Editor—The National Institute for Clinical Excellence (NICE) aims for the highest attainable standards of care.1 The bedrock of its advice is published evidence of benefits from treatment (mainly pharmaceuticals).
In the report accepted in May consideration of safety issues focused on invasive surgical and diagnostic procedures, and the “judgment” on risk assumed that such risks are small and calculable.2 In economic terms, to distinguish between real risk (calculable and potentially manageable) and uncertainty, where judgment of costs is purely subjective, is important.
In July the new health service director of research and development announced a forthcoming national programme of research on drug treatment in children. Given the serious and quite common adverse consequences of paediatric treatment reported,3 a fundamental reassessment of child health interventions is warranted. Adverse drug reactions or interactions between new and existing drug treatments are uncertain in caring for children aged 0-16 years. NICE has hitherto sought to judge the best treatment (singular), but in an uncertain interaction between doctor and child simultaneous identification of “good enough” second line treatments that can understudy for the “best” treatment when the safety of an individual child may preclude using the most cost effective drug may make good economic sense. This “good enough for some children” standard is not currently in the expertise of the licensing authorities, but it could become a feature of NICE expertise.
In the absence of safe treatment alternatives, the long term costs to some children and families (and the health service) of adverse drug reactions could be heavy. For adult health care the burden of adverse drug reactions is 6.5% of hospital admissions.4 For childhood drug treatment, what will be our options? options?