One Vicodin or Five—Who Cares?

Everyone Messes Up Their Pills, But It Doesn’t Have to Be This Bad

Do we take so many pills these days that we don’t even notice what the labels say anymore? I barely pay attention to the labels myself, and I write about this sort of thing for a living. I fill a prescription, get a few quick words from a pharmacist, and off I go. What does “take one tablet twice a day” mean anyway? Do I break a tablet in half in order to take it in two doses, or is each dose a full tablet? And just when are those two times a day? Guess I’ll wing it.

I don’t really blame patients for their poor practices. There’s only so much information a regular person can absorb. It’s hard to heed every part of those endless warnings–don’t take this on an empty stomach, don’t take it with oranges, don’t take it with dairy products, don’t take it in warm weather, don’t take it in Denver, and avoid scuba diving. It’s even harder when the warning is presented on a three-inch bottle with a strip of print so small it’s best saved for intra-KGB communication. And imagine how much worse it is if you’re old.

It’s no wonder that Americans make about 1.5 million preventable medication errors a year. That’s what the Institute of Medicine (IOM) revealed in an eye-opening report in 2006. Another IOM report estimates that 90 million Americans don’t fully understand or follow health instructions. And I suspect that’s an underestimation.

Clearly, lots of us have no business handling medication–either for ourselves or anyone else. But people need pills. So what can we do about it?

Experts think we could do a lot to be better about our medicines, and their ideas are all based on extremely simple principles. That doesn’t mean they’re easy to pull off, though. The first principle is just to make medicine labels readable and consistent. That’s apparently harder than it sounds. This year, Consumer Reports sent some staffers out to fill prescriptions for warfarin at five different chain pharmacies near Yonkers, New York. What they got back wasn’t good. Some pill jars had labels with impossibly small text. Others were missing crucial warnings. Some even failed to describe the drug inside. As for the words and numbers to describe drug dosages, those were all over the map. Overall, critical information was found to be “confusing, misleading, buried or absent.”

As is so often the case, legal fears underlie some of the impossibly elaborate labels. Pharmacies and drug companies prefer to overload patients with information to cover themselves in case of lawsuits. But that just makes the print smaller and the instructions more pointlessly detailed. That’s why some experts recommend that doctors give patients–or the relatives of patients–a single sheet of paper that spells out all a patient really needs to know–why the drug has been prescribed, what the drug does, how it works, how to take it and what are the repercussions if not taken as instructed.

Of course, whether instructions are blown up to the size of billboards or made to fit on a sheet of paper, they’re only any good if they’re understandable. And that gets to principle two of getting people to take their drugs correctly. Instructions must be written in comprehensible, human–or at least semi-human–language. Jack Fincham, a professor at the School of Pharmacy at the University of Missouri at Kansas City, told me that even some small changes in how things are described would go a long way. Use “high blood pressure” on a label rather than “hypertension,” for instance. And when it comes to vague directions like “every six hours,” instructions should make clear how rigid such time intervals really need to be. For example, as Fincham asked, “If the directions say every six hours, should a patient get up in the middle of the night?”

Paper instructions are best for certain patients, but others only pay attention to what they hear directly. So the third principle of making drug mistakes is to give patients a proper spoken explanation of how to take their medicines. Again, that might sound simple, but that doesn’t mean it’s something people do. Doctors often leave the business of pill instructions to pharmacists, but pharmacists have other responsibilities, like getting orders filled and keeping the line moving. After all, identify which of the following three experiences you’ve more commonly had: 1. Being annoyed that your pharmacist didn’t tell you enough about your medication. 2. Being annoyed your pharmacist told you too much. 3. Being annoyed that the line at the drug store took forever. I’m willing to bet on your answer.

Fincham believes that pharmacists should take a much more active role, perhaps even establish a phone line that patients can call during all hours to ask any questions that come up. After all, a lot of us don’t think of the questions we need to ask until long after we’re meeting with a doctor. “Patients should be able to ask any question anytime,” said Fincham. “If you don’t understand something on a label, ask until you do. Consumers have to be their own best advocates.”

“Their own best advocates”–yes, indeed. In fact, that’s the fourth principle of improving habits of drug-taking: getting patients to care. It’s the simplest principle of all, but it’s also the hardest to achieve. Of course, if you’re reading this article, you’re probably the type of person who cares enough to take the initiative on getting it right. But that makes about one of you.

To hear a weary voice from the front lines, listen to that of Afrouz Nikmanesh, a pharmacist for Walmart in Pico, California. “It is not so much the inability to read labels and prescription instructions but the desire to do so,” she complained to me recently. “No one seems interested in his or her own health anymore. Everyone wants to just take a pill to make their problem go away and they don’t even have the time or desire to do it correctly.”

Nikmanesh admitted that every pharmacy has its own labeling and that there’s a lack of uniformity. However, she added, “This by no means devalues what I truly believe. It is mostly the lack of education and desire to know more about the way a medication is supposed to be taken that gets people into trouble.”

In the real world, some players are now trying to put these principles into action, mainly by making drug labels more readable. For instance, in 2005, Target redesigned its bottles and labels to reduce errors. (It even uses a color-coding system so patients won’t mistake one medication for another.) Merck has, among other things, increased font size and added a 3-D picture of the medicine tablet. And in 2010 the U.S Pharmacopeia (USP), an official public standards-setting authority for all prescription and over-the-counter (OTC) medicines, set some recommended standards. These included using simpler language, making dosage more explicit, and improving general readability.

These things are a start. But if all we fix are labels, then doctors get a pass, pharmacists get a pass, and patients get a pass. That won’t do, if we really want to fix the problem. What we prefer, of course, is to make this someone else’s headache. That’s human nature. And, speaking of headache, it might be time for a couple of Tylenols. Or just one? I can’t read those instructions. Guess I’ll wing it.

Mari Edlin is a healthcare writer in California.

*Photo courtesy of EssjayNZ.


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