Making medicine safe for children

Every time a parent administers medicine to a child, there is a fear in the back of their mind. What effect will the drug have? Is it safe for my child?

The fear is well-founded. Dr. Michael Rieder says 100,000 people die each year in North America from adverse drug reactions. About 20 per cent of them are children – or the equivalent of a fully loaded 747 airplane crashing into the ground every two weeks.

Finding ways to alleviate that fear and reality is the focus of Dr. Rieder’s research at Children’s Health Research Institute. “Potent drugs are great,” he says. “But if they are potent, they come with side effects. ” Part of the problem is ignorance, not knowing what those effects might be. Dr. Rieder is out to fight that.

“People must realize that drug therapy for children is not based on science as much as for adults,” he said. “But drug use for children is common. In North America, in any given year one million children are given five million prescriptions. 65 per cent of children take none or one prescription, while 75 per cent of drugs used are taken by 25 per cent of children. Thus, there are children – and many of them – who take lots of drugs.”

Dr. Rieder says about 1,400 different drugs are used for child care in any given year. They are prescribed for pain, infection, seizures, asthma and the common serious illnesses of childhood. The use of these drugs in children is understudied. Doctors and researchers need more support from evidence-based medicine, as there is for adults. His team hopes to provide some of that through their research.

This team includes the largest clinical pharmacological division in Canada. It is multi-disciplinary and the members offer a wide range of talent. A number of clinical studies have been completed including drug safety studies, studies on the best use of drugs in emergency care and optimal drug use in a variety of settings.

“We are developing expertise and projects in better drug therapy for children,” says Dr. Rieder. “We are examining safer ways to treat diabetic coma and severe asthma for example. We are looking at the barriers to children receiving medication on a regular basis. We are studying how serious side effects occur and drug safety. We are developing an understanding of interventions in the Emergency Room and Intensive Care Unit to improve the outcomes.”

As clinician/researchers, our team members can make some immediate applications of their research. For example, we have already made recommendations to eliminate some barriers to children getting medication. There are direct spinoffs to drug safety.

“We are a little closer to patients than some investigators,” says Dr. Rieder, who heads the team of 34 scientists. It is the largest team at CHRI.

Dr. Rieder has had an interest in optimal therapy for many years. He was inspired by his PhD supervisor at the University of Toronto, Dr. Stephen Spielberg. He has been at Western since 1988 and his laboratory is based in the Robarts Research Institute near Western’s main campus. Being part of the CHRI team allows him to work with like-minded and bright people. He’s also passionate about the benefits of his research for children.

“One highlight was discovering the fact some drug side effects were due to metabolics changing how the cells signal and talk to each other.” This is related to changes in how the cells handle drugs. He won an international award in recognition of that discovery. But seeing the research applied to help patients is even more rewarding.

“I had a young girl who was on a drug for seizures, but it caused blisters on her skin and mouth,” he says. So he gave her intravenous hemoglobulin and she improved greatly in just a few days. Steroids were used 10 years ago, but the new treatment produces more immediate and better outcomes.

He was the first in Canada to define a family of genes to identify why adverse drug effects occur using blood from patients with adverse drug reactions. He took the whole genome of someone who had a negative reaction to a drug and compared the cells to someone with no reaction.

Dr. Rieder says this type of research can lead to personalized medicine. “Certain people should not get certain drugs. We can either modify the drug for them, or not give those people that drug. It is targeted drug therapy with the goal of right drug, right time, right patient.”