It is only in the 20th century, that we (society) have recognised that children are different to adults. Previous generations would dress children up as adults and often send them out to work at an early age, unable to recognise their social and developmental vulnerability.

Our knowledge of therapeutics in children is languishing, even though many influences on our current use of drugs are based upon mistakes made which affected children (e.g. thalidomide). The end of the 20th century has brought with it a renewed interest in the uniqueness of children and their treatment.

Initial attempts by the American Food and Drug Administration to address the `vulnerable child' resulted in legislation to ensure that only studies of the highest quality were performed in children. The unfortunate result was that even fewer trials were performed in the young. Children have been identified as therapeutic orphans (only 20% of drugs licensed in Australia have paediatric information). There are now incentives, such as extension of marketing exclusivity, to perform studies in children. I hope that this will result in children having full access to the medicines that they need.

This century will further encourage the safe and efficacious use of medicines in children and adults. The human genome project will have defined many of the differences that currently confound our use of drugs. Drugs and doses will be individualised depending upon individual genotype and phenotype (defined by simple bedside testing). The `numbers needed to treat' statistic will be a thing of the past. No longer will evidence-based medicine meta-analysis be required for treatment of a population _ appropriate therapy will be aimed at individuals based upon their unique characteristics. By the start of the 22nd century, many of the therapeutic approaches in current practice will be considered as antiquated as we now consider the widespread therapeutic use of arsenic.

Noel Cranswick

Clinical Pharmacologist, Royal Children's Hospital, Melbourne