- Email: [email protected]
Dramatic Trends in Childhood Poisonings in Los Angeles County
Dramatic Trends in Childhood Poisonings in Los Angeles County By Lawrence S. Krain, MD; William H. Bucher, MD, and Gerald A. Heidbreder, MD
W
bile the National Clearinghouse for Poison Control Centers, located in Washington, D.C., does an excellent job of summarizing poisonings annually ,1 the recent wide gap between the national statistics and the Los Angeles County experience bears special scrutiny. For example, there is evidence of salicylate (aspirin) poisoning of only two to three percent in Los Angeles as compared to 25 percent nationally. Other noteworthy statistics are1. The absence of lead poisoning in
Los Angeles compared to the national figure of five percent. 2. Three times the national percentage of amphetamine and propoxyphene (Darvon) poisonings in Los Angeles. 3. Twice the national percentage of spray-wick and block and cake deodorant poisonings in Los Angeles. As acCidental poisoning in childhood has been the subject of numerous papers stating that its causation, prevention and control are constantly changing in nature, 2 ·3,4 a detailed epidemiologic investigation was undertaken to determine some of the underlying factors for these deviations in Los Angeles County.
phone calls is believed to represent the numerator for true incidence data. As calls are compiled by location, the number of in-county calls is an indicator of the amount of poisonings for the entire area. Less than 10 percent of the total caiis for a five-year period have come from outside the county. Table I (below) shows the relative constancy of the calls by category through time, also showing _e vidence of the reliability of this system. A phone questionnaire at the poison center ascertains the facts as to the reason for the phone call, the age and sex of the patient; the time the incident occurred, the time the call was received and the subject of the phone inquiry grouped by general area of use. To supplement this data, phone interview surveys were made of pharmacists and pharmaceutical distributors for the first week in March 1970; these figures were extrapolated for the entire county population according to the percentage ratio of total drugs and specific drugs based on the commercial price of the drug. A random sample was taken-questions were asked of 100 physicians and 50 emergency rooms concerning their poison cases for the first week in March 1970.
Results and Discussion 1. Trends in Poisoning in Los Angeles County (Tables I and II, helow, page 14) -Inhalation, eye and skin contact with poisons made up less than five percent of the reasons for telephone caiis; ingestion accounted for the vast majority. Salicylate and Propoxyphene Poisonings-Proproxyphene poisonings made up seven percent of the children's poisonings in Los Angeles whereas they make up only about two percent of such poisonings nationally. However, even assuming that propoxyphene is substituted for aspirin does not bring the Los Angeles figures to the 25 percent salicylate poisoning level nationally. Results of the distribution survey made in March 1970 indicates that propoxyphene (Darvon) is three times more available now than in 1965, and that aspirin is as available now as it was in 1965, correcting for the population increase, in Los Angeles County. Surveys of the physicians and hospital emergency rooms for this same period indicated that there was gross under-reporting of cases to the
Materials and Methods Hospital and phone report records from the only poison information center in Los Angeles County-Children's Hospital of Los Angeles-were examined to establish the epidemiologic features that might explain the above trends. The Children's Hospital Poison Center serves some seven million people in Los Angeles and is a resource for the rest of Southern California. It has received over 270,000 poison reports from 1957-1970 (October). As infonnation is almost exclusively from trained observers, i.e., as physicians or veterinarians, the number of
TABLE I
Summary of Statistics of Phone Call Reasons to Poison Information Center, Children's Hospital1964-1968 1964
1965
1966
1967
1968
13,650
15' 139
16,022
17,490
18,339
1 '715
2,073
2,309
2,547
2,654
0
0
Information only
756
981
1,142
1,059
Veterinarian cases
101
136
178
289
392
16,223
18,329
19,647
21,469
22,494
Reason Accidents Suicides (intentional) Unknown
Total
1 '138
0
Vol. NSll, No. 1, January 1971
13
Lawrence S. Krain, MD, earned his MD from the University of Illinois college of medicine and his MPH in epidemiology as a USPHS trainee at the 'University of California, Berkeley School of Public Health in l969. He is currently completing field training at the State of California Department of Public Health (assigned to the Los Angeles County Health Department) for certification by the American Board of Preventive Medicine and Public Health. His major projects have involved studies in cancer epidemiology and health services research ili East Los Angeles. He has authored a number of medical publications.
William H. Bucher, MD; has been medical consultant to the Thomas J. Fleming Poison Information Center at Childrens Hospital of Los Angeles since its inception in 1957. The center receives calls primarily from physicians and is one of the largest of its kind with 24-hour coverage. Bucher holds a MPH and has had traini1ig in child psychiatry and child development. Presently he is acting director of the division of child development at the Children's Hospital and associate professor of pediatrics at the University of Southern California.
Gerald A. Heidbreder, MD, is a clinical professor of community medicine and public health at the University of Southern California medical school and U.C.L.A. schools of medicine and public health. He also serves as special consultant to and member of the National Speakers Bureau (venereal diseases) for USPHS. Active in venereal disease control activiti·es, Dr. Heidbreder most recently is the pioneer of a multimillion dollar model drU:g abuse ·p revention and youth clinic programs for Los Angeles County. He is the author of numerous medical and scientific publications in the area of communicable disease.
Poison Information Center for both propoxyphene arid salicylate poisonings. Only 35 percent of propoxyphene reports showed up in poison information phone call data and only 15 percent of aspirin poisonings were noted for this March period. Overa11, the poison information center sampled only 37 percent of the potential poison~ ing incidents extrapolated from the random sample of physician and hospital emergency rooms surveyed.
Lead Poisoning-In January 1970 the Los Angeles County Health Department started an extensive lead level survey in children ranging from 1-14 years of age throughout Los Angeles County. Through October 1970 there has been only one al;mormal case confirmed by blood and urine byproduct (lead) analysis. Furthermore, emergency rooms and physicians surveyed for lead poisoning reports have not reported a single case in Los Angeles for the period 1969-70. Newer construction materials and the absence of leadbased paint are without doubt the reasons for this encouraging phenomenon. To check on the existence of lead in older dwe11ing construction materials, a special fluorescent detector is being tested. This survey is still in progress. Amphetamine Poisonings-The national figure for amphetamine poison14
ings averages 0. 7 percent of all poisonings. In Los Angeles this figure is 2.2 percent and has trebled in the last five years. Indeed, surveys indicated that amphetamines are three times more available to the public now than in 1965. While this could account for the total increase, another factor, i.e., under-reporting of these episodes must
be considered. Less than 10 percent of such episodes ( potent~al) show up in the Children's Hospital data based on physician and hospital surveys for the March 1970 (first week) period. All figures cited above have been standilfdized to remove population increases as a factor. Similarly, although the incidence of LSD (lysergic acid) poisoning has sextupled in the last five years in Los Angeles, only six percent of these episodes are reported to the Children's Hospital Poison Information Center based on this physician and hosp~tal survey.
Deodorant Poisonings-Based on physician and hospital surveys, the Children's Hospital Center tends to overreport both spray-wick and block and cake deodorant poisonings. Physicians and hospital emergency rooms sampled picked up only 44 percent of such incidents. reported to the Poison Information Center. Surveys indicated that these deodorant products are four times more available now than in 19-65 to the· general public, correcting for population increase· figures. 2. Detects of Poison Registries-The N ation?l Clearinghouse for Poison Control Centers does ari excellent job of standardizing reporting on an objective forin for the oyer 300 poison centers in its system. The defects of such a system that remain are1. Such registries are riot population-
based and over-represent rural areas while under-representing populous areas such as .Los Angeles County. 2. The quality of form completion and reporting in a given reg-ion is largely unco:ntrolled and there is no incentive for accuracy.
TABLE II
Subject of Telephone Inquiries Grouped by General Area of Use, 1964-1968 Children's Hospital Poison Information Center (Percent Distribution) 1964
1965
1966
1967
1968
7.4
7.4
7.0
8.1
7.1
Internal medications
26.8
27.7
27.4
28.6
27.6
Household products
13.6
14.4
13.9
13.5
16.9
Salicylates
2.2
2.2
3.2
Glue sniffing and LSD and related plants
0.2
1.3
1.9
External medications (alcohol, antiseptics, boric acid, lotions and liniments)
Cosmetics
9.0
8.9
8.2
8.5
12.5
InsectiCides and pesticides
7.5
8.9
6.1
7.5
6.7
7.2
7.0
6. 1
5.5
4.9
28.5
25.7
28.9
24.8
20.2
Plants and plant products Miscellaneous
Total
~"~Numbers
100 .0 (16, 223)*
100.0 ci8,329)
in parentheses indicate total number of cases.
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
100.0 (19 '647)
100.0 (21 ,469)
100.0 (22,494)
3. Data fed into the individual centers comes from a large variety of sources which may be different for each poison center. For example, the New York reporting system reported by J acobziner2 receives reports only from hospitals, thereby only reporting the more serious poisoning e·pisodes. Some poison centers count in their statistics calls from the lay public which may be "crank" calls, thereby tending to overreport certain poisoning events. Yet the national statistics do not reflect these important distinctions except for such special tabulations as may be presented. _ Since poisonings are not a reportable disease in Los Angeles County, this phone cail data is as good, if not better, an epidemiologic base as is the total hospital reporting system. Quality control must be maintained with periodic surveys for short periods of time (i.e., a week) to insure that the Poison Information Center knows. what it is measuring and what it fails to measure. While this is the standard practice with federally funded tumor registries, this has not been done with any widespread application for poison registries. Furthermore the level of reporting must be capable of being estimated by an individual poison registry based on peri-
odic surveys of the area rather than "a guess" on the national poison information form. Public alertness can vary from region to region in regard to poison reporting. Periodic surveys can reflect this degree of aler~ness on the part of both physicians and ~atients. Health education can be used to increase the public awareness of those under-reported poisoning episodes. Finally, nationally reported poisoning statistics might be better reported by fewer than the 300 registries now reporting if these fewer registries _ were--
questionnaire completion from lay people with cross-checks to eliminate duplicate reporting. A registry should ideally be based upon some such standardization of the reporting system so that generalizations can accurately be made. The national statistics currently do not have this virtue. While the surveys in Los Angeles have shown that this system is far from perfect in this area, at least these data have indicated areas where generalizations should and should not be made and where corrective action is needed. •
1. Geared to report representatively
and accurately a definitive population area. 2. Accompanied by periodic community surveys to insure quality control. 3. Standardized to compile poisons based on one or more of the following systems of reportinga. all poisoning -episodes in hospital emergency rooms; b. all poisoning episodes in physician offices; c. verified phone call data from phy. sicians, pharmacists, veterinarians or other paramedical personnel with sufficient poison information backgrounds, for a circumscribed and well-defined population area, d. poisoning reports by phone or by
References 1. National Clearinghouse for Poison Control Centers, "Poison Statistics," Bulletin, National Clearinghouse for Poison Control (Sept.- Oct. 1969 and 1970) 2. Jacobziner, Harold, "Causation, Prevention and Control of Accidental Poisoning," lAMA, 171, 1769 (1959) 3. Craig, J.O., and Fraser, M.S., "Accidental Poisoning in Childhood," Archives of Disease in Childhood (Great Britain), 28, 140, 259 (1953) 4. Done, A.K., "Drug Intoxication," Pediatrio Clinics of North America, 7, 253 ( 1960)
Acknowledgement Research supported in part hy Mrs. As a V. Call Fund at Children's Hospital, Los Angeles.
APhA Participates at Health Meeting
APhA co-sponsored two sessions on pharmaceutical services
at the annual meeting of the American Public Health Association in Houston, Texas, October 25-30. On Sunday, October 25, APhA joined the American AssoCiation of . Colleges of Phanmicy in sponsoring a session tit!led "Pharmaceutical Services: Today and Tomorrow" which featured presentations on "Training Pharmacists for Tomorrow" ~. by Hugh F. Kabat; "Patient-Oriented Pharmacists-Will They Meet the Needs of Society?" by Sister Emmanuel Schott; a report on the Student APhA Appalachian Project; "Pharmacy Manpower for Tomorrow" by T. Donald Rucke.r and William Sobaski; "The Role of the Community Pharmacist and the Pharmacy As·sociation in Health Education" by Frederick S. Mayer, and "Health Education-An Integral Part of Pharmaceutical Services" by Philip J. Levine. On Thursday, October 29, APhA joined the medical care and mental health sections of American Public Health Association in presenting a session titled "Pharmaceutical Services as a Component of Comprehensive Health Care." This marked the first 'time that APhA has participated directly in American Public Health Association's annual meeting. Papers included in that Session were "Drug Benefits Under National Health Insurance" by Frank Furstenburg; "Psychotropic Drugs: Studies of Pres<;ribing Patterns arid Usage Patterns" by Mitchell B. Balter and Jerome Levine; "Poverty Area Residents Look at Pharmaceutical Services" by Sydney P. Galloway and Charles Eby, and "The Pqarmacist as ·a Member of the Heal,th Team" by Miss Rosalyn M. Cain and Joel S. Kahn.
Chief of USPHS Indian Health Service division of pharmacy, Allen J. Brands (left) shares a lighter moment at the APHA annual meeting with T. Donald Rucker, Social Security Administration.
Texas Southern University school of pharmacy Dean Patrick R. Wells discusses the future of pharmacy with Sister Emmanuel Schott, Wayne State University college of pharmacy assistant professor, who spoke at the meeting. Vol. NSll, No. 1, January 1971
15
W
bile the National Clearinghouse for Poison Control Centers, located in Washington, D.C., does an excellent job of summarizing poisonings annually ,1 the recent wide gap between the national statistics and the Los Angeles County experience bears special scrutiny. For example, there is evidence of salicylate (aspirin) poisoning of only two to three percent in Los Angeles as compared to 25 percent nationally. Other noteworthy statistics are1. The absence of lead poisoning in
Los Angeles compared to the national figure of five percent. 2. Three times the national percentage of amphetamine and propoxyphene (Darvon) poisonings in Los Angeles. 3. Twice the national percentage of spray-wick and block and cake deodorant poisonings in Los Angeles. As acCidental poisoning in childhood has been the subject of numerous papers stating that its causation, prevention and control are constantly changing in nature, 2 ·3,4 a detailed epidemiologic investigation was undertaken to determine some of the underlying factors for these deviations in Los Angeles County.
phone calls is believed to represent the numerator for true incidence data. As calls are compiled by location, the number of in-county calls is an indicator of the amount of poisonings for the entire area. Less than 10 percent of the total caiis for a five-year period have come from outside the county. Table I (below) shows the relative constancy of the calls by category through time, also showing _e vidence of the reliability of this system. A phone questionnaire at the poison center ascertains the facts as to the reason for the phone call, the age and sex of the patient; the time the incident occurred, the time the call was received and the subject of the phone inquiry grouped by general area of use. To supplement this data, phone interview surveys were made of pharmacists and pharmaceutical distributors for the first week in March 1970; these figures were extrapolated for the entire county population according to the percentage ratio of total drugs and specific drugs based on the commercial price of the drug. A random sample was taken-questions were asked of 100 physicians and 50 emergency rooms concerning their poison cases for the first week in March 1970.
Results and Discussion 1. Trends in Poisoning in Los Angeles County (Tables I and II, helow, page 14) -Inhalation, eye and skin contact with poisons made up less than five percent of the reasons for telephone caiis; ingestion accounted for the vast majority. Salicylate and Propoxyphene Poisonings-Proproxyphene poisonings made up seven percent of the children's poisonings in Los Angeles whereas they make up only about two percent of such poisonings nationally. However, even assuming that propoxyphene is substituted for aspirin does not bring the Los Angeles figures to the 25 percent salicylate poisoning level nationally. Results of the distribution survey made in March 1970 indicates that propoxyphene (Darvon) is three times more available now than in 1965, and that aspirin is as available now as it was in 1965, correcting for the population increase, in Los Angeles County. Surveys of the physicians and hospital emergency rooms for this same period indicated that there was gross under-reporting of cases to the
Materials and Methods Hospital and phone report records from the only poison information center in Los Angeles County-Children's Hospital of Los Angeles-were examined to establish the epidemiologic features that might explain the above trends. The Children's Hospital Poison Center serves some seven million people in Los Angeles and is a resource for the rest of Southern California. It has received over 270,000 poison reports from 1957-1970 (October). As infonnation is almost exclusively from trained observers, i.e., as physicians or veterinarians, the number of
TABLE I
Summary of Statistics of Phone Call Reasons to Poison Information Center, Children's Hospital1964-1968 1964
1965
1966
1967
1968
13,650
15' 139
16,022
17,490
18,339
1 '715
2,073
2,309
2,547
2,654
0
0
Information only
756
981
1,142
1,059
Veterinarian cases
101
136
178
289
392
16,223
18,329
19,647
21,469
22,494
Reason Accidents Suicides (intentional) Unknown
Total
1 '138
0
Vol. NSll, No. 1, January 1971
13
Lawrence S. Krain, MD, earned his MD from the University of Illinois college of medicine and his MPH in epidemiology as a USPHS trainee at the 'University of California, Berkeley School of Public Health in l969. He is currently completing field training at the State of California Department of Public Health (assigned to the Los Angeles County Health Department) for certification by the American Board of Preventive Medicine and Public Health. His major projects have involved studies in cancer epidemiology and health services research ili East Los Angeles. He has authored a number of medical publications.
William H. Bucher, MD; has been medical consultant to the Thomas J. Fleming Poison Information Center at Childrens Hospital of Los Angeles since its inception in 1957. The center receives calls primarily from physicians and is one of the largest of its kind with 24-hour coverage. Bucher holds a MPH and has had traini1ig in child psychiatry and child development. Presently he is acting director of the division of child development at the Children's Hospital and associate professor of pediatrics at the University of Southern California.
Gerald A. Heidbreder, MD, is a clinical professor of community medicine and public health at the University of Southern California medical school and U.C.L.A. schools of medicine and public health. He also serves as special consultant to and member of the National Speakers Bureau (venereal diseases) for USPHS. Active in venereal disease control activiti·es, Dr. Heidbreder most recently is the pioneer of a multimillion dollar model drU:g abuse ·p revention and youth clinic programs for Los Angeles County. He is the author of numerous medical and scientific publications in the area of communicable disease.
Poison Information Center for both propoxyphene arid salicylate poisonings. Only 35 percent of propoxyphene reports showed up in poison information phone call data and only 15 percent of aspirin poisonings were noted for this March period. Overa11, the poison information center sampled only 37 percent of the potential poison~ ing incidents extrapolated from the random sample of physician and hospital emergency rooms surveyed.
Lead Poisoning-In January 1970 the Los Angeles County Health Department started an extensive lead level survey in children ranging from 1-14 years of age throughout Los Angeles County. Through October 1970 there has been only one al;mormal case confirmed by blood and urine byproduct (lead) analysis. Furthermore, emergency rooms and physicians surveyed for lead poisoning reports have not reported a single case in Los Angeles for the period 1969-70. Newer construction materials and the absence of leadbased paint are without doubt the reasons for this encouraging phenomenon. To check on the existence of lead in older dwe11ing construction materials, a special fluorescent detector is being tested. This survey is still in progress. Amphetamine Poisonings-The national figure for amphetamine poison14
ings averages 0. 7 percent of all poisonings. In Los Angeles this figure is 2.2 percent and has trebled in the last five years. Indeed, surveys indicated that amphetamines are three times more available to the public now than in 1965. While this could account for the total increase, another factor, i.e., under-reporting of these episodes must
be considered. Less than 10 percent of such episodes ( potent~al) show up in the Children's Hospital data based on physician and hospital surveys for the March 1970 (first week) period. All figures cited above have been standilfdized to remove population increases as a factor. Similarly, although the incidence of LSD (lysergic acid) poisoning has sextupled in the last five years in Los Angeles, only six percent of these episodes are reported to the Children's Hospital Poison Information Center based on this physician and hosp~tal survey.
Deodorant Poisonings-Based on physician and hospital surveys, the Children's Hospital Center tends to overreport both spray-wick and block and cake deodorant poisonings. Physicians and hospital emergency rooms sampled picked up only 44 percent of such incidents. reported to the Poison Information Center. Surveys indicated that these deodorant products are four times more available now than in 19-65 to the· general public, correcting for population increase· figures. 2. Detects of Poison Registries-The N ation?l Clearinghouse for Poison Control Centers does ari excellent job of standardizing reporting on an objective forin for the oyer 300 poison centers in its system. The defects of such a system that remain are1. Such registries are riot population-
based and over-represent rural areas while under-representing populous areas such as .Los Angeles County. 2. The quality of form completion and reporting in a given reg-ion is largely unco:ntrolled and there is no incentive for accuracy.
TABLE II
Subject of Telephone Inquiries Grouped by General Area of Use, 1964-1968 Children's Hospital Poison Information Center (Percent Distribution) 1964
1965
1966
1967
1968
7.4
7.4
7.0
8.1
7.1
Internal medications
26.8
27.7
27.4
28.6
27.6
Household products
13.6
14.4
13.9
13.5
16.9
Salicylates
2.2
2.2
3.2
Glue sniffing and LSD and related plants
0.2
1.3
1.9
External medications (alcohol, antiseptics, boric acid, lotions and liniments)
Cosmetics
9.0
8.9
8.2
8.5
12.5
InsectiCides and pesticides
7.5
8.9
6.1
7.5
6.7
7.2
7.0
6. 1
5.5
4.9
28.5
25.7
28.9
24.8
20.2
Plants and plant products Miscellaneous
Total
~"~Numbers
100 .0 (16, 223)*
100.0 ci8,329)
in parentheses indicate total number of cases.
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
100.0 (19 '647)
100.0 (21 ,469)
100.0 (22,494)
3. Data fed into the individual centers comes from a large variety of sources which may be different for each poison center. For example, the New York reporting system reported by J acobziner2 receives reports only from hospitals, thereby only reporting the more serious poisoning e·pisodes. Some poison centers count in their statistics calls from the lay public which may be "crank" calls, thereby tending to overreport certain poisoning events. Yet the national statistics do not reflect these important distinctions except for such special tabulations as may be presented. _ Since poisonings are not a reportable disease in Los Angeles County, this phone cail data is as good, if not better, an epidemiologic base as is the total hospital reporting system. Quality control must be maintained with periodic surveys for short periods of time (i.e., a week) to insure that the Poison Information Center knows. what it is measuring and what it fails to measure. While this is the standard practice with federally funded tumor registries, this has not been done with any widespread application for poison registries. Furthermore the level of reporting must be capable of being estimated by an individual poison registry based on peri-
odic surveys of the area rather than "a guess" on the national poison information form. Public alertness can vary from region to region in regard to poison reporting. Periodic surveys can reflect this degree of aler~ness on the part of both physicians and ~atients. Health education can be used to increase the public awareness of those under-reported poisoning episodes. Finally, nationally reported poisoning statistics might be better reported by fewer than the 300 registries now reporting if these fewer registries _ were--
questionnaire completion from lay people with cross-checks to eliminate duplicate reporting. A registry should ideally be based upon some such standardization of the reporting system so that generalizations can accurately be made. The national statistics currently do not have this virtue. While the surveys in Los Angeles have shown that this system is far from perfect in this area, at least these data have indicated areas where generalizations should and should not be made and where corrective action is needed. •
1. Geared to report representatively
and accurately a definitive population area. 2. Accompanied by periodic community surveys to insure quality control. 3. Standardized to compile poisons based on one or more of the following systems of reportinga. all poisoning -episodes in hospital emergency rooms; b. all poisoning episodes in physician offices; c. verified phone call data from phy. sicians, pharmacists, veterinarians or other paramedical personnel with sufficient poison information backgrounds, for a circumscribed and well-defined population area, d. poisoning reports by phone or by
References 1. National Clearinghouse for Poison Control Centers, "Poison Statistics," Bulletin, National Clearinghouse for Poison Control (Sept.- Oct. 1969 and 1970) 2. Jacobziner, Harold, "Causation, Prevention and Control of Accidental Poisoning," lAMA, 171, 1769 (1959) 3. Craig, J.O., and Fraser, M.S., "Accidental Poisoning in Childhood," Archives of Disease in Childhood (Great Britain), 28, 140, 259 (1953) 4. Done, A.K., "Drug Intoxication," Pediatrio Clinics of North America, 7, 253 ( 1960)
Acknowledgement Research supported in part hy Mrs. As a V. Call Fund at Children's Hospital, Los Angeles.
APhA Participates at Health Meeting
APhA co-sponsored two sessions on pharmaceutical services
at the annual meeting of the American Public Health Association in Houston, Texas, October 25-30. On Sunday, October 25, APhA joined the American AssoCiation of . Colleges of Phanmicy in sponsoring a session tit!led "Pharmaceutical Services: Today and Tomorrow" which featured presentations on "Training Pharmacists for Tomorrow" ~. by Hugh F. Kabat; "Patient-Oriented Pharmacists-Will They Meet the Needs of Society?" by Sister Emmanuel Schott; a report on the Student APhA Appalachian Project; "Pharmacy Manpower for Tomorrow" by T. Donald Rucke.r and William Sobaski; "The Role of the Community Pharmacist and the Pharmacy As·sociation in Health Education" by Frederick S. Mayer, and "Health Education-An Integral Part of Pharmaceutical Services" by Philip J. Levine. On Thursday, October 29, APhA joined the medical care and mental health sections of American Public Health Association in presenting a session titled "Pharmaceutical Services as a Component of Comprehensive Health Care." This marked the first 'time that APhA has participated directly in American Public Health Association's annual meeting. Papers included in that Session were "Drug Benefits Under National Health Insurance" by Frank Furstenburg; "Psychotropic Drugs: Studies of Pres<;ribing Patterns arid Usage Patterns" by Mitchell B. Balter and Jerome Levine; "Poverty Area Residents Look at Pharmaceutical Services" by Sydney P. Galloway and Charles Eby, and "The Pqarmacist as ·a Member of the Heal,th Team" by Miss Rosalyn M. Cain and Joel S. Kahn.
Chief of USPHS Indian Health Service division of pharmacy, Allen J. Brands (left) shares a lighter moment at the APHA annual meeting with T. Donald Rucker, Social Security Administration.
Texas Southern University school of pharmacy Dean Patrick R. Wells discusses the future of pharmacy with Sister Emmanuel Schott, Wayne State University college of pharmacy assistant professor, who spoke at the meeting. Vol. NSll, No. 1, January 1971
15