Atoms.

SSRIS IN THE US--STRUGGLING WITH UNCERTAINTY

Following the lead of the British Government, the FDA in the US has announced a review of the relationship between suicide risk and SSRI drugs. (1) A spokesman for the FDA reported that 109 of 4000 young people who had participated in 25 studies of these medications experienced suicide related behaviours. None had actually committed suicide. In a recent hearing in Washington, protagonists and antagonists battled it out about the value of the medications. Some parents suggested that their use had caused suicidal and aggressive behaviour in their children. Others suggested that the drugs dramatically improved the lives of their children. Is their scientific truth to be had in this debate, or because of the complexity of human behaviour coupled with drug therapy, will we never be certain about the risk of suicide associated with SSRIs? Truth is likely to be elusive, and with an increasingly informed and vociferous public, debates like this one will become far more common. A long, tedious, and complicated campaign to educate the public about risks and benefits of medical tests and interventions is necessary.

INTRAVENOUS IMMUNOGLOBULIN IN CHILDREN WITH CYSTIC FIBROSIS

In this issue, Balfour-Lynn and colleagues, in a retrospective case series, extend their initial report of the success of intravenous immunoglobulin (IVIG) for lung disease associated with cystic fibrosis (CF). Although the gains in FE[V.sub.1] and FVC are modest, equally as important is the steroid sparing effect of the treatment--both oral steroid and inhaled steroid use declined significantly following treatment with IVIG. Should all children with CF and lung disease receive IVIG in attempt to reduce steroid effect and improve lung function? The authors suggest that since a large randomised clinical trial is unlikely to be conducted, treatment with IVIG should be considered in all children with CF who have severe obstructive lung disease. We must be aware of the "slippery slope" of therapeutic and technological advances--that is, indications for a new or aggressive treatment often become less rigorous with time. Rather than deciding on an individual basis, I believe that the use of IVIG should be tested experimentally, in a sufficient number of children, to provide an answer to the question.

See page 315

HEART DISEASE IN CHILDREN WITH SICKLE CELL DISEASE

The care of children with sickle cell disease (SCD) has improved dramatically over the past two decades. The introduction of penicillin prophylaxis dramatically reduced early mortality from sepsis. Chronic transfusion protocols have reduced recurrent stroke. Aggressive inpatient and outpatient management of pain has improved functional status. Hydroxyurea has been found to have beneficial effects for many of the complications of SCD. A group of French investigators describe yet another area in which medical advances may be possible--cardiac insufficiency. ...