy's persistent and aggravating cough were intended for an adult.

"I took my son to the Children's Hospital of Shanghai and we were given a medicine called Clarityne. Although the doctor asked me to give my son half a pill at a time, I was very uncomfortable when I read the medicine's literature at home which stated that the medicine was intended for adults and children above the age of 2 years," Wu told the Global Times. "I didn't follow the doctor's instructions but I cut the pill into four pieces, crushed one piece and mixed it with water before giving it to my son. I wanted to reduce any potential side effects because this medicine is not designed for babies."

She is not the only parent who is troubled at the lack of suitable children's medicines on the market in the country. Recently the China Youth Daily reported that the father of a 5-month-old child suffering from kidney disease has to cut a pill into small sections, crush the sections and then dissolve them in water before he can give the medicine to his child every day.

Difficult to obtain

John Elliot, a pediatrician at the Shanghai United Family Hospital, worked as a pediatrician for 15 years in the US before he moved to Shanghai. He said he found that common medicines, like some antibiotics and asthma medications, were not available in China in liquid forms, and some more specialized medicines were difficult to obtain.

"Sometimes when we don't have the medicine required in a liquid form, we have to get our pharmacist to crush the pills and add them to water to make a solution so that children can take the medicine safely. In the US, a lot of these medicines are already available in liquid forms."

Elliot said that in China some other medicines, like anticonvulsants, were not available with the range of options they were offered in Western countries. Ji Lianmei, a pharmacist with the United Family Healthcare's Beijing branch, said that domestic medicines often lacked child suitable versions and adequate advice on dosage.

Statistics from the Pharmaceutical Chamber of the All-China Federation of Industry and Commerce suggest that of the 3,500-plus medicines available, specific children's medicines account for only 1.52 percent.

In the US, it's easy to find children's medicines in powdered or liquid forms, but in China, parents are commonly given pills and instructed to crush and mix them with water. Even treating diseases like thrush, a common yeast infection characterized by creamy white spots on the tongue or the inner cheeks, doctors rely on tablets.

Many of the pills given to children are those designed for adults but with a lower dose recommended. "The instructions often tell parents to reduce the dose according to the doctor's advice," Ji said.

But this is not a good medical practice. "Children are not microformed adults. Their metabolisms are different from those of the adults. Their digestive functions and organs haven't matured. They need specialized medicines," Ji said. "Medical guides tell parents to reduce the dose when using adult medicines. However, it's hard to be precise with a broken tablet."

"Some medicines don't crush or dissolve well in water, so you don't know if they are getting the proper dose," Elliott said.

"With the liquid medicines they have in Western countries, it's easy to see if you have the proper amount. Improper dosages might retard the treatment and could harm the liver and kidney as these are the organs that metabolize medicines," Ji said.

Many medicines are powerful and can have lasting effects if wrongly prescribed. The China Rehabilitation and Research Center for Deaf Children has reported that drug overdoses are the cause of 30 percent of the cases of deafness in children under 7 years old. According to the Ministry of Health's Adverse Drugs Reaction Monitoring Center, nearly 13 percent of children have suffered adverse drug reactions.

Lacking profit

Experts say that a lack of profits and government support are the major barriers to encouraging pharmaceutical companies to produce medicines designed for children.

Statistics from the Pharmaceutical Chamber of the All-China Federation of Industry and Commerce reveal that of some 6,000 domestic pharmaceutical companies, only 10 of the household brand names and another 30 lesser-known companies have departments for children's medicines.

"Pharmaceutical companies will always produce medicines that make large profits. Few companies manufacture children's medicines because the adult medicine market has a much larger market share and a bigger output," Ji said.

Hou Huimin is the director of the National Pharmaceutical Engineering Research Center. He believes that as well as the profit motives, the regulations governing children's medicines are problematic. "There's much stricter supervision for clinical trials on children so pharmaceutical companies are reluctant to manufacture children's medicines because it's harder to assess the drug's effects and side effects," he told the Global Times.

Few companies were manufacturing liquid form medicines because it cost more to store these and maintain their stability.

Then there is the trials problem. More children are needed to take part in clinical trials for new medicines designed to treat hypertension, obesity and diabetes. These diseases, common among adults, are affecting children more and more but few parents want their children to take part in the trials even if they know that the medicines might help treat their complaints, Yin Li, the director of the State Food and Drug Administration, told the People's Daily.

An anonymous executive from the marketing department of the Shanghai Sine Wanxiang Pharmaceutical Corporation told the Global Times: "In our factory, children's medicines account for less than 1 percent of all the medicines we produce. The children's medicines we make are low priced and make little in the way of profit. Doctors are unwilling to prescribe them and we don't have special sales representatives promoting them."

She told the Global Times that the sales were dependent on pharmacies and there was no spur for manufacturing companies to develop new drugs for children. "It's very complicated to develop a new drug and this needs approval from the drug authority for its quality and from the National Development and Reform Commission for the price."

Jin Xuanyu, the government affairs director of the Harbin Pharmaceutical Group, said that the cost of most children's drugs is twice as much as for adult medicines. "Production is much more complicated and because many children's diseases are seasonal, the production lines are often not working."

As well the prices companies can charge for children's medicines do not match the actual cost of production, he told the Health News.

Support needed

With pharmaceutical companies constantly seeking higher returns, the production of children's medicines needs government support and encouragement, pharmacist Ji Lianmei said.

"First, an essential children's medicine system should be established to set uniform guidelines for pediatricians. China has no specific regulations on children's medicines and dosages although it adopted the World Health Organization's essential adult medicines system 30 years ago," she said.

Second, she said, pharmacists should be given a bigger role in helping parents and the public understand the proper use of medicines. "A proper public education program could encourage more people to search for and buy specific medicines and certainly could help boost the children's medicine industry."

Hou suggested the most urgent and achievable step would be to develop liquid forms of the most commonly used tablets. "Medicine in a liquid form is easy to measure and this can eliminate the side effects caused by administering the wrong dose. Because these commonly used medicines have been proven safe and effective, it would be easy to replace these.

"Although the central government has started to promote the production of children's drugs by shortening the approval time for drugs that treat rare diseases, it's far from enough. The drug approval system should been simplified further. Companies that make liquid forms should be getting faster approval from drug supervisors."

Hou also said the huge market for children's medicines was just waiting to be explored.

"We will give precedence to companies that increase the production of children's medicines, possibly by purchasing more drugs from them and by listing more new children's medicines," Yin Li said, adding that the State Food and Drug Administration is also considering analyzing overseas clinical records, especially from Asia, and importing more children's medicines from abroad, if it was difficult to manufacture those medicines at home.

The Health News recently reported that the National Development and Reform Commission is considering raising the price of children's medicines according to market demands.


Posted in: Metro Shanghai

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