Fixing Prescription Labels: Are they really broken?

script label 3

Complicated Label       Target label


I pity the poor prescription label.

For at least the past 20 years researchers in health literacy have pointed Groundhogdayout that patients with low health literacy have trouble accurately reading their prescription directions and therefore, show poor medication adherence.

So when I recently read that Wisconsin announced a new project to improve medication taking by “adopting of uniform, patient-centered medication labels” I was, well…feeling a bit like Bill Murray in Groundhog Day.


Because the announcement cites the same troublesome evidence that’s been used for the past 20 years to justify fixing prescription labels – “Misunderstanding and incorrect medication use is linked to non-adherence, which has been associated with a 20 percent greater risk of hospital readmission.”


Full Disclosure: I believe that problems reading prescription labels is insignificant compared to the real reasons people don’t take their medications as prescribed. And we should be addressing those problems.


My question:

Why do we keep thinking that the demonstrated link between low health literacy and medication adherence is due to people not reading labels correctly when the evidence for this is weak?


The Evidence that we’re barking up the wrong tree:

Exhibit #1    A large study done with the new Target retail chain’s new prescription labels (2005) did not translate into better compliance among consumers… at all. In fact researchers found no statistical significance among those using a new, clear Target Prescription Drug Label ( 2009) Journal of General Internal Medicine

BTW – Target still promotes its label as a “clear winner”.

Exhibit #2      In 2014 Nang, Terry and McHorney did an extensive lit review of the evidence of a link between medication adherence and health literacy. They found a “weak” relationship between health literacy and medication. And they conclude that there must be other mediators.

Exhibit #3     My dear, intelligent mother takes her Lipitor every other day even though she’s supposed to take it everyday. Why? Because she once heard a commercial on TV warning about possible liver damage. She likes her liver just the way it is. Thank you.

She’s doing a bit of her her own, what I once heard Dr. Ethan Halm call, “homegrown evidence based medicine”. It should come as no surprise that we often don’t take medication as directed.

Exhibit #4    There are many identified reasons why patients don’t take their medications as prescribed.  None having to do with reading labels. (See reasons below)

reasons for prescription

From Gifford AL, Bormann JE, Shively MJ, Wright BC, Richman D, Bozzette SA. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. Journal of Acquired Immune Deficiency Syndrome. 2000;23:386–395.


So if the prescription labels aren’t the thing that is really broken, why do we continue to try to fix them?

 Why aren’t we turning our focus to the health literacy issues that contribute to medication taking?

  • Only about 5% of patients can tell what they’re medication is supposed to do and how long it takes for the medication to actually make you feel better.
  • Efficacy – we haven’t figured out good, clear ways to talk about the evidence from one medication over another.  Do we think patients are interested or can’t grasp it?
  • The relationship between dose & response: A parent might learn that she has to give her daughter Children’s Tylenol, but has anyone explained to her why an adult dose of med for a child is almost always risky?


2 replies
  1. Naomi Gewirtzman
    Naomi Gewirtzman says:

    This is a really great post! I think a big problem is “only about 5% of patients can tell what their medication is supposed to do and how long it takes” to work. I myself have fallen into this category. I don’t have a problem reading the label. I know how often I am supposed to take something. But when people don’t see or feel a change in their health after taking a medication, they often make the decision to stop taking it. There is also the disconnect between patient and doctor. A person may say to their doctor while at an appointment that they understand how to take their medication and why it’s important, but once the patient leaves, they may forget and/or feel uncomfortable calling the office for help. I know there have been times when my doctor has explained something to me and then when I pick up the prescription, I forget exactly what was said. Another issue is cultural differences and popular beliefs about health. People may be prescribed a drug, but still choose to follow their cultural beliefs, or may be opposed to medication because of something they read on a blog, instead of taking their doctors advice. To answer your question about why we keep blaming labels for people not taking their medication even though the evidence says otherwise; I hate to say it, but maybe because we don’t like change? Things have been done in a particular way for a long time, and many people, myself included, sometimes have a hard time adjusting or fear that everything will fall apart. If the EVIDENCE says that labels aren’t the problem, we need to CHANGE the way things are done. If this means changing/improving the way doctors and patients communicate, then do it. If it means changing the way we address pop culture or religious beliefs regarding health, then that is what needs to happen. Not to say that people shouldn’t adhere to their traditions, but perhaps a better conversation between doctor and patient.

  2. Nevila Bardhi
    Nevila Bardhi says:

    Very good topic! Completely agree. In this country we are mostly concerned with reading labels without really asking what do they really mean. The focus should be shifted to do we know what is inside each medicine, do we understand the side effects associated with them? If each patient would dig more into what each medication offers, then we would perhaps see less compliance, but that would be a conscious decision taken by the patient. I think we do have that right to think for ourselves instead of just following prescription orders written on a piece of paper that are supposed to makes us good patients that follow their doctor’s orders. We live in an era where science is evolving, information can be found easily(for those that seek it) and health literacy can be achieved. We need to take a critical approach to our medicines and not blaming the labels for being not easy to read as the main reason for lower adherence. The labels are just fine, what medicines can really do for us is what it is broken.

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