A pill bottle with a skull and crossbones on it sends a universal warning: DANGER.
But in plain view in the average home, dozens of items used every day are potentially hazardous. And when young children touch and swallow things that catch their eye -- peppermint pink cleaning fluid or bright red iron pills -- the substances can be fatal.
Hundreds of children were dying from poisoning each year when Frederick Mayer, a pharmacist in San Rafael, California, first launched his campaign to protect them some 40 years ago. His first goal was to educate parents and motivate them to lock up household poisons. As for dangerous medicines, the consumer activist, who has a master's degree in public health, saw a simple way to keep them out of children's hands: Companies that produce medicines should make caps harder to open.
Mayer still bristles as he recalls the resistance he and other activists faced. "The industry didn't want safety caps because they'd have to develop a new one that adults could use but kids couldn't," he recalls. His organization, Pharmacists Planning Service, Inc. (PPSI), joined forces with the U.S. Consumer Products Safety Commission to fight for child-resistant packaging so that fewer children would fall prey to tragic preventable deaths. In the early 1970s, the safety groups prevailed, and a mandate for child-proof safety caps for aspirin and other oral medicines went into effect. All in all, the CPSC estimates, child safety caps have saved the lives of about 700 children since they were introduced.
And children are not the only group that Mayer and his group are looking out for. In the early 1990s, the pharmacist's group circulated a citizens' petition demanding that the Food and Drug Administration increase the regulation print size on over-the-counter drug warning labels to make them legible for seniors. "Seniors like myself weren't able to read labeling. If you can't read it, you can't understand what to take or not to take," says Mayer. At federal hearings organized by PPSI, citizens' groups testified that seniors could not read the tiny-print warning labels on pill bottles. Over-the-counter drug manufacturers countered with an offer to comply voluntarily and managed to postpone new laws by a forceful media campaign with such slogans as "Don't let the government into your medicine cabinet."
To Mayer, however, that's exactly where the government needs to be. PPSI stirred up enough people to launch an annual Poison Prevention Month nearly 40 years ago. (The federal government went on to recognize the third week of March as National Poison Prevention Week.) And with new over-the-counter drugs and herbal supplements flooding the shelves of supermarkets, pharmacies, and grocery stores each year, Mayer's group has plenty to keep him busy. Shortly before he rushed off to his next conference, Mayer granted this short interview from his northern California home.
Why did you start your poison prevention campaign?
Because so many children were dying from swallowing poisonous stuff they found in their homes, everything from ant and rat poisons to paint, paint thinner, medicines, poisonous plants and mushrooms, fancy-looking berries, you name it: Kids will put anything in their mouths. When we started our program (in the early 1960s), Walt Disney allowed us to use Jiminy Cricket in our campaign. After 23 years, though, Disney took it back because they merged with another company that didn't want us to use him.
What's the most important thing parents can do to protect their kids?
Store anything potentially poisonous in a locked place or up high, out of children's reach. This includes items like nail polish remover, silver cleaner, furniture polish, insect bombs, toilet bowl cleaner, and chlorine for swimming pools. Pay special attention to the bathroom -- it's full of things like rubbing alcohol and mothballs, which are small and round and probably look good to a child. And get rid of all your medicines that have expired.
What else should parents do?
Make sure you know the number of your local poison control center, and keep an instruction sheet in a place where everyone can see it that tells what to do in the event of poisoning. Give your babysitter, the grandparents, and other caregivers these instructions and the number of the poison control center.
Could you tell us more about your campaign to increase the print size for drug warning labels?
One of the main reasons we wanted larger warnings was that seniors were misusing ibuprofen, a common over-the-counter painkiller. Thousands of people get gastrointestinal bleeding from it each year, and a number of them die. They wake up at night with arthritis pains and they take the drug on an empty stomach because they can't read the label telling them to take it with food. We got a law passed in California that calls on the FDA to increase print size of warning labels.
You've recently turned your attention to warning labels for herbal supplements. How does this work relate to your poison control campaign?
Alternative medicine is an area of great concern for us, because people are dying, literally, for lack of good information. People think that if something is advertised as "natural," then it's healthy, and that's not always true. The FDA has logged more than 180 reports of deaths linked to dietary supplements. One of the most dangerous is ephedra, or ma huang, whose active ingredient is ephedrine, a stimulant. Kids use it as a stimulant, and what happens? Sometimes their blood pressure goes up so high they pop a blood vessel and die. (Editor's note: The FDA banned over-the-counter supplements containing ephedra in 2004, but there is still some question whether small amounts of ephedra can be found in certain products.)
The problem is that there are no regulations requiring the manufacturers to spell out all the possible side effects of these supplements. I mean, if you use an over-the-counter medicine that can raise your blood pressure or interfere with pregnancy, the label has to tell you that. But if you buy an herbal supplement, the label doesn't have to tell you anything. No one is watching out for the consumer. So we want to change the law to require the same kind of warning labels for herbal supplements that you find on regular medicines.
As a pharmacist, are you concerned about the possibility that some herbs can interact in a dangerous way with over-the-counter or prescription drugs?
Absolutely. That's the biggest issue. Although some supplements are beneficial, some interact with over-the-counter or prescription drugs in a way that can harm or even kill you. Popular products such as ginkgo, which is available in health food stores, may be lethal in some cases if taken with the anticoagulant drug warfarin. Countless Americans take warfarin, but if you combine that drug with ginkgo, which also has anticoagulant properties, it can cause fatal bleeding. And not everyone realizes that.
Because products found at health food stores are unregulated, it's not even clear what you're getting. There are no standards, so you often don't know if the product is coming from the root, the leaves, or the stem. There is no good labeling, no warnings. It's strictly "buyer beware."
What about poisoning from prescription and over-the-counter drugs?
That's a huge issue. More than 100,000 people in hospitals die each year from adverse drug reactions. That makes them the fourth leading cause of death, behind heart disease, cancer, and stroke. Isn't this incredible? Why aren't people screaming and hollering? And we have other consumers getting their drugs mixed up at home. Pharmacists are underutilized; they're in the back of the shop typing and pouring. Consumers need them to be up front counseling and answering questions. We're not talking about rocket science here; we're talking about simple solutions.