Cold Medicine & Kids: Why We Should've Known Ages Ago

There's been much hubub in the news over the past few months about children and cold medicine, with the emerging reports and studies coalescing into the realization that the young children - ages 2 to 5 - and infants and toddlers, probably shouldn't be taking the stuff. (The FDA recommended such for infants this fall.) A study out yesterday in Pediatrics bolstered the thinking. Researchers looking at emergency room admissions found that 7,000 kids a year were going to emergency rooms because of cough medicine (mostly kids guzzling the stuff on their own). This is good science, and I'm glad to see that the system, on one level, is effectively monitoring over-the-counter medicines and raising alarms.

But I've got a contrarian take, too: Why do we need science - in the form of long-term, retrospective epidemiological studies - to suss out these public health concerns? Consider the Pediatrics study: It drew on two years of US emergency room visits from 2004 and 2005. And here it is January of 2008, and the study is finally completed and published. That seems alarming to me - we're going back four years to discover that there was and is a problem. But what's happened in those intervening years? All those missed cases.

I'm not suggesting the study is ill-conceived or designed; rather I'm asking why we aren't drawing better real-time information from emergency rooms and other aspects of our health system in order to spot and flag this instances as they're happening. In other words, why don't we have syndromic surveillance systems - which the federal government has spent billions on this decade - that can effectively flag these issues in real-time, so that we can take some sort of public health action? Then, sure, conduct a retrospective study and validate what the real-time information is telling us. But it seems to me that waiting for the mechanism of traditional science to make it's case is 1) overkill and 2) a band-aid, analog approach to public health when we should be pursuing instanteous, digital solutions.

After all, this isn't a bizarre, unexplained disease cluster or such that could have loads of causal factors. This is pretty straightforward - kids are being hurt by cough medicine, and going to emergency rooms because of it. Isn't that the low-hanging fruit a proper, robust surveillance system should be flagging as a matter of course? Alas, syndromic surveillance has been too much about spotting terrorist threats - which nearly never happen - or things like bird flu - which hasn't ever happened here - and not enough about flagging actual threats to public health - which are happening all the time. The data is out there, floating around. It's not hard to tap and sift.