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Twists and turns fill Rx for a new pill bottle

The testing on a cap that foils toddlers but not old people takes place in preschools and senior centers.

Jack, a 3-year-old in a green flannel shirt, sits on the blue carpet at the Epworth Early Childhood Education Center, gnawing on a medicine bottle. He is trying to open the bottle with his teeth.

Next to him is Emily, a 4-year-old with a blonde ponytail and a pink Gap vest. Scrunching up her face, she's cranking on her own pill bottle, pressing it to the floor, twisting the cap.

Soon Jack is scratching his head. Emily picks up her bottle and palms away at the lid. "I'm getting it off," she says, really winding now. "Got it," she says with a smile. At that instant, Judy Seabring, a market researcher, checks her stopwatch and marks down the time: two minutes, 19 seconds.

This test and others taking place in preschools around the country are aimed at solving one of the biggest riddles in packaging: How to make a cap that foils the little fingers of toddlers but isn't too hard for old people to open?

For three decades, this question has taxed the ingenuity of engineers. In 1970, Congress passed the Poison-Prevention Packaging Act, ushering into U.S. homes two of the most-frustrating consumer packages in memory _ the line-up-the-arrows bottle and the push-and-turn bottle, for aspirin and prescription drugs. Almost overnight, the bottles became the butt of jokes by stand-up comedians and the bane of many older people. Still, with the flood of child-resistant bottles came a sharp decline in poisoning deaths of youngsters.

The matter might have ended there, but demographic trends in the past two decades produced a troubling side effect. Millions of young children and grandparents began living together in the same households. By 1987, the Consumer Product Safety Commission found that grandparents' medicine was responsible for 17 percent of accidental poisonings of young children by prescription drugs.

Even as the rate of fatal poisonings dropped, overall incidents were climbing. In the period from 1993 to 1998, the annual number of children poisoned by prescription drugs jumped 15 percent to 477,452, according to the American Association of Poison Control Centers in Washington. The modern routine of preparing dinner has become so hectic that poison center staffers have come to call the late afternoon "the arsenic hour."

What happened? Some people think that many older people find unscrewing child-resistant caps so frustrating that they simply leave them off _ and leave the open bottles within small children's reach. "The packaging industry hasn't responded to the needs of the elderly," says John M. Bitner, manager, package design and development, for Monsanto Co.'s Searle pharmaceutical division.

In Toledo, 70-year-old Betty Harkliss couldn't agree more. "I hate them," she says, picking up a child-resistant bottle with her bent fingers during a recent test at a senior center. "Sometimes you just turn them and turn them, and it just can't open." She has a suggestion: "They should do away with all those bottles. Children can probably get into them, and adults can't."

The quest for a better cap has been heating up since new regulations took effect in 1998. Faced with the sober statistics about poisonings with grandparents' medicines, the product-safety commission by the mid-1990s had conceded that many child-resistant caps were just too hard for many older people to push down and turn. To spark work on protective packages that would be easier on the elderly, the commission raised the age range for adults on its test panel, to 50- to 70-years-old from 18- to 45-years-old. "If older people revolt and leave tops off, we can't avoid child poisonings," says Ken Giles, a commission spokesman.

The mandate for caps that are more accessible to a grayer population has forced pharmaceutical and packaging companies to experiment. Some designs are no mere plastic bottles: They are highly engineered devices, designed with "removal torque" and "inch-pounds of downward force."

Sanner of America, a Cherry Hill, N.J., packaging company, has developed a bottle that uses something like a key, which is inserted into grooves on top of the cap. Sanner says it eliminates the "press-and-turn" motion that many older people find so difficult.

One of the most active innovators is Searle, which counts a huge elderly patient population taking Celebrex, its blockbuster arthritis-pain drug. In the past two years or so, Searle has reviewed some two dozen new bottle and cap prototypes. There's the "counter cap," which employs a type of combination-lock device, and the "slide-button cap," with a little door and tiny plastic "shock absorbers" for removing it.

Bitner, Searle's packaging manager, is something of an evangelist on this issue. At a recent Washington industry conference attended by people from packaging companies and the Food and Drug Administration, he handed some panelists medicine bottles to open. To demonstrate the limitations of some older people, he first had the panelists slip on gloves and don goggles glazed with Vaseline. "They age instantaneously," he says.

Whenever Bitner receives a new type of child-resistant bottle from a packaging company, he gives it the glove treatment. He personally tries it out with his own special pair of garden gloves, which have some of the fingers bound together with gray duct tape. If he can't open the bottle easily, he passes on it.

"A 4-year-old and a 70-year-old have the same hand-strength," says Bitner.

Lately, Searle has been focused on the "Friendly & Safe" cap, which it is developing with Kerr Group, a Lancaster, Pa., packaging company. It uses a tapered bottle design and four locking grooves. It can be "palmed off," meaning the fingers don't have to squeeze the cap at all. It also requires less than a quarter turn to open or close, while other models may require a burdensome full revolution or more.

The new cap may be available by year's end and may be coupled with a square bottle, which is easier to wedge in the palm, Bitner says. "Every child-resistant cap we get in the market potentially saves a life," he says.

Before federal regulators sign off, though, the "Friendly & Safe" cap will have to get past the young and old test panelists used by contractors such as Great Lakes Marketing. The Toledo company sends Seabring and other testers into nursery schools, day care centers and senior centers to carry out the tests for major medical-packaging companies, including Kerr and Owens-Illinois.

Government testing rules require that children from 42 months to 51 months old be handed the bottles, shown how to open them and then told they may use their teeth if they wish. For a package to pass muster, 80 percent of the kids must be unable to open it after 10 minutes. For the 50- to 70-year-old set, 90 percent must be able to open and close it even more quickly.

The idea isn't to create packages that absolutely no youngster can open, but rather to build in a level of difficulty so that a child left unattended for a few moments can't get inside. "They aren't childproof, they're child-resistant," says Lori Mitchell Dixon, principal of Great Lakes Marketing. "They're supposed to give parents a window of opportunity to save a child, a safety net of 10 minutes."

One challenge: Teachers and day care operators say youngsters are improving their finger coordination, partly because of new toys sharpening their motor skills. Some toys twist, turn and transform from animals into robots and back.

"It's getting more difficult to outsmart the kids," says Great Lakes Marketing spokeswoman Mitchell Dixon.

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