Why Are Children Always Last?

By Myron Yaster

ASA Monitor Volume 85 Number 5, May 2021 Page 3

As ASA members, we all get the ASA Monitor in our mail every month…I must admit I rarely read it and just throw it out as one more piece of junk mail.  But something big has occurred, namely it has a new editor-in-chief, Dr. Steve Shafer, who many of you know is a giant in our profession and was previously editor-in-chief of the major anesthesia journals. The ASA Monitor is now a must read.  Over the next few days I’m going to highlight and summarize some of the pediatric articles in this issue (and none are more than 2-3 pages!).  So, if you’ve just gotten this issue “DON’T THROW IT OUT!”  Further, the first In the series: “Why Are Children Always Last?” is particularly fitting for the PAAD because it discusses why children are always last when it comes to new drugs, therapeutic interventions and now vaccines.  Regulatory supervison of new drugs was a special concern of our beloved friend and colleague Ron Litman who served on many FDA advisory committees.

“Why are Children always last?” Steven L Shafer MD and Elliot J. Krane MD

As you are all aware, COVID vaccines remain unavailable for children less than 12 even though there are “strong ethical and practical reasons to develop COVID vaccines for children (Pediatric Research 2021: 1-5).”Why?The authors point out that very few drugs get tested and labeled for children (they are often called therapeutic orphans”) because of appropriate caution by both industry and regulators and pharma’s belief that the costs to do trials is too high and difficult for what is perceived to be too small of a market. Further, they know that physicians will prescribe drugs “off-label” which puts the onus of complications and liability on the practitioner rather than the company producing the drug.They also know that in our desire to do what is best for our patients, many will independently study the drugs with minimal or no funding. Over the past 25+ years there have been many attempts at fixing this problem with limited success.Over the next few days, I’ll summarize the articles on the drugs used in chronic pediatric pain, the psychiatric considerations for children with chronic pain, the use of multi-modal analgesia without opioids in children, an overview of regional anesthesia (techniques and drugs) in pediatrics, and a description of the evolving use of acupuncture in children. So stay tuned!  Myron Yaster MD