Perplexing Prescription Labels
May Get a New Look

 

If you’ve ever picked up a prescription bottle and found yourself straining your eyes and puzzling over its instructions, you’re not alone. Almost half of patients misunderstand the dosage instructions on prescription labels, research has found. It’s not surprising, considering how cluttered these labels are with information. Their fonts are small and jammed together, instructions are cryptic — for example, “take as directed’’ — safety warnings are hard to find or altogether absent and, not surprisingly, the only thing that usually stands out clearly is the pharmacy’s logo.

Hopefully, this is about to change. The United States Pharmacopeia, the organization that sets the quality standards for all drugs in the United States, recently proposed national standards for prescription labels.

Poorly designed medication labels aren’t just inconvenient — they are a safety concern. Of the estimated 1.5 million medication errors that occur each year in the United States, misunderstanding of the prescription label is a major culprit. The problem hits certain groups especially hard: senior citizens, who take two to three times more medicines than the general population, have the most trouble understanding what prescription labels say, according to several studies. Labels with multiple instructions, unfamiliar terms, or confusing icons tend to be at higher risk of being misunderstood, but even seemingly simple instructions can be confusing. In one study, 16 percent of patients did not understand the label “take with food.’’

Pharmacies basically have free rein to write whatever they deem proper on their labels. There are a few items a label must have, as per a mandate from the Food and Drug Administration, but there are no standards on how to present usage directions, what kinds of fonts to use, or how safety information should be presented. Some states, like New York and California, have made some inroads with more stringent regulations on prescription labels, but it’s a piecemeal approach nationwide.

The proposed standards would include: putting the patient’s name, the name of the drug and the strength of the dosage at the top of the label, followed by clear directions for use; putting less critical content, such as the pharmacy name, doctor name, refill date, and expiration date in a less-prominent location, such as the bottom of the bottle; leaving more white space between lines of text and using bigger fonts to improve readability; and using simple language to describe usage directions so, for example, instead of stating “take 2 pills twice daily’’ it could say “take 2 pills in the morning and 2 pills in the evening.’’

Those sound like the kind of obvious features that should already be on all labels, but sadly that’s not the case. A few years back, researchers at Harvard Medical School, Northwestern University in Chicago, and the Greater Los Angeles Veterans Affairs Healthcare System took identically written prescriptions for four common drugs to 24 pharmacies — six each in Chicago, Boston, Los Angeles, and Austin — and evaluated the format and content of the prescription labels that came back.

They found that the pharmacy was listed first on all labels and that in 84 percent of labels the pharmacy’s logo was the most visible item, often the only one in color. Font size varied greatly and was usually small for the usage directions. There was also great inconsistency in the use of safety or warning stickers.

Proposed standards are now out for public comment and could be adopted as early as May 2012. Yet some of the changes, such as making instructions clearer, as in writing “take two pills in the morning and two pills in the afternoon’’ don’t need to wait for an official sanction: most pharmacies could begin to implement these now. Other changes involve a more thorough label redesign, and may translate into added costs for pharmacies.

But it could pay off. The retail chain Target did a major redesign of its bottles and labels in 2005. The redesign has garnered high praise from consumer advocates and the pharmacy has ranked number one in customer satisfaction among mass merchandisers for four years in a row, according to the J.D. Power and Associates U.S. National Pharmacy Study.

That it took the United States Pharmacopeia to finalize a list of standards is both wonderful and lamentable: a fix is hopefully near, but how sad that we have functioned with such sub-par labeling practices until now. The proposed changes are a welcome prescription for common sense.

-From “Cure for confusion; Perplexing prescription labels may get a new look” by Sylvia Pagan Westphal, January 28, 2011, The Boston Globe, http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2011/01/28/cure_for_confusion/, retrieved 1/28/11.

 

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