Mar 16th 2017 by AmyChu • 38 Questions • 41 Points
I am a federal budget analyst. My focus is macro fiscal policy, including the main drivers of spending and revenue, deficits, and debt. I am happy to talk about the Trump skinny budget, and I am happy to talk about the American Health Care Act, though I'm not a health policy expert. The opinions expressed here are my own and do not reflect those of my place of employment.
Amy, if you were to create a superhero who derived their powers from alcohol, what would they drink and what powers would they gain?
What is the wildest / Funniest call you guys have gotten?
Thanks for the great response. Why don't we (the government or people who can) close the fiscal gap then?
okay you get the prize for the best question so far... :-) hold on...
A family called us after attending a funeral where the corpse spontaneously exploded. They were worried that they might explode too. Jess Benson, Pharm.D., DABAT
I just realized I didn't give a good enough answer on this. Sorry about that. The reason we don't is that we can't agree, and there's still a long way to go to get there. Republicans don't want to do tax increases. Democrats don't want to do significant cuts to Social Security, Medicare, or Medicaid (the parts that are actually growing). So, that leaves us at a longer-term impasse.
But, all the stuff I said about the progress is still true.
Isn't LIHEAP proposed for either drastic reductions or total elimination every year?
You are welcome. Glad we could be of service to you. The decision to send someone to the emergency room instead of treating them at home is based on many different factors including what substance is involved, amount, how long ago the exposure occurred, age, weight, prior medical conditions, symptoms, time of day, distance from the hospital and whether they are responding to home treatments. In general if there is any chance that the person could develop serious injury or life-threatening symptoms they are referred to the emergency room. That being said, poison centers are able safely treat 67% of exposures at home. This is a good reason to call before you go. Many times you will not need to go to the emergency room for common poisoning exposures. Jess Benson, Pharm.D.
Great question. The answer is that most of the low-hanging fruit is used in deals. There just aren't trillions of dollars for things that each side says is fine. In order to get to a place, one side needs to have the ability to exert its will, or each side needs to be willing to do stuff it doesn't like. One of the biggest issues with growing polarization is that agreeing to the stuff you don't like is a much bigger deal. Bush 41 increased taxes. When's that happening again? For the Joint Select Committee of Deficit Reduction, Paul Ryan was one of the Republicans appointed. Not a chance in the world that he was going to accept big tax increases. Chris Van Hollen was there on the other side. Not a chance he was going to go for major Medicaid cuts.
Yes. Tony Hillerman's son (Tony Hillerman is a famous mystery author) once called to run a few poisons by us. He was helping his dad at the time. I was also asked to give a talk to a group of aspiring authors about qualities of the perfect poison. If you are interested in this topic I recommend a book called "Criminal Poisoning: Investigational Guide for Law Enforcement, Toxicologists, Forensic Scientists, and Attorneys (2nd ed.)" by John Trestrail III. Jess Benson, Pharm.D.
I think that humans generally don't deal with percentages or multiplication well. And so even if we know how much things "should" cost (questionable), I don't think anyone intuits the multiplication of that across the population. So, when people hear, "The budget is $4 trillion," that sounds crazy. But when I tell you that Social Security and health care make up half of that, it's a little less crazy. In truth, I think humans (myself included) are bad at estimating everything until they're forced to make percentages add to 100. That's how people can think that foreign aid is 28% of the budget, when it reality it's (depending on whom you ask - this is an impossible question because the classification of what's really foreign aid is too murky) is anywhere between like 0.2% and 2%.
Regarding the “order” of the information, the most important initial information to give Poison Control would be: the name/description/brand of the substance that the patient was exposed to (ex: Advil Cold and Sinus liquid, D-Con Bait Pellets, Fabuloso All-Purpose Cleaner, Crayola Markers, holly berries, dog poop, a white mushroom, a brown snake, Tylenol Extra Strength tablets, etc.), how much of the substance was taken (10 tablets, a sip, 2 mouthfuls, one leaf, two pieces, a small taste, etc.), when the exposure/ingestion occurred, how the patient is doing now, what has been done for them so far, and their age/weight.
RP, PharmD, MPH, Certified Specialist in Poison Information
Which memes? Are you talking about the ones showing defense at over 50% of spending?
If the federal government eliminates the national endowments for the arts and humanities, how likely is it private citizens will step up and donate funds to sustain these programs while the obese orange man is president?
Good question! I think everyone has a different story about how they "broke in" - it's kind of a long answer for me, but the short answer is-- by accident. I was trying to help a writer girlfriend of mine and I just got kind of got sucked in... (FYI she's now writing for The Expanse on the SyFy channel)
This is a very common question, I'm so glad you asked! Generally speaking, breaking a CFL bulb will not pose much danger to a person. The most important thing is to clean it up and dispose of it properly. The amount of mercury is very very small - it would fit on the head of a pin (much less than what you find in a household thermometer). The mercury vaporizes and so the route of exposure is generally through inhalation. If you break a bulb, DON'T VACUUM it up (this just vaporizes the mercury into the air you are breathing). Call the Poison Center before you do anything else and we will give you step-by-step instructions about how to clean it up and how to minimize your exposure to the mercury. N. Reid, RN/BSN, DABAT
It depends. There are some things, that private donations handle really well. But part of the issue is that donations are obviously limited. What about in a recession? And of course, this is much bigger for something like health. We're pretty good at donating to sexy diseases like cancer. But the federal government has a vested interest in looking at things that only might be an issue, but might be "wasted" money. For instance, we were looking at Ebola for years before the scare.
I will say that my personal believe is that not everything would be made up. What percentage of very rich people do you think would donate 25% of their income? Certainly not 100%.
Awesome, thanks. Would you say the description given by the EPA is appropriate or a bit of an over precaution?
Iocane powder, of course. We have all spent the past few years building up an immunity to it. As you wish ;) P Soto, PharmD
How do you mean, outside of the budget? Money for the president's travel and security are inside the budget. I think this is sort of a definitional thing. If there's money for it, by definition, it's in the budget.
There are many. Button batteries are some of the most dangerous items that kids get into and they are found in so many products now -- remote controls, toys, hearing aids, key fobs and much more. These batteries can cause life-threatening injuries to the esophagus. Here's some more info: What can happen if a child swallows a button battery?
Also, rare earth magnets -- the really strong ones -- that you can find in kids' toys. If children swallow more than one, or a magnet with a metallic object, they can link up in the gut, trapping tissue between them causing the gut tissue to die.
Finally, I would caution parents and others involved in childcare to not rely too heavily on child resistant caps on medications. These caps are not "child-proof" (nothing is really). Even though they help to slow kids down, many children can open these caps at ages as young as 15 months! N Reid RN/BSN, DABAT
The Executive Office the President has a budget of roughly $400 million, and it might go up next year. The president has large discretion in how the money works in that.
I really only get to visit Baltimore nowadays for Baltimore Comic Con (I will be a guest this year again, yay!) but I love the new Asian art gallery at the BMA- you'll see my digital comic there on display next to the Guanyin statue. And I love love Baltimore eats- !
Here's the condensed version.....what we tell everyone to help stay poison safe: 1. Up, up and away! Keep medications and poisonous household products out of your child’s sight and reach. Locked up is best. 2. Avoid container transfer. Some of the most devastating poisonings occur when toxic products are poured into food or beverage containers, then mistaken for food or drink. 3. Read the label and follow the directions. Misusing products has dire consequences. 4. Use child-resistant packaging. It’s not child-proof, but so much better than nothing. Sorry it’s inconvenient, but using it could save a life. 5. Keep button batteries away from children. Swallowed batteries can burn through your child’s esophagus and cause permanent injury or even death. 6. Keep laundry pods out of your child’s reach. They are as toxic as they are colorful and squishy.
Great group! But I'm not with Brookings. But no more hints. :)
If one finds themselves without access to the internet, is there an easy way to remember what poisonous substances one should induce vomiting for and which ones they should not?
Center on Budget and Policy Priorities!!!
We no longer recommend inducing vomiting for anything. There are a couple reasons why -- 1) we actually found that inducing vomiting does not improve clinical outcomes in poisoned patients; 2) the common emetics people use can often cause more poisoning or injury than the original substance that the person swallowed. Some emetics can cause heart problems, ruptured esophagus, or seizures!
Spectacular group! Not with them, but I'm seriously not responding anymore, haha. :)
My friend once stuck a flashlight in his mouth and turned it on to see if it would shine out his eyes. While in his mouth the battery popped and burned the back of his mouth. About 3 or 4 months after (now), he still has the chemical burns in his mouth. Is that a cause for concern?
I agree, most people earning at that level know something about marginal rates but a lot of others don't and assume that a rate hike on the top 20% or even the upper 50% is going to affect them when they are in no danger at all.
And I'm given to understand that most of those in those top brackets don't earn their income from labor but from rents and other unearned income: hours of work per week doesn't play into it.
Yes, persistent, severe symptoms are definitely cause for concern. I would have your friend call his/her physician at this point. He/she needs a medical evaluation and treatment.
Yeah, that's correct, though it doesn't have to be that way. It's only that way because the capital gains rate is lower than the top marginal tax rate.
(This is also why the focus on the top rate at the expense of the cap gains rate really is lacking if the goal is talk about growing inequality.)
We have such an optimistic society, where no one wants to burden the high-income classes in case, through hard work, they end up there themselves. As most people understand, hard work is only part of it. If hard work alone made you wealthy, field workers and mothers of young children would be in the 1%
"Life Goes On", We'll Have "Nothin' But a Good Time"! By the way, if you inhale too much hairspray, call Poison Control. P Soto, PharmD
Haha, that's right. I think I personally have pretty radical views on what people deserve. People don't get to pick whether they're born smart. In what possible world could it be fair for that to be the difference between being a mega millionaire and dirt poor? Obviously hard work is a factor, but it takes almost no imagination to recognize that there are huge elements that are totally outside of our control.
What are the most common household items people swallow, splash or inhale?
Quite a few people work "under the table" at legal and illegal jobs. Working construction I see many who do this.
Bleach is definitely a common exposure that people often accidentally swallow, splash and inhale. Although it is not pleasant, it is typically well tolerated, in small amounts. Other than bleach, bathroom cleaners are also pretty common. P Soto, PharmD
Do you think there's a significant sex bias in terms of non-reported work? Because the long-term trend for men is different than for women, which is one reason Jason Furman in his paper thinks it's likely demand-driven.
I had the good fortune of doing one of my 4th year pharmacy rotations at a poison center (not NCPC), and found it one of the most rewarding experiences I've had. Thank you for the great work you guys do!
What is the most obscure/unlikely substance you've encountered in a poisoning case?
I don't know. What I do know is there are many men in the trades that under report or work on cash basis that is not reported at all. There is also the drug trade where the wife can work a minimum wage job while the husband sells drugs. A little SNAP or SSDI on the side with this and you can live a comfortable life. There is a very large underground economy out there.
It is wonderful to have pharmacy, nursing and medical students on rotation. We all learn from all the questions you ask us. I remember a case where a child came to the emergency room with irritability and progressive drowsiness. He eventually required intubation and mechanical ventilation. Pupils were dilated, dry skin ... the parents had given him a medicine for treatment of diarrhea. One tablet ...Lomotil. He was given naloxone and he stood up and extubated himself. Fortunately we don't see this type of exposure very much anymore. Jess Benson, Pharm.D., DABAT
There is a very large sex divergence, so we need a working theory to explain it. I'd check out the paper I linked to above, which talks about DI rolls. One other question is whether those folks are even included in the denominator if they're so worried about reporting their doings.
Do you think the new pod detergents are helping to prevent little kids from consuming detergent? Or are kids still trying to chow down on the packets?
What do kids mostly eat that causes problems? Is it detergents? Or something else?
Right now we have 16 Trillion in income in the US, The federal income revenue is 1.750T with Payroll being 1.160T ... if we were to give a tax break to everyone on the first 75K they make, but tax all income above this mark with a flat tax we end up with an approximate amount of 24.80%. Would this work?
Sources for numbers: https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_05_EST_S0803&prodType=table https://bea.gov/iTable/iTable.cfm?ReqID=9&step=1#reqid=9&step=3&isuri=1&903=58 https://www.thebalance.com/current-u-s-federal-government-tax-revenue-3305762
It's a little too soon to tell if the new packaging for the pods is helping. Pods are extremely dangerous and they have caused serious injury. When a child puts a pod in his mouth and bites down, the pod pops open and the detergent is forced into the back of their throat. The liquid from the pod goes into the lung and causes injury - some children need to be on ventilators, or breathing machines. Also the irritating liquid can injure the eye as it splashes out of the mouth. Burns are also sometimes seen in the esophagus, again because of the extreme irritation. Regular liquid detergent, while irritating, does not normally cause serious injury in small amounts that children usually swallow.
Common ingestions include household products, such as cleaning products, personal care products like make-up and lotions, and plants. These items are responsible for about half of the calls about kids. The other half include medications, such as cold and cough products and prescription medicine.
Your BEA link just sends me back to the NIPAA main page. What part were you looking at? Is that were you got the $16 trillion figure?
In general, the answer is "It depends at what rate you're taxing." There is a lot of money in the under 75k range. To steal from another part, for taxes, the more money touched, the easier it is to tax and get a lot from it. So, consumption taxes hit everyone, and make a lot of money, but they're regressive. The raising just the top bracket will get less, but it's progressive. FWIW, we have a much more progressive tax system than most European countries, but a much, much less progressive benefit system (on net, thus being less progressive). A lot of European countries make a lot through consumption taxes and then much higher income taxes on poorer folks than we have, but then give out a lot more in benefits.
This bad boy is a mammoth document: https://www.cbo.gov/publication/52142 I strongly recommend checking out the revenue section. Part of the reason I'm most hesitant to answer for the specifics of a scenario is that there are certainly behavioral changes whenever tax laws are changed. How rich folks get income changes based on laws. There's a reason for instance, that now so much rich income is capital income rather than labor income. I'm not a tax policy expert, so I'm less comfortable thinking through the specific behavioral changes because I don't know all the tax laws on the books and how people might try to shift how their income works to get around it.
For the BEA link go to: https://bea.gov/iTable/index_nipa.cfm
then click on --> Table 2.1. Personal Income and Its Disposition
Government websites are a PITA to navigate. They estimate total income at 16T
For a breakdown of what people make, go to this link: https://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t
Topics --> People --> Income & Earnings --> Income/Earnings (Individuals) (3,375)
Data Set - S0803 - Workers 16 Years and Over in the United States
Bottom of the table breaks down that there are 133 million workers, and what they make "estimated" in the year
Those were the main tables I found with the data I used.
There is a lot of money in the under 75k range.
Less than you think (if the data set S0803 is correct). Assuming the MAX of each range of breakdown, then adding them up, you get 4.2646T under 75K earned or 26.65% of the 16T in total income. Now if the total income is less than 16T, then it changes the numbers quite a bit. But all the data I've found puts 16T as correct (ie. 2014 was 14.7, or 2012 was 12.7T)Wage Range % of work-population Number Max Agg. Value % of overall 16T $1 to $9,999 or loss 15.1% 20,089,788 .2009 1.26% $10,000 to $14,999 8.7% 11,574,911 .1736 1.09% $15,000 to $24,999 17.4% 23,149,821 .5787 3.62% $25,000 to $34,999 15.9% 21,154,147 .7404 4.63% $35,000 to $49,999 16.9% 22,484,597 1.1242 7.03% $50,000 to $74,999 14.5% 19,291,518 1.4468 9.04% $75,000 or more 11.6% 15,433,214 11.7345 73.35%
There is WAY more income above the 75K mark than people realize. It's because even two people like Warren Buffet or Bill Gates who earn HUGE amounts of money it takes MANY, MANY earners who work minimum wage to equal them.
My idea is that ALL income is treated equally, and deductions are not given. Charity, home loan interest, etc. etc. are not eligible to lower your taxable income. It's a blunt tool
PS: I'll PM you the google sheet I'm working on for this topic, but it's at night when I have time, it's a topic of interest to me. I'll also go through your CBO report.
Ingestion, or eating something is probably the most common, but people can be poisoned through the skin, by inhaling fumes, and eye injuries can occur from chemicals being splashed in the eye. Poisoning can occur from injecting drugs in the vein. The most common poisonings are due to medications found in the home.
This is really neat. I'm going to chat with our tax person on Monday, and I'll get back to you. One thing that could mess with the calculation is that NIPAA tables include all money in an area, including stuff that came from the government, though that should only be an issue at the lower end, and I'm not sure about the total size of all refundable tax credits, but I think it's less than half a trillion.
Do I really need to call poison control if my kid swallows toothpaste? Why can't we come up with a toothpaste that is edible?
What would a healthcare tax look like if the US were to go the single-payer route?
Absolutely, it's always prudent to call Poison Control if your child swallows toothpaste (or anything else that he/she wasn't supposed to), but in general small amounts of fluoride-containing toothpastes (ex: less than a mouthful) in children are typically well tolerated. In these cases we usually only see some mild stomach upset or an episode of vomiting. Obviously, larger amounts of toothpaste ingested (especially Rx strength) can be problematic in children. However, there are toothpastes out there that are “safer to swallow”, that do not contain fluoride. They typically contain sorbitol, which may only cause some loose stools.
RP, PharmD, MPH, CSPI
It's big. It's really big. Depends how generous we want to be, but we're talking 8ish% of GDP (maybe $10-25 trillion over the decade, depending on how we do it). It's cheaper on a per-person basis than our current system, but that's a lot of new tax to get people to swallow.
So I was on my bed last night getting tired and downs comes the biggest spider in my life a couple feet away from me. My first instinct is oh shit, then I try and look for my Guinness world records book to kill it as it's rappeling down. Long story short, I couldn't find the book and I just stared at it while it made its way down to the side of my bed, where I lost it and still can't find it. I found some Raid bug spray and sprayed it under my bed andon the sides of it. The window was wide open.
Question: How much Raid would be needed to end up in the ER or to be on the phone with you guys?
It's cheaper on a per-person basis than our current system
Can you go into this a bit more? Because if that's true, it's an amazing argument for single-payer. Is that counting health insurance, some average of medical bills, etc.?
That is a common scenario. Folks get scared by something and in their panic they use a chemical to try to kill the insect (bees are common as well as spiders). You can certainly try to look it up on webPOISONCONTROL, but if you don't feel comfortable please call us and we'll help you sort it out. You don't have to think you are seriously poisoned to make the phone call. And some people are surprised that many accidental exposures often don't cause serious injury. Sometimes when you are in panic mode it's best to talk to a specialist at poison control, because we are great at calming our callers down.
Yeah, sure, with all else being equal, an organization that is running 0 profit can afford to have lower prices than one that's running a profit. By that very issue, government can do some things cheaper than private market. We see this in the fact that government student loans charge lower rates than the private market - and the government still profits off of them. Among other things, the federal government is incredible liquid at not risk-averse at the margins.
Take this as an example. Do you want a play this game with me: heads, I give you $100,000, but tails you give me $100,000? The expected value of that game is no profit! But we absolutely do not want to play that game because the value of gaining $100,000 is a lot less than the badness of losing $100,000. Because we are resources limited. That is not the case for the federal government. If it's down $50 billion one year, but up $51 the next, it just doesn't matter. It can run deficits and print money. But for me, if I'm down, I miss my rent payment. So, that allows the government to not have to charge a risk premium.
In addition, the more people involved in something, the more risk can be spread, and the more efficient we can be. Think of insurance as an example. Spreading risk over 300 million people is safer than spreading it over 10 people. So yes, it's cheaper on a per-person basis. And we see that in Medicare rates. And that's also partly seen in the fact that we spend more per capita than other countries for worse health outcomes (http://i.imgur.com/VqU3FFN.png), though part of that is surely deadly chemicals we allow, and part of that is also that they allow for the government to negotiate prices. But yeah, it's certainly cheaper, all things being equal.
The conservative response is, "That might work in theory, but in reality, competition and the quest for greed actually forces innovation and itself drives down prices in the long run, whereas government doesn't really have an incentive to drive down prices." That might be correct - and in fact that's why Obamacare's exchanges were conservative ideas. But that requires actually competition and not monopolies, and b) those are fighting against what I had above. The neat thing about the price negotiation is that that itself is a competitive act that forces competition from the providers. And as I said, we see this borne out in the data, so I personal believe that the conservative rebuttal is far oversold.
Again, I think the graphs and tables will get you most of the way there.
Thanks! Pictures for the bigger words! Lol I have a small curiosity of causality/correlation economics. So this is awesome.
Don't know whether it's good or bad that we aren't a government agency, but we are not. We're a 501(c)(3) charitable organization. Sadly, the National Capital Poison Center is projecting a budget deficit of $2.2 million - of a total cost of just over $5 million/year. About half of our funding is from state government grants. The rest is philanthropy.
Haha, well, I say this is as someone who deliberately does math instead of words for his job. Causality is obviously very difficult in economics, but this is one we're more certain of. I'm new to Reddit, so I didn't realize I was supposed to edit my response instead of just posting an addendum, but I responded again below with something that drives that point home.
So drown the deficit, and starve the surplus. Major lightbulb today thank you
Mr. Yuk, with his green scowly face, was first introduced in 1971 by the Pittsburgh Poison Center and was used in parts of the US. There was some concern that the application of Yuk stickers to products attracted children to the products. In about 2002 there was a move to a single phone number for all 55 U.S. poison centers (1-800-222-1222) and with it a national logo was introduced - Poison Help.
Exactly! And monetary policy (something I'm by no means an expert in) tries to mimic that as well!
Glad you found it useful!
So drown the deficit, and starve the surplus. Major lightbulb today thank you
Times have changed! Poison Help commercial has replaced that one!
Oh, and I meant to say, for what it's worth, a large number of center-left people really think the stimulus should have been significantly bigger. Everyone's estimates of just how deep the recession was were way, way, way too low. But there likely weren't the votes for a much bigger one. And already, some of it was passing tax cuts that likely were going to happen anyway.
But, for what it's worth, economists do not agree that it was useful. The first link I gave above work to estimate counterfactuals to show how useful it was, but here you can see that essentially everyone agrees that it helped, and almost everyone agrees it helped so much as to have been worth it.
Besides calling, is there a way people can text or chat poison control?
I was very unhappy seeing the reduction in funds to the EPA in Trump's proposal. Shouldn't this be one of our priorities? What is your opinion on this?
There are 55 poison centers covering the U.S., each with a designated service area. Some have chat capabilities, but most don't - yet. Throughout the U.S. (or internationally), if you prefer to get your poison help online, you can use the webPOISONCONTROL tool. There you enter age, substance, and amount swallowed and get case-specific automated recommendations, including a determination of whether it's safe to stay home, you need to go to the ER, or you need to call Poison Control. In most cases (73%), it's OK to stay home. We never discourage calls, but if that's not the way you like to get help, feel free to go online. Toby Litovitz, MD
I was also very unhappy. Trump's EPA pick is of a similar opinion to Trump, though, and the really incredible thing is that the Trump skinny budget called for even deeper cuts to the EPA than Pruitt himself asked for.
If you care about future generations, this should be!
Allegedly, a bunch of Republicans are displeased with the EPA cuts, but being silent about it doesn't really help anyone.
For reasons discussed in my first post, this budget is doomed to fail, but it's still deeply problematic because it sets negotiations for a lot of programs we care about at a much more difficult place.
Do you agree with the Bell Biv DeVoe assertion about that girl?
Where is it widely considered worthwhile to spend much more money among budget wonks even though it is acknowledged a good portion of it will be wasted, and so therefore wouldn't be palatable to the public?
I'm not sure there's a great answer for this because budget are about priorities, and parties disagree on priorities. Everyone agrees there should be some military, and everyone agrees there should be some roads, but the level and degrees are really tough.
Currently, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) and NASA stand strong, for what it's worth. WIC is food stamps for pregnant women and young kinds. The evidence is so overwhelming that it leads to major benefits that it enjoys deep bipartisan support (Trump's budget slightly cut it, but it covers all expected need). But it's the policies within things that are tough. So, while NASA was barely touched, there's always disagreement about the degree to which humans should be involved in projects.
NIH was that way for a very long time, but Trump's skinny budget proposed $5.8 billion in cuts, nearly 20%.
I recently had an experience where someone had ingested kerosene from an unmarked container in the garage, it was mistaken for water. When I called the poison control line, they didn't offer any advice, only asked me questions like, "How do you know that it wasn't windshield wiper fluid?" (It smelled like kerosene and wasn't blue). It also seemed like they were stalling for time. I ended up hanging up and looking up information online instead (don't induce vomiting!).
Was this just an inexperienced operator? Does the phone number get traced in case of an emergency that requires authorities?
What do you think of John Kasich?
I'm sorry that you had an unsatisfactory experience calling Poison Control. I can't really speak to what the specific specialist might have been thinking or what their level of experience might be. In general, Specialists in Poison Information are registered nurses with at least 2 years of experience in the hospital, or pharmacists with a clinical background. Once you are hired by a poison center, you have to train for at least a year, and pass a national exam to become a Certified Specialist in Poison Information.
Our Poison Center utilizes a system similar to 911 to obtain phone numbers and location and we do confirm this information with the caller at the beginning of the call in case the connection drops or the patient becomes incapacitated while on the phone with us. The Poison Centers do have the capability to mobilize EMS to the patient's location if necessary.
And just to be clear, all of this personal information is kept strictly confidential by the Poison Center. N. Reid RN/BSN, DABAT
During the debates, I quipped that John Kasich is the sort of guy who visits elementary schools and talks to the kids about Smokey the Bear and Scruff McGruff. I think he's in person an incredibly nice guy.
He's a former chairman of the House Budget Committee. He likes to take credit for being there during when the budget was balanced, but he voted against the bill that balanced the budget (Clinton's tax increases).
John Kasich's budget resolutions called for the deepest cuts to Medicare of any budget resolutions (i.e., ones that actually passed the full chamber) of all time ever, much deeper than Paul Ryan's (though his deepest cuts were phased in over time, so it's unclear what it would look like 30 years out), with the possible except the of FY1982 House budget resolution (this was the year that the Republican budget resolution defeated the Democratic budget resolution on the House floor when Southern Democrats en masse did whatever Reagan asked - I reached out to the House Budget Committee health staffer of that time, but she couldn't remember the size of the Medicare cuts proposed).
In general, I think he's pretty overrated. He's not unhinged, but he's not remotely moderate, if that's what you were asking.
What is the reasoning behind cutting funding to the NIH? The way I see it, every dollar given to research is a well spent investment on our country's future.
Most of us were drawn to the medical profession because we had an interest in helping people. I worked at a suicide prevention telephone service while in pharmacy school. Most of the calls were about possible poisonings. During my clinical rotations I saw many poisonings in the emergency room and admitted to the ICU. It seemed like I was drawn to clinical toxicology. Over the years I have seen many changes in poison control. One thing that has remained the same is the poison centers' ability to help people quickly and compassionately. Jess Benson
I was personally surprised by the requested cuts to NIH. For a very long time, NIH has enjoyed bipartisan support. You are not the only person who supports R&D, particularly medical R&D.
I would be surprised if there is anything more than a minimal cut to NIH.
What was the hardest part of putting the app together and how do you keep track of the "logic" for all the different possible scenarios?
Super late to the AMA, but are there any good books you recommend? Preferably in line with the topic at hand. Great answers, by the way!
If you ask the toxicologists (as opposed to the software developers), we'd say the hardest part is developing the algorithms, product database and logic. Each of the 1325+ ingredient algorithms is matched to the corresponding ingredients in 49,000 products - so we have to be able to handle products with multiple ingredients, too. Each algorithm has age- or weight-based thresholds for the ingredient, a list of expected minor symptoms which may develop, a list of symptoms that require further medical evaluation, specific home treatment where appropriate, the expected onset and duration of symptoms and a risk window beyond which significant toxicity is unlikely if symptoms have not already developed. Since algorithms are also used in traditional poison centers, they also outline the justification for the threshold and provide references.
On the other hand, the developers might tell you that the greatest challenge was the overall scope and complexity of the code and the many little nuances required to accommodate variations. Specific logic is incorporated in the software to handle each formulation type, multi-ingredient products, unknown amounts, unknown weight, and the minimum possible weight for age.
It may be difficult to imagine the complexity of the engine driving this app. There are more than 50 administrative interfaces that enable tracking, linking and manipulation of products, images, barcodes (yes, you can scan the barcode of the product your kid swallowed to enter the product name), algorithms, and case data. It also includes tools for quality assurance and data analysis.
Toby Litovitz, MD
Haha, that's an important caveat, or else we could have gone off in all sorts of different directions. I'm glad you've enjoyed it!
Stan Collender has a guide to the federal budget that's really quite excellent. Unfortunately, it was last updated I think in the year 2000, so some things are a little dated. https://www.amazon.com/Guide-Federal-Budget-Stanley-Collender/dp/0847684032
This CRS report by Bill Heniff is absolutely worth reading, although it's pretty dense: https://fas.org/sgp/crs/misc/98-721.pdf
The tough thing about the federal budget is that there really are very few instruction manuals. A lot of the knowledge is passed through word of mouth and direct teaching. As I mentioned in other places, the budget world is very, very small, and much of it is very technical, and so there isn't quite as much content put out for non-budget folks.
How do you account for new products that enter the market place? Do they need to disclose the ingredients to you before being allowed to be on a shelf?
Since we have a debt based currency, over the long run will we have to continually grow the debt to sustain the currency?
Companies introducing new products are not required to disclose their ingredients. Many do voluntarily, which is a big help. But many companies are also fearful their proprietary blend of ingredients will be stolen. In these cases previous experience of the specialist at the poison center can be very helpful in determining likely ingredients and possible concerns.
I'm sorry, I wish I knew more about monetary policy, but I really don't. But from what I know, I don't believe that should be the case among other things because we also control our own monetary supply, and our debt is in our own currency, which is also the world reserve currency. But I'm pretty outside my area on monetary supply.
What are some common poisons that often get overlooked as safe?
You just showed that you know 100x more about monetary policy than the person you replied to. Seriously. "Debt based currency" is a meaningless term. If you see someone use it, it's generally a tell that they read far right wing tinfoil hat type sites. I've asked people who use this term to explain what it means and they can't.
In children we worry about imidazoline-containing nasal sprays (contain oxymetazoline or tetrahydrozoline). Most people will not think of them as poisonous because they are over-the-counter and generally viewed as safe. Unfortunately, small amounts can produce loss of consciousness, slowed heart rate and loss of breathing. Button batteries are another example. See our reply at https://www.reddit.com/r/IAmA/comments/5zrfrq/we_are_the_national_capital_poison_center_ready/df0etyz/ We also worry about laundry pods. Jess Benson, Pharm.D., DABAT
I typically have a rule against engaging with gold folks because it's always pointless. Given that this was my first AMA (and really, first time on Reddit, except for the occasional search for deep video game-related knowledge), I figured I should answer everything! You can see my mistake carried out below.
Hi NCPC! I read a book on poison response and the vast majority of treatments seem to be ingesting medical grade activated charcoal. In a pinch, if I cut open a water filter filled with activated charcoal and took the same amount, could it be used as a somewhat effective treatment? (This is not an endorsement for people eating Brita filter charcoal instead of going to the hospital, just in a case where you're in the wilderness a few hundred miles away from civilization and just so happen to have a Brita)
What do you mean exactly by "currency based on debt and an economy based on infinite growth"? Are you referring to the fractional banking system or something else? It's not like USD is dependent on debt or the economy growing. Growth is good for obvious reasons and debt makes it much easier to buy homes and start businesses, but the US dollar doesn't depend on growth and debt for it's existence.
Hi! Yes, that is true. People are often worried about getting their stomachs "pumped", but that isn't done very often at all anymore. Activated charcoal is still a method of decontamination that we recommend when an ingestion is recent. You're right - we don't recommend doing home treatments of activated charcoal, because if it is serious enough to require activated charcoal, we will likely want you to go into the ER. Unfortunately, the activated charcoal sold over the counter, and in water filters are probably not as "activated" as the ones available in the emergency room. Also, there are some things that charcoal cannot absorb. Some people get nauseated and vomit after drinking charcoal, which can make some situations much worse (aspiration). Overall, I would not recommend using it. P Soto, PharmD.
A lot of people are into the idea that the growth is unsustainable because debt is increasing. I tend to point them to the post-war period, in which debt increased essentially every year, but shrank as a percent of GDP and we had higher per-capita growth than during the no-deficits period. http://www.vox.com/policy-and-politics/2015/8/18/9168417/budget-deficits-growth-rate
Tell the truth: What do you really think of parents that have to call multiple times a year for the same child that seems to have taste tested half the house?
It does, I can give you a doc that can show you. Im not really great at explaining it all since I'm not an economist or whatever so i dont want to miss anything.
Zeitgeist Addendum Its kinda long, maybe boring for some, but its very enlightening.
Debt: Money is built of the fractional banking system, yes, so it has built-in debt from its genesis.
Infinite Growth: Think the housing market, and any other bubble that breaks. They grow and pop. The economy is no different. However, we attempted to establish an economy that has continued growth. Capitalism running rampant. For example, a company I used to work for wanted a constant growth of 5% every year. That took a lot of resources. People especially. So eventually labor ran high as well, but proportionally. Now. When business tanks, they have to lay off people because they want the continued growth of 5%. This is a smaller echo of the bigger picture. So when sectors tank... like Oil when it runs out. What happens? The bubble pops. The party's over.
It wouldn't be a problem if the Oil kept coming, but it will end, therefore stifling a business plan that never accounted for sustainability.
Perhaps that was all rambles... Another good doc is Collapse much better with the infinite growth than i
I think children explore their environments with their mouths. This is totally normal behavior. They are quick and curious and parents are often just one step behind them when things go in the mouth. We don't judge, we want people to call -- even if it is something that seems silly. Call to be sure, don't guess. And if you are too embarrassed to call, use the webPOISONCONTROL app or online tool. N. Reid, RN/BSN, DABAT
There are a lot of resources in space. But even if there's no growth, there's always human capital. And if we've gotten a lotttt of wealth at that point, and we're stuck at that point, I'm not really sure the party ends? Lots of solar energy for lots of fun.
What has been done to raise awareness of Dihydrogen Monoxide?
Solar, exactly. But most of our economy is based on Oil. We were head in the right direction. And since Trumps new budget completely guts the NASA budget, I don't think we'll even research the mining technology let alone fund a mission.
Dihydrogen monoxide a.k.a water is necessary for human life. However keep in mind, the poison is in the dose. If someone were to drink excessive amounts of water, it can cause electrolyte disturbances leading to vomiting, seizures, mental confusion, and yes even death. Oh, plus you can drown in it. N. Reid, RN/BSN, DABAT
Sure, yeah. I should have made two separate points. First, I think we can keep growing because of other resources. The reason we weren't growing for thousands of years is that we weren't really accumulating stuff. We were just living.
Second, though, just living at current levels is way better than just living in poverty. That is, I'm not convinced that growth itself is the party. I think having sweet things is the party.
Is alcohol poisoning within your purview? Secondly, if so, what kind of data do you have about alcohol poisoning (and is it made available to the public)?
having sweet things is the party.
touche, we would essentially be living sustainably at that point... in the dark lol
Yes. You can call or use the webPOISONCONTROL site anytime about possible alcohol poisoning. The previous year's national poisoning experience is published yearly in a medical journal called Clinical Toxicology (http://dx.doi.org/10.1080/15563650.2016.1245421). This report contains statistics for all kinds of poisoning including ethanol (alcohol) poisoning. The report will under-represent the true number of people who suffer from alcohol poisoning because many people will not call their poison center when it happens. It will give you a rough idea however of how frequent these exposures are. For instance in 2015, there were 6761 calls to all U.S. poison control centers regarding possible ethanol beverage exposures. Jess Benson, Pharm.D., DABAT
Yep! Though your fun part at the end brings up a good point that a lot of the valuation that we have right now is based on current costs of energy. If that goes up, a lot of our machines become a whole lot less valuable. So I amend my point to admit that the value of life would go down, but yes, it would still be pretty sustainably, but just in the dark. :)
I called because my cat had eaten something, but I pretended that it was my child. Did you know that I was actually calling about my cat?
So we want to stress that it’s always important to be upfront when calling Poison Center since our pets (dogs, cats, etc.) have different metabolisms than humans, and some things that are completely safe for humans can be very toxic to dogs and cats. For example, certain foods that humans can safely enjoy such as: grapes, raisins, onions, shallots, garlic, coffee, and even chocolate can be toxic even in small amounts to our pets!
RP, PharmD, MPH, Certified Specialist in Poison Information