P&G says today that it had no unique concerns about the safety of Tide Pods at launch, given the lack of any poisoning crisis in Europe. Rick Hackman, head of North America regulatory and technical external relations at P&G, says that the company applied the same stringent safety process to the pod launch that it does to all its products.
Yet P&G took an additional step that seemed to indicate an unusual degree of caution. Immediately after the launch, the company enlisted the Cincinnati Drug and Poison Information Center to collect data on exposures. In response to questions from Fortune, P&G says that a panel of external medical advisers recommended the data collection because the product was new to the market. (P&G also says the company took similar action when it introduced dishwasher packets, which are similar in size and shape.)
P&G declines to say whether the commissioning of the Cincinnati data collection reflected concerns that the product was uniquely risky. But Richard Dart, head of the Rocky Mountain Poison and Drug Center at Denver Health and an expert in the field of consumer safety for over 30 years, describes this as highly unusual. With “prescription drugs, if the FDA has concerns, they will require monitoring right from the minute it enters the market,” he says. “But for consumer products, especially, I don’t think I’ve ever even heard of one that did this.”
In regulatory circles, meanwhile, the surge of pod injuries was dramatic enough to draw attention. In October 2012 the Centers for Disease Control and Prevention issued a warning to consumers that laundry pods, which had a “candy-like appearance,” were “an emerging public health hazard.” In March 2013 the Consumer Product Safety Commission (CPSC) issued a statement calling on the industry to take voluntary action to address the hazard. While the CPSC has wide regulatory powers, including the ability to force a mandatory recall or unilaterally develop safety standards for a product, it uses these levers only in rare instances when a product is patently dangerous, says Cheryl Falvey, a partner at Crowell & Moring and former general counsel at the commission. Otherwise, she says, the commission prefers to nudge businesses and consumer advocates to come up with voluntary standards, which, despite their name, manufacturers are required to follow. And even in that context, the CPSC’s call for action on pods was relatively unusual—something that Falvey says happens only once or twice a year at most.
While other manufacturers also make laundry pods, P&G as the market leader took the lead role in responding—and by most accounts, the company’s actions were serious, urgent, and diligent. By mid-2012 it had already begun installing double-latch lids on the tubs containing its pods. And by the summer of 2013, P&G had changed the tubs’ design to be opaque, placating critics who felt the clear tub resembled a candy jar. Still, the number of poisonings kept climbing. In February 2015, Sen. Dick Durbin (D-Ill.) and Rep. Jackie Speier (D-Calif.) introduced federal legislation that would have forced manufacturers to make the design of packets “less attractive to children” and use less caustic ingredients.
The legislators noted that they would drop the bill if the industry took stronger action on its own. In September 2015 that effort took concrete form as manufacturers, industry lobbyists, and consumer advocates approved a new set of safety rules. The standards required that pods have opaque, difficult-to-open packaging; standardized warning labels and safety icons on packages; and burst-resistant, bitter-tasting outer film.
By 2017 the new standards had been implemented across the industry. And in June 2018 the standards committee met again to review injury numbers and determine their progress. The results they saw, depending on one’s point of view, were either a reassuring sign or an indictment of a failed safety system.
The studies measured the impact of the industry’s safety intervention on children under 6, comparing a 12-month period before the new measures went into effect (July 2012 to June 2013) to a 12-month period after the intervention (calendar year 2017). During that time span, the number of pods sold more than doubled, from 2.1 billion to 4.7 billion, according to Nielsen data used in the reports. The upshot: The ratio of exposures to total pods sold dropped 53%; the ratio of exposures involving health care facility treatment to sales dropped 63%; and the ratio of exposures involving major medical injuries or death to sales dropped 86%.
For the industry, these were an important sign of progress. But consumer advocates at the same table saw a glass half-empty—because while injury rates, measured by market size, were down, injuries as measured by absolute numbers (and when adjusted for population growth) barely budged. Annual emergency-¬department visits dropped only slightly over that span, from 4,300 to 4,200, while total exposures actually rose slightly, from 10,229 to 10,776. (Exposures dropped to 9,440 in 2018, according to preliminary AAPCC data, but those numbers are likely to rise slightly once the data has been fully analyzed.) And the share of total exposures involving health care facility treatment—a measure of injury severity—dipped slightly, from 42% to 33%.
As Rachel Weintraub, legislative director and general counsel for the Consumer Federation of America, notes, the reports “gave both sides data, to pursue either their views that it was working very well, or views that more needed to be done.” Today, P&G cites this data as evidence that the industry’s approach is successful. “As long as we continue to see reduction in incident rates, even if the number of [poison-control] calls increased, we would think of it as progress, as the form is new and people are learning how to use it,” Damon Jones and Petra Renck of the P&G communications team told Fortune in an email.
Consumer advocates, meanwhile, argue that the industry is setting the bar too low. Measuring progress relative to market size is an incomplete measure of success, says Gary Smith, the injury expert at Nationwide Children’s Hospital, who has been part of the standards process. For 150 years, epidemiologists have used the absolute number of cases, or the number of cases relative to the population at risk, to measure public health burden, Smith says. “If this were Zika virus, and the number of cases of encephalopathy were still going up, but the number of cases per mosquito population were going down, we would take no comfort in that latter number.”
The standards group plans to meet again in mid-2019 for another progress review. Both sides hope to see further improvement, but that’s uncertain. Richard Dart, the Denver poison-control expert, notes that the decline in exposures has already started to slow. “We’d like the number of incidents to go down, and that’s how we look at public health measures across the board,” says Weintraub.