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Why Burn Doctors Hate Instant Soup

Dec 5, 2011
Originally published on December 5, 2011 12:02 pm

Instant cups of soup — the kind that often come in a Styrofoam cup full of noodles — send children to the hospital every day.

"I don't have them in my house," says Dr. Warren Garner, director of the burn unit at University of Southern California's County Hospital in Los Angeles. "I would say that we see at least two to three patients a week who've been injured by these products."

These soups are dangerous because of the way the cups are designed. The cups are tall, lightweight, and have an unstable base that makes them tip over easily. At Garner's unit, the most common cases are small children, often toddlers, accidentally tipping the cup over on to themselves.

"It pulls down on top of them," Garner says. "The hot liquid then burns their chest, arms, torso, sometimes their privates, occasionally their legs." He says there's no other injury that he sees as regularly that can be so directly attributed to a product's design, and calls these soups "uniquely troublesome."

Through calls to a dozen burn units at hospitals across the country, we learned that this is a common phenomenon, with children being the most frequent victims. Eight of the 12 hospitals said they see the injury several times a week. One hospital located in Washington D.C. says they regularly see 5-6 patients a week with the injury, especially during the colder months.

Noodle soup is strangely perfect for delivering a serious burn. The sticky noodles cling to the skin, which leads to deeper, more severe burns, according to a study published in 2007. The study showed that hospital stays for upper body noodle-soup burns are more than twice as long as scalds from hot liquids alone. Garner says that about one in five children he sees with the burns end up needing surgery, and these patients can face permanent scarring and limited mobility in their joints.

But not all noodle soup cups are equally dangerous. To illustrate this point, I visited an Asian grocery store with Dr. David Greenhalgh, Chief of Burns at Shriner's Hospital for Children in Northern California, and the author of a study entitled "Instant Cup of Soup: Design Flaws Increase Risk of Burns." He swats at eight brands, and describes how some containers tip more easily than others.

"Seems like we get a scald burn and [we'd say], 'Well, what's this from? Oh, another cup of noodles soup,'" says Greenhalgh, describing his experience at Shriner's. "It just came to me. It was like, 'Wow, it's a very simple test. Can you knock over one kind of cup more than another?'"

That was the study's question. To test it, the study authors went to they grocery store and bought 11 brands of soup manufactured all over the world and calculated the angle at which the soup tipped over and spilled. Not surprisingly, tall cups with a narrow bottom tip over about three times more easily than short, squat containers with a wide, stable base. (Here's the study.)

Cup Noodles by Nissin is one of the most prone-to-tip brands in Greenhalgh's study. It is also one of the cheapest and most popular. Nissin invented the product forty years ago, and has sold more than 25 billion worldwide. Cup Noodles spills at 22 degrees. Compare that to the best performer, a brand called Nicecook, which has a shallow, squat container. You need to turn Nicecook almost vertical-- 64 degrees-- before it tips over.

Greenhalgh says this problem might have an elegant and potentially low-cost solution. Imagine a Yoplait yogurt container-- skinny on top and wide on the bottom. In other words, just invert the design of the cup.

"All you have to do is flip it over," says Greenhalgh. "It would seem to be a very easy thing to do and think I could get some of my team members to go to one of the companies and say, 'Here why don't you try this?'"

I reached out to Nissin and manufacturers of some of the other "tippiest" cups in Greenhalgh's study. Every company declined to comment or failed to get back to me. Greenhalgh calculates that his simple change-- inverting the design of the cup-- would make Cup Noodles almost three times less likely to tip, comparable to the safest brand in his study.

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STEVE INSKEEP, HOST:

Let's turn to a much smaller economic story, one that could mean a lot to certain people. It has to do with the design of a cup of instant soup. The shape of this product might increase injuries, and a simple change could make a big difference. How that design came about, and the effort to change it, is a story for Mara Zepeda of NPR's Planet Money team.

MARA ZEPEDA, BYLINE: You know these soups. Some come in a Styrofoam cup. You stick them in a microwave, or add boiling water. And a few minutes later, they're ready to eat. Here's Dr. Warren Garner, director of the burn unit at USC's hospital in Los Angeles.

DR. WARREN GARNER: I don't have them in my house. I encourage everyone I know to not have them. I would say that we see at least two or three patients a week who've been injured by these products.

(SOUNDBITE OF BEEPING)

ZEPEDA: Just about everyone who works at Dr. Garner's unit is terrified of these products - like Ana Beltran. She used to enjoy the occasional cup of soup herself, before she started working here as a nurse.

ANA BELTRAN: But now, I just absolutely cringe. I can be at a supermarket paying for my groceries, look behind me, and there's a mom with two young children buying a big pack of cup of noodles. And I just can't help but ask her to please be careful.

ZEPEDA: I should mention here, there is a specific brand called Cup Noodles. But Beltran and others use cup of noodles as shorthand for all of the different brands of instant soups in cups.

What makes these soups so dangerous has to do with the way the product is designed. The cups are tall, lightweight, and have an unstable base. They tip over easily. Dr. Garner, at the burn unit at USC, says the most common cases are small children, often toddlers, accidentally tipping the cup over onto themselves.

GARNER: It pulls down on top of them. The hot liquid then burns their chest, arms, torso; sometimes their privates; occasionally, their legs.

ZEPEDA: Are there other injuries that you see as regularly, that can be so directly attributed to the product design?

GARNER: No. This is a uniquely troublesome product.

ZEPEDA: I called a dozen burn units at hospitals across the country, and the story is pretty much the same - injured patients, mostly children. A few hospitals see a patient every once in a while. But eight of the 12 hospitals I called said they see the injury about one to three - and sometimes as many as six - times a week.

It turns out noodle soup is strangely perfect for delivering a serious burn. Unlike coffee or tea, noodles conduct heat and stay hotter longer. The sticky noodles cling to the skin, which leads to deeper, more severe burns. Dr. Garner says that about one in five children he sees end up needing surgery. His patients can face permanent scarring, and limited mobility in their joints. Studies show that hospital stays for upper-body noodle soup burns are more than twice as long as scalds from hot liquids alone.

But not all noodle soup cups are equally dangerous.

DR. DAVID GREENHALGH: These are the different designs of soup in a Vietnamese grocery store. That doesn't take much to knock them over as opposed to knocking...

ZEPEDA: I'm swatting at different cups of soup with Dr. David Greenhalgh, chief of burns at Shiners Hospital for Children in Northern California, and the author of a study entitled "Instant Cup of Soup: Design Flaws Increase Risk of Burns."

GREENHALGH: Seems like we get a scald burn and it says, well, what's this from? Oh, another cup of noodles soup. It just came to me. It was like, wow, it's a very simple test. Can you knock over one kind of cup more than another?

ZEPEDA: That was the study's question. So they went to they grocery store and bought 11 brands of soup manufactured all over the world, and then calculated the angle at which the soup tipped over and spilled. Not surprisingly, tall cups with a narrow bottom tip over about three times more easily than short, squat containers with a wide, stable base.

GREENHALGH: This is Cup Noodles by Nissin. Pull back lid to dotted line, fill cup with boiling water. Close the lid...

ZEPEDA: One of the worst, most prone-to-tip brands in Dr. Greenhalgh's study is also one of the cheapest and most popular. The company invented the product 40 years ago, and has sold more than 25 billion worldwide - Cup Noodles by Nissin. Their cup spills at 22 degrees. Compare that to the best performer, a brand called Nicecook, with a shallow, squat container. You need to turn Nicecook almost vertical, 64 degrees, before it tips over.

Dr. Greenhalgh says this problem might have an elegant and potentially low-cost solution. Imagine a Yoplait yogurt container - skinny on top, wide on bottom. In other words, says Dr. Greenhalgh, just invert the design of the cup.

GREENHALGH: All you have to do is flip it over. It would seem to be a very easy thing to do, and I think I could get some of my team members to go to one of the companies and say, here why don't you try this?

ZEPEDA: I reached out to Nissin and manufacturers of some of the other tippiest cups in Dr. Greenhalgh's study. I wanted to know if they'd been sued, how much they'd settled for, and how much it would cost to redesign the cups. Every company declined to comment, or failed to get back to me.

Dr. Greenhalgh calculates that his simple change, inverting the cup, would make Cup Noodles almost three times less likely to tip, comparable to the safest brand in his study.

For NPR News, I'm Mara Zepeda in Los Angeles.

INSKEEP: And you can find Dr. Greenhalgh's study, and see illustrations of the re-imagined inverted cup, at NPR.org/planetmoney.

It's MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.