NIST: The Metric Cheese Shop

By The Metric Maven

Extra Bulldog Edition

On Sunday, February 7, 1904, a fire began in Baltimore. It would take 1,231 firefighters to bring the fire under control and when it was over 1,500 buildings would be destroyed. One reason the fire burned unchecked for so long was the absence of national standards for fire-fighting equipment. Fire engines from Philadelphia, Washington D.C., Atlantic City, New York City and other metropolitan areas arrived on the scene. Unfortunately, many fire departments were unable to help as their hose couplings would not fit Baltimore’s fire hydrants. Those fire-fighters could only watch as the fire engulfed more and more of the city. It has been claimed that over 600 different sizes and variations of fire hose couplings existed at the time. This was similar to what French Engineer Charles Renard encountered with balloon cables, which caused him to develop preferred numbers.

The National Bureau of Standards was founded in 1901. Two metrication advocates championed its creation, James H. Southard, and John Shafroth. The Great Baltimore Fire directly demonstrated the need for mandatory standardization of fire-fighting equipment. Furthermore, no standards for building construction (building codes) existed, which allowed the fire to rapidly spread.

One would think that with the lessons of the Baltimore fire, and the establishment of a government agency for standards, that soon fire departments across the country would be induced to adopt national standards for fire-fighting equipment.  On March 22, 1975 a fire started at Unit one of the Browns Ferry Nuclear Reactor.  Plant employees attempted to extinguish the fire despite the fact that professional firemen from Athens, Alabama were on the scene. They mistakenly believed there was a problem with a nozzle at the end of a fire hose. This in turn caused the employees at the plant to request a replacement nozzle from the Athens fire department. The threads on the the fire department’s nozzle were not compatible with those of the fire fighting equipment purchased by Browns Ferry.  Because of this, the nozzle would not stay on the end of the hose.

Well, certainly by now, well over a century after the founding of NIST, we would have national standards for fire couplings and this would not be a problem right?  According to Wikipedia:

A national standard for fire hydrant and hose connections was adopted by the National Fire Protection Association. However, inertia remained, and conversion was slow; it still remains incomplete. One hundred years after the Baltimore Fire, only 18 of the 48 most populous American cities were reported to have installed national standard fire hydrants.[18] Hose incompatibility contributed to the Oakland Firestorm of 1991: although the standard hose coupling has a diameter of 2.5 inches (64 mm), Oakland‘s hydrants had 3-inch (76 mm) couplings.[19]

The idea of standardization strangely seems to be at the bottom of the priority list of many engineers. Those who have seen the movie Apollo 13 were reminded that the the carbon dioxide scrubbers for the Command Module and the LEM were not compatible. Fortunately, they were able to engineer their way to compatibility with a duct-tape solution. One should not rely on good fortune instead of planning and standardization, but in the US hoping for good fortune appears to be the standard back-up plan.

The lack of standardization in the US can and has cost lives. The acronym NIST stands for The National Institute of Standards and Technology. A year ago on May 24th 2013 (2013-05-24), on the Friday before Memorial Day weekend, a time when bureaucrats know that news media is generally not paying attention, the Director of NIST, Patrick D. Gallagher, penned a response to a citizens petition requesting that the metric system be adopted as the sole measurement system in the US. His response can be succinctly stated as he supports a “do your own thing” approach to standardization. Standardization is just too confining of a concept for a standards institute to embrace apparently. The title of his response, in case readers have forgotten, is Supporting American Choices on Measurement.  It is well known to metric advocates that 95% of the world’s population uses the metric system. It would appear from just a cursory inspection of this  fact, that one could, with reasonable certainty, state that the metric system is probably the most successful standard in the history of humanity.  The director of the US government body which is tasked with standards, cannot even agree with a petition that the metric system should be the standard of the US?

When one is confronted with Dr. Gallagher’s assertion that the best standard is a lack of standards, and  I remind you he is the director of the standards body of the US, one’s mind can only interpret the strange dark and contradictory humor of this apparently willful cognitive dissonance in but one way—–by resorting to a Monty Python Metaphor. One of the most famous of the Python’s sketches is The Cheese Shop. A patron walks into a cheese shop and requests some cheese. He requests all different manner of cheeses one by one, red Leicester? Tilsit? Caerphilly? Bel Paese? Red Windsor? Stilton? Ementhal? Gruyere? Norweigan Jarlsburg?….. These requests continue ad nausium until finally:

Mousebender Well let’s keep it simple, how about Cheddar?
Wensleydale Well, I’m afraid we don’t get much call for it around these parts.
Mousebender No call for it? It’s the single most popular cheese in the world!
Wensleydale Not round these parts, sir.

The exchange continues as the patron continues to request cheese after cheese until finally he states:

Mousebender It’s not much of a cheese shop really, is it?
Wensleydale Finest in the district, sir.
Mousebender And what leads you to that conclusion?
Wensleydale Well, it’s so clean.
Mousebender Well, it’s certainly uncontaminated by cheese.

I could see a similar exchange with the Director of NIST acting as a standards proprietor where one could request mandatory metric industry standards for fire hose couplers, foot measurement, wire sizes, drill bit sizes, sheet metal thicknesses, medical weights and heights of humans, over the counter medical dosages and on and on. Each time the Director would parrot back “no.”  And when one states “it’s not much of a Standards Institute is it?” this phrase might be met with “finest in the US sir.” Indeed, NIST appears to be quite clean, and uncontaminated with metric standards for the US. As in the sketch, the most popular world measurement standard, which is metric (aka Cheddar) is to be found nowhere as a standard in the standards shop.

It is hard to take NIST’s assertion that it is a standards institute seriously when it promotes the notion that a lack of standards is of exceeding utility to the US, and serves as an illustration of  what makes our nation great. NIST is a Metric Cheese Shop, with no Cheddar, and it is completely uncontaminated by cheese as far as I can tell. It is sad that a scientific standards organization has been turned into a worldwide metric joke. At least the Python players had much better writing, and were actually funny while making important points. Patrick D. Gallagher’s response last year was so feckless, it was almost a killer joke to metric advocates. Now stop me if you’ve heard the one about the 600 choices of hose couplings available to the Baltimore fire department.

Postscript:

In 2012, I wrote an essay entitled Feral Units Endanger Our Health. In it I detailed the well known problem of the confusion between teaspoons and tablespoons. I pointed out that confusion between the two units can lead to a 3:1 or 1:3 dosage mistake. I then cited a column from JAMA, The Journal of The American Medical Association, dated September 20, 1902 (page 712), which is reproduced here in the upper left. The 1902 JAMA column advocates for mandatory implementation of the metric system through the Shafroth Bill. It was brought to my attention (thanks Dr. Sunshine) that just two days ago (2014-05-21) JAMA published a column which yet again addresses the same issue over 111 years later. The new column is entitled Group Urges Going Metric to Head off Dosing Mistakes and is authored by Bridget M. Kuehn (pp. E1-E2). The article opens with modern day examples of the problem:

The article goes on to state that “about 3000 to 4000 children are treated in emergency departments each year as a result of medication errors by a caregiver. Poison control centers in the United States also field approximately 10 000 calls each year about dosing confusion,..”

It has been said that a working definition of insanity is to do the same thing over and over and expecting a different outcome. This apocryphal quotation danced in my mind as I read “The CDC worked with the US Food and Drug Administration and the Consumer Healthcare Products Association to develop voluntary guidelines that were published published in 2011.”  Our current answer to all measurement problems in the US is to adopt voluntary guidelines.

The suggestions are all mostly reasonable, such as including a dosage device with medication which does not use “unusual units” (I guess they mean metric?), adding zeros before decimal points (they could also adopt the whole number rule), and “dosing devices that are not substantially larger than the largest recommended dose of the medication.” Further it is stated:

The CDC recommends using only milliliters as a measure for liquid medications to avoid confusion between teaspoons and milliliters and avoiding relatively unfamiliar measures such as drams (a holdover from apothecaries). The CDC wants the dosing device with the appropriate unit of measurement included with the medication to avoid caregivers using a kitchen spoon or other implement that uses a different unit of measurement. Further, the enclosed device should only have the recommended doses labeled on it to make it even easier and safer to use.

 The ISMP (Institute for Save Medication Practices) goes further than the CDC recommendations and argues for expressing a patient’s weight only in kilograms. The “ISMP, explained that because there are 2.2 kg per pound [sic], switching back and forth can lead to 2-fold errors in dosing of medications by weight.”  Once again, in an echo of the 1902 JAMA column they point out that over the counter medications need to conform to these voluntary recommendations. The article also argues against the use of dual-scale dosage devices.

The article goes on:

Stephen C. Mullenix, RPh, senior vice president of public policy and industry relations at NCPDP, said the white paper is “a call to action” for pharmacists to make sure dosing is correct. They can verify with the prescribing physician to ensure they understand the dosing for a particular drug.

I’m sure the authors of the 1902 JAMA column also saw their words as a “call to action.” The big difference between then and now is the Meyer Brothers backed John Shafroth’s bill for mandatory metrication.

The article ends with the problems encountered when using electronic prescriptions. The example cited is of a doctor prescribing in milliliters and when it arrives electronically, the pharmacies software has a default setting to teaspoons. The article ends with a familiar modern refrain:

Converting all dosing and patient weights to metric is going to take time, Cohen acknowledged. But already he noted that soda cans and many other types of packaging already use metric units and that people will learn the conversions over time. “This isn’t something that is going to happen overnight,” he said.

The lack of mandatory metrication in this country is making people sick, costing our economy financially, and showing us for what we are, a nation that is willing to sacrifice people on an altar of ideology rather than acknowledge and engage with reality. Given our history, I suspect that in another 100 years we may still be waiting patiently for these voluntary recommendations to adhere.

Meyer Druggist April 1922

15 thoughts on “NIST: The Metric Cheese Shop

  1. > because there are 2.2 kg per pound

    Those are some heavy pounds.

    • I backtracked to make sure that error is in the original JAMA article. Not clear whether it is a JAMA mistake or an ISMP mistake, but they may not be completely ready for metric.

      As a reminder, the legal definition of a pound is 0.453 592 37 kg, since 1959. JAMA and ISMP, please take note before you kill someone.

      • Hmmm, no way to edit. The error is in the original 2011 ISMP position paper. Since ISMP hasn’t noticed in 3 years and JAMA hasn’t noticed in quoting, are they really ready for metrication? I sent them a note.

        MM: “Unusual units” are things like drams, whatever they are. There are subdivisions of both the fluid and av. ounce, but I’d have to look up the subdivisions. They are basically obsolete.

        • To RalphYou raise a number of ieusss but I will deal with just one of them as my response to it is a bit lengthy.If the UK goverment had handled the changeover to metric, announced in 1965, properly and completed the project within 10 years according to their stated intention, then the people now in your care, who would have been younger and more adaptable at the time, would have understood the advantages of us using the metric system and the reasons for the change. By now they would have been happy to be weighed in kilograms just as they count their money in (new) pence instead of shillings and old pence.Alas it didn’t happen that way. The government never bothered to promote the change or educate people accordingly. Worse still they betrayed the whole process and sent out the wrong message by not changing road signs, a major element directly under their control. They did instigate changes in health, education and other public service practices but only because there was no short term impact on the chancellor’s budget.However, it is not too late to put this right. It is not realistic to expect the people in your care to change belatedly true enough and we can sympathise with the situation you now face, but at the same time we shouldn’t condemn future generations to the same fate.As it is, being stuck half-way through the change, we all have to cope with both imperial and metric which, as you have experienced directly, is not easy or convenient and certainly not necessary.The only realistic way out of this enpasse is to complete the changeover and phase out imperial measures decisively.

      • While I am satisfied that British hilpotass use metric units as a matter of routine, there is possibly a culture of We will use metric units to keep the auditors happy, but will otherwise use imperial units . Apart from making medically-oriented articles unintelligible for the man in the street (unless the units are dumbed down), there is also the risk that medical staff who think in terms of imperial units in respect of their personal lives will be slow to pick up errors (such as recording 572 kg instead of 57.2 kg) because these are just meaningless numbers . There is also the risk of a figure-conscious nurse switching scales to show imperial units so that she can check her own weight, and then forgetting to reset them, resulting in a person’s weight being recorded as 128 kg rather than 80 kg (12 st 8 lbs) Following recent government announcements, this might well become a thing of the past due to dual-unit scales being prohibited in hilpotass.

    • I’m not completely prcoifient at the metric system but I love it and would love to see us move over to it.Plus, I could then say I’m swinging a big 12 down there and most Americans would not understand that I’m talking centimeters.Gary Z

    • Aren’t over the counter medicines like cough syrup sold in rounded ounce sizes? Will these now be sold in millilitres too?

  2. I am encountering some possibly confusing measures with my wife’s prescriptions now. As I mentioned in my post about the tires, she had sinus surgery this past Monday. The the papers the hospital sent home with us had her weight and height in metric units only. However, as Paul Trusten I know would be familiar with, the packets, directions and bottles for her nasal rinses have both units listed. I believe that SI units are listed first, with the outdated units in parenthesis. I am able to quickly decipher for her, but it irritates me to have to do so. It could easily be misinterpreted by someone not familiar with SI and/or medical procedures. As your blog states, there have been fatal consequences due to confusion when trying to switch between the units.

    This morning I was repairing a piece of lawn equipment. A nut had fallen off and I was replacing the lost one. I had to loosen a larger nut also, and it was in the old units. The nut I used to replace the lost one is 11 mm. Fortunately, I still have a set of wrenches in the outdated sizes, otherwise I would have had to go around the neighborhood borrowing from my neighbors. It was still frustrating.

    • Wasn’t it hard trying to ram a 7/16 inch nut onto an 11 mm screw thread? I hope you didn’t strip the thread.
      (7/16 inch = 11.1125 mm)

      • Oops, I meant the other way round: 11 mm nut on a 7/16 inch screw thread.

      • An M10 nut goes on smoothly on a 3/8-ths bolt and an M5 bolt goes in smoothly on a #10 nut.

        There are many people who falsely believe a particular fastener is not metric because either know non-metric tools work well on it or complimentary parts that shouldn’t fit, do fit even if not 100 % properly.

        • In order for the NHS to go completely SI, it will rqeiure more then just assuring all the scales read in kilograms only. Hospital staff must be rqeiured to have a working knowledge of SI units and must speak only in SI while on the job, both amonst themselves and to patients.When hospital staff are weighing patients, it doesn’t help the situation if they have one eye on the scale and the other on a conversion chart. It defeats the purpose of the metric only scale if they convert measures either via charts or by other means and refer to the converted results rather then the measured from that point on. Experience, competence and a feeling for metric numbers can only come from daily use. If hospital staff convert then they will never obtain the needed familiarity with metric units and will be more prone to mistakes. Thus dosing errors will continue as will misplaced decimal points, as the errors will never be noticed due to lack of familiarity with the metric system.Recording data in records in both SI and non-SI units must also stop and only SI must be used. Reading the wrong numbers on the record can be just as dangerous as making a wrong calculation. Assuring that the language of the hospital is always SI is as important as making sure all the instruments are SI.

      • BrownNo one ever answered your qtosuien about blood pressure. In the US, we also use mm Hg. However, Continental Europe mostly uses the kilopascal.Converting real columns of mercury to pascals involves latitude and height above sea level (for local gravity) and temperature for thermal expansion of both the mercury and the brass scale. However, conventional mercury is based on 760 mm Hg = 101.325 kPa, regardless of gravity and temperature; aneroid instruments are usually calibrated on this basis. A VERY close approximation, easier for mental conversion is 750 mm = 100 kPa.120/80 (mm Hg) becomes 16/10.7 (kPa). Hectopascals would provide better resolution (using integers) but the possibility of a units mistake if units are omitted as is the norm.@Ralph,If the nurses can’t work out metric dosing, grains or av. scruples per stone/pound must just be a delight. And after working that out, you still have to consider liquid medicine in grains/fluid drachm and find a suitable syringe. And, of course, you mustn’t confuse your apoth scruples and fluid scruples, drams, etc.

    • Working on an elderly acute ward I am caiunntolly asked to work out stones and pounds, feet and inches for people who will never wish to go metric. What exactly needs to be worked out? Drug doses are worked out by the doctors and are based on metric amounts, including body mass in kilograms. The patients, no matter what their age, don’t need to know the details of how the dose is derived. Why should we be compelled to? My experience of drug errors is of mathematically incompetent nurses using metric measures. You should be compelled to because that is the agreed standard for the industry. If you don’t like it then resign from the medical industry. If the nurses are incompetent using metric measures, why are they still employed? Aren’t they reviewed? Doesn’t someone check to make sure medical professional are fully capable of doing their job? If they can’t do the math in metric, there is no way they would be able to do the more complex math using imperial. On the flip side of the coin, are they really incompetent in using metric or are they just unable or don’t wish to bother with metric to imperial conversions, pushing the burden on you? Which is it?

Comments are closed.