The Surprising Reason Why Pen Caps Have Tiny Holes at the Top

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iStock

If you’re an avid pen chewer, or even just a diehard fan of writing by hand, you’re probably well acquainted with the small hole that tops off most ballpoint pen caps, particularly those classic Bic Cristal pens. The reason it’s there has nothing to do with pen function, it turns out. As Science Alert recently reported, it’s actually designed to counter human carelessness.

Though it’s arguably unwise—not to mention unhygienic—to chomp or suck on a plastic pen cap all day, plenty of people do it, especially kids. And inevitably, that means some people end up swallowing their pen caps. Companies like Bic know this well—so they make pen caps that won’t impede breathing if they’re accidentally swallowed.

This isn’t only a Bic requirement, though the company’s Cristal pens do have particularly obvious holes. The International Organization for Standardization, a federation that sets industrial standards for 161 countries, requires it. ISO 11540 specifies that if pens must have caps, they should be designed to reduce the risk of asphyxiation if they’re swallowed.

It applies to writing instruments “which in normal or foreseeable circumstances are likely to be used by children up to the age of 14 years.” Fancy fountain pens and other writing instruments that are clearly designed for adult use don’t need to have holes in them, nor do caps that are large enough that you can’t swallow them. Any pen that could conceivably make its way into the hands of a child needs to have an air hole in the cap that provides a minimum flow of 8 liters (about 2 gallons) of air per minute, according to the standard [PDF].

Pen cap inhalation is a real danger, albeit a rare one, especially for primary school kids. A 2012 study [PDF] reported that pen caps account for somewhere between 3 and 8 percent of “foreign body aspiration,” the official term for inhaling something you’re not supposed to. Another study found that of 1280 kids (ages 6 to 14) treated between 1997 and 2007 for foreign body inhalation in Beijing, 34 had inhaled pen caps.

But the standards help keep kids alive. In that Beijing study, none of the 34 kids died, and the caps were successfully removed by doctors. That wasn’t always the case. In the UK, nine children asphyxiated due to swallowing pen caps between 1970 and 1984. After the UK adopted the international standard for air holes in pen caps, the number of deaths dropped precipitously [PDF]. Unfortunately, it’s not foolproof; in 2007, a 13-year-old in the UK died after accidentally swallowing his pen cap.

Even if you can still breathe through that little air hole, getting a smooth plastic pen cap out of your throat is no easy task for doctors. The graspers they normally use to take foreign bodies out of airways don’t always work, as that 2012 case report found, and hospitals sometimes have to employ different tools to get the stubbornly slippery caps out (in that study, they used a catheter that could work through the hole in the cap, then inflated a small balloon at the end of the catheter to pull the cap out). The procedure doesn’t exactly sound pleasant. So maybe resist the urge to put your pen cap in your mouth.

[h/t Science Alert]

A Generic EpiPen Coming in Early 2019 Could Save You Money

Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Alex Wong/Getty Images

For an incredibly common, life-saving medication, EpiPens (epinephrine auto-injectors) are surprisingly difficult for many consumers to get ahold of. Their cost has skyrocketed in recent years from less than $100 for a pack of two to more than $600. They’ve gotten so expensive that some EMTs have resorted to using syringes to manually administer epinephrine rather than purchasing the standard auto-injectors, which are almost exclusively made by the pharmaceutical company Mylan. Generic options have been slow to come to market, but according to Business Insider, a recently approved EpiPen rival is coming in the first few months of 2019, and it could save consumers a significant chunk of change.

The drug’s developers have had an unusually hard time getting the new EpiPen alternative, called Symjepi, onto store shelves. The drug was approved in 2017, but the company, Adamis Pharmaceuticals, had trouble finding investors. Now, Novartis, the Swiss-based pharmaceutical giant that manufactures drugs like Ritalin, is releasing the drug through its Sandoz division (perhaps most famous for it role in discovering LSD in the 1930s).

Symjepi will cost $250 out-of-pocket for a pack of two doses. That’s 16.6 percent less than the Mylan-authorized generic EpiPen or Teva’s generic EpiPen, which both sell for $300. It differs a bit from its rivals, though, in that it’s a pre-filled, single-dose syringe rather than a spring-loaded auto-injector. Auto-injectors are plastic, pen-like devices that keep the needle shielded until the moment of injection, and are specifically designed to help make it easier for untrained (even squeamish) people to use in an emergency. With this version, patients will need to remove a needle cap and inject the needle. Just like the EpiPen, though, it’s designed to be injected in the upper thigh, through clothing if necessary.

If you have health insurance, the difference in cost may not matter as much for you as a consumer, depending on your plan. (I personally picked up a two-pack of Mylan-authorized generic Epipens at CVS recently for $0, using a manufacturer’s Epipen coupon to knock down what would have been a $10 copay.) But it will matter considerably for those with high-deductible plans and to insurers, which, when faced with high costs, eventually pass those costs on to the consumer either through higher co-pays or higher premiums. It also affects agencies that buy EpiPens for emergency use, like local fire departments. And since EpiPens expire after just a year, the costs add up.

However, there’s currently a shortage of EpiPens on the market, according to the FDA, making it more important than ever to have other epinephrine drugs available to those at risk for serious allergic reactions.

[h/t Business Insider]

Brain-Eating Amoeba Kills Seattle Woman Who Used Tap Water in Her Neti Pot

CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain
CDC/Dr. Govinda S. Visvesvara, Wikimedia Commons // Public domain

If you use a neti pot to clear out your sinuses, there's one important rule you should always follow: Don't fill it with tap water. Doing so could land you a sinus infection, or worse, a potentially fatal disease caused by a brain-eating amoeba. Although the latter scenario is exceptionally rare, a 69-year-old woman in Seattle died from doing just that, The Seattle Times reports. Experts are also warning that these infections could become more common as temperatures in the northern hemisphere continue to rise.

Physicians at Seattle's Swedish Medical Center initially thought the woman had a brain tumor. She was brought into the emergency room following a seizure, and a CT scan of her brain seemed to reveal a tumor-like mass. The only other known symptom she had was a red sore on her nose, which was previously misdiagnosed as rosacea. When surgeons operated on her the following day, they noticed that "a section of her brain about the size of a golf ball was bloody mush," neurosurgeon Dr. Charles Cobbs told The Seattle Times. "There were these amoeba[e] all over the place just eating brain cells. We didn't have any clue what was going on, but when we got the actual tissue we could see it was the amoeba."

She died a month later of an infection called granulomatous amoebic encephalitis (GAE), according to a recent case report published in the International Journal of Infectious Diseases. The disease is caused by a single-celled amoeba called Balamuthia mandrillaris, and it's extremely deadly. Of the 109 cases between 1974 and 2016, 90 percent were fatal.

According to the FDA, some bacteria and amoebae in tap water are safe to swallow because acid in the stomach kills them. However, when they enter the nasal cavity, they can stay alive for long periods of time and travel up to the brain, where they start eating their way through tissue and cells. Another brain-eating amoeba called Naegleria fowleri can cause a similar disease, except it acts faster and can cause death in just a few days. Although it's also rare, it's usually found in warm freshwater, and infections start by getting contaminated water up one's nose while swimming or by using a nose irrigation device filled with tap water.

Dr. Cynthia Maree, an infectious disease doctor at the Swedish Medical Center, said the changing environment could facilitate the spread of these infections. "I think we are going to see a lot more infections that we see south (move) north, as we have a warming of our environment," Maree says. Researchers say these amoebae are still little-understood. Future studies would need to be conducted to learn more about the risk factors involved.

[h/t The Seattle Times]

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