11/01/2008 05:12 am ET Updated Nov 17, 2011

Something Other Than The Financial Crisis: Children Are "Orphans of Medicine."

Would you like to think about something, anything, other than the financial crisis or the election? I know I would. Let's talk about the real future of our nation: our children.

There are fewer children than adults, and therefore, children have less power-by-numbers. Because they don't spend money and they do not vote, children have NO direct power in our society. People with no power generally are ignored and thus, children are the "orphans of medicine."

Consider money spent on health care as an investment. Where will you get the most bang for your buck: in an 80 year old or a five year old? Which investment in health is better for long-term national productivity? Who gets the vast bulk of healthcare dollars, whether in clinical care or research? That was three hopefully rhetorical questions.

Did you know that statistically, you will spend more on health care in the last six months of life that your entire life before then? According to a Dartmouth Center Study, many elderly citizens feel that money spent on them for futile, pre-terminal care would be better spent on the young. Children are orphans when the dollars are being allocated.

Twenty years ago, there were thirteen pharmaceutical companies that manufactured childhood vaccines. Today there are three. When company CFOs did the math, vaccines made no financial sense. What happens to our children when no one makes vaccines?

Drugs approved for adults are often not available for children. The adult market offers the possibility of profit while the child market generally does not or the risk is very high. Why should a pharmaceutical company go through the lengthy, painful and very costly (now almost half a billion dollars) to try to get a drug through the FDA? So they don't, and again children are made orphans.

When I took my pediatric cardiology board exams, the correct answer for "the best diuretic to use in children" was Lasix. Yet Lasix (then) was "not approved for use in children." For the doctors who care for children, it is sometimes a no-win proposition. You could use an inferior drug (and get poor results), or use the better drug and get sued or your license revoked.

Risk is considered a bad word, especially in today's economic climate. In health care, risk is to be avoided at all costs, particularly in our most precious possession: the children. Unfortunately, many research protections for children are so stringent, so risk-averse, that children are denied potentially life-saving research because the system rejects any risk. This is often true even when the child's disease itself carries a significant risk of death.

You only need to look at David Dilt's research flow chart showing 87 (!) different steps required before you can begin medical research or the eleven page (!) consent form that is standard for the children on cancer protocols. Then consider "risk" for a medical malpractice standpoint.

Intent on protecting the patients, by making biomedical research difficult-to-impossible, the system "protects" them from the very research they need. Thus, children with rheumatoid diseases, cancer, congenital defects, even asthma or diabetes are (again) orphaned.

In the nineteenth century, we had County orphanages.
Is that where we should put today's children who have medical problems??