At Christ­mas, Al’s Grandma brought two boxes of Ibupro­fen with her — 200mg and 400mg. The ques­tion was, which was which? Al’s Grandma is eld­erly, often con­fused and has prob­lems with her vis­ion. Given that she was nurs­ing a broken thumb at the time, adequate pain relief was neces­sary, so we explained which was which and how many of each to take, set­tling the mat­ter. But it niggled at me that the mat­ter wasn’t even slightly settled — as soon as she got home, she’d be straight back to square one: one of these dosages is higher than the other, and I don’t know which.

So this art­icle from Futur­ity, “Cau­tion, may cause con­fu­sion and mis­use” has me think­ing about why med­ic­a­tion dir­ec­tions, both pre­scrip­tion and over-the-counter, are so dif­fi­cult to follow.

“Half of adults mis­un­der­stand com­mon stand­ard drug warn­ings on pre­scrip­tion labels, put­ting them at risk for using the medi­cine incor­rectly or even hav­ing a life-threatening event.”

The inform­a­tion on med­ic­a­tion is overly com­plex and often dif­fi­cult to fol­low. Instruc­tions are mis­lead­ing, abstract and word­ing used just because it always has been, even when there is no evid­ence of its effectiveness:

“A lot of the cur­rent warn­ings were phrased very abstractly and were con­fus­ing. For example, we changed ‘For external use only’ to ‘Use only on your skin.’ We moved from the intan­gible to the concise.”

A sim­ilar pro­ject was under­taken by a graphic designer for Tar­get in the US in 2005, com­plete with identi­fy­ing col­our labeling for fam­ily mem­bers. As far as I’m aware, noth­ing sim­ilar has made it over to UK phar­ma­cies yet.

The photo to the right is the label from some nose drops when I had a sinus infec­tion (let’s skip over who pre­scribes med­ic­a­tion that needs you to hang upside down four times a day to someone with a bad sinus infec­tion). One drop to be “instilled” four times a day for “esven” days, later con­tra­dicted with mildly ter­ri­fy­ing warn­ing “not to be taken”. The instruc­tion is in small, blurry, badly prin­ted text, with the name of the phar­macy as, or more, prom­in­ent than any of the directions.

I take a lot of med­ic­a­tions, and there is noth­ing con­sist­ent about them. While they all come in boxes (apart from the odd ear/nose drop) almost all are gen­er­ics, so there’s often very little pack­aging dif­fer­ence between one and the other — it’s brand­ing for the gen­er­ics com­pany, not the med­ic­a­tion, so get two from the same com­pany and con­fu­sion ensues. If I hap­pen to go to a dif­fer­ent phar­macy to pick up my pre­scrip­tion, then I’ll more than likely get a dif­fer­ent brand of gen­er­ics from them than my usual phar­macy, with a dif­fer­ent box and dif­fer­ent brand­ing. As for the actual pills, they can vary so much between brands that there is no real point in try­ing to identify them by shape, size or colour.

I’m lucky. I can read without prob­lems, and I have no prob­lem remem­ber­ing what the GP has told me about my med­ic­a­tion (or ask­ing them to repeat it until I have no prob­lem remem­ber­ing). I can pull out a load of pill boxes, men­tally sort them, and remem­ber which ones to take when — when I remem­ber to take them at all, that is. I’m bolshy enough that if a medi­cine isn’t work­ing as it should I’ll go back to the doc­tor and whine until they change it. But what if I couldn’t read well? What if I couldn’t remem­ber? What if I’d had a stroke and couldn’t com­pre­hend writ­ten lan­guage well but lived alone? What if I for­got why I was tak­ing any med­ic­a­tion in the first place, let alone what it was or how many to take? What if I was too embar­rassed to ask for help? What if I didn’t know where to go for help? At least one, if not all, of these things will hap­pen to me in the course of my life. You too.

So why is labeling so bad here in the UK? Why is there so much vari­ation, odd Eng­lish and so little help? What would help? If I could, I’d go back to Christ­mas and make some large colour-coded stick­ers to label the ibupro­fen with. Even if she struggled to read the digit some days, Al’s Grandma would soon learn to asso­ci­ate the pink with the pills she takes two of. Why can’t she walk into a phar­macy and say, “I’m not sure how many of these to take as a stand­ard dose” and have them sticker the packs for her?  Why can’t she get large-print, colour-coded labels on her pills, and why can’t the doc­tor print out a timetable for her detail­ing which of her pre­scrip­tions to take when?* I can Pho­toshop up a giant pink 2 icon in less than a minute (and poten­tially print it out and stick it on a box. I’m a grafter, me.), but ima­gine what could be done for labeling with a bit of research, some user test­ing and, most import­antly, some consistency?

*When think­ing about this, I planned a web­site which luck­ily already exists: MyMed­Sched­ule. It is US-based, so most UK drugs will have to be labor­i­ously typed in, but I can’t find a UK equivalent.