Medicine and the Metric System, Part 2

(A previous post I wrote on the metric system and medicine is here. Hence, this is Part 2.)

When I was interviewed by Vox News for a podcast last month, I mentioned a recent recall involving confused unit dosing. I’d like to explore that issue in more depth this month.

August 2018 recall of children’s liquid medicine

A news release issued by the Pfizer Inc. on August 27, 2018, began with the following sentence:

Pfizer Consumer Healthcare, a division of Pfizer Inc., is voluntarily recalling one lot of Children’s Advil® Suspension Bubble Gum Flavored 4 FL OZ Bottle because of customer complaints that the dosage cup provided is marked in teaspoons and the instructions on the label are described in milliliters (mL).

Let’s take a closer look that. What that means is that if someone was paying attention to the number of units and not the units themselves (teaspoons vs. milliliters) — and why wouldn’t everyone expect consistency between the two? —that person could have given their child a significant overdose all the while thinking that they were following the directions.

As the Food and Drug Administration noted:

Pfizer concluded that the use of the product with an unmatched dosage cup marked in teaspoons rather than milliliters has a chance of being associated with potential overdose.

That is putting it mildly. Since there are roughly 5 mL in a teaspoon, giving the smallest dose in teaspoons could result in administering a whopping 20 mL more than prescribed. For a 72-95 pound 11-year-old child, the error compounds to an overdose of 60 mL when only a 15 mL dose was intended!

Image from this site: https://childrens.advil.com/childrens-advil-suspension

While not necessarily deadly, the recalls note that “The most common symptoms associated with ibuprofen overdose include nausea, vomiting, headache, drowsiness, blurred vision and dizziness.”

I’m not a doctor, but I image the reactions could be worse for a small child whose health was compromised before the overdose was innocently administered by a caregiver.

We’re just not moving quickly enough to remove such errors from our medical system. As noted by the Institute for Safe Medication Practices in 2015:

While progress is being made in hospitals in regards to prescribing liquids in mL, many hospitals still use dosing devices that have household measures (e.g., teaspoonful, dessertspoonful, tablespoonful) and, as above, even drams and ounces. This sets healthcare professionals up to fail because the dosage scales on embossed cups are difficult to read, have dangerous abbreviations that are easily confused (e.g., TBS and TSP), and measures that are no longer used (e.g., drams). .

It’s easy enough to make mistakes moving between U.S. customary and metric units without having organizations responsible for our over-the-counter medicines layering on their own errors that might be difficult to immediately perceive.

But changing to the metric system will cost money, I hear some cry

One of the pushbacks I’ve gotten over the years is that it would cost money to switch to the metric system. Let’s take a second and consider the cost of a recall such as the one cited here.

According to Investopedia:

Though insurance may cover a minimal amount to replace defective products, a majority of product recalls result in lawsuits. Between lost sales, replacement costs, government sanctions, and lawsuits, a significant recall can become a multi-billion dollar ordeal. For multi-billion dollar companies, an expensive short-term loss can be easily overcome, but when shareholders and customers lose confidence, there may be greater long-term effects such as plummeting stock prices.

The bottom line: This recall of children’s medicine could have been completely avoided if we weren’t constantly juggling multiple measurement systems in this country.

I’m not saying that using one set of units would solve all problems. After all, it’s still possible a company could put out dosing instruction that contained a typo (or a host of other problems), but let’s do what we can to try to remove easily avoidable errors from the system.

Cost of a recall?

Based on some research I did, it sounds like an average recall cost is over $10 million dollars in direct costs (pulling product off the shelves, etc), while indirect costs (lawsuits, fines, and customer avoidance, stock price, harm to reputation) can mount for years after the recall.

That’s something to highlight when talking about using consistent measures and the cost to implement them.

Thanks for getting this far!

Linda

Some resources on the cost of recalls:

https://roadscholar.com/blog/how-much-do-product-recalls-really-cost
https://www.foodsafetymagazine.com/magazine-archive1/junejuly-2018/the-costs-of-foodborne-illness-product-recalls-make-the-case-for-food-safety-investments/

 

 

 

Time wasted without the metric system

When I talk to people about a future where we switch over to the metric system, many  bemoan how difficult the change would be. The problem with that perspective is that most people have no idea how much of our time is wasted due to our using U.S. customary units. I’m highly confident that after a few months of using just metric units, our response would be: “What were we thinking? Why didn’t we do this ages ago?”

Ounces made it into two top 10 questions for recent Google searches.

Just last week I came across an infographic titled “10 Most Asked Questions on Google.” It included queries searched for during a previous six-month period and was global in nature. The graphic belies the assertion that Americans understand their current system (“So why go from something we know to something we don’t know?” they ask me). Bottom line:  Because questions eight and 10 are about how many ounces there are in a cup and a pound (respectively) so we really don’t know our units, despite what we say. (Money amounts refer to the cost of ads on the answer landing pages.)

Between the two of them, they accounted for 900,000 questions in that six month time frame. So how does that play out? Let’s say you’re working in the kitchen and you decide you want to scale a recipe up or down and need that “How many ounces in a …?” question answered. The first thing I’d do is search my memory bank to see if that was something I already knew. Then, if I didn’t know, or was less than confident in my answer, I’d need to either whip out my phone or mosey over to my computer to get the answer.

While the actual Google search might seem almost instantaneous, the process of getting to enter the question is not. Let’s say that it takes about 90 seconds before you get to the Google search part (I have nothing to back this assertion up but it is probably conservative). If so, that means we (and by “we” I mean either Americans or the poor souls who find themselves confronted with our crazy units here or elsewhere in the world) spend 45,000 hours each year searching for this information. Put another way, every year we spend more than five years of our time reminding ourselves how many ounces there are in things.

This amount of time, of course, doesn’t include all the time spent looking such information up in a cookbook only to discover (in most cases) that conversions between metric units are sometimes included but not how many ounces, for instance, there are in things.

Most cookbooks include units between U.S. customary and metric system, not within customary units.

I can’t confidently promise that we’d likely spend any saved time on something productive but at least we’d have the opportunity to spend it on something less wasteful.

Confusion in the kitchen

Our units make scaling ingredients very difficult

As if that wasn’t bad enough, I also recently came across the cheat sheet on the right.

It’s just nuts that we put ourselves through these machinations when using the metric system is so easy. Unless you’re really slow, you wouldn’t even need such a chart.

1/4 liter    =     250 mL
1/3 liter    =     333 mL
1/2 liter    =     500 mL
2/3 liter    =     666 mL
3/4 liter   =      750 mL

Given that we already use decimalized currency, most everyone could immediately tell you that half a dollar is 50 cents and a quarter of a dollar is 25 cents without a calculator or a Google search. It’s the same with metric system mesures.

While it might take some thought and effort to switch over to the metric system initially, once there, our lives become a whole lot simpler.

If only more people knew. Help spread the word please.

Thanks,

Linda

Hiatus and the Metric System

I’m now working on book with the title “America’s biggest miscalculation.”

It was almost five years ago that I began down this road of working to bring awareness of the harm we are doing to ourselves through our lack of metric system adoption. The plan has been to do it via a documentary on the subject. (I thought it was only four until I looked it up!)

During that time I put quite a few things in my life on hold while I devoted considerable time and resources (including my own money) toward making metric system awareness a reality. I recently took some time off as a greatly needed it for multiple reasons.

That said, I am far from giving up. This is the first time that I’m saying this publicly but I’ve had discussions with a couple of different producers over the years but the funding to make the documentary has yet to materialize. As a result, I’ve decided to take a different tack.

Part of the reason I started this blog in the first place was to give you some “behind the scenes” looks at the process as it evolves. So here’s what I’m thinking…I need money to produce the documentary and, ultimately, the onus to do that falls on my shoulders.

I had originally thought that I would reach more people through a documentary than through a book but now I’m thinking I need the book to raise the money to make the documentary. I had always thought about writing a book but expected it would be more of a companion piece than the catalyst.

The additional research it will take to write the book will be considerable. For instance, something that I could gloss over in a script like, “When early man began to settle down for agriculture, measurement tools became increasing important” now needs a whole chapter that I have to back up with references and notes. At least if I want it to be any good—and I do.

I have already begun work on the book. I even took some time off to do additional work on it a couple of months ago then came down with pneumonia, which put some kinks in that plan. Still, I think (with the help of my boss, Linda Deck), we came up with what I think is the perfect book title. I needed something that would catch people’s attention, be as unique as I could get it but also not mislead anyone.

Its main title will be America’s biggest miscalculation. Not only does it perfectly describe the situation but I was unable to find another item with that exact title. I did find things named America’s biggest mistake and other such titles but the use of “miscalculation” appears to be unique. I’ve already purchased the domain names.

I am writing the book to fit that title. At my daughter’s suggestion, I purchased Scrivener software and am at almost 20,000 words into the book’s contents. Given that the average non-fiction book is around 70,000 words, I still have a ways to go but there is much more subject material to cover.

Given that I’m writing and project managing full time AND writing a major book on the metric system AND still have to do things like laundry, food prep, cleaning and organizing (where I got really far behind—I hate cleaning), etc., I plan in future to only post once a month. But I do plan to continue posting.

Just the make sure I keep my promise, I plan to write a couple more posts today so I have them ready while I work on the book.

If you want to write to me at milebehind@gmail.com to suggest topics for columns, I can’t promise I can immediately address them, but I will consider all comers.

See you in June and thanks for your patience.

Linda

The Smithsonian and the Metric System

In September, I got a much-needed getaway. During that time, I made a trip to Washington D.C. to visit friends.

While there, I took advantage of my proximity to visit my contact at the National Institute for Standards and Technology (or NIST and the keepers of the metric system in the United States).

Artifacts in the museum at the National Institute of Standards and Technology in D.C.

The NIST Museum

I was at NIST three years ago when I was just a few weeks into this project. Needless to say, my experience at its museum was radically different now that I had some context for the things that I saw. (Note: the museum is open only to official visitors. Still, there is a lot of information on the organization’s website.)

I also got a chance to meet with Elizabeth Gentry, my NIST contact there, and our country’s finest Metric Coordinator. While I’ve been keeping her up-to-date on the project, I’d yet to meet her in person.

Convert between systems only when necessary

I’m not sure how or why, but the friend I was staying with had some old U.S.-to-metric conversion slide rules imprinted with the Detroit Teachers Credit Union logo and a copyright of 1973.

A conversion “helper” from the 1970s

One of the complaints that I’ve heard while on this project has been that our last attempt to convert to the metric system back in the mid-1970s spent too much time trying to teach people conversion formulas. Transitioning this way is actually quite complicated because there are so many formulas to memorize because we use so many different units (feet, pounds, ounces, gallons, ounces, etc.). The image to the right only captures part of the problem.

Any future plans to adopt the metric system would benefit from just straight measurement using the metric system, rather than trying to teach very complex and lengthy sets of conversion factors. (Only convert when absolutely necessary, like your grandma’s favorite recipes.)

For example: Do you have a space that needs a table? Just measure using the metric side of the ruler and do the same when shopping. I know I’m oversimplifying but it’s a start.

We were early decimal adopters—our coins

Needless to say, now that I’m involved with the metric system, I see its relevance almost everywhere.

A display depicting the different foreign coins in use in colonial America prior to our independence and establishment of our own mint.

I did end up coming across a coin display at the National Museum of American History (part of the Smithsonian museum complex) called “Legendary Coins & Currency.” It reinforced some of my previous research that one of the reasons that the United States ended up with decimalized currency came from the fact that when we landed on this continent, we were not allowed to mint our own money while still part of England.

Note this quote from the History of Colonial Money that I found on the Federal Reserve Bank of Boston site:

By 1652, the problem resulting from a shortage of coins had become extreme. England had turned a deaf ear to the colonists’ plea for specie [gold and silver coin. ed], and the colonial leaders did not believe that the people should have to continue using the mixture of foreign coins, wampum, bullets, and barter objects any longer. In an effort to provide more good coin to further trade and commerce, the Massachusetts Bay Colony established an illegal mint in Boston in 1652.

That meant that we had a total mishmash of currencies, not only from our home country but with all the other countries with which we were trading. And there were many. It made for a difficult time. Thomas Jefferson was more than well aware of the problem as one source notes:

…one of Jefferson’s most troublesome legal clients finally paid him in a motley mixture of silver and gold — half joes and moidores from Portugal, doubloons and pistoles from Spain, and 308 English half crowns.

As a result, our fabulous founding father:

…had the rational idea to create a decimal-based currency system. Meaning that money should be based on the number ten. The word for one hundred in Latin is cent, so Jefferson suggested that the word for a 1/100th of a dollar be “cent.” The Latin word for “one tenth” is dime; so again, Jefferson suggested that as the name for the 1/10th of a dollar coin. The five-cent coin would become known as the half dime and then later, the nickel.

Thus, he was able to move us as a nation to the decimalized currency we still use in the U.S. today.

Jefferson was one of the earliest Americans to consider a decimalized currency. He gave it, in 1784, its most articulate and persuasive expression in his “Notes on Coinage.” Congress, convinced by these arguments, adopted the new coin units with little dissent.

Unfortunately, he has more problems passing a decimalized system for our lenghts. But that’s another post.

[Please note: I am now starting a book on the subject of metric system adoption in the United States. I will post to this blog on occasion but the bulk of work on this project (when not at my full-time job) will focus on writing the book. If you want to keep up with what I’m doing, the best thing will be to follow my Twitter feed and Facebook page. I’m finding those easier to keep up with. I now hope to post here once a month.)

Stay tuned!

Linda

 

Living La vie Mètrique: An Australian’s Take on Metric System Adoption Part II

It’s forty-one years since the metric conversion process began in Australia, and thirty years ago the Metric Conversion Board lowered their flag, produced their last report and said “Mission Accomplished.”

So what has changed? Just about everything, that’s what!

A metric kitchen

Here’s a photo of what’s in my kitchen cupboard: a kilo of flour, a liter of vinegar, a 100 gram jar of coffee. The water bottle is 600 mL, as that size replaced the Imperial pint. You can also get 1 L and 2 L sizes for milk and other liquids. The plastic container of pasta at the back has a capacity of two liters, and that size is stamped on the base; a lot of storage containers are marked like that.

(Note: All the photos in this article, plus a few extra are available here: http://www.imgur.com/a/hYZjb at a slightly larger size)

A loaf of bread is usually 680 g, as that replaced the 1½ pound loaf, but you find other sizes. The labels on the supermarket shelves include comparison prices (in $ per kilo or $ per 100 g) to make it easy to compare prices of different-sized packets.

All of the products except the tin at the far right are labelled in metric units only. The only ounces or fluid ounces I ever see are on goods intended for the US or UK markets.

Beer is sold in 750 mL “long necks” or 375 mL “stubbies.” Wine is also in 750mL bottles, or in casks (Americans call it box wine) of two or three liters.

Metric road sign

Traffic signs are all metric. Speed limits are in kilometers per hour (abbreviated km/h), distances in kilometers and  height clearances in meters. Speed limits are usually 40 or 50 km/h around built-up areas, 60 km/h on arterial roads, 80 or 100 km/h (sometimes 110) on highways.

Walking and cycle tracks have distances marked in kilometres or meters on signposts. In fact, unless the distance is meters the unit is omitted, so if you see a sign saying “City 5.3” you can correctly assume it is kilometers.

Cars have had metric nuts and bolts for years, the same as the US, and we buy gas and oil by the litre. Engine capacity is in litres and power is in kilowatts instead of horsepower.

My gas meter reads in cubic meters and my water meter clicks over a notch every time a liter flows through it. Electricity bills have always been in kilowatt-hours, and on gas bills they convert the cubic meters into the energy consumption in megajoules (MJ) where it used to be in therms. (1 therm = 100 000 BTU)

At the hardware store, what you would call a “2 by 4” and we used to call a “4 by 2” is now sometimes advertized as 100 x 50 mm and sometimes as 90 x 45 mm. Timber is sold by the metre or in lengths which are multiples of 1200 mm to match the standard 1200 x 2400 mm plywood and plasterboard. (2 x 4s are actually a bit smaller than the advertized size, the metric dimension is the finished size.)

Nails and screws are listed with descriptions like “Nails, Bullet Head, Galvanised, 75 x 3.75 mm” and you can buy them in packs of 2 kg or more if you are building something big. Wood screws and self-tapping screws are described by length in millimeters but their thickness is by gauge. Some old measures keep hanging on.

Plumbing fittings, electrical conduits, switches: all their sizes are in millimeters, but I think the British Standard Pipe Thread might outlast civilization itself. I used to install water-saving showerheads and their flow was listed as 9.5 liters per minute.

The standard ceiling height for houses is 2400 mm (7ft 10½ ins) which was dropped from 8ft to accommodate a rational metric size. A standard door is 2040 mm high, about 6ft 8in. The builders do everything in millimeters; there are no centimeters and no misplaced decimal points.

Buying an appliance? Airconditioners, heaters and stoves all do their cooking in degrees Celsius. The capacity of your refrigerator is measured in liters. It’s easy to envision an array of milk cartons that the fridge will hold when making comparisons. The capacity of a washing machine or dryer is in kilograms.

TVs (and computer monitors) are usually measured in centimeters, but you still see a lot of them advertised in inches for the screen size. The dimensions of all products, appliances, furniture, curtains, bedsheets, is always in millimeters or centimeters and their weight is in kilograms.

Paper sizes changed, too. Australia previously used the British sizes with strange names like Octavo and Foolscap, and odd ratios of height to width. Now, ISO 216 sizes are used everywhere. Standard writing paper is A4, 210 x 297 mm; two of them side by side are an A3 poster-sized sheet if you turn it through 90º, and an A4 folded in half is an A5 which is suitable for a pocket notebook.

This makes things easy for enlarging and reducing on a photocopier; you scale the original up by 41% or down to 71% to get to the next size. You see fliers, bills, newsletters, posters, catalogs, brochures; all of them based on the A-series paper size.

Weather forecasts are all metric, as is information in the news. Temperatures are in degrees Celsius, rainfall in millimeters and wave heights in meters at sea, but wind speed is in knots for shipping and km/h on land.

When they were discussing irrigation and river flows on the news a while ago, (a hot topic on a continent that is mostly desert,) we heard about megaliters and gigaliters. That’s a thousand and a million metric tons of water. A serious amount of water.

The language hasn’t changed a lot. People still use terms like footage, mileage and say “going the extra mile,” but in describing metric measurements people will say so many ‘mil’ for millimeters or milliliters, and say ‘kilos’ for kilograms. The next pub might be a few ‘kays’ down the road.

There are still a few minor problems. Clothing sizes for one. For mens’ trousers and shirts it’s just a matter of measuring the neck or waist in centimeters. For womens’ clothing there is a supposedly standard set of sizes, but no two manufacturers are alike. Also, sizes have inflated over the years, as we have become a nation with a larger waistline. (I remember seeing a cartoon of a woman telling her husband “Size twelve? No, much too big. Get me a size ten, and make sure it’s the biggest size ten they’ve got.”)

Shoe sizes are much the same. My feet are the English size 9 but I wonder, 9 what? Why can’t they just measure the length from toe to heel? That’s how they do it for the flip-flops (thongs) you wear on the beach.

You can’t get incandescent light bulbs any more, they are all compact fluorescents, so instead of bulbs being described in watts, which is a measure of the power they consume, the output is described in lumens, and I have yet to learn how many lumens my living room needs.

There are still a few Imperial holdovers: some pubs serve craft beers in pints, people still ask about the weight of new-born babies in pounds, and computer typography is 72 (and a tiny bit) points to the inch. But on the whole, metric conversion is complete. Of course, there are lots of older buildings and a lot of industrial machinery, railway track, roads, bridges and dams built in Imperial measurements which will need maintaining for a long time, but they aren’t a major problem, and everything new is in metric measurements.

We have an entire generation of adults who have grown up using metric measures, and I don’t know anyone who would want to change back. And kids at school don’t need to wonder why there are sixteen ounces to the pound, fourteen pounds to the stone, and twelve inches to the foot.

Peter Goodyear

Footnote:
You can download a copy of the Metric Conversion Board’s final report, Metrication in Australia if you click on this link: http://themetricmaven.com/wp-content/uploads/2012/03/Metrication-in-Australia-built-2013-06-24.pdf

It’s a PDF document, fairly short, (127 pages,) but quite comprehensive in covering the background of the decision to change to metric, how the change  was accomplished and the notable successes and failures encountered on the way.

The story of how it came to be publicly available is interesting, and is documented here: http://themetricmaven.com/?p=3612