Are Prescription Labels Readable? Clues From The Marketplace
The preceding post, Check The Fine Print For Noncompliance – Part 1, included a couple of studies indicating that, indeed, there are problems deciphering the medication information and instructions printed on prescription pill bottles in a font size technically known – on this blog – as “too damn small.” That these texts are too often smudged, faded, irregular, and disorganized, as well as plastered onto a curvilinear surface, is just a bonus.
In addition, the marketplace also suggests that the difficulty of reading prescription labels is a recognized and widespread problem.
Otherwise, why would products like the Label Enlarger exist?
Label Enlarger
This Label Enlarger and gadgets like it can be purchased from a number of sources for less than $10.
A more sophisticated device, the pill bottle capable of providing audible label information, was originally developed for blind patients but is now marketed to a wider market, including those with age-impaired vision.
The Talking Pill Bottle
Like the Label Enlarger, the Talking Pill Bottle is available in several versions and from several sources.
Specialized labels, warning symbols, and large print labels are available to patients to transform prescription bottle label information into a format that is clearer and less given to misinterpretation.
Pill Bottle Labels
This, of course, begs the question of why patients have to provide this service for themselves.
What Have We Learned?
The proposition that follows is my own idiosyncratic take on the matter, but it is so basic that I am confident I can defend it easily enough.
- If special aids are required to read medical instructions on pill bottles, those instructions are too hard to read.
- Instructions that are too hard to read will not be read as often or as accurately as instructions that are easy to read.
- Instructions that are not read accurately or not read at all will cause unintentional noncompliance.
- Noncompliance leads to unnecessary fiscal costs and increased morbidity and mortality.
Other Lessons From The Marketplace
The problem with font size is not limited to prescription medicines.
And the problem doesn’t seem to be going away on its own.
Wanna see something scary? The label formats displayed below are currently offered for sale to pharmacies (I have changed only the pharmacy name; otherwise, these are exactly as shown in their presentation on the printing company’s web site).
Prescription label form sold to pharmacies (click image to enlarge)
Prescription label form sold to pharmacies (click image to enlarge)
Imagine these overfilled, pre-faded labels affixed to the curved surface of a pill bottle. Imagine my Aunt Hazel and Uncle Foster, both in their 90s, trying to read that text.
The Solution and Why It’s Important
Before Ross Perot was a third-rate third-party presidential candidate, he was a creative, successful businessman who would, on occasion, observe, “If you see a snake, just kill it – don’t appoint a committee on snakes.”
Well, in this case, the snake is pretty obvious: The US population is aging with the huge boomers cohort approaching the age when visual changes make reading small print more difficult. Many prescription labels contain medication information and instructions written in especially small type. The inability to read a prescription label or, even worse, the inaccurate interpretation of medical instructions because of impaired vision and tiny print leads to unintentional noncompliance and that, my friend, is a snake.
Having identified this specific snake, killing it turns out to be a straightforward matter – at least, hypothetically. How about this? The government simply passes a regulation forbidding the use of a font size below, say, 12 points, on prescription labels.
Some may protest that providing sufficient information in larger print on a small label is a physical impossibility. Solving that design problem seems, however, less complex than, for example, decreasing automobile pollutants and increasing fuel mileage to meet those progressively more demanding governmental mandates.
Further, some pharmacies have already been at work on this problem. I came upon this example of from HealthPartners.com.
Even the “After” label isn’t perfect but it’s certainly a significant improvement.
Another heartening example I serendipitously discovered comes from Pharmacy In Focus, the Ulster Chemists’ Association’s official trade publication:
While Mr Perot might point out that there seems to have been more snake committee-forming in this process than was essential, especially since the nurses were already aware that “patients had raised previous concerns about their medicines,” a better label system was introduced.
I suspect clever designers could come up with a variety of inexpensive, easy to implement solutions, but even an unsophisticated approach, such as a page attached at one corner to the pill bottle that folded out to reveal the information in readable text, would be better than ignoring the fact that a large and growing number of people can’t reliably read the the essential information about their medication from the labels.
Larger fonts on medication labels is not a panacea for all noncompliance, nor is it a sexy issue likely to attract a high ranking celebrity as spokesperson for the cause.
Instead, it’s a simple problem with simple solutions. Mainly, it requires dropping the pretense that the use of small, unreadable print is a necessary annoyance and changing a few printers to eliminate a lot of grief, decrease the course of treatment for many, and save more than a few lives.