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The Health of the Nation: The BMJ view

sixth decades of life, with a subsequent decline. And fourth, a survey of how often and for which indications NSAIDs are prescribed for children under the age of 16 years by paediatricians, rheumatologists and general practitioners, which shows that NSAIDs are often prescribed for unlicensed indications in children. This latter study provokes a commentary by Professor Stephen Spielberg from Toronto on the paradox of paediatric therapeutics, in which many drugs are used outside the terms of their Product Licences, partly because of the scant attention paid to drug use in children during the drug development process, and partly because data acquired in the course of unlicensed use after marketing, while sufficient to convince prescribers of the drug's efficacy and safety in children, may not provide adequate support for an application to extend the terms of the Product Licence. There are two papers on methodology: one identifies the value of a database of primary care records as a resource for post-marketing surveillance, for the generation and testing of hypotheses regarding the causation of adverse reactions, and to monitor drug prescribing; the other suggests basic requirements for the use of terms in reporting suspected adverse reactions, such as anaphylactic shock and arrhythmia. Finally, there is a report of a debate convened by the Faculty of Pharmaceutical Medicine on whether scientific and ethical standards in pharmaceutical medicine should be self-regulated. The editors hope that their new journal will stimulate debate and discussion among those interested in the benefit and risk ofdrugs used in populations. After such a promising start, they deserve to succeed; though the subscription will be beyond the pockets of many.