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  • BIOETHICS FORUM ESSAY

The Children’s Cold War

Chandra Wilson isn’t a doctor; she just plays one on TV. But  she’s giving advice about treating children’s colds that contradicts that of real doctors.

Wilson, star of the hospital TV show “Grey’s Anatomy,” is the spokeswoman for a new public service campaign by the nonprescription drug trade association that says that nonprescription cough and cold medicines are safe and effective for children ages four and older.

The American Academy of Pediatrics (AAP) and many individual physicians disagree. “Studies have shown cough and cold products are ineffective in treating symptoms of children under 6 years old, and may pose serious risks… including death, convulsions, rapid heart rates and decreased levels of consciousness,” reads a statement issued by the pediatrics grouplast January.

Last month, Michael Shannon, a pediatric emergency medicine doctor and pharmacologist/toxicologist at Children’s Hospital Boston, testified before the FDA about the dangers of giving cough and cold medicines to children under age 6. One cause of danger is overdose, he said, but even at the recommended dose there can be adverse interactions with other drugs that a child is taking or serious reactions in vulnerable children such as those with underlying heart abnormalities.

It’s a no-brainer that doctors are a more legitimate source of pediatric information than an actress working for the pharmaceutical industry. The problem is, most parents and caregivers don’t know about the doctors’ advice. But Wilson’s message will be all over TV, radio commercials, magazines, and newspapers, and is already on a web site,www.OTCsafety.org.

So, parents, pay attention. Here’s what you need to know to make informed decisions when your child gets a cold.

Last fall, a Food and Drug Administration advisory panel voted to ban over-the-counter cough and cold medicines in children under six because of evidence that they don’t work in these children and may cause harm. The panel also raised concern about the use of these drugs—decongestants, antihistamines, expectorants, and cough suppressants–in children up to age 12.

In response, the FDA recommended that OTC cough and cold drugs not be used to treat children under two years old, and major manufacturers pulled infant cough and cold medicines from the market. The agency is reviewing data for children ages two to 11, raising the specter of a restriction or a ban on such medications for them.

Considering how slowly the underfunded, overwhelmed FDA moves, any action could take years. Fortunately for the OTC drug industry, it can act quickly.

Last month, the Consumer Healthcare Products Association, the OTC trade group, announced that it would go beyond the FDA recommendations and modify the labels of its children’s cough and cold products to say that they should not be used in children under age four.

Why the age four cutoff? There’s no scientific basis, and the trade group gave no explanation. “A year ago they were saying these medicines worked for infants,” said Ian Paul, associate professor of pediatrics and public health science at Penn State Children’s Hospital and a member of the AAP’s section on clinical pharmacology.

Enter Chandra Wilson and the PSA campaign to promote the new labeling, along with the unsupported message that children’s nonprescription cough and cold medicines are safe and effective for children ages four and older.

That this message seems so trustworthy – bundled with photos of mothers hugging their young children and Chandra, “working with OTCsafety.org to make sure parents take extra care when using these medicines” – makes it insidious.

Chandra is right about one thing, though: parents should take extra care when using children’s cough and cold medicines. The state of the science on the subject is in flux and is bound to change in the coming months and years. But for now, taking extra care means following the AAP’s advice, and not hers.

Published on: November 11, 2008
Published in: Children and Families

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