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TechnologyHey Reddit, I’m Chris Richardson, author of “POJOs in Action” and microservices guru, here for an AMA brought to you by Oracle for the Developer Legend Series. Ask me anything!

Mar 21st 2017 by ceracm • 39 Questions • 1460 Points

Hello Reddit! We are pharmacist, nurse and physician toxicologists and poison specialists at the National Capital Poison Center in Washington DC. It’s hard to imagine what people swallow, splash, or inhale by mistake, but collectively we’ve responded to more than million phone calls over the years about….you name it!

National Poison Prevention Week (March 19-25) is approaching. Take a few minutes to learn how to prevent and respond to a poison emergency. Be safe. AMA!

There are two ways to get free, confidential, expert help if a poisoning occurs:

1) Call 1-800-222-1222, or

2) Logon to poison.org to use the webPOISONCONTROL® tool for online guidance based on age, substance and amount swallowed. Bookmark that site, or download the app at the App Store or Google play.

You don’t have to memorize that contact info. Text “poison” to 484848 (don’t type the quotes) to save the contact info directly to your smart phone. Or download our vcard.

The National Capital Poison Center is a not-for-profit organization and accredited poison center. Free, expert guidance for poison emergencies – whether by telephone or online – is provided 24/7. Our services focus on the DC metro area, with a national scope for our National Battery Ingestion Hotline (202-625-3333), the webPOISONCONTROL online tool, and The Poison Post®. We are not a government agency. We depend on donations from the public.

Now for a bit of negative advertising: We hope you never need our service! So please keep your home poison safe.

AMA!

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Hey Redditors, thank you for all your amazing questions. We won't be taking any new questions, but will try to get to as many of the questions already asked that we can.

Q:

What trends do you see in products that switch from a monolithic architecture to a microservice architecture? If I'm starting something new with a small team, I'll lean towards a monolithic architecture so I can move faster, but what part should I break out early or from the outset to help me 2 or 3 years down the road?

A:

Thanks for the great response. Why don't we (the government or people who can) close the fiscal gap then?


Q:

Have these analytics helped you to be dangerous?

A:

What is the wildest / Funniest call you guys have gotten?


Q:

There is a good argument that you should just focus on the solving today's problems and building a good product, e.g. https://en.wikipedia.org/wiki/You_aren't_gonna_need_it . It is possible that the extra effort you would spend on being 'microservices ready' would slow you down too much and incur too much risk.

Having said that you could try to ensure that your system remains modular. For example, implement your business logic using loosely coupled DDD aggregates and use eventual consistency rather that ACID transactions.

A:

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.


A:

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


Q:

What's your advice to parents who wants their children to learn code (but don't know themselves)?

A:

Isn't LIHEAP proposed for either drastic reductions or total elimination every year?


Q:

Assuming your technology is designed for good, what would happen if it's used for evil?

A:

that's terrifying


Q:

Perhaps the kids can learn at school or at a meetup such as this https://www.meetup.com/Devoxx4Kids-BayArea/

A:

Obama's final year called for a reduction, but his first years called for large increases. Bush 43's first budget called for an 18% reduction. That's pretty drastic, but not in the realm of complete elimination. Budgets before FY1996 are not online, and Bush 41 and Reagan were before my time, so I couldn't answer that.


Q:

Everyone has a different definition of what makes something evil. I will go out on a limb though and say probably bad things.

A:

Indeed. Not a common occurrence but according to my mortuary colleagues it has happened before. There are no risks of collateral explosions. ;-) Jess Benson, Pharm.D., DABAT


Q:

Hi Chris, thanks for doing an AMA, I have to admit that I don't have extensive knowledge of microservers, but do you believe that they are the future of enterprise software solutions?

A:

What's a step that Americans on both sides of the aisle would agree to that would help balance the budget?


Q:

Good definition. How do you feel if your software was used for bad things?

A:

I just wanted to thank you all. The other night my 4-yo daughter broke a glow-stick and it spurted in her eye. I have never heard her scream like that. And it went on and on...

We called you guys and got a very calm, cool woman on the phone who advised us to stop the saline wash we were trying, get her in the shower and force her eye open for 20 minutes. She told us what to look for and how to act and then called back 20 minutes later, as promised, to check on us.

What's your rule-of-thumb for sending people to the hospital vs. staying home and treating themselves?


Q:

It depends. There are tradeoffs - http://microservices.io/patterns/monolithic.html and http://microservices.io/patterns/microservices.html

For some applications - especially the simpler ones developed by a small team - the monolithic application is fine. But for large complex applications developed by large teams it is likely that a microservice architecture can be helpful.

A:

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.


Q:

I would feel bad.

A:

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.


Q:

Top predictions in tech for the next 5-10 years?

A:

What are some of the more surprising things that the average American wouldn't know about major spending / how the government pays for things?


Q:

Predicting behavior seems like a page out of the Minority Report movie.

Can it predict crime before it happens?

A:

Have you ever had someone call in trying to inquire which home substance would make the best poison for criminal intentions?


Q:

The transition from coarse-grained compute resources to fine grained resources will continue: pets (long lived, mostly physical) machines that are lovingly cared for) -> cattle (disposable, immutable VMs) -> rabbits (disposable containers) -> microbes (AWS lambda and other cloud functions). There will undoubtedly be a few surprises along the way.

A:

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%.

I'd check this out: http://www.cbpp.org/research/federal-budget/policy-basics-where-do-our-federal-tax-dollars-go


Q:

Theoretically, yes. However, it is a question I don't want answered. It would not be just to punish someone for something they haven't done yet, even if you could stop it from happening.

A:

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.


Q:

How do programmers come up with names for different programming languages (i.e. java, sql, c++)?

A:

So all those memes are way off?


Q:

I will be in Hannover, Germany next week. Can you provide a bit more information about your presence at CeBIT 2017? Where is your stand located?

A:

Thanks for the AMA.

Was wondering what sort of exposure would be considered harmful to an average-sized person who happened to break a light bulb containing mercury. Also, what way could the substance enter into the body in that scenario that a person would need to be careful of?


Q:

The reasons are varied. Some like SQL are acronyms - structured query language. C++ because it is the successor to C. C because its the second language derived from BCPL - the first was B.

A:

Which memes? Are you talking about the ones showing defense at over 50% of spending?


Q:

Our booth location can be found at our CeBIT page feel free to come visit me or one of our team at the booth while you are there. If you would like we can supply you with a ticket code as well.

A:

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


Q:

Is it true that you want to take the Microservices boldy to where no man has gone before?

A:

Exactly. If your figures are correct myself and many liberals have been duped. I'm way less attached to being right than the truth. I'm so sick of the twisted misinformation.


Q:

RemindMe! 5 days

A:

Awesome, thanks. Would you say the description given by the EPA is appropriate or a bit of an over precaution?


Q:

No person has gone before.... Yes!

A:

The figures I linked to are correct. The image you see floating around is from the National Priorities Project. The percentages are correct, but they represent funding for only what's called the "discretionary" part of the budget - that which Congress actively debates each year through the annual appropriations process, rather than programs where the funding has already been agreed upon. The discretionary part of the budget is only about one-third of all spending.

The two categories are discretionary and mandatory. On the mandatory side is Social Security, Medicare, Medicaid, Food Stamps (that's another thing typically wrong the graph - it mentions food stamps, but it shows something hitting WIC), school lunches, unemployment insurance, some retirement things, and whatnot. On the discretionary side is most of what we think about when we think of government programs. It's WIC. It's Section 8. It's NASA. It's NIH. It's the National Science Foundation. It's funding the arts and humanities. It's all the tiny things that get a little big of government help. And, because of Article I, Section 8, Clause 12 of the Constitution, that's where our military budget lives. The founders were very wary of standing armies, but of course it doesn't make sense to have a non-professional army.

At any rate, it is correct that the military is over half of what Congress approves every year, but I consider it deeply misleading, and I mention it whenever I see my friends share that graph on Facebook. It's true that we aren't debating Social Security and Medicare, and so the military is getting half of what we're debating, but the whole question is "what does XX say about our priorities," and current spending on mandatory programs need to be part of that question.

I similarly don't like the statistic "we're spending more than the next XX countries combined!" Yeah, well, we're also bigger than the next XX countries combined. That would be like complaining that California is spending more on police than all of New England combined. Yeah, well, its economy is bigger than all of New England combined. The reason we're spending too much is not because of what France is doing. It's because we don't need to be ready to go to war with the entire world at a moment's notice. It's because the threats we face are not the kinds that would require major troop mobilization. So, don't get me wrong - I still think 16% is huge. I think spending 1/6 of your dollars on the military is a lot. But it's not half.

In general, if something feels crazy, you should see what a few fact checkers have to say. It might be true. Some really crazy things are true. But some have been slightly twisted.


Q:

I sincerely doubt that it will. It operates completely offline to avoid situations like that.

Edit

A:

Our recommendations are consistent with EPA recommendations. The reason they are so extensive is that out of an abundance of caution, they want to make sure people are not only handling CFL bulbs properly, but also other types of mercury-containing bulbs (large cylinders) properly. Mercury air contamination can be higher with exposures to the larger bulbs.


Q:

What do you think about the rise of dynamic languages, like Javascript, Ruby, Python etc? Java isn't really "cool" anymore and Javascript is arguably receiving the hype Java received a decade ago, with now anything and everything being written in the language (including desktop applications). Could it be time to jump ship?

A:

Exactly. If your figures are correct myself and many liberals have been duped. I'm way less attached to being right than the truth. I'm so sick of the twisted misinformation.


Q:

If I ever need to call you, how would you prefer that I order the information about the poisoned victim?

A:

Coolness or Hype is irrelevant when making technology choices. What matters is whether a technology solves your problem. Java is still an incredibly popular language and systems are still be written using it. Having said that NodeJS, for example, is useful.


Q:

This is all to say that there's currently a budget for travel and for protection, and it's not difficult to move around money to make it work. I promise you that this money was appropriated.

A:

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


Q:

Do you think at some point everyone will know basic coding? Or will it stay a relatively niche industry that serves as an under layer to many others?

A:

What is your personal opinion of the Trump budget, as presented yesterday?

E: added "personal"


Q:

What is odorless, tasteless, dissolves instantly in liquid and is among one of the world's more deadly poisons?

A:

Software development is a profession like any other. I am not convinced that everyone needs to know how to code.


Q:

I don't like it's priorities. We currently spend about 16% of our money on our military, and I don't think we need to spend more than that. If we want to spend more money on military, I don't think it should be at the expense of programs that keep people out of poverty.

That said, this was a very incomplete document. We'll get a lot more information in the bigger budget in May, and so we'll get a better sense of his priorities, which may look different by then.

A:

Iocane powder, of course. We have all spent the past few years building up an immunity to it. As you wish ;) P Soto, PharmD


Q:

Well into my 20s, I've noticed a lot of my friends expressing the sentiment that they want to learn code. Would you encourage someone to learn coding as a hobby and if so why?

A:

Thanks for the reply!


Q:

What are some commonly overlooked areas in childproofing? Are there any items that parents don't realize are poisonous?

A:

Sure why not. But I'd also encourage people to cook, play tennis or go fly fishing. As a hobby, you should do what is fun and stimulating.


Q:

Sure - hope you found it useful!

A:

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


Q:

how do you guys plan on handling such tight knit teamwork in an industry where independence is still highly regarded?

A:

I did. Just yesterday I was wondering what sorts of things budget analysts think when reading such an unusual budget. Turns out, in this case anyway, at least one of them thinks more or less what I thought (with far less swearing!).


Q:

So there is a ton of safety information out there for new parents, can you give me some simple tips for not poisoning my kid?

A:

I think the reality of software development is that it is a social activity. In many cases the idea of a lone coder performing heroic feats is an illusion. It takes a team.


Q:

Haha, well, this is my measured response the day after. Yesterday was a very long day with a lot of unhappiness. There are a lot of things I'm willing to compromise on. Food, shelter, and heating are not among them.

A:

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.


Q:

So is my impression correct that the GOP and WH are trying to sell this budget in terms of the 'trickle down' theory that tax cuts for the richest will result in job creation?

A:

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?


Q:

We'll have a better answer to that when we see the bigger budget likely in May. This budget only had discretionary spending (about 1/3 of the budget), and it didn't have any tax policy.

That being said, President Trump has been pretty explicit about the fact that he believes his policies will lead to higher growth, which is the concept being supply-side economics - that there will be a change in the underlying supply of labor in response to changes in tax policy. His tax cuts he proposed on the campaign reflected that. So probably, but we will have to wait to be certain.

A:

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!


Q:

Republicans have preached that reducing taxes will boost the economy and net tax revenue will remain the same. In you experience and analysis, have you found this to be true?

A:

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?


Q:

Stealing from an answer in another place, the concept behind supply-side economics is that taxes are so high, that they disincentive work, and so, while cutting them loses revenue, it gains back at least some from increased work.

So, if your taxes are cut, you earn a little bit more per hour worked, so you might work more. But, on the flip side, you might decide that you can actually work less to get the same income, so you might work less. That's the concept, and the question is behind the income effect and the substitution effect.

It's tough because most people can't dial up or down their work. I have a salaried job. I can't go to my boss and say, "Hey, I'd like to work 5% more hours, so please pay me 5% more."

At some level, this is certainly true. If you went from 100% taxation to 90% taxation, you'd probably get more work. But from 39.6% to 35%? That's less clear, and there isn't evidence to support it. We certainly didn't have kick-ass growth during the Bush 43 era, and we certainly lost a lot of revenues. It might very well have been true for Kennedy going down to 70 percent. But that top tax rate was hitting so few people, it's hard to imagine it really had a large change. Again, it depends how many people are being affected, how much their incentives are changing, how much they're able to change their work, and how much they actually do.

Reagan's own budget group, in his final year, estimated that his first round of tax cuts cut revenues by 26%. Subsequently, he raised taxes by 14%, relative to that new base.

In truth, labor is not being supplied by prime-age folks at the rate we would expect, and it's unclear why. I don't believe it's exorbitant benefits because Europe does better than we do. Here's a very long report on the decline in prime-aged male workers: https://obamawhitehouse.archives.gov/sites/default/files/page/files/20160620_cea_primeage_male_lfp.pdf

A:

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.


Q:

Wow, that was much to read and I still contend that the author does not understand what happens in the shadow economy as he calls it. How does he count the legal immigrant that collects the check and distributes cash to the five undocumented immigrants that work under him. How does he count the crews I compete against for construction work that are completely off the books. Do you think the guys in the hood answered his survey honestly?

I have really enjoyed your explanations of fiscal policy. Thanks!

A:

if Poison ever reunites how will you respond?


Q:

I'm glad you read it! That's a great point, and I couldn't tell you. All I know is that the government uses advanced statistical methodology to try to estimate and account for non-response bias, but we obviously can't tell. There's frequently no natural experiment to see how well the methods did.

I couldn't really expound beyond this because this isn't my area - I just know that the author, Jason Furman, is incredibly highly respected (and Matt Damon's freshman year roommate in undergrad) and is a person who does all he can to make sure he's not biasing data through omission.

Thanks! I'm glad you enjoyed it!

A:

"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


Q:

How do you think the cuts will affect agencies like the National Parks Service and the U.S. Forest Service?

A:

What are the most common household items people swallow, splash or inhale?


Q:

Well, for what it's worth, the budget will not pass. It's just an initial place the Trump administration is digging in for leverage. I still think it's hard to tell what they're going to do. Bush 43 more or less kept non-defense discretionary growing with inflation, and just boosted defense greatly.

I personally think that Democrats will shut down the government before letting the non-defense discretionary numbers go below what are called "sequestration levels" (the second caps, referenced in the first question above). But it's really tough to figure out political pressures.

Right now, the topline levels are essentially flat from FY(fiscal year) 2016 to 2017 to 2018, and that's on purpose. The two-year deal that boosted defense and non-defense for FY2016 and FY2017 gave more money in the first year than the second in order to create levels that would facilitate a future deal and make it harder to go below (Murray/Ryan did that as well): http://imgur.com/a/7j0D1

So, people who want more funding are in a good negotiating place for FY2018 funding (what Trump is proposing), but it will be harder in the future years because the blue bars will keep growing with inflation, and it's harder to get an increase than it is to keep something flat.

A:

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


Q:

Wow, thanks for such a detailed response!

A:

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?


Q:

Sorry I didn't got into more detail about the two you asked, it's just that there are a lot of unknowns right now. If the topline levels are relatively flat, they might not see much cutting. It's just hard to say at this point. And the specific cuts won't come to pass in the coming year (unless the politics of the budget world change dramatically).

A:

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


Q:

Do you think trickle-down economics works or would you have a middle-out approach that targets an increasing demand that leads to increasing supply?

A:

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?


Q:

The concept behind supply-side economics is that taxes are so high, that they disincentive work, and so, while cutting them loses revenue, it gains back at least some from increased work.

So, if your taxes are cut, you earn a little bit more per hour worked, so you might work more. But, on the flip side, you might decide that you can actually work less to get the same income, so you might work less. That's the concept, and the question is behind the income effect and the substitution effect.

It's tough because most people can't dial up or down their work. I have a salaried job. I can't go to my boss and say, "Hey, I'd like to work 5% more hours, so please pay me 5% more."

At some level, this is certainly true. If you went from 100% taxation to 90% taxation, you'd probably get more work. But from 39.6% to 35%? That's less clear, and there isn't evidence to support it.

Reagan's own budget group, in his final year, estimated that his first round of tax cuts cut revenues by 26%. Subsequently, he raised taxes by 14%, relative to that new base.

In truth, labor is not being supplied by prime-age folks at the rate we would expect, and it's unclear why. I don't believe it's exorbitant benefits because Europe does better than we do. Here's a very long report on the decline in prime-aged male workers: https://obamawhitehouse.archives.gov/sites/default/files/page/files/20160620_cea_primeage_male_lfp.pdf

A:

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.


Q:

I can't get behind trickle-down economics. It seems to me they could possibly work if you remove greed from the equation, but cutting taxes on the wealthy does nothing at all to my situation (below poverty level) and my boss just got a bit richer. A small business owner who needs seven employees to do her work is going to keep seven employees on the payroll no matter what rate her taxes are taken. Eight would just be too many, and if she can get away with paying minimum wage she certainly will.

Apple, admittedly an extreme example, has $246 billion cash on hand and 115,000 employees worldwide, yet they went to court last year over $2 million in unpaid wages for not allowing Apple store employees to take meal a rest breaks. They ultimately lost that case. Changing their tax rate will not result in higher wages, nor will it result in more people being hired. It will only result in further enriching the wealthy.

A:

What's the most common way for people to be exposed to poison?


Q:

Supply-side is theoretically on the individual rather than business side. Conservatives will make the argument that cutting corporate taxes is good for workers because they say that economics says that any tax on corporations is ultimately borne by workers or consumers (it does say this), but I've never been sold on that because if it were true that it were 100% borne by other folks, I don't think they'd actually argue so vehemently for lower rates.

But yes, changing the after-profit tax rate isn't going to suddenly create more demand for extra workers. That is absolutely correct. And they already got to write off that extra worker's salary for purposes of taxes anyway, so the argument extra doesn't fly.

A:

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.


Q:

How would you incentivize the private sector to invest more in job training, like Trump seems to want. And do you think Trump will do what needs to be done to make this happen?

A:

I'm an epidemiologist at a local health department so I have a public health-y question.

In light of the opioid epidemic that we see across the country, is poison control on the national level doing any sort of surveillance to monitor this? What kind of a role does poison control play not only in reporting these instances but also in using the data to study trends and outcomes? If so, what agencies does poison control collaborate with or hope to collaborate with?

Thank you!


Q:

Businesses try to maximize the net present value of their profit, discounted to infinity (or at least the life of the current heads of the company). That is, they try to get as much profit over the period they care about. Currently, they do job training if they think it's helpful/if they need to (because there's a supply shortage, as during the dot com boom, rather than a demand shortage). A government policy that focused on that would be in changing the profit margins and thus the incentives for them. But we already let companies write off training and salaries as a business expense, so that's not it. We could pay them to do it! But then why not directly do it? The government actually has plenty of jobs training programs. Unfortunately, Trump's budget proposed to cut some of them. So, I'd be surprised, but you never know. We'll get more detail about all of his priorities in the bigger budget in May, which will go line by line through every account in the federal budget.

A:

Hi. What a great question! Poison control centers collect data and submit these data in real-time to the National Poison Data System (NPDS). These data are used to look at poisoning trends over time and to see spikes in poisonings in near-real time ... opioids included. Right now the American Association of Poison Control Centers (the parent organization for poison centers in the US) collaborates with the FDA and CDC primarily. In addition poison centers collaborate with their health departments, emergency rooms, health systems and sometimes with the Office of Medical Examiner to provide additional data and to enhance mutual surveillance efforts. Realize that dead people don't call poison control and many emergency room physicians will not call a poison center about routine opioid overdose so these collaborations are really quite important if we are going to get a robust view of the opioid epidemic. In addition to surveillance many poison center are involved with drug take back effort and naloxone distribution efforts within their states. Suffice it to say, opioids have been a very important part of poison center activity over the past 10 years.
Jess Benson, Pharm.D.


Q:

In your view, what are the biggest levers the government can pull to affect 1) spending and 2) tax revenue?

For example, while there is much focus on automobile standards for mpg capabilities, the majority of gasoline is used in industry, specifically by giant tanker ships. Are there any particular taxes that if changed would have a bigger impact on the budgets than the topics people commonly discuss?

A:

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?


Q:

For taxes, the more money touched, the easier. 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. That's not necessarily a bad way to do it, but people should just be aware of the politics of it.

For spending, half of our budget is just Social Security and health care, and another 16% is the military. http://www.cbpp.org/research/federal-budget/policy-basics-where-do-our-federal-tax-dollars-go

But in truth, it's a much tougher question because, excluding interest, health and Social Security are growing, and the group of "everything else" is shrinking: http://www.cbpp.org/research/federal-budget/program-spending-as-a-percent-of-gdp-historically-low-outside-social

So that poses a tough question. You can only cut the shrinking parts so much. Do you think we're currently spending the right amount per person with respect to health and Social Security? If yes, then you have to support more spending in the future because those, even outside of demographically-adjusted "excess cost growth," are set to grow for demographic reasons. If no (and you think we're spending too much), then those are the places to hit because they're the biggest.

A:

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


Q:

This might be too broad of a topic but Ill give it a go anyways...

I contend that a representative govt. is almost inherently dysfunctional (to a degree) due to shifts in policy that occur every few years. Imagine a company that changes positions/focus/CEOs on a dime every few years. How can government programs succeed if down the line they get changed, reduced funding etc.?

Have you seen this happen to a significant degree or am I making too big a deal about it?

A:

Backstory;

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?


Q:

I think that's certainly a very real thing, and bigger the bigger the issue is. For instance, we just that the Obamacare exchanges signed up fewer people this year than the previous year, which is the first time that has happened. It was the difference between the Obama administration pushing very hard to sign people up, and the Trump administration did not do anything. But we can see even more in enforcement of regulations. During the Bush administration, the Department of Labor scaled back on most activities, except for union busting.

I think it's pretty clear that having a single-party system would be more efficient in that changes would be done not for political reasons, there wouldn't be whipsawing of markets (as might happen with the health market - there's a reason some parts of Obamacare are still being phased in 7 years later), and there would be no one working to undermine laws. But I'm not really sure how to get around that, except with less frequent elections. And we don't want to make it toooo hard to pass laws.

A:

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.


Q:

I'm curious about your thoughts on income inequality. Do you believe it is a threat to the US and Canada's economies? Thanks for doing this AMA especially with the political climate!

A:

How is your budget looking for the next fiscal year?


Q:

I don't personally like deep income inequality, but I don't think it's really a threat to economies that much. One thing that is pretty destabilizing is if more and more of the nation's income is through capital rather than through labor. Labor is a lot more reliable than capital, and so huge capital can allow for bigger recessions. In that sense, yes, but I don't think inequality itself is an inherent threat to the economy.

That said, interesting work from the staff of the IMF (of all places) seems to be making the case that high income inequality actually leads to lower growth (for ages, the construction was always "how much are you willing to impact growth to fight inequality?") https://www.imf.org/external/pubs/ft/sdn/2014/sdn1402.pdf

This actually makes some intuitive sense if you think about it. The more people that can actually buy stuff, the stronger the economy is. If you had an economy with 10 people, and 9 were destitute with 1 insanely rich, the rich person wouldn't need to be buying 10 microwaves. But spread that out, and you have more stuff bought.

Poorer folks have a higher propensity to spend, which is (a reason) why stimulus bills most target poorer folks. There's more money directly put right back into the economy.

But the conservative response would be, "Yeah, but the richer people invest, and that's worth all the growth." And that's why for ages the construction was always inequality versus growth. I've never bought that argument, but I'm not an economist. But we have evidence that that's likely not the case, so I guess there's that.

And, of course! It was actually what's been happening recently that finally pushed me too, along with a friend prodding me, haha.

A:

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.


Q:

Does a "stimulus bill" actually stimulate? If so, for how long and how far does it reach? Do all sectors get a boost or just some?

A:

How can we donate?


Q:

The idea behind a stimulus bill is that, given a shortfall in demand, it will be temporarily plugged by a commensurate increase in government spending.

The government already has a bunch of what are called "automatic stabilizers." Check out figure 4 on the second to last page: https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/workingpaper/51005-AutomaticStabilizers.pdf

These come from means-tested entitlement programs, i.e., entitlement programs that spend based on a formula, rather than a set amount determined each year, where your eligibility is based on your income. An example is Medicaid. If you lose your job and your income, you automatically become eligible. Another is unemployment insurance. (I'm happy to give more if you're curious). So, in a recession, lots of people lose their jobs, and the government automatically spends more. At the same time, because we have a progressive income tax, people pay less of their income in taxes, so they have more to spend. And in the extreme example, we give money through the tax code in refundable tax credits (the Obama stimulus bill created some of these and expanded some other ones).

As you can see from the picture, it deepened the deficit in bad times, and made it smaller in good times.

The point of a stimulus bill is to do more. So, well-targeted stimulus bills work. Ones that don't lead to more spending don't.

This isn't to say that investment isn't great, but it's not the purpose of a stimulus bill. The only way investment in a stimulus bill is "right" is if there's immediate hiring and building. This, by the way, is why all those infrastructure investment reports in 2010 showed as many jobs as they did.

A:

You can donate here. Thank you!


Q:

Does a "stimulus bill" actually stimulate? If so, for how long and how far does it reach? Do all sectors get a boost or just some?

A:

[deleted]


Q:

Haha, thank you!

A:

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.


Q:

Thank you, I understand that now.

A:

[deleted]


Q:

Happy to clear that up - sorry I skipped too many words before!

A:

Times have changed! Poison Help commercial has replaced that one!


Q:

what is your biggest concern about Trump's budget?

A:

That commercial is like on a completely different spectrum from the Mr yuck commercials.


Q:

From a conceptual standpoint, it's the deep cuts to and sometimes elimination of programs that keep people out of poverty, like LIHEAP and housing programs (and of course all the programs that he didn't mention which would be due for an average cut of roughly 15%). But because it won't pass, the actual worry is that I think it sets the beginning negotiations in a really tough spot.

A:

There are even a few different versions, both in English and Spanish, and sheet music too!


Q:

Which do you think causes more problems. How much money is spent or how that money is spent?

A:

Besides calling, is there a way people can text or chat poison control?


Q:

Well, I approve of spending money on things that I like, so I'll definitely pick the latter. Obviously there's an upper limit - the nation can't spend more than all of it's possible income. But the US is a low-tax and low-spending nation, compared to other economically advanced countries. We could do less, but we could also do a huge amount more without even getting to the average among economically advanced countries.

A:

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


Q:

Good answer, Thanks.

Follow up. Q: How do you account for value when priming the spending pumps at the center of an economy the size of the US?

A:

Do you agree with the Bell Biv DeVoe assertion about that girl?


Q:

Thanks! How do I personally, or how does the US government?

A:

Yes, that girl is poison. P Soto, PharmD


Q:

Personally. When writing the follow up report. What are the success markers?

A:

Follow up: is there any way to mitigate or, I guess, stop a poison from affecting you if there's no known antidote or cure (something that's 100% fatal)?


Q:

It really depends on why we're spending the money. Just yesterday, OMB Director Mick Mulvaney was talking about the success of nutrition programs and said (incorrectly) that after-school nutrition programs weren't helping performance, and so they were failing. But sometimes we just give people food so they don't starve.

And, in fact, the government is often an entity that deliberately makes low-return investments. Roads and bridges between major areas don't need government funding to happen. But that bridge connecting those 50 people with the rest of society? That's something big. To use the Post Office as an example, NYC could run it its own independent, NYC-only post office, and stamps would be cheaper. But we have a national rate, even if you're going to Alaska. Think of how much it would cost to send stamps between places in Alaska if we had a localized stamp rate.

Anyway, this is all a long way of saying that it depends on the project. If the goal of something is to stimulate the economy, that's what you look at. If the goal is to improve test scores, that's what you look at. If the goal is to help people get jobs, that's what you look for. If the goal is just to help make people's lives less miserable, that's what you look for.

Anti-poverty programs are pretty big for me, so I assess how many people they're keeping out of poverty. I assess how much they close the poverty gap for each dollar spent.

A:

You can always call Poison Control, but if you are exposed to a very serious substance, you can call 911 and the ambulance will take you to a hospital Emergency Department where expert care will be given. Many poisonous substances don't have an antidote anyway. Patients survive serious poisonings with excellent treatment of symptoms present.


Q:

Personally. When writing the follow up report. What are the success markers?

A:

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?


Q:

I realized I misread your question! This has to be a priorities question, I think, and not one that budget wonks hold a special answer to. Economists will give one answer, and there are certainly programs that economists will agree make sense (automatic stabilizers and stimulus spending - see here: https://www.reddit.com/r/IAmA/comments/5zzssm/i_am_a_federal_budget_analyst_with_a_focus_in/df2ghlv/). But there's no reason that our government's goal should be maximizing economic growth at all costs. The point of growth is for that to translate into utility for people. There's no point of growing if people don't get to reap the benefits. So what about the programs that don't really help growth, but we consider necessary for civilization, like parks and some elements of the arts? So, this is why I think this ultimately becomes a values question.

A:

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


Q:

How would one get into your line of work? Are you hiring any interns or entry level positions for newly grads?

A:

What made you want to get into the medical profession?


Q:

Do you mean politics specifically, or the federal budget world?

A:

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


Q:

leaning more politics but a bit of both. I was in DC this past summer and the idea of doing something bigger than myself really appealed to me!

A:

what are the most common questions you guys get?


Q:

My first job out of college was on a political campaign, which is sort of a badge of honor because everyone knows that it's terrible work that takes incredible stamina (it was 76 hours a week, not counting transportation). After that, I interned for a year, building my resume and my network, until I finally got my first permanent job (I was pretty picky, so that hurt). I am incredibly fortunate that my parents live so close to DC and were happy to support me through unpaid internships as I worked on this.

My jobs more or less randomly ended up going towards budgeting (though I did major in math). My office sadly is not hiring, and the budgeting world is actually quite small. All of OMB (which is largely the M part anyway) isn't many more than 500 people, CBO is around 235, each corner of the budget committees has only about 20 staff, and there are very few budget think tanks.

If you want to get involved in the budget world, I'd probably try for CBO or OMB.

If you want to get involved in politics generally and don't have a resume for it, it really helps to be independently wealthy or a place you can crash in the area. Otherwise, people go for the cheapest housing they can find ($600 at like the barest of minimums) and work part time while interning and lose money all the while.

I think campaigns are a good place to start because, while they pay shit, most will get the workers free housing (at least on the Democratic side), and there are always more campaigns. And beyond that, it's a great bonding experience, and people leave campaigns and go everywhere, so your network expands a lot. But it's really terrible work, with people yelling at you all the time.

I would also definitely get a USAJobs account, for sure! And sign up for the senate employment updates and the House employment listserv. And many agencies also have their own employment updates. For instance, CBO does.

A:

Over half of Poison Control calls are regarding children under 6 years old, with a peak in the 2-3 year old age group. Children this age tend to get into things of convenience - household medications, and cleaners are common. It's amazing how quickly children can get into things. Also, visitors who may have loose pills in their purses or pockets, or pill minders are often accessed and can be a danger. P Soto, PharmD


Q:

Dead serious....where does the money go. They keep saying the US is the richest country in the world but everything seems to be old and falling apart. I am an average person and the government takes a good chunk of money out of my paychecks but I can't see the effect it has or where it seems to magicially vanish too.

Also how corrupt is the government in your opinion?

A:

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?


Q:

By corrupt, do you mean, like as a kleptocracy? Or just wasteful?

On where our tax dollars go, I'd start with this: http://www.cbpp.org/research/federal-budget/policy-basics-where-do-our-federal-tax-dollars-go

Half of our spending goes to Social Security and health care. Another 24 percent goes to military and vets. That's 75% right there, so if you like those things, I think it's harder to think of it as largely a waste? Another 6% is interest, which we have to pay, and another 10% is other social safety net, which leaves approximately 11% on all else.

The US has a lot of money that the federal government doesn't touch. Among economically advanced countries, we are a low-tax, low-spending country (by a lot).

I'd also say that a lot of times we don't see the effects of government. Do we see it when the Consumer Product Safety Commission makes a dangerous product illegal, and then we don't die? Or do we just notice it when the government isn't doing it's job and things go wrong? Do we see it when the USDA successfully keeps us from getting poisoned? So, I think the idea of government use is harder when talking about the remaining bit of the budget.

A:

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


Q:

Is social security fixable for my generation (born 1990's)? If so, how? If not, why not?

A:

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?


Q:

Great question! Social Security indeed is projected to have a net liability, with the Trust Fund running out of money in 2034 (if you trust the SSA actuaries, or a little sooner if you think CBO is more correct). After that, it will begin to pay out money only as it takes it in, which would be roughly a 25% cut in benefits. So, it's definitely not going away, but due to demographic issues, unless changed, all of our benefits will be significantly lower than they would be if we don't do anything.

There are four options for dealing with it: 1) Raise taxes and put them into the SS Trust Fund 2) Cut benefits (but that's the same as letting them get automatically cut) 3) Some combination of 1 and 2 4) Dump money from the General Fund (all of our other taxes) into the SS Trust Fund, and pay benefits through deficits.

The fifth option is magic unicorn growth.

Point four might seem like a trick to you, but it's a real option. Many times when we've had to plug the Highway Trust Fund (due to issues about how we wrote the gas tax, which pays for the Highway Trust Fund and the LUST Trust Fund (fun name)), we just transferred money into it. Section 257(a) of the Balanced Budget and Emergency Deficit Control Act of 1985 tells CBO to create the baseline to assume that all obligations can be met. What this means is that, even if Social Security were to be projected run out of money in the baseline, CBO would project the Trust Fund to pay out benefits as if it had all the money. CBO projects this in the creation of its deficits, off of which all estimates of how much things cost are based. In other words, deficits are projected to be "artificially high" because they assume we're already going to pay out all of our SS and Medicare benefits. That's why the statement "We're running out of money because of SS" and "We can't afford to pay SS benefits because we're running out of money" are incompatible.

So, what this means is that, deficits already assume we're spending that money, and so a bill that instructs the Treasury to put money into the SS Trust Fund is actually costless, relative to the deficits already assumed. This means there's not budget point of order against that. What's more, it means that CBO will call anything less than that a benefit cut relative to baseline assumptions. This means that the politics are even more strongly in favor of Social Security than they might otherwise be.

I do not necessarily think it's too unlikely benefits will be cut some, but, again, at max they're being cut around 25%. And I think it's entirely possible that there are no cuts when the time comes around.

A:

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.


Q:

Oh, don't worry! At this point, my viewpoint is "explore everything and probably change my major 30000 times" so don't worry. Again, thank you so much for the detailed responses. This AMA is the most nerdy fun I've had in awhile.

A:

What are some common poisons that often get overlooked as safe?

Thanks


Q:

Haha, fair enough! And of course - I'm glad you found them useful! :)

A:

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


Q:

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.

A:

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)


Q:

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.

A:

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.


Q:

Looking at current projections, where could you see the debt going to in the next four years?

Following the cuts of the EPA there were heavy opposing cries from citizens, how do the cuts of the EPA contribute positively to the government?

Was the amount of money cut really worth it?

A:

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?


Q:

Debt net of financial assets as a percent of GDP is projected to reach 68.2% by the end of fiscal year 2017 (which ends September 30th). By the end of FY2021, it is projected to have increased very slightly to 70.7%, after which it is projected to increase a bit more rapidly, hitting 80.5% by the end of FY2027.

These projects assume now changes to current policies - that programs that need to be reauthorized are reauthorized in the same way, that we fund discretionary appropriations at sequestration levels and adjusting for inflation afterwards, and that existing permanent programs continue to work in the way they're currently set up. This also assumes no recession.

FWIW, the EPA policy is just a request from the administration, as opposed to a cut that's been enacted. Right now, Congress hasn't agreed to the overall amount of spending they want to happen next year. After that, it will need to agree to how much spending happens on the non-defense side. After that, the budget committees will file levels setting a maximum amount of spending for each appropriations subcommittee, and after that, the subcommittee that has jurisdiction over the EPA will write a bill with funding for the EPA. If Congress agrees to that, and Trump does, only then will we know the level.

I would be very surprised if cuts even close to that deep come to fruition - among other things, because I would be immensely surprised if the 10ish% cut overall to non-defense happens. This just sets to starting point for discussions.

A:

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


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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!

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What has been done to raise awareness of Dihydrogen Monoxide?


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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.

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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


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My understanding is that before Trump's budget proposal, the USA already spends over $500 billion on the military alone.

What is the military going to do with an extra 60 billion?

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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)?


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The specifics of where it would go aren't fully detailed, but there are always more projects that could be funded. There's always more R&D that could happen, and there are always more people we could hire. Allegedly there's a readiness gap, wherein the military feels that if we needed to deploy tens of thousands of troops immediately for a massive ground assault, folks aren't properly trained. And so funding would theoretically go towards that. And of course, higher pay is more competitive and can attract better people.

But, yes, this is a rhetorical gesture. You can tell because of how non-specific most of the DOD section in here on pages 21 and 22 of the PDF (15 and 16 of the report): https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/2018_blueprint.pdf

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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


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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.

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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?


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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

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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!

http://imgur.com/a/tMbLb

RP, PharmD, MPH, Certified Specialist in Poison Information


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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.

Essentially:

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

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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.