This Podcast Will Kill You - Ep 149 Poison Control Part 2: Call me maybe

Episode Date: August 20, 2024

In last week’s episode/love song to poison control centers, we journeyed through the history of these centers, from idea to institution. This week, we pick up where we left off by taking stock of the incredible impact that poison control centers have had on public health and individual lives. We also get a thrilling behind-the-scenes look at the operational side of things - who is on the other end of the line when you call poison control? How do they know so much and where do they get their information? Dr. Suzanne Doyon, Medical Director at the Connecticut Poison Control Center and Assistant Professor of Emergency Medicine at the University of Connecticut joins us to answer these questions and so many more. If last week’s episode didn’t turn you into a poison center superfan, this one certainly will. Tune in today! See omnystudio.com/listener for privacy information.

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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 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 book?

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 I Heart Radio app, Apple Podcasts, or wherever you get your podcasts.

Hi, I'm Aaron Welsh. And I'm Aaron Alman Updank. And this is, this podcast will kill you. And we're obviously doing things weird because why are you hearing from us straight away? That really felt weird. I was like, but there's no first hand to kill you. count. So I just, how do we begin? Ease into this? No? We eased in last week. Yeah. Yeah, we did. Last week, did you listen? If you haven't heard last week's episode, I'm not saying like, you must pause this and go check it out, but like you probably should.

Because we had so much fun talking and learning about what is poison control and how did poison centers come to be. Like where did they arise from and how did we even figure out that that needed to happen? It's a great episode. Definitely check it out. And so today we're picking up essentially where that left off. Right. So we learned all about how they came to be, but we didn't learn what they do, how they work, who works there. All of these questions that are really kind of integral to the existence of poison control centers today.

And so that is what we're getting into this week. And we are getting into that with the help of an actual super duper expert, Dr. Suzanne Duryon, who is the medical director of the Connecticut Poison Control Center and is an associate professor at the University of Connecticut School of Medicine. And she's a toxicologist. I mean, like, honestly, this conversation was so much fun. She knows everything about all the stories. She has incredible. So this is why we don't need another first-hand account because she's got so many stories for us.

It's phenomenal. She sat down with us to answer all of our burning questions about what it is like on the other end of that phone line when we call in to poison control. What it took to become a medical director of a poison center, what it takes to be a poison specialist. By the way, best job title I've ever heard of. And there's so much more in this interview. we are thrilled to be able to have had this conversation and to share it with all of you.

It's going to be a really great episode. We're stoked. It really is. But before we get into all of that, it is quarantine time. It still is. It still is. The same drink as last week. It's just that good.

Name your poison. Yeah. I mean, and if you want to stick with last week's recipe, it is whiskey, again, of whatever kind, probably not a peted scotch, blah, blah, blah, whatever. Do a whiskey. And then peaches, lemon juice, simple syrup. It's delicious. But hey, it's called Name Your Poison. If you're like, you know what, I'm going to do a variation on this. I'm going to do something else. I'm going to do nectarine instead of peaches. Wow. Go wild. Go wild. Go wild. Go absolutely wild. All that's to say, the recipe is on our website. It's on our social media. Do you follow us

on social media. We're on TikTok. We're on Instagram. We're on Twitter X. Is that what they're calling it these days? I don't. I'm not sure. I think it's like Prince. The artist's formerly known as so it's like X formerly known as Twitter. The website formerly known as Twitter. Yeah. Yeah. Okay. Anyways, we're there. Um, Aaron, yeah. Do peach pits contain cyanide? Great question. Did I just have that realization after we? Great question. I don't know. Okay, we just confirmed via the search engine that we all use that yes indeed. Peaches contain, peach pits contain, well, a compound that gets turned into cyanide when digested. And we didn't realize this.

I mean, we should probably have just, like, delete all this in editing and then claim that we knew it from the beginning. Right. Rerecord our other intro. Yeah. It's too late now. Yeah. Anyway, yeah, we totally did this intentionally. Enjoy your drink. Enjoy your drink. Back to the other stuff. Website. This podcast will kill you.com. Check it's got great stuff. You know, it's got transcripts. It has got links to merch, links to music by Bloodmobile, links to our bookshop.org affiliate account, our goodreads list. It's got to submit your first-hand account form. If you all have a poison control, send her story, send us it. We would love, we would love to hear those stories. Use the first-hand account form or email us, whatever. Are we have a contact us form on our website? Things. Can we get into the episode? Let's take a quick break and then we'll get to hear from Dr. Suzanne Dwayan

herself. Let's do it. We are thrilled to have you here, Dr. Dwayan. Thank you so much for joining us. If we could start off with you introducing yourself a little bit and telling us how you became interested in the field of toxicology and how you ended up as the medical director of a poison control center. Thank you. And thank you for having me. This is just for me a wonderful opportunity to share a little bit about the world of poison centers.

So my name is Suzanne Doyon, and I'm a physician. I went through medical school. but after finishing medical school, emergency medicine was where I was headed. And so I did a residency in emergency medicine. And during those four years, as an emergency physician, you rotate to a number of different places. You do a little bit pediatric work. You do this at the other. One of the rotations was a whole month at the New York City Poison Center.

And I just, you know, really, really enjoyed that work. So upon finishing my four years, I chose to do a work. what they call the fellowship. So that was my entire training. Four years of medical school, four years of emergency medicine, and two years of medical toxicology. What was it about the specialty that attracted you, right? And so, of course, poisoning's very, very interesting,

but really it's the opportunity to really dig deep into a subject matter, to have an expertise and to honestly bring that expertise to the bedside to physicians with a little bit less expertise and guide them, you know, through the process. Because I always found emergency medicine to be more of a horizontal specialty. You know a little bit about a lot of different topics. This was an opportunity to know a lot about one small topic. And that really attracted me.

Now, following that, you asked me, how did I become a medical director of a poison center? So once you do all this training, you have a couple of avenues. you can go in the industry, you can do a number of things, but the two big avenues are, are you going to be in a hospital where you consult at the bedside and, you know, see poison patients at the bedside? And you're responsible for that one patient in front of you and make decisions accordingly. The other avenue, which is the avenue I chose, is to go more into a bit of more of a public health around, so to speak. You become medical director of a poison center. And then, yes, you are to some degree involved with the management or the care of a patient

at a bedside because you will be on call for the poison center. But also as a medical director, you will make more population-based decisions. You will build the kind of decision trees. You will have to make big decisions on, you know, this antidote for my patient, my entire state patient population versus this antidote. How are we going to kind of deal with this? I found that to be very, very impactful. Because again, the decisions you may impact the population of your state. So that's millions of people usually. And then as I said, we're on call. What does that mean? So when a poisoning is that that's severe, we have physicians on call 24-7, 365. So occasionally, that's me. But I parachute in and talk to the physician at the bedside. So the physician at

bedside sees whatever it is that they see, whatever poisoning that they're seeing, they give me the details. We go back and forth with questions to try to kind of get the story straight. I help with the diagnostic testing and any therapy that is administered at the bedside. So just to give you an idea, you know, cyanide poisonings don't occur very often. Given poison center of my size, Connecticut is about 3.5 million people. We'll get about one cyanide overdose per year. So there's no single physician in a hospital out there that has a lot of experience with cyanide overdose. It just doesn't exist. But I get to see about one a year. It's not a heck of a lot, but I get to see one a year. So after 10 years, I've seen about 10 or roughly. And so

there are antidotes for cyanide poisoning. But often the physicians I'm speaking to have never given the antidote before. They're just like, I'm a little bit uncomfortable here. I've never given this before. And I'm like, that's okay. I'll stay on the phone with you. Just stick me on hold. I will not disappear from the phone. Administer it if you run into any problems. I'm right there. And we can kind of navigate whatever difficulties you're having. Now, in reality, the Sinai Antidote is pretty easy to administer. It's pretty safe. But still, it's addressing that comfort or that lack of comfort. And so sometimes we stay on the phone. We really do stay on the phone with the physician in a critically ill patient to really help them at the bedside.

So I find that very rewarding as well. It's not population-based medicine. It's case-by-case medicine, but that's very, very rewarding. Of course, you get an incredibly diverse array of phone calls at a poison control center every single day. And I was hoping you could take us through sort of this decision tree for what happens when you get a phone call, what are the first step? What are the questions asked?

What, like, what sort of paths can you follow down afterwards? So first of all, let's talk about the phone and the phone system. We are not like 911. Our phone number is a 1-800 number. It's quaint. We're working. We would love legislation to have a three-digit number. But getting Congress to agree is a little bit difficult at times.

But that 1-800 number, no matter where dialed from, A landline cell phone doesn't matter will be answered 24-7-365. And I want to specify here not by AI, not by artificial intelligence, a person will answer it. On occasion, there's wait times, but we really strive to keep our wait times extremely short. So at 1-800 number available 24 hours a day, we never, ever, ever not answer the phone. But what's going to happen? And so you're going to get a person who's going to first ask sort of what's the emergency. Is this really, really something extra emergent?

Or is this something I can take my time and get the patient's name and so on and so forth? But they will ask you your name or the name of the child. You know, if it's a parent calling, they will ask the age of the person. They will often ask, you know, a gender as well. And then what happened? What's the scenario? Was it ingested? Is this more of a dermal?

exposure that we're worried about? Is it an ocular exposure that we're worried about? Is it an injection exposure that we're worried about? Is this an acute exposure? It just just happened one time, one time right now just happened or is this something that was every day for the last month or so or something like that? Is this an accidental exposure or is this something intentional? And ultimately, what is this substance? Is it a drug? Is it a chemical that we find in the household? Is it a snake bite? Is it a spider bite? Is it something that was breathed in?

Is it some kind of smell or some kind of smoke or some kind of gas in your neighborhood? So then once all this information is collected, often the poison, they're called poison specialist. The poison specialist right off the top of their head knows what the ingredients are, knows what are the potential pitfalls, and will make recommendations. So the recommendations will vary from stay at home. and we don't need to worry about it too too much, to you need emergent, immediate medical help.

How they make these decisions is based on their intrinsic, sort of internalized knowledge of things. And then I create for them 100 to 200 different complicated algorithms that they can follow as well. The algorithms are available for them 24-7. and it's on a computer platform. And over time, though, they internalize, again, a lot of these algorithms. You use the same algorithm every day for, you know, a week.

You've internalized it usually. So that's what happens when they call the Poison Center. I love it. Having called the Poison Center several times, it's just, it's always a phenomenal experience. If that is a thing that you can say about an emergency situation. Well, I'm happy to hear this. We strive to be nice, polite. on the phone, but we mostly strive to be helpful.

Collectively, in the United States, every poison center feels the same way. If we're not helpful, we just, yeah, then we have failed terribly at our jobs. Let's take a quick break. 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 arrive with pre-portioned ingredients, so there's no meal planning and no extra grocery trip. There, assemble and bake meals, take about five minutes of hands-on prep.

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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

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In 2023, a story gripped the UK, evoking horror and disbelief. 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 Letby, 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. So speaking of that, of your staff

and everyone that you have at your Poison Center, who are the people, the Poison? The Poisoned and specialists who work at the poison center? What kind of training does someone need to have to be able to be a poison center phone operator? So who are the people answering the phones? They are not operators. They're not volunteers. They're paid. They are usually of two trainings. They are pharmacists or nurses. If they're pharmacists, usually they're licensed in the state, in that state, and nurses are licensed as well. If they're nurses, they're usually, they usually have one or two years of critical care experience or something like that. And that's to qualify for the job.

Now, once they qualify for the job, there's usually about one year of solid training that goes on, where they are supervised in real time. We listen to their calls to supervise and make sure that they do the job correctly. And as they get better and better at their jobs, of course, then we don't listen to every single call. A lot, a lot of one-on-one teaching hours. and hours, hours of didactic training.

All this culminating into a certification exam. Once they become certified, they can really fly solo on the phones. If the case is very, very serious, they will then immediately call the physician on call. The physician on call is someone like me, someone with medical toxicology training. We can sometimes just speak to the poison specialist to give them some guidance, but sometimes this is just plain so serious, we must speak to the ED physician, to the intensive care physician, whoever is at the bedside of the patient to help with what's going on. So yesterday I was on call.

Sometimes the patient had been in the ED, the patient was stable, completely stable, but they had done all the labs and the labs had been reported back to the poison specialist, and it is at that point that the poison specialist called me to review the labs to see if, based on the labs, it was safe to send the patient home from the ED and not admit to a patient. So sometimes the questions are those. You know, how can we safely take care of this patient and so and so forth? And think about that. That saves an admission.

Yes, it saves health care resources. But think about the patient. The patient is not facing an admission. The patient's family doesn't have to drive back and forth to the hospital to visit the patient. A patient doesn't get pricked for blood work and so and so forth. gets to sleep at home, all these things are good, good things for the patient, for the system in general. So we try as much as possible to keep the patients away from the hospital if we can. So this was a good use of poison centers in terms of saving health care resources and doing right

by the patient. The Poison Decks. What can you tell us about the Poison Dex? So Poison Index is how some people call it. Other people call it micrometics. we use the terms interchangeably. But what is this? What is this? This mammoth that it is. So I will tell you, the poison specialists are probably in micrometics every minute of every shift. But what is it?

It's an online database. There's an internet and there's an intranet version. But it's a huge, huge, huge database. You know, you just put, for example, Mr. Clean, whatever, some kind of cleaner you use in the household, but you put the brand name and it will start outlining the ingredients for you. But you say you can get that from the label, so why do we have Micromedics? Because then Micromedics classifies the different individual ingredients into kind of categories or buckets, so to speak. And that helps us kind of understand the product much, much, much, much better.

So let me give you an example. Let's say this cleaning agent used in the household has benzolamonium chloride. We in poison centers all know what that is. But let's say you're a new poison specialist. You don't know what that is. Micromedics or poison index is going to classify benzolamonium chloride into cationic detergents. Now, the poison specialist should know cationic detergents of all the detergents out there. Those are the ones I need to worry about. So there starts the process. And in cationic detergents, it's only concentrations of the detergents above 7.5% or so that we worry about. So the next step, once the poison specialists recognizes a cationicotionic detergent, is go back at what percentage this?

Is this 2%, 3%, 5%, 17%, what is this? And then take it from there. So it's a combination of knowing how to use a database, but that's what micrometics does. You need to be able to read labels as well. So we're very fortunate in the United States that we have very strong labeling laws. They date back to the 1960s. And so they will list the active ingredients and they will list the inactive ingredients. And then when you see that list of active or inactive ingredients, it doesn't matter.

The most concentrated one will appear first. Not the most toxic one. The most concentrated one will appear first. And then the least concentrated ones will appear less. and usually if the concentration is less than 1%, they're not mandated to put it on the label at all. Those are the basic, basic roles. So that, again, if you know these rules,

you can start decoding a little bit, these labels that we have on all the products out there. But that's what we do with micrometics. That's what we do with labels. Using brand names, it helps us kind of drill down to what the ingredients are and what the toxicities are. So how do you analyze the risks of ingestion or exposure when there are multiple substances, either the example that you gave of like a cleaning product that has this long list of

ingredients or someone who either intentionally or accidentally took a mixture of different medications? Like how do you, I assume with the assistance of micrometics, prioritize these ingredients and what other data do you need to be able to work through that problem? So I think we probably encounter that, honestly, a little bit more when people ingest different medications. And these are called drug-drug interactions. And they're getting a lot more common than they used to be. There are not that many, honestly, computer programs that help you with it.

So what it is, is honestly, just having a basic knowledge of what gets metabolized what way and what medications can interfere with that metabolism. So that's a pharmacokinetic. Or just knowing intrinsically that, for example, a medication gets primarily eliminated by the kidneys. And then just hearing that either another medication is added or just hearing that the patient's kidney function, the patient's renal function, is a little bit off. So having a little bit of knowledge of these kinetics is important. important. So we have to teach the poison specialists. We really kind of just have to teach and teach and teach them. Then we have the other drug-drug interactions that we call pharmacodynamic. So a drug

binds to a receptor and another drug is added that binds to the exact same receptor. That's basically bottom line, knowing how every drug out there works. And we carry that knowledge. We just have that knowledge. We teach it. And so we can often, often, just right off the top of her head, say that mix of that drug with that drug is just not going to be a good mix because they tackle, they affect, they target the same receptor, and that's going to be a bit of a problem. We're going to have too much of an effect or not enough in effect, depending on whether they're agonists and antagonists and so on and so forth. When we're talking about all the different chemicals in household cleaners, for example,

the cleaners are all there to kind of clean, so they all have kind of one, they're all there to aim for one given thing. And the active ingredient is the active ingredient for the purpose of that product. So, for example, an insecticide, you look at the active ingredient. The active ingredient is the ingredient to kill insects. So is that going to be an active ingredient in the human? Maybe, maybe not, right? So a lot of insecticides these days contain what we call pyrethrines.

Pyrethrines kill insects, but they're not particularly. problematic in humans. So we're not going to worry too much with the insecticides, or at least the active ingredients. Then we're going to start looking at all the other things they added there. Things to make it more liquid. Things to make it smell. God knows what smell they're searching for. Things to make it maybe a bit oily. So when you spray it on your plants, because it's oily, it stays on the leaves. All these things we're going to look at and see if it's particularly problematic for humans. And then, so if the patient ingested the insecticide, but also then ingested turpentine, so then does the turpentine interact with the insecticide?

So that's just a lot of thinking, a lot of thinking, but again, we navigate that and again, try to figure out how to best help the patient at that point in time. Let's take another quick break. 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 Letby, 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 Eckerd, 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, 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 warrant. 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. You mentioned how some of the calls that you're getting more of these days involve interactions between different medications as people are going on more medications. Have you noticed any other trends in what calls you're getting more or what types of calls you're getting more, today compared to calls in the past or even just like in the overall number of calls that you're getting? Absolutely. So we keep abreast of these trends. And so you're going to hear a whole host of things as just the population shifts in what it is that they purchase, what it is that they have in the home, what children have access to. So you're going to hear a lot of noise right now about

melatonin, for example. So the melatonin products have been largely manufactured into gummies. They look like little candies. Some of them are actually shaped like little teddy bears, but they certainly have very beautiful colors. They look like candy. So not surprisingly, even though they are provided in big jars with child resistant caps, children are just either breaking through the child resistant cap or some way, shape, or form getting into the gummies. And so there's a lot of, you know, melaton gummies. So on the issue of gummies, marijuana gummies, not to those around. So the states that have legalized marijuana, adult use marijuana, will have usually a component of their marijuana products that are what we call the edibles. And the edibles can be all kinds of different confections.

And so some states have been very strict on this. Connecticut has been very strict on this. Our edibles must have uninteresting square shapes. They can't have any interesting colors. They're kind of bland, really. They must be in child resistant. containers. A given edible cannot contain more than five milligrams per edible, five milligrams of THC, the five Delta THC, the active ingredient in marijuana. And you cannot have more than

100 milligrams in a bottle so that if the child gets into the entire bottle, it's still a large amount of 5 THC for the child, but we're not talking thousands of milligrams. We're talking 100 milligrams. And so gummies, you're going to hear a lot about gummies as being a problem. The changes in abortion laws are recent. So we haven't quite, quite studied yet or produced the data yet, but we expect an increase in use of herbals, dietary supplements, to terminate a pregnancy in women who have very few other. options. I can't say that we've seen, but we're watching this. We're watching this right now. We're surveilling this. We've definitely seen an uptake in the GLP1 receptor agonist,

the OZempig, Wgozi, there are a couple of others out there, injectables that are used for the management of diabetes, but more recently for weight reduction. And we see all kinds of behavior with that from wellness spas that are dispensing ozempic. We've also had people who, if one dose of ozempic is good to lose weight, then doubling the dose is probably better. You have to be very careful with these products. The escalation of the dose is very, very slow. So if you escalate the dose too quickly, you run into adverse effects and they get a lot of nausea and vomiting and it lasts for days and days and days. It's a gastroporesis type of nausea vomiting. So problematic. Back to the, you know, the OZMPIC dispensed from non-retail pharmacies. One such product was

analyzed. It contained insulin. It did not contain any semi-glutide, which is the ingredient in Ozmpic. It contained insulin. So the wellness spa sent non-diabetic patients who were looking to lose weight, they sent them home with syringes of insulin. Of course, the opioid epidemic, we're seeing a lot, a lot of that. The opioid epidemic right now is really a fentanyl epidemic. That is our major, major issue in the United States, is the fentanyl, its potency. Everybody's kind of hot under the collar about xylasein, but it's really the fentanyl that is the problem. And we're not out of it. Most of us don't predict we're going to be out of it for a good 10 years. It's going to take time to change the tide on that big, big epidemic. So I would say those

are the big, big trends we're seeing right now. But of course, that will change in six months. What do you find to be the most rewarding aspect of this work that you do? I think the times I go, yay, right? It's usually the appropriate use of an antidote. Appropriate meaning we We thought the problem was right. We aimed to solve the problem with an antidote, and then the patient did well. A cyanide overdose that gets the appropriate antidote turns the corner and survives, because cyanide is quite toxic, is just a cause for celebration. But they come in all shapes and forms.

I remember this. It was way way back, but funny story, the child was bitten by copperhead, had a pretty significant wound to the hand and was seen in the hospital that could not, they could not admit pediatrics. So this child went from this peripheral hospital by helicopter to what we call tertiary care pediatric center and got the antidote in the meantime, did very, very well, did recover, I think he was seven or eight, and kind of left the hospital. And so think about this. He was out there, got bitten by snake, got an antidote, helicopter ride to the city, all that stuff.

He goes, I have got a story for showing. tell. I've just got the best story. That was just like, yeah, you probably do. And that was just, it still brings a smile to my face, just really, really funny. Those are yay moments for us in poison center circles. But it's usually saving a life, getting the antidote right, getting it in quickly, and the patient turns the corner. And any physician will tell you that that's just, you feel like a thousand bucks, or a million bucks. You really, really feel like. like you're a superstar at that point in time. And it's so great to turn and turn to the family say, yeah, he's going to do okay. So those are great saves and are great, great moments.

They're few and far between, but they're great. That was such an amazing conversation. Erin, we could have talked all day. I was just going to say, I could have sat there for so many more hours, just like picking her brain and asking for stories. I know, I know. I would love to sit for a day in a poison center as well just to like hear it and experience it? Yeah. Well, and it's also, I think what's really amazing to me is that like this is a hugely impactful area of public health that I didn't really ever think that much about or know that much about or know was an option.

And I just think it's really amazing to know that, okay, let's say that you go into the field of medicine and you're like, I want something that has one foot in public health and one foot in medicine. This is a great opportunity for that. Or if you're just like, hey, you know what, I want to keep in my brain an absolute database of compounds and what organ metabolizes them and what receptor they use and blah, blah, blah, like, it's so cool. Yeah. Also, Aaron, I agree 100% that this is like, especially coming from the field of public health, not realizing how amazing and impactful poison control is, that's what we're about to get into. It's like what poison control can do for you, what it's already doing that you didn't even know about. I will say that we're going to focus on the

U.S., and this has been a very U.S.-centric episode, but we're also going to get into just how much the U.S. doesn't focus enough on poison control, hint, hint, funding-wise. And I will get a little bit into the global status of poison control centers worldwide. Spoiler, there's never enough of them, but they do exist. Nope. And yeah, because there is just, there's so much there, Aaron. I can't wait to get into it. So currently as of 2024, there are 55 poison control centers, which have recently rebranded into Poison Help Center, I think is what they're calling themselves. So not every state has their own poison control center, but every state in the U.S. is served by at least one poison control, as are all U.S. territories. But here is a thing that I, again, thinking back to how this started, I just love this about the poison control centers in the U.S.

is that all 55 of these use a centralized reporting system, which is called the National Poison Data System. And we heard a little bit about this and the information system that they used in our interview, but this reporting system is the National Poison Data System, or the NPDS. This uploads real-time data of every single call that is made to all of these poison control centers.

This generates so much data that we can use to understand the impact of poison control centers and be able to actively in like real time see trends like we talked about in our interview on like, what are people calling Poison Control Center about? Surprise, surprise, it's Ozempic these days, right? Yeah. And so from this, we also get these incredible annual reports. The most recent annual report that came out was from 2022 that was released in January of this year. And it happened to be the 40th NPDS report.

So happy anniversary. And so this gives us some pretty solid statistics on how many people are calling and for what reasons. So in 2022, in the U.S., there were over 2.4 million encounters logged. Of these, over 2 million of them, 2,064,000. 875 were human exposures. 50,000 of them were animal exposures, and 360,000 of them were information requests, which means people contacted poison control, even though there wasn't an actual exposure. Okay.

And we can see what the top substances were that people called about or that people were exposed to. And these, interestingly, like the top four main categories haven't changed a ton over the years. And what's interesting is that in this report, because it was the 40th, they had a data table that was, like, compared to 1983 when this started and 2022, what are the differences? And there are definitely some, but top of the list for exposures is analgesics. And that is things like acetaminophen or Tylenol and ibuprofen, which account for 11% of all calls. Okay. Next on the list is household cleaning substances, followed by antidepressants. followed by antidepressants and then cosmetics or personal care products, which is also interesting.

Now, who is calling in? We get that information as well. Unsurprisingly, unfortunately, kids under five account for the majority of exposures, like kind of overall. So kids under age three accounted for 28% of all exposure calls, and kids under five accounted for 40% of all exposure calls. And kids under five accounted for 40% of all human exposures. Okay. And they are actually more likely to be exposed to cleaning products over analgesics, which is like we talked about because they're easily accessible. And a lot of times we might not think about them having as kid proof of access like a lot

of our medications do these days. Right. All told, all of these over 2 million exposures resulted in 3,255 cases of death. 2,622 of which were judged as directly related to the exposure. And what I found really interesting is that out of all of these poison control calls, whenever there is a death that's reported, there's a really complex review process where they go back to that data to try and determine how likely it is that the exposure was related to the death,

if that makes sense. Okay. Interesting. Yeah. So that was like a lot of data thrown at us. And there was a really interesting radio lab episode that I listened to. You listened to it too. I did too. Yeah, it was so good. It's really great. Their production value can't be matched.

But one of the things that they mentioned in that episode is that calls have been on the decline to poison control centers. And it's in this report as well, too. Calls have been on the decline. There have been a fairly continuous decline in total calls to poison control centers since about 2008, which is when it peaked. When it peaked, there were just over 4.3 million calls to poison control centers in 2008, which included 2.4 million exposure calls, human exposure calls,

and 1.7 million information calls. There was some spikes during the pandemic, especially related to disinfectant use and then COVID vaccines and things like that, which is probably interesting in its own right, very interesting. But I'm not going to get into the detail. But what I think is so interesting about these trends specifically are a few important details that are even bigger picture than just a declining calls. What this declining call seems to reflect is a number of different things. The report from 2022 cites that there has been overall declining birth rates, which is important because exposure rates are so much higher in children under age five.

Interesting. And an increasing reliance on the Internet. Because a huge part of what I just said, 1.7 million calls were information-only calls compared to 360,000 information calls in 2022. So when someone is looking for just information about a substance without a direct exposure, they're going to go to the Internet first.

And that makes a lot of sense. Yeah. Now, as of 2015, poison help.org can actually get you really similar information to what you're going to get from a poison control call because you can get in touch with poison control via their website poison help.org as of 2015. So some of these cases might still make it into the poison control database if they're coming from that website, if that makes sense. Uh-huh. Yeah. But what we can't necessarily interpret from this reduction in calls is that, exposures are decreasing because what this data from 2022 shows is that exposures with more serious

outcomes, including hospital facility calls and calls that result in major harm or death, have actually been on a slight increase across the same time period. Okay. What are the characteristics of these calls? Like, are there patterns in this? Not necessarily patterns aside from just that they're more serious calls that, that have a more serious outcome, whereas information only calls and calls about less serious exposures tend to be, have been on the decline around the same period. And it's not a huge increase. I think it was like 0.17% from last year, for example, and that's about on average. I think it's like 1%ish over the years. But it is really important, right? That people are still having dangerous

exposures and still relying on poison control to call either from their home, or healthcare facilities are relying on calling poison control for information. And so this is a really important thing that poison control centers are kind of grappling with, is like how to bring themselves into the 21st century, which is really important, because we can look at lots of data and see how important poison controls are in terms of lives saved and in terms of health care dollars saved, Aaron. Uh-huh. which I love to talk about.

We don't like to think about health care dollars, but we talk about them on this podcast a lot because, especially in the world of public health, you have to unfortunately justify your existence using dollar signs. And it happens that in the case of poison control, we can absolutely do that. There was a ton of different studies that I saw, but I'm actually going to cite a few that were really old

just because they highlighted this point so well. There was a paper from 1991 when the state of Louisiana closed their poison control center, and then they were able to compare after this closure in Louisiana, information between Louisiana and Alabama, which is right next door, has very similar demographics, and prior to the closure of the Louisiana Poison Control Center, had very similar almost identical triage patterns for expanse. of their poison control center.

So when they looked at the data, it was like really, really similar calls that were coming in. Okay. And what they found is that the rates of people who had to end up going to the emergency room or urgent care or the doctor's office in Louisiana after the closure of this poison control center,

four times as many people sought care for poison exposures in Louisiana compared to Alabama during that time. And the estimated cost of this hospital and outpatient utilization for things that these are low-level exposures that did not need to be managed by health care facilities at all was $1.4 million. Oh, my gosh. And you might say, well, that's not that much money when you look at like huge health care spending

overall, but it was also three times as much as the Poison Control Center cost to run in its entirety. Oh, my gosh. Okay. So I have a question, though, just like logistically, when you call poison control, it's 800-22-2-2-2-2-2-2. That's the number. So when Louisiana shut down, it's poison control, what did that mean if you were in the state of Louisiana and you called that number? That is such a good question. I don't know what happened in 1991. Okay, 1991. So things might have been organizationally different. So I don't know if like they just lost

access entirely. I know that they had enough data to be able to say there's no access here. Let them hear and see what happens. Yeah. Because right now, when a poison control center shuts down and we'll get there, then calls are going to be rerouted. But it could end up then overwhelming another poison control center if you don't have enough people to kind of run it and that sort of a thing. Okay. But yeah, that's a good question. Follow question. After this report came out, did Louisiana immediately go, oh, wow, whoops. I don't know the time frame, but there is one now. Okay.

Hopefully it was 1992 or like whenever this paper came out. I don't know. But there are a lot of other things that go into how much poison control centers can help, right? There are a lot of other examples like this. There's also some really good ones. There's a paper that details how in El Paso, when they coordinated really well with a poison control center, they have documented that they were able to avert like 1,700 ambulance calls in a really short time period. Whoa.

There's a review paper from 2009, and a lot of these papers were really quite old, but it had a lot more numbers. And that combined with a report that I will say was commissioned by the American Association of Poison Control Centers. So there was some bias for that because it was a consulting firm commissioned by Poison Control. But looking at all of this data, the overall cost savings estimate of Poison Control Centers is between $7 and $15 per dollar spent, which accounts for close to a billion dollars in health care savings annually. And that's not even counting how many lives are saved because there are a lot. Like, there is a lot of data that shows that you can reduce hospital length of stay and you can improve health outcomes by having access to poison control center.

Despite this, budgets are constantly at risk for poison control centers in the U.S. It's the same story for public health in general, and it is infuriating. It is the most infuriating and just the tail as old as time, honestly. Most of the funding for poison control centers is a mish-mash cobbled together budget, right? Some of the funding comes from state budgets, some comes from federal budgets. There's like over 29 different agencies which contribute to various poison control centers. And I said that there were 55 poison control centers in the U.S. If you read some of these papers, they'll tell you that there are 61 because there used to be.

But in the last few years, several of them have closed due to budget cuts. The poison control centers in the U.S. are so vulnerable. It is bananas. When you look at the data of how much they contribute, how many dollars they save, how much data we are able to generate from this real-time reporting system, like the value that they bring is incredible. So that's our rant. I don't know how to fix that, but it's a thing. I mean, invest in public health. Mm-hmm. Yep. Yep. Now, globally, speaking of investing in public health, as of January 20203, only 47% of World Health Organization member states have poison control centers. Hmm. So it's a pretty low number. Most of the countries in Europe, Australia, the

UK, they all have poison control centers, but especially in low and middle income countries, there's a lot of parts of the world where people just don't have access to this information. which is a huge issue. Right. Well, and I think it just sort of shows in general that pattern where it's expensive to invest initially in poison control centers, but over the long run, it saves money. Exactly. But if you don't have that initial investment and it's more like, okay, well, just triaging

the healthcare situation, then preventative stuff is like down the line. Right. Yeah. If you're so deep in survival mode, you can't. I think, yeah, that many steps ahead. Yeah. It's tough. But they're incredibly valuable.

I also, so that everyone can say they know exactly how to contact, if you are exposed to a potential poison or you're worried you are exposed to something hazardous, you too can have the joy of calling your friendly neighborhood poison control center. The phone number is 1-800-222-2-2.2. Or you can go to poison help.org. And another plug for the incredible poison-holt. help.org website is that in 2022, they updated this website. So in addition to you, if you don't want to talk on the phone, you are not into talking on the phone. A lot of people aren't into talking on the phone. You don't necessarily have to. You can through their website, fill out this information. They ask you very specific questions and you essentially go through the same exact steps as you

would talking to someone on the phone, which is great. But as of 2022, they also have an option where you can say that this is a test or an information call rather than an actual exposure, which I think is just really, really helpful. If you're like kind of worried about something but you don't know if anyone is exposed, but you're just worried about bringing something into your house or whatever it is, you can go there and get some information. It's phenomenal. That's all I got, Erin.

Poison controls. Wow. Love them. Love them. Are there poison control T-shirts that we can? You know what? We should find out. We should find out.

And get some. But until then, until we can get our hands on a T-shirt or make a T-shirt, design a T-shirt? Until then, you can read more all about it. Specifically, let me tell you where I got my information today. So Aaron already told you last week. Unsurprisingly, almost entirely, my information was from the 2022 annual report of the National Poison data systems or NPDS from America's poison centers. It was their 40th annual report. It was really phenomenal. There is literally so much detail in this report. It's like it just keeps going on and on and on.

But I also had a number of really interesting papers about the impact of poison centers, both historically and today and then a list from the World Health Organization of a directory of poison centers, which isn't entirely up to date, but is really interesting. You can find the list of these sources from this episode and every single one of our episodes on our website, this podcast will kill you.com under the episodes tab. Thank you again so, so much, Dr. Doyan, for taking the time to chat with us and sharing those amazing stories. We had the best time. We really, really did. And also thank you for being so enthusiastic and like sending more ideas and things that we have so many more things to cover. I am thrilled about it. Yes, totally. Thank you also to Bloodmobile.

for providing the music for this episode and every one of our episodes. Thank you to Tom Brifogel and Liana Skulachi for the amazing audio mixing. We love it. Thank you to everyone at Exactly Right Network. Thank you to you, listeners. For listening.

We really hope that you enjoyed these last two episodes and learned more. And maybe, again, if you have a poison control story that you want to share, please send it our way. Yeah, love to hear it. Thank you especially to our patrons. Thank you so much for supporting us on Patreon. We really appreciate it.

It means the world to us. It really does. Well, 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.

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