When a spoonful of sugar won't do
当一勺糖不起作用时我们该怎么办？
Wanted: medicine for a group whose voice is still too small to be heard
有这样一个群体，他们的声音太小了，人们都听不到，但是他们却非常需要药品
IMAGINE a class of human beings, amounting to about one-third of world's population, whose needs are barely noticed by the people who are dealing with all the most pressing public-health problems. In fact, such a group exists: children, especially those in poor countries who are often among the first victims of epidemics and other life-threatening upheavals.
想象一下，世界上有这样一群人，他们的总数大约是全世界人口的1/3，但是他们的需求只被那些负责处理最紧要公共卫生问题的人们所注意。事实上，这个群体是存在的：他们就是儿童，特别是那些贫穷国家的儿童，他们经常成为流行病和其他威胁生命的剧变的第一批受害者。
According to the World Health Organisation (WHO), about 60 essential medicines are unavailable in formulations appropriate for use by children. A general lack of child-friendly drugs has been made more obvious by the particular difficulty of treating children with HIV/AIDS, who have to ingest massive doses of nasty stuff.
根据世界卫生组织的报告：有大约60种重要药品没有适合儿童服用的配方。一些像爱滋病那样的特殊疾病缺少儿童用药的情况就更是司空见惯的了，这使得许多孩子不得不大剂量的服用那些对自己身体有害的物质。
“Some kids with HIV need to take 12 huge tablets a day...and they taste horrible,” says Hans Hogerzeil, a specialist on medicines at the WHO. There are no suitable combination drugs—
medicines that have two or more active ingredients, thus reducing the number of pills needed—no soluble tablets and very few syrups, he adds.
WHO的药学专家Hans Hogerzeil先生说：“一些患爱滋病的孩子一天要吃12片大药片，这对他们而言太痛苦了。”但是却没有合适的合成制剂（即含有两种或多种有效成分的药物），速溶片没有，糖浆也很少。
In the hope of making these and other medicines go down in at least a more bearable way, the WHO is trying to raise $50m from its member governments, for a fund that would kick-start the development of children's drugs—and highlight the need for governments and firms to pay more attention to youngsters' medical needs.
为了早日生产出适合儿童服用的药物，WHO正在尝试从各国政府筹集5千万美金，启动一个发展儿童药物的基金，以促使各国政府和制药公司将更多的精力放到满足儿童的药物需求上来。
Some rich countries have already taken steps in that direction. For example, America's Best Pharmaceuticals for Children Act, passed in 2002, puts more onus on the Food and Drug Administration to take children's needs into account when certifying drugs. But that law has more to do with avoiding risk to children than with helping positively to treat them.
一些富裕国家已经在这个方向上迈出了步伐。例如美国2002年通过了最佳儿童医药用品法案。要求FDA在将儿童的需求转化为通过认证的合格药品方面承担更多的责任，但是这部法律在很大程度上是为了避免儿童的用药风险而不是从积极的方面去创造适合他们服用的药品。
Creating new drugs for children, especially babies, is not a straightforward business. Children metabolise drugs in a way that is quite different from adults. And when combination drugs are put together—for HIV/AIDS, for example—the proportions that suit children are not the same as those needed by grownups. In fact, combination pills for children can be three times more expensive than adult doses, because they are harder to make.
为儿童特别是婴儿创造适合他们的药品，并不是一件简单的事情。儿童对药物的新陈代谢的方式与成年人相比有很大的不同。对治疗爱滋病的合成制剂而言适合儿童的成分配比和适合成人的也不一样。事实上，适合儿童的合成制剂可能比适合成人的要贵3倍，因为它们更难生产。
Still, the WHO has identified a dozen combination drugs that ought to be developed in order to treat children with malaria, tuberculosis and HIV/AIDS. The WHO wants some of its proposed fund to pay for the basic research necessary to create children's formulations. It will initially focus on a small group of diseases that account for most deaths among the under-fives, including HIV/AIDS, malaria, tuberculosis, pneumonia and various forms of diarrhoea.
为了帮助患疟疾、肺结核和爱滋病的孩子，WHO已经确定了十余种应当重点发展的儿童药物，他们也准备从拟建立的基金中拿出一部分钱用于支持儿童药物配方的开发。这些药物最初集中在那几种最容易导致五岁以下儿童死亡的疾病包括爱滋病、疟疾、肺结核、肺炎以及各种腹泻。
The biggest problems in children's medicine concern diseases that afflict the poor. But the shortage of childfriendly medicine is not confined to poor countries. Even in Europe, fewer than half of the drugs administered to children have been tested and authorised for their use. And there are gaps in the treatment of diseases not unusual among rich-world children, including epilepsy and psychotic conditions. At present, very few clinical trials are conducted in children, partly because obtaining “informed consent” is hardly possible. (The WHO hopes that countries can at least compare notes on how to get round that problem.) This in turn deters pharmaceutical firms from researching and developing child-friendly medicines, and generic drug producers from producing low-cost versions. And before testing any new formulation on children, paediatric specialists have to make very hard judgments about the benefits and risks.
目前儿童用药所针对的疾病都是让穷国苦不堪言的疾病。但是儿童用药的短缺并不是只有穷国才遇到的问题。即使在欧洲也只有不到一半的药品曾经做过儿童的临床试验，并被批准可以用于儿童。即使是在富裕国家想找到适合孩子的治疗癫痫症和精神类疾病的药物也并不容易。现在很少有临床试验是针对儿童的，部分原因是因为“告知同意”原则很难遵守（WHO希望各国能够想办法绕过这个问题），这也给制药企业研发儿童用药，非专利药制造商生产廉价的仿制药制造了障碍。而且在儿童药的新配方得到临床检测之前，儿科专家也很难判断它的风险与收益。
However, there are also risks in not creating children's drugs. At the moment, the lack of proper formulations forces health workers and parents to use fractions of the adult dosage; or else they resort to makeshift solutions such as crushing pills (and mixing them with something nice) or dissolving portions of capsules in water.
然而不去创造儿童用药同样是有风险的。目前，由于缺少合适的儿童配方迫使医务人员和父母们只能通过将成人用量缩小比例或者将药片粉碎扮糖溶解再或者将胶囊的一部分溶到水中等方法让孩子服药。
The WHO's hope is that by putting some public funds into research, it will lessen the risks for private firms, and simultaneously “convince and shame them into investing a bit more”. The Geneva-based body is also giving gentle encouragement to those companies that have already started trying to close some of the more scandalous gaps.
WHO希望将基金中的一部分用于研发以降低私人公司的风险，同时促使他们增加这方面的投入。对那些已经在这方面努力的公司它也给予温和的鼓励。
For example, the latest drugs for malaria, based on artemisin, have no childfriendly version, despite the fact that fully 40% of malaria cases occur in children. Sanofi-aventis, a pharmaceutical firm based in Paris, has been working to develop a new malaria drug for children. The WHO is backing this effort by helping the company make evaluations; the drug may soon—perhaps as early as February—be approved for UN procurement. As for tuberculosis, another deadly killer of the young, no effective, child-friendly drug exists at present, even though the scientific knowledge to produce one certainly does. That is just one reason, say the policymakers at the WHO, why urgent action is needed to give that big, voiceless interest group a better chance of growing up.
例如最新的治疗疟疾的药物主要成分是蒿属素，但是却没有适合儿童的用药，虽然40%的疟疾案例都发生在儿童身上。总部设在巴黎的赛诺菲安万特公司正在致力于开发一种适合儿童的新型抗疟疾药物。WHO将帮助该公司进行评估，这种药最早明年二月就会获得联合国的批准。肺结核是另一种儿童杀手，现在也没有有效的儿童用药，即使从科学的角度肯定可以生产出这种药来。WHO的政策制定者们说现在应当采取紧急措施给这些巨大的、沉默的利益群体以更好的发展的机会。
好像是网上转来的，似曾相识。
呵呵,楼上的这样说有根据吗?
我的博客:http://blog.tom.com/jl917921
当一勺糖不起作用时我们该怎么办？
Wanted: medicine for a group whose voice is still too small to be heard
有这样一个群体，他们的声音太小了，人们都听不到，但是他们却非常需要药品
IMAGINE a class of human beings, amounting to about one-third of world's population, whose needs are barely noticed by the people who are dealing with all the most pressing public-health problems. In fact, such a group exists: children, especially those in poor countries who are often among the first victims of epidemics and other life-threatening upheavals.
想象一下，世界上有这样一群人，他们的总数大约是全世界人口的1/3，但是他们的需求只被那些负责处理最紧要公共卫生问题的人们所注意。事实上，这个群体是存在的：他们就是儿童，特别是那些贫穷国家的儿童，他们经常成为流行病和其他威胁生命的剧变的第一批受害者。
According to the World Health Organisation (WHO), about 60 essential medicines are unavailable in formulations appropriate for use by children. A general lack of child-friendly drugs has been made more obvious by the particular difficulty of treating children with HIV/AIDS, who have to ingest massive doses of nasty stuff.
根据世界卫生组织的报告：有大约60种重要药品没有适合儿童服用的配方。一些像爱滋病那样的特殊疾病缺少儿童用药的情况就更是司空见惯的了，这使得许多孩子不得不大剂量的服用那些对自己身体有害的物质。
“Some kids with HIV need to take 12 huge tablets a day...and they taste horrible,” says Hans Hogerzeil, a specialist on medicines at the WHO. There are no suitable combination drugs—
medicines that have two or more active ingredients, thus reducing the number of pills needed—no soluble tablets and very few syrups, he adds.
WHO的药学专家Hans Hogerzeil先生说：“一些患爱滋病的孩子一天要吃12片大药片，这对他们而言太痛苦了。”但是却没有合适的合成制剂（即含有两种或多种有效成分的药物），速溶片没有，糖浆也很少。
In the hope of making these and other medicines go down in at least a more bearable way, the WHO is trying to raise $50m from its member governments, for a fund that would kick-start the development of children's drugs—and highlight the need for governments and firms to pay more attention to youngsters' medical needs.
为了早日生产出适合儿童服用的药物，WHO正在尝试从各国政府筹集5千万美金，启动一个发展儿童药物的基金，以促使各国政府和制药公司将更多的精力放到满足儿童的药物需求上来。
Some rich countries have already taken steps in that direction. For example, America's Best Pharmaceuticals for Children Act, passed in 2002, puts more onus on the Food and Drug Administration to take children's needs into account when certifying drugs. But that law has more to do with avoiding risk to children than with helping positively to treat them.
一些富裕国家已经在这个方向上迈出了步伐。例如美国2002年通过了最佳儿童医药用品法案。要求FDA在将儿童的需求转化为通过认证的合格药品方面承担更多的责任，但是这部法律在很大程度上是为了避免儿童的用药风险而不是从积极的方面去创造适合他们服用的药品。
Creating new drugs for children, especially babies, is not a straightforward business. Children metabolise drugs in a way that is quite different from adults. And when combination drugs are put together—for HIV/AIDS, for example—the proportions that suit children are not the same as those needed by grownups. In fact, combination pills for children can be three times more expensive than adult doses, because they are harder to make.
为儿童特别是婴儿创造适合他们的药品，并不是一件简单的事情。儿童对药物的新陈代谢的方式与成年人相比有很大的不同。对治疗爱滋病的合成制剂而言适合儿童的成分配比和适合成人的也不一样。事实上，适合儿童的合成制剂可能比适合成人的要贵3倍，因为它们更难生产。
Still, the WHO has identified a dozen combination drugs that ought to be developed in order to treat children with malaria, tuberculosis and HIV/AIDS. The WHO wants some of its proposed fund to pay for the basic research necessary to create children's formulations. It will initially focus on a small group of diseases that account for most deaths among the under-fives, including HIV/AIDS, malaria, tuberculosis, pneumonia and various forms of diarrhoea.
为了帮助患疟疾、肺结核和爱滋病的孩子，WHO已经确定了十余种应当重点发展的儿童药物，他们也准备从拟建立的基金中拿出一部分钱用于支持儿童药物配方的开发。这些药物最初集中在那几种最容易导致五岁以下儿童死亡的疾病包括爱滋病、疟疾、肺结核、肺炎以及各种腹泻。
The biggest problems in children's medicine concern diseases that afflict the poor. But the shortage of childfriendly medicine is not confined to poor countries. Even in Europe, fewer than half of the drugs administered to children have been tested and authorised for their use. And there are gaps in the treatment of diseases not unusual among rich-world children, including epilepsy and psychotic conditions. At present, very few clinical trials are conducted in children, partly because obtaining “informed consent” is hardly possible. (The WHO hopes that countries can at least compare notes on how to get round that problem.) This in turn deters pharmaceutical firms from researching and developing child-friendly medicines, and generic drug producers from producing low-cost versions. And before testing any new formulation on children, paediatric specialists have to make very hard judgments about the benefits and risks.
目前儿童用药所针对的疾病都是让穷国苦不堪言的疾病。但是儿童用药的短缺并不是只有穷国才遇到的问题。即使在欧洲也只有不到一半的药品曾经做过儿童的临床试验，并被批准可以用于儿童。即使是在富裕国家想找到适合孩子的治疗癫痫症和精神类疾病的药物也并不容易。现在很少有临床试验是针对儿童的，部分原因是因为“告知同意”原则很难遵守（WHO希望各国能够想办法绕过这个问题），这也给制药企业研发儿童用药，非专利药制造商生产廉价的仿制药制造了障碍。而且在儿童药的新配方得到临床检测之前，儿科专家也很难判断它的风险与收益。
However, there are also risks in not creating children's drugs. At the moment, the lack of proper formulations forces health workers and parents to use fractions of the adult dosage; or else they resort to makeshift solutions such as crushing pills (and mixing them with something nice) or dissolving portions of capsules in water.
然而不去创造儿童用药同样是有风险的。目前，由于缺少合适的儿童配方迫使医务人员和父母们只能通过将成人用量缩小比例或者将药片粉碎扮糖溶解再或者将胶囊的一部分溶到水中等方法让孩子服药。
The WHO's hope is that by putting some public funds into research, it will lessen the risks for private firms, and simultaneously “convince and shame them into investing a bit more”. The Geneva-based body is also giving gentle encouragement to those companies that have already started trying to close some of the more scandalous gaps.
WHO希望将基金中的一部分用于研发以降低私人公司的风险，同时促使他们增加这方面的投入。对那些已经在这方面努力的公司它也给予温和的鼓励。
For example, the latest drugs for malaria, based on artemisin, have no childfriendly version, despite the fact that fully 40% of malaria cases occur in children. Sanofi-aventis, a pharmaceutical firm based in Paris, has been working to develop a new malaria drug for children. The WHO is backing this effort by helping the company make evaluations; the drug may soon—perhaps as early as February—be approved for UN procurement. As for tuberculosis, another deadly killer of the young, no effective, child-friendly drug exists at present, even though the scientific knowledge to produce one certainly does. That is just one reason, say the policymakers at the WHO, why urgent action is needed to give that big, voiceless interest group a better chance of growing up.
例如最新的治疗疟疾的药物主要成分是蒿属素，但是却没有适合儿童的用药，虽然40%的疟疾案例都发生在儿童身上。总部设在巴黎的赛诺菲安万特公司正在致力于开发一种适合儿童的新型抗疟疾药物。WHO将帮助该公司进行评估，这种药最早明年二月就会获得联合国的批准。肺结核是另一种儿童杀手，现在也没有有效的儿童用药，即使从科学的角度肯定可以生产出这种药来。WHO的政策制定者们说现在应当采取紧急措施给这些巨大的、沉默的利益群体以更好的发展的机会。
好像是网上转来的，似曾相识。
呵呵,楼上的这样说有根据吗?
我的博客:http://blog.tom.com/jl917921