Expert Opinions

Leonard Snellman, MD, FAAP

August 1, 2014

Re: De Novo, Inc. AC Cookie


Dear Dr. Stang,

I am a general pediatrician in an office based practice in Minnesota and the Vice Chief of Staff of Children's Hospitals and Clinics. I am writing this letter to express my support for the De Novo, Inc. AC Cookie. The following three paragraphs are copied from an article on Prevention of Poisoning in Children from the UpToDate subscription website (Author Nancy R Kelly, MD, MPH; Literature review current through: Jun 2014. This topic last updated: Apr 08, 2014):

Exposure to poisons is a common problem. The Institute of Medicine estimates that the incidence of poisoning in the United States is approximately 4 million cases per year, with 300,000 cases leading to hospitalization, and approximately 30,000 deaths (1]. In 2003-2004, poisoning accounted for 18 percent of all injury deaths and 10 percent of hospital discharges for injuries [1].

Poisoning is a significant public health issue for children. Each year in the United States, more than 1 million poison exposures among children younger than six years of age are reported to the American Association of Poison Control Centers (AAPCC) [3-5]. In addition, approximately 140,000 to 150,000 exposures are reported for children 6 to 12 years and 150,000 to 160,000 exposures for teenagers 13 to 19 years. Because not all poisoning exposures are reported to poison control centers, these numbers are most likely an underestimate.

Over 90 percent of poisoning exposures occur in homes [3-5]. The pattern of poisonings varies by age and sex. For preadolescents, poisoning occurs slightly more often in males than females, but this trend reverses in teenagers, with slightly more than half of all poisonings in the 13- to 19-year age group occurring in females (55 percent in 2012) [5]. The majority of poisonings involving young children are classified as unintentional. In contrast, more than one-half of poisoning exposures involving teenagers are intentional (54 percent in 2012) [5]

In the past, pediatricians relied on families having syrup of ipecac available in their homes for early treatment of poisonings. Unfortunately, although well intentioned, research showed that treatment with ipecac was unsuccessful and often caused the vomiting of activated charcoal given when the child arrived at a medical facility for treatment. In a study published in Pediatrics in 2004 (Risk Factors for Emesis After Therapeutic Use of Activated Charcoal in Acutely Poisoned Children. Pediatrics, Apr 2004; 113: 806- 810), 20% of patients treated with activated charcoal in an emergency room setting vomited. One of the independent risk factors for vomiting was the use of a nasogastric tube. In addition, the American Academy of Pediatrics policy statement on poison treatment in the home (American Academy of Pediatrics: Committee on Injury, Violence, and Poison Prevention: Poison Treatment in the Home; Pediatrics, Nov 2003; 112: 1182-1185), despite stating that activated charcoal "is the most effective intervention for reducing the bioavailability of ingested substances" felt that the most important factor mitigating against its use in the home is that "it is poorly accepted by young children." The policy statement also states that "Because it is often vomited and very messy, caregiver acceptance is an issue."

Thus, for me, a practicing pediatrician, I see poisoning as a very common, dangerous condition, with the most impo1tant impediment to home treatment, with the most effective intervention, being poor acceptability by children in the highest risk age range. In addition, in Minnesota, families spend large spans of time together at remote cabins, often separated from emergency medical care by large distances and long travel times. The availability of activated charcoal in a vehicle acceptable to young children will be a great advantage. The AC Cookie is the solution to this problem. Cookies are not just well accepted, but sought out by young children. They would be easily stored by parents, and because of the inherent safety of activated charcoal, would not be a risk to the child who finds and ingests them as "real" cookies. I see the availability of this treatment option as a tremendous opportunity for pediatricians and the families in their care.

If you have any questions for me, I would be happy to talk with you.

Leonard Snellman, MD, F AAP
Vice Chief of Staff, Children's Hospitals and Clinics
General Pediatrician
HealthPartners Medical Group and Clinic


  1. Committee on Poison Prevention and Control, Board on Health Promotion and Disease Prevention, Institute of Medicine of the National Academies. Magnitude of the problem. In: Forging a Poison Prevention and Control System, National Academies Press, Washington, DC 2004. p.43.
  2. Bergen G, Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook, National Center for Health Statistics, Hyattsville, MD 2008.
  3. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila) 2011; 49:910.
  4. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol (Phila) 2012; 50:911.
  5. Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol (Phila) 2013; 51:949.