Tuesday, September 11, 2012

Mistakes (Don't Have to) Happen

Part of how public health works "while we were sleeping" is to take away opportunities for making the wrong decisions.  Figuring out what decisions to target isn't always easy.  Banning cars will drastically reduce the number of car accidents on the road.  But it would also prevent people from giving me rides.  Public health succeeds then, when it strikes the right balance between what's good for the individual and the public.  Here are a couple of clever examples:

Haizhu Bridge

Maybe "clever" was too generous a term.  This wacky idea might not score an A in design, but it is reportedly successful.  If you're the officials of a crowded city with a growing bridge-jumping suicide problem, how might you combat an issue?  Making the bridge harder to jump off of is a good place to start.  The traditional approach is to put up barriers, but officials in Guangzhou had another idea: grease up the bridge with brown oils to make it difficult to climb.  Weird?  Yes. Unsightly?  Yes.   Effective in curbing the number of jumpers?  Also yes. 

Children's Aspirin*
This is one of my favorite stories of While We Were Sleeping.  In the 1940's, children's aspirin first came onto the market.  They were a commercial success.  Pink and flavored, they were attractive to children.  Some literally ate them “like candy” such that 200 children each year were dying from ingesting aspirin.  It took the work of a Duke pediatrician, Jay Arena, and the head of a small pharmaceutical company, Abe Plough, to stop these deaths.  They made the bottles more difficult for children to open.  Safety enclosures are routine for our pill caps now, but back then, no other company was willing to do so.  Plough took the risk.  “If it if it saves the life of one child," he said, "I’ll do it.”  They didn’t stop there.  Arena and Plough also worked to cut down the dose and number of tablets per bottle, so that even if all the other measures failed and a 2-year-old somehow ate an entire bottle of aspirin, the dose would not be toxic.   The child could still be safe simply because Arena and Plough adjusted the bottles. 

Policy Implication:  "It is possible to protect children without changing their or their parents' behavior.*"

*While We Were Sleeping pp 30-31, 37-39 (I swear I'll stop quoting DHem every other post.  But it's a hard habit to break.

P.S.  Those of you who like good long form non-fiction or want to read more about bridge jumpers, check out this excellent New Yorker piece on the Golden Gate Bridge.

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