[Children and adolescents with mental disorders as orphans of managed care?]

Failure of incentive to investigation in infantile pharmaceutical trials has lead to insufficient supply with drugs within pediatrics and child- and adolescent psychiatry in Germany. In practice, drugs that are approved for adults are used to treat minors as a remedy. In many areas such "off label use" has become the medical standard and is therefore owed by the doctor under medical malpractice law. The principle of economy, that rules the law of public health insurance, forbids the prescription of drugs, that are not tested. However, as minors have the right to equal protection, the principle of economy can not prohibit off label use to the determent of minors. By virtue of the European orphan drug direction we can expect an improvement of drug supply in the field of pediatrics and child- and adolescent psychiatry in the long run. But meanwhile it would be unethical and unlawful to deny minors through restrictions on drug prescription a standard treatment, where the medical standard demands off label use of a pharmaceutical product.