This Podcast Will Kill You - Ep 148 Poison Control Part 1: Who you gonna call?

Episode Date: August 13, 2024

If you’ve ever called poison control, you probably already have a deep appreciation for the voice on the other end of the line who provides solid answers, emanates calm, and empowers you to take whatever steps necessary to be safe and healthy. If you haven’t, this episode will turn you into a superfan anyway. How did this incredibly valuable yet often overlooked service come to be, and why did it arise when it did? In the first of what ends up being a two-part ode to poison control centers, we explore the origins of poison control centers in the US, from the early days when literally one guy answered calls from all over the country to the lifesaving nationwide coordinated organization it is today? Tune in to find out! See omnystudio.com/listener for privacy information.

This is exactly right. There are already enough things charging your card every month. Dinner should not be one of them, which is exactly why Blue Apron is now subscription-free. You heard that right, Blue Apron no longer requires a subscription. You can order meals when you want them and skip when you don't without adding another recurring charge. Blue Apron meals are designed by chefs and arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. Order now at Blue Apron.com. Get 50% off your first two orders plus free shipping with code this podcast 50.

Terms and Conditions Apply. Visit blueapron.com slash terms for more information. I'm Amanda Knox, and in the new podcast, Doubt, the case of Lucy Lettby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit. The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to book?

Oh, my God, I think she might be innocent. Listen to Doubt, The Case of Lucy Letby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Clayton Eckerd. In 2022, I was the lead of ABC's The Bachelor. But here's the thing. Bachelor fans hated him. If I could press a button and rewind it all I would. That's when his life took a disturbing turn.

A one-night stand would end in a courtroom. The media is here. this case has gone viral. The dating contract. Agree to date me, but I'm also suing you. This is unlike anything I've ever seen before. I'm Stephanie Young. Listen to Love Trapped on the I Heart Radio app, Apple Podcasts, or wherever you get your podcasts.

So my name is Suzanne Doyon, and I'm the medical director of the Connecticut Poison Control Center. We're going to start the podcast today with a little story, a very common story, that every poison center really in the country encounters at some point in time, you know, in the course of their work. We're going to talk about the little laundry pods. You've seen them in your grocery stores. The little laundry pods are on the shelves right there with the other laundry detergents, and they are used to clean your laundry. They hit the market in the United States probably 15, maybe even 20 years ago.

And we moved at that point from kind of powder-based detergents to there were a lot of liquid laundry detergents to these little pods. And these little pods, and I'm sure you've seen them, but they're wrapped in plastic. And they're usually very colorful, but there's a component of laundry detergent. It's a component in there of usually water softener, other components in there as well. And again, all wrapped up in a nice, a little plastic pouch. and their single use. We call them laundry pods,

but really the technical name is single-use laundry detergent. And even before they hit the market in the United States, they had been quite popular in Europe. And they had adopted this quite, quite avidly in Europe. So the manufacturers of these detergents and these single-use pods were quite confident that this was going to take off in the United States, and it did. And I want to take you back again, 15, 20 years. years ago when they just hit the market. And we had this interesting email from North Carolina

going, what is up with these laundry pods? I had a child, or a child in North Carolina, bit into it and got quite, quite sick. And I don't, you know, the medical director said, I don't quite understand what's going on. And then we had other people in upstate New York and then and then a few months later in Florida going, we have had the same issues. We have little children who bite into these laundry pods and they get quite, quite ill. And we looked at the illnesses and all this stuff, but let's just take a step back. Here we are in the United States used to liquid laundry detergents. We've had that product on the market for decades. Children have ingested that product for decades and never did it result in any really serious injury. Certainly never resulted in

ICU admissions never resulted in death. It was just not our expectation. So here this new product enters the market, or at least a new packaging of the product enters the market, and we're starting to see a lot more ED visits. Children are having problems with it, and we're seeing a lot more admissions to the hospital. We're seeing admissions to the intensive care in things we had never, ever seen before with laundry deterges. So something's going on, basically. And so we sit down, we sit down, with each other. We sit down with, you know, kind of the pods themselves, start looking at them, stop looking at them differently. We even sit down with the manufacturers of these laundry pods. So we sit down with Procter & Gamble, we're going, what did you put in those laundry pot?

What are the ingredients? What's going on? And they came back. They said, no, no, no, it's laundry detergent. It is just plain laundry detergent. We're going, what's the pH? Did you change the pH? Did you do something? And they laughed a little bit when we mentioned the pH. they go, yeah, the pH of that product is lower, meaning it's closer to a pH of seven than our typical laundry product, because if we had its pH at 9, which is what it usually is, it would destroy the plastic as it's sitting on the shell. So we have to lower the pH. Well, if the pH is lower than 9 and somewhere between 9 and 7, that should be perfectly fine for the child. So, again, just hitting, hitting against a lot of kind of like none of this makes sense. then I think after thinking about this and thinking about this and just realizing what it was

that we were seeing at the bedside, we came up with likely what the answer was. So what were we seeing at the bedside? So these children would bite into these laundry pods. Sometimes, you know, think about these laundry pods. They're under a little bit of pressure. So when the child bites and bites again often, the contents start to squirt out. And they could squirt out vertically up. squirt out horizontally out of their mouth or they could squirt out horizontally to the back of their

mouth. If it squirted up and ended up in their eyes, and we did have a number of ocular exposures, we had a bit of corneal issues. The cornea of the eye looked burned, was injured. If it squirted out, you know, that would end up on the floor. We don't worry about that. If it squirts back, it would hit the back of their throat, the uvula. Children aren't very small children, are not terribly coordinated in terms of swallowing, and they would kind of choke, cough, and swallow kind of all at the same time because they're not very coordinated, and some of it would end up in their lungs, and we had kind of an aspiration type of issue. Some of them would kind of go down into the stomach and kind of sort of reside in the stomach as a result. And then we were seeing

a few, just a few injuries to the stomach, burns to the stomach. So studying this and looking at this a little bit, it sort of behaved like, again, something with a very high pH, something with a very low pH, but this was not the issue here. It behaved a lot like the very concentrated detergents that we have out there. We ended up looking at the surfactants. The surfactant is a component of detergents that stabilize bubbles. We like things to bubble up, right? If we put a detergent, we want it to bubble in our, you know, in our washing machine. And so because they're packaging such small quantities of detergents, they had to increase the amount of surfactants. And it turns out that the surfactants were the issue. They're concentrated surfactants and the concentrated surfactants

kind of destroy a little bit, the inner lining of the trachea, the lungs, the bronchia and the lungs. can to some degree wash away a lot of that nice mucus that coats the stomach, causing a bit of gastrointestinal kind of burns. Many, many poison centers, after a few months, we're kind of declaring themselves going, this is an issue, this is an issue, this is an issue. So who do you sit with? Kind of regulate this a little bit, and this is not a food, it doesn't, or drug, it doesn't fall under the Food and Drug Administration. This falls into the Consumer Product Safety Commission, CPSC. And so you sit down with CPSC, or at least you alert this. to CPSC. They have discussions with the manufacturer. They try to negotiate and kind of arrive

at some kind of understanding about what's going on. And now and since you will see these products often, often packaged child resistant bigger packages. It's the double zip pouch. It's a container with a child resistant cap. So there was a child resistant component to it. So that was part of the regulation. The other part is education needed to occurred. There needed to be a public health education campaign. And if you watch your TV, you will occasionally see really nicely, they're really nicely made commercials paid for by the manufacturer or alerting parents of young children to not let them get a hold of these laundry pods that they could be dangerous, store them away from children and so on and so forth. This all took years,

but it was through the work of poison centers that, well, first of all, recognize it was a problem. in and kind of found sort of what we think likely the problem is and sort of alerting the federal regulatory entities and having them kind of weigh in on this. So it was a terrific, terrific effort right there. We were a little bit puzzled since these products had been in use in Europe for years before they were introduced in the United States. Don't you have children in Europe? Isn't this occurring? You're like, don't you have this problem in Europe? And in turns out that yes, they have children in Europe. But more importantly, they don't have a very cohesive poison center system. So if they were encountering the issues, they really didn't have a

great way of communicating that to each other, certainly across countries. And so because of that, they told us, yeah, we did have a problem, but we didn't know the extent of the problem. So now, 20 years later. I wouldn't say we never get a laundry pod exposure. We do. But they're much fewer and far between. I think parents know now to keep it away from children. I think that's one of the big reasons why we see less. I think physicians are also much better prepared to take care of these problems when they arrive to the emergency department. We have a much better understanding of what to do. So we rarely have the ICU admissions, the deaths that we recorded years ago, decades ago, with the introduction of the single-use laundry detergents.

So I think that's a great success story to share with everybody. I loved that story. So much, Erin. So much. Yeah. I feel like I remember when Tidepods and like Tide Pod Challenge was a thing on TikTok or something a few years ago. Yeah. And then I never really thought, like, why are tie pods so bad? I just assumed all detergents were

probably not good for you. And that, like, more people just were eating these because they're cute and, like, good looking. Right. And also to just learn how the whole process worked to be like, we see this. What is happening? Let's get to the bottom of it. How do we stop it? Beautiful. Beautiful. And also, like, the working across industry and, like, government and, like, other bodies. Like that was so, it's so interesting. Like, wow, I love this. And to hear from an expert, thank you so much, Dr. Doyan, for sharing that story with us. And you are going to be hearing so much more from her in next week's episode to be continued. But first, hi, I'm Aaron Welsh. And I'm Aaron Elman Updike. And this is, this podcast will kill you. And today, if you haven't guessed it,

we're talking about poison control. Yes. We are so excited. We say this every single time, but we are so excited for this episode, or should we say these two episodes? I mean, there is so much more to poison control, and it is all so fascinating. Aaron, you have been talking about your intellectual crush on toxicologists and toxicology for ages, and so I really feel like we're digging deep, but not even as deep as we could. Like we're covering so much ground because there's so much ground to cover when it comes to poison control. We're not even digging that deeply. I know.

I, when you first, Aaron, brought up the idea of covering poison controls, like, as a topic on this podcast, I was like, okay, like, I love toxicologists, all of them. And I love the field of toxicology. But I was like, I have no idea, like, how to do an episode the way that we usually do things. And turns out, can we do it? Sure can. Can we do it more? over and over again, I'd love to. Oh, yeah. Yeah, so just to give you a little bit of a rough idea

of how the structure of these episodes are going to go, what we're going to do in this first episode is kind of share the story of how poison control came to be from its humble beginnings in Chicago, Illinois, spoilers, all the way to this, like, beautiful nationwide system that we have today. How did that process begin? who looked at this need and said, oh, yeah, we should do something about this. Yeah. So that's going to be this first episode. It's going to be thrilling. You might not think that, like, you would ever have wondered, like, how did poison control

center come to exist? But after this episode, you're going to be like, I'm sorry, I will never not think about this. I know. It will be your new Roman Empire. Is that what they say these days? Is that still a thing? I don't know.

Maybe by the time this comes out, probably not. And then next week, we're going to get the chance to interview the provider of our first-hand account, Dr. Suzanne Doyan, who is not just the provider of our first-hand account. She is the medical director of the Connecticut Poison Control Center. Oh, my gosh. She's also an associate professor at the University of Connecticut School of Medicine. I am so thrilled. We're going to get to ask her all kinds of behind-the-scenes school.

questions about like how what goes on at poison control centers who do you have to be to work at a poison control center what kind of calls do you get what like what what happens what what do you what does one do in poison centers it's going to be such a great episode it was such a fun conversation we got super nerdy oh yeah we did but before we can get into any of that it's quarantine time it certainly is what are we drinking this week This week we're drinking, name your poison. Yeah. You know, I have these sweet, sweet glasses that say name your poison on them.

And they have a bunch of different poison names on them. And I think I've used one once for arsenic maybe. I did Paris Green or something. That sounds right. But I have more. So now I have to pick which one I want to use. I love them. I'm so excited to get to use these.

I mean, I can use them anytime. We should have split into however many episodes you have. of these glasses, like just that many poison episodes. Honestly, what I need to do is go back in there and be like, okay, what can we do? What can we cover for future? So add it to our long list of ideas that never is never ending. But in this, name your poison, it is, it's delicious. It's whiskey. It's whiskey. Name your whiskey. Really, I think a lot of whiskeys will work with this, probably not like a heavily peated scotch, but a lot of other whiskeys will work. And then peaches and a little bit of lemon juice, some simple syrup. It's simple, it's delicious, it's amazing. It really is. Check it out.

We'll post the full recipe for that quarantini, as well as our non-alcoholic placebo rita on our website, this podcast will kill you.com and all of our social media channels. Are you following us on social media? Are you? You should be. We've had some pretty stellar content coming out if I do say so myself. If we do toot our own horn like that to do to do. We've got reels. We've got, you know, other posts. That's all we've got. We've also got a website, though, which is pretty sweet. The website has all kinds of cool things.

You know, we've got transcripts. We've got a submit-your-first-hand account form, which is amazing, thanks to everyone who has ever submitted their firsthand account. We've got links to merch. We've got music by Bloodmobile. We've got links to our bookshop.org affiliate account. Our Goodreads list, sources, things. The list goes on and on and on and on.

Yeah. All right. Can we get to like the episode already? Yes, Erin, please start us off with how the heck we got to hear, Erin. I will. Let's take a quick break and then that is exactly what I'll get into. Dinner shows up every night, whether you're prepared for it or not. And with Blue Apron, you won't need to panic order takeout again. Blue Apron meals are designed by chefs and arrived with pre-portioned ingredients so there's no meal planning and. and no extra grocery trip. There, assemble and bake meals, take about five minutes of hands-on prep. Just spread the pre-chopped ingredients on a sheet pan, put it in the oven, and that's it. And if there's truly no time to cook,

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Order now at Blue Apron. com. Get 50% off your first two orders plus free shipping with code this podcast 50. Terms and conditions apply. Visit blue apron.com slash terms for more information. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization

that lasts up to 48 hours. It's made for people whose hands take a beating at work, from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit O'Keef's company.com slash this podcast and code this podcast at checkout. In 2023, a story gripped the UK.

smoking horror and disbelief. The nurse who should have been in charge of caring for tiny babies is now the most prolific child killer in modern British history. Everyone thought they knew how it ended. A verdict, a villain, a nurse named Lucy Letby. Lucy Letby has been found guilty. But what if we didn't get the whole story? The moment you look at the whole picture, the case collapses.

I'm Amanda Knox, and in the new podcast, doubt the case of Lucy Lettby, We follow the evidence and hear from the people that lived it. To ask what really happened when the world decided who Lucy Lettby was. No voicing of any skepticism or doubt. It'll cause so much harm at every single level of the British establishment of this is wrong. Listen to Doubt, the case of Lucy Lettby on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. It's midnight. In six hours, you're supposed to be heading to the airport.

for a two-week trip to, I don't know, say Scotland. And even though you promised yourself that you'd be fully packed well before now with enough time to get a full, glorious eight hours of sleep, that promise has long since been shattered. Tossing in that extra pair of just-in-case socks, you zip your bag and you sit back, breathing a long sigh of relief. It's finally over. But your mind is still restless,

and it starts to run through the list of non-packing things you're supposed to have done. Water the plants? Check. Clean out the fridge? Check. Leave instructions for the dog sitter? Check. Oh, God, you realized, you haven't given the dog his flee and tick medication. What if the dog sitter takes him to the park? And he gets tons and tons of ticks. You scrounge around for the front line and kneel down next to your peacefully sleeping dog.

because it's late and because you're desperate to crawl into bed, your brain doesn't register the bold lettering on the frontline package stating to open away from your face in all caps, complete with illustrations, and you twist open the applicator inches from your face. A burning sensation in your eye alerts you to the fact that something has gone horribly wrong, that a drop of who knows what chemicals has found its way into your eye.

Panic coursing through your body, you run to the sink to flush out your eye, but the burning doesn't cease. What do I do now, you think? Should I go to the ER? Have I permanently damaged my eye? Who could possibly have the answers? I don't even want to go on the internet. Then it hits you. Poison control. With one phone call, the reassuring voice on the other end tells you, that you don't need to go to the ER, that you should keep flushing your eye and that you're going to be okay. As someone who personally witnessed this entire incident, my favorite thing, Erin, is that from the first line, I was like, oh, I know this, I know this story. This is a real-life scenario. This is a real-life scenario.

But yes, as a witness to this, it was really amazing to see. this resource that I had, you know, seen mentioned, I had read on so many medication packages and other packages for my whole life, had never used myself, and then to finally see it be used. And I was just like, this is an absolute gold mine of information that anyone could use at any time to get potentially life-saving instructions. But even though it may seem like it's always been around, that's how it seems to me, it most definitely has not. And so that's the story that I want to tell today. The need for poison control centers is clear to all of us, whether we've used them or not. But who first recognized

this need and decided to do something about it? I'll get to the who in a bit, but first, let's get into the need, the why that motivated the who to create poison centers. That sentence was very confusing, but I loved it. We'll get there. Poisons, as in substances that have the capacity to cause harm or death to humans, have been around since the dawn of humanity. Whether accidental, like eating a poisonous mushroom, or intentional, like lacing someone's dinner with arsenic, poisoning has been something humans have contended with forever. And if you haven't listened to our book club episode with Dr. Noah Whiteman about his book Most Dangerous Poison from a couple weeks ago, here's your

your cue to check it out. For millennia, the concept of poison primarily included substances found in nature, whether from a plant, an animal, or a mineral slash metal, and accidentally encountered slash ingested or administered with the explicit goal of causing harm. The Industrial Revolution shook things up a bit as the number of people working with or using toxic substances, both natural and artificial, in manufacturing rapidly increased, and poison grew to encompass those occupationally encountered substances as well. But largely, going into the 20th century, poisons were seen as specific instances, poisonings tied to certain substances rather than ambient toxins, unless you were talking about workplaces where the threat could be environmental. And with the

exception of certain medications where paraphrasing paraselsis from the 16th century, the dose makes the poison, poisons weren't really seen as a super common household item, which I think is a really interesting thing to think about. Because if you asked me to think about the poisons that I would encounter on a daily basis, I'm like, oh, well, you know, there's a lot of chemicals in my, underneath my sink, in my laundry room, like in my garage. There are things. that are absolutely toxic. Right. Antifreeze, the stuff I used to clean my toilet.

Bleach. Yeah. Like, there's a lot. And that has not really, that's been a more recent development over the course of humanity, or at least like for most people encountering on a day-to-day basis. I don't know. Yeah. I just thought that was a really interesting shift.

It is interesting because you don't think about it. And I think too, but probably, like, we probably don't often think of those things as poisons, but we would think of them as poisonous or hazardous to our health. And so it's also that distinction of like, is it a poison or is it poisonous? And like, oh, what does it mean? Yeah. And there's a really interesting paper that I'll put on the website, but there's a lot of fascinating links to the environmentalism movement in the 20th century as it became recognized that like, oh, these aren't just like specific things that cause one person. and harm, but these are things that can leach into our entire world, the environment, basically.

Yeah. And I'm not getting into that here, but I just, I thought that was a really interesting perspective on that. It really is. But yeah, going into the 20th century, things were beginning to change as the continued growth of industrial chemistry and food and drug manufacturing brought new products to the market and into the home. I read that between 1879, and 1920, sales of quote-unquote drug, toilet, and household preparations for the home increased from $40 million in 1879 to $765 million in 1920. Just by 1920. Yeah.

Wow. I know. And these industries initially faced very light, if any, regulation. We've touched on this a bit in our supplements episode. and in our book club episode featuring Deborah Blum chatting about her book, The Poison Squad. But it was a real uphill battle to get manufacturers to accurately label the contents of their products. The Food and Drug Act of 1906 helped to increase transparency, but just for food and drugs, primarily not household cleaners or other chemicals, which were becoming increasingly popular

as marketing campaigns targeted housewives and told them that they needed these products to maintain a sparkling, clean, germ-free home. You know, I'm going to put germ theory in here. It was only because of germ theory, no. And even if labels on these household, these new household products contained information about what was in this cleaner or that cleaner, who knew what some of those confusing sounding names, chemical names meant? Like, what's, for instance, I pulled a bottle of a window cleaner from my sink. What is isopropanolamine? I probably mispronounce that.

Or sodium C-10-16 alkalobenzine sulfonate. You don't like there are things. You don't have all of your O-KEM things memorized? I have tried to block that part of my undergrad from my memory. Also, that was like 20 years ago now. Yeah. Or what if you were a child and you couldn't even read those labels? Some magazines like Good Housekeeping published safety information about common household products,

but there wasn't a central database where someone could find this information, information which was growing exponentially by the year. Manufacturers initially placed the responsibility on mothers to know whether or not a product or medication was safe or not and in what amounts it would be a danger, and it didn't provide that information directly. Or if it did, it was in like the tiniest fonts possible where it would say like danger if ingested. And you have to like get out of magnifying glass. To illustrate, this is testimony from a 1926 Senate committee meeting about a bill to appropriately label certain products as poisons. Quote, here is the picture of a child of a citizen of Pennsylvania which swallowed a preparation known as clean all up in the state of Massachusetts.

The child's passage to the stomach was totally obliterated. A person saved her life by putting a tube in the stomach. When I asked the mother, why did you let the child have that? She said, why I did not know that it was poison? And I got her to bring me a can. And here you can see on this can that I have here, which was bought in the stores, that there is not only no poison label whatever on it, but it says, quote, does not injure the finest fabric or the most delicate skin. Now, how could you expect any mother to think that thing was dangerous? End quote. Wow. Right? That's really interesting. I mean, and that's a whole separate episode, like the labeling of products as poisonous or toxic or whatever. And even still today, I was kind of going through some of the cleaning products.

And there's not a whole lot of, like, blatant, holy cow, you know, this is really bad. Right. Yeah. It's like if contact with eyes, rinse and call poison control. If ingested, call poison control. Like, that's all they say. Uh-huh, uh-huh. And it's like, we're not going to freak you out here.

We're going to let somebody else tell you just how bad. How freaked out to be. So hopefully you read enough English to be able to see this on the label and know how to call. Yep. Yeah. Yeah. Yeah. Yeah, and some of it didn't even call poison control.

Just said, like, seek help or... Oh, interesting. Or, and then some doesn't have... Some don't have the poison control number. Anyway, I think that's, like, really labeling. Who knew? There's so much to a label, but there is. Is that going to be our new niche, Erin?

I'm into it. I'm there. As a reaction to this, these issues surrounding labeling, and as part of a larger trend in consumer protection, regulation was passed in the U.S. to help oversee the labeling of these products and, in some cases, the packaging, such as childproof lids, which varied in their childproofness. You know, some reports of like, oh, the kid had to instruct the mom how to open the baby aspirin, which tasted like candy. And then it's like, that's a whole thing too, where it's like, it tastes like candy. It must be candy anyway. Yep. But this didn't really seem to make a huge dent in the frequency of accidental poisonings in the home, especially for children.

And part of this rise in the frequency of accidental poisonings in children was certainly due to the wider availability of potentially dangerous household products with or without labels. But another big part was that these accidental poisonings were becoming much more visible, thanks to what was happening in the background in terms of medicine. Essentially, the drastic reduction in infectious diseases as a leading cause of mortality in children. I never thought about that. So it's like we're fixing this problem, and so now we have more bandwidth to be concerned about this other problem. Right. So it's like how much, I mean, an epidemiologist,

epidemiological studies of even accidental poisonings were rare in the 1940s, but before then, like, who even knew? Right. How interesting. It's, yeah. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working hands creates a protective layer on the skin that locks in moisture. It's non-greasy, unscented, and absorbs quickly. A little goes a long way. Moisturization that lasts up to 48 hours. It's made for people whose hands take a beating at work,

from health care and food service to salon, lab, and caregiving environments. It's been relied on for decades by people who wash their hands constantly or work in harsh conditions because it actually works. O'Keefs is my hand cream of choice in these dry Colorado winters when it feels like my skin is always on the verge of cracking. It keeps them soft and smooth, no matter how harsh it is outside. We're offering our listeners 15% off their first order of O'Keefs. Just visit o'keef's company.com slash this podcast and code this podcast at checkout. In 2023, a story gripped the UK, evoking horror and disbelief. The nurse who should have been in charge of caring for tiny babies

is now the most prolific child killer in modern British history. Everyone thought they knew how it ended. A verdict, a villain, a nurse named Lucy Letby. Lucy Letby has been found guilty. But what if we didn't get the whole story? The moment you look at the whole picture, the case collapses. I'm Amanda Knox, and in the new podcast, Doubt the case of Lucy. Lettby, we follow the evidence and hear from the people that lived it to ask what really happened

when the world decided who Lucy Lettby was. No voicing of any skepticism or doubt. It'll cause so much harm at every single level of the British establishment of this is wrong. Listen to Doubt, the case of Lucy Letby on the Iheart Radio app, Apple Podcasts, or wherever you get your podcasts. I'm Clayton Nekard, and in 2022, I was the lead of ABC's The Bachelor. Unfortunately, it didn't go according to plan. He became the first Bachelor to ever have his final Rose rejected. The internet turned on him. If I could press a button and rewind it all I would.

But what happened to Clayton after the show made even bigger headlines. It began as a one-night stand and ended in a courtroom, with Clayton at the center of a very strange paternity scandal. The media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you. Please search for it.

This is unlike anything I've ever seen before. I'm Stephanie Young. This is Love Trapped. This season, an epic battle of He Said She Said, and the search for accountability in a sea of lies. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. vaccines and antibiotics and other medical advancements had slashed the rates of infectious disease

cases and deaths by, I think, a rate that is unfathomable to many of us today, upwards of 90%, especially for children. You know, infant mortality due to infectious disease was absolutely slashed. Incredible. Vaccines, man. Vaccines, we can't say it enough. I know. And as many deadly infectious diseases became preventive.

another leading cause of death, also viewed as preventable, in children, took their place. Accidents, especially accidental poisonings. By the 1940s in the U.S., studies found that seven out of ten accidents resulting in death for children under the age of five took place in the home. And the numbers were rising in 1930, an estimated 11% of all deaths among those aged 1 to 4 were caused by accidents. but in 1950 that had risen to 17%. There was one group, though, that didn't need to see these numbers to know that there was a concerning rise in the incidence of accidental poisonings among their patients.

And that was the pediatricians. When a child ingested or got into something that they should not have, which that's what they do, parents often turned first to pediatricians for answers. my kid just ate this or drank that. Are they going to be okay? What should I do? Like, how do I proceed? Pediatricians and other healthcare professionals did their best to answer these questions. But as the number of household products grew, it became more difficult to keep a grasp on what was in this cleaning product or that furniture polish, you know, this disinfectant, that insecticide and so on, like more and more and more and more. And not only like what is in these different products, but like what do you do afterwards,

how much is an okay amount to ingest? Is there an okay amount to ingest? You know, like all of these different decision trees, how is one person or even one doctor's office supposed to hold all that information at once, especially as things are growing? And this was, need I say, pre-internet. So right? They couldn't Google it. They couldn't Google it. And to say this was frustrating for the pediatricians, I think would be a huge understatement. Because pediatricians saw accidental poisonings as a largely preventable cause of death with so many opportunities at many different stages or layers to reduce their incidents. There could be better design, like with childproof lids or childproof containers or cabinets where you could store these things under lock and key. there could be better labeling transparency, saying whether or not a substance was toxic and needed a childproof lid or needed to be locked away in that cabinet.

There could be less toxic formulas. Like maybe we don't need industrial strength pesticide in our garage, right? Maybe there are other ways. There could be lots of different stages in terms of like design at the front end of things. Right. But even with all of these extra safety. measures in place, kids still get into things. Kids are still going to get past that lock and key. They're still going to get into that childproof, pass a childproof lid. You know, it's just... They're very good at it. They're experts. Yeah, it's how it is. And so a crucial layer of

protection against accidental poisonings was access to information about what was in these products and the best course of treatment for an exposure. With hundreds of thousands of trade-name substances on the market and rising, that information was impossible for any one person or one doctor's office to keep track of. But some people still tried. One of these people was Chicago pharmacist Louis Godalman, who began working as the director of the two-person pharmacy department of St. Luke's Hospital in Chicago in 1930. The other person was the delivery boy.

Isn't that cute? I don't know why I love that. I love that that detail was in this paper. That's really good. It just so happened that at St. Luke's, the pharmacy department was located right across the hall from the emergency room, and Godalman, with his pharmacy and chemistry background, would get requests for information from ER docs and other hospital staff,

wanting to know whether a patient that had just eaten some type of poison or toxin was in danger or what kind of danger they were in. Over time, news of Godalman's expertise spread beyond the hospital and spilled over into other hospitals around Chicago, then around Illinois, then around the country, and even into the general public. And his phone number was published in all emergency references. And so Godalman would get phone calls at all hours of the day and night, like 24 hours a day, at work, at home, and he never refused a call. He knew as much as any one person could about this. Realizing that speediness and efficiency was key, he began writing out information on little note cards, like index cards, where he could quickly access the most relevant info, like maybe

the most commonly purchased products or the ones that were like, oh, we need this seconds matter here. Let's get this information first. And by 1950, he had amassed quite the stack of cards. But still, it's just one person, right? One human. One human. One human. And there's only so much that one person could do. And given that his phone never stopped ringing, essentially, there was a clear need for a standard formalized service to provide this life-saving information. In 1952, the American Academy of Pediatrics established its Accident Prevention Committee. And one of the first things they did was survey the most common household factors associated with children's accidents. And they found that 50% of the reported accidents involved poisoning, which was much higher than anyone had expected

to find, except probably for the pediatricians who were seeing these patients like every day. These findings, combined with the impact of Godalman's informal poison control hotline, led to the first official Poison Control Center being established at Godalman's Hospital, St. Luke's Hospital, in November of 1953. I love it. I do, too. I want you to keep going. Okay. Just a few months later, the second Poison Control Center was named in Durham, North Carolina, and over the next few years, hundreds more followed.

hundreds, hundreds. I mean, has there been anything that has caught on so quickly in medicine? I mean, probably, but, like, still, it's impressive. And so did Godalman's, like, stash of cards, like, get grandfathered to all of these places? Like, did the information make it to all of these new centers that were opening up? Yeah. So I don't know about the logistics of that, but that was something, like, I don't know whether that precise stack of cards or the info that he had there or whether whether they just adopted his technique. But that is something that I'll talk about in a second in terms of like organization, coordination, et cetera. Yeah. I love it. But I want to read you a bit from a 1954 paper where the rationale for this poison control program like generally was proposed.

It's kind of a long quote. Quote, there is a toxin that may be more deadly than that generated by the germs causing typhoid fever, tuberculosis, diphtheria, or leprosy. And this toxin has already spread to almost every household in the United States. Although there are a variety of strains of this toxin and many type-specific groups, sublethal attacks usually confer no immunity. We are speaking of the ready-made and often highly virulent test-tube toxins, synthesized by modern industry and used in millions of households. to clean clothes, kill flies, or rats, provide heat, and accomplish many other everyday tasks.

The same machine age responsible through its advances in sanitation, immunization, chemotherapy, and antibiotics for controlling the damage done by the toxic products generated by germs that caused epidemics, has by similar advances posed new threats to life and health, end quote. test tube toxin. Test tube toxin. I want that on a t-shirt. I love it. But I love that.

I think it kind of, it wraps it up so nicely where it's like, put it all into perspective. Like here's this world. We can see how far technology has allowed us to come in terms of medicine, in terms of technology, in terms of other things.

And yet. And yet. Yeah. And we need to do something about that and yet. Right. And we can do something about that. And we can. And we are, and we will.

Yeah. Over the rest of the 1950s, poison control centers grew in leaps and bounds, and there were certainly some growing pains to work out. There was still some inefficiency or inconsistency in how information was gathered and transmitted. And so in 1957, the FDA established the National Clearing House for Poison Control Centers, which essentially acted as a place where information about poisons and toxicology, was gathered and then distributed in the forms of bulletins, index cards, and so on. Okay.

The following year, 1958, the first meeting of the American Association of Poison Control Centers was held in Chicago, and the majority of attendees and members were pediatricians. Throughout the 1970s and into the 1980s, poison control centers continued to grow in number, shooting up to 600 at one point, nationwide in the U.S., at one point in the 1970s. at one point in the 1970s. And then eventually it began to grow in coordination, which led to fewer centers overall because it was like,

we don't need a poison control center at each hospital or at each doctor's office. Like we can have one for the area. Consolidation. Yep, efficiency. In 1980, the creation of a national database for all poisoning cases in the U.S. really helped to centralize information.

and also helped to demonstrate the impacts of these poison control centers. For instance, in 1972, at least 216 children died as a result of poisoning. In 2007, that number would drop to 39. And remember, during that time, the U.S. population grew a lot. But besides the obvious and incredible effect that poison control centers have had on providing life-saving information to get people the help they need. They have also dramatically helped to reduce health care costs, especially when it comes to emergency health care utilization, which I know you'll talk a bit more about later on. So much. It's thrilling. It's amazing. But another core,

and I think sometimes underappreciated aspect of poison control centers, is that they represent something that seems harder and harder to come by these days. A reliable, source of factual information that provides answers, guidance, and often peace of mind for nothing. For nothing. In minutes. In minutes. Instantaneously. It's truly phenomenal to call poison control. Yeah. Like the amount of information, how detailed the information, how factual the information and when you're in a panic, how reassuring that information is, you cannot overstate it. Yep.

Absolutely. And I feel like nowadays, so many of us go straight to the internet to seek answers to our questions, whether that's like, what headphones should I buy? Or what's this mole on my arm? And where we're met with an absolutely overwhelming tsunami of information, good and bad, and opinions, also good and bad. And we can sift through results and forums for hours and emerge on the other side with no more clarity than we had at the start.

But when you don't have the luxury of time and you need accurate information immediately from a trusted source, that Reddit thread from five years ago about somebody accidentally squirting frontline in their eye, it's not where you're going to want to turn, right? Instead, you're going to want to want to. to call poison control, where the voice on the other end has the answers that you so desperately need. And I think that also can't be understated, because if you go online and search for anything,

like, you will never come to an actual answer. You will see every possibility which inevitably ends with, well, it could be colon cancer, because that's how all internet searches about anything medical end. You can't get an actual answer. But when you call poison control, at the end of it, there will be an answer. It will be either, you don't need to panic, don't worry about it. You need to go to the emergency room, in which case they will continue to follow, by the way, as you go to the emergency room, or it will be something else, but it will be like a concrete answer, like do X, Y, and Z steps, and if that doesn't work, then do A, B, and C steps. Like, it's, it is so concrete in that way. Yes, that is, concrete is great. It is like, no waffling. There isn't, oh, well, let me just

keep, you know, this is the sequence of events. This is how we're going to make our decisions. Yeah. Decisions will be made. I love it so much. I've loved every conversation I've ever had with Poison Control. I have had several. It's so, I love it. We're big fans. Big fans, if you can't tell. But that's poison control. That's the story of how we got to where we are today, more or less. More or less. I really love, like, I, I wish that I could talk to Goodalman. I know he has passed.

But I just wish that, like, imagining the series and, like, the conversations that happened between him and, like, people at AAP and, like, you know, other people that were, like, in these medical organizations and then talking to people in state governments and federal governments to get this funding and to get started and at the hospitals. And to have it now exist the way that it does today. Like that is just, it's so cool. As a household name, like, hopefully everyone knows about Poison Control or they do after this episode.

Exactly. Yeah. And it's on packet. Like, it is just, it makes so much sense. It does. Yeah. And it's beautiful. Like, of course it exists.

Yeah. But also, Aaron, we have, like, I have more questions. and those questions are mostly like, but it exists. Yes. Awesome. What does that mean? How does it work? What happens when you call? Who are we talking to? Yeah. How do they know what they know and what to tell us and in what order and everything? Everything. And they know so much when you talk to them on the phone. How do they know all of the things? I'm sure that all of you all out there also have these burning questions and you're in. a lot of luck because next week, that is exactly what we'll be getting into with our amazing provider of our firsthand account and also the medical director of the Connecticut Poison Control Center, Dr. Suzanne Doyon. A big thank you again to Dr. Doyon. Make sure that you smash that

subscribe button so that you don't miss that episode when it drops next week. It's going to be great. It's going to be great. And to tide you over until that. if you're like, oh my gosh, but wait, poison control, guess what? There are sources that you can read. There always are. So I have a long list of sources actually for this episode. I'm going to shout out just a few of them, and then you can check out our website where you can find lots more. So the one that I mentioned earlier in the episode where I was talking about sort of the rise of environmentalism, That is by Burnham from 1995, and it's called How the Discovery of Accidental Childhood Poisoning contributed to the Development of Environmentalism in the United States.

Another source that I used is by Berta and Berta from 2000, called Taking a Stand Against Accidental Childhood Poisoning, the founding of the nation's first poison control center in Chicago. And then there was a paper that I liked from 1978 because it was a little bit older, so it had a different perspective on like the history of poison control centers. This was by shares and Robertson and it was titled the history of poison control centers in the United States. So from 1978. So it was like very new at that point, but I liked that. Anyway, you can find a full list of all of our sources on our website. This podcast will kill you.com. So go check it out. Thank you to Bloodmobile for providing the music for this episode and every single one of our

episodes. Thank you to Liana Squalachi and Tom Brigh Fogel for the amazing audio mixing. Thank you to everyone at Exactly Right Network. And thank you to you, listeners. We hope that you are as jazzed about poison control centers as we are. Jazz is a good word. Pretty jest. Super jazz, like jazz fingers over here. Yes. And especially thank you to our patrons. We appreciate your support so, so, so, so much. We can't say it enough. Yes, thank you, thank you, thank you. Until next time, wash your hands. You filthy animals.

I'm Amanda Knox, and in the new podcast, Doubt the case of Lucy Letby, we unpack the story of an unimaginable tragedy that gripped the UK in 2023. But what if we didn't get the whole story? Evidence has been made to fit. The moment you look at the whole picture, the case collapsed. What if the truth was disguised by a story we chose to believe? Oh my God, I think she might be innocent. Listen to Doubt, The Case of Lucy Lettby on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

I'm Clayton Eckerd. In 2022, I was the lead of ABC's The Bachelor. But here's the thing. Bachelor fans hated him. If I could press a button and rewind it all I would. That's when his life took a disturbing turn. A one-night stand would end in a courtroom. The media is here. This case has gone viral. The dating contract. Agree to date me, but I'm also suing you. This is unlike anything I've ever seen before.

I'm Stephanie Young. Listen to Love Trapped on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. This is Special Agent Regal, Special Agent Bradley Hall. In 2018, the FBI took down a ring of spies working for China's Ministry of State Security, one of the most mysterious intelligence agencies in the world. The Sixth Bureau podcast is a story. of the inner workings of the MSS, and how one man's ambition and mistakes opened its fault of secrets. Listen to the Sixth Bureau on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts.