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What drug labels don't tell you
This article appeared in 
Roughly 90 million Americans have trouble understanding health information, including the instructions on prescription-drug labels, according to the Institute of Medicine.
To see how well the labels, stickers, and information sheets at chain drugstores inform patients, we had staffers fill prescriptions for 5 milligrams of warfarin at five drugstores near our Yonkers, N.Y., offices: Costco, CVS, Target, Walgreens, and Walmart. Given the known dangers with warfarin—a blood thinner that's the second most common drug (after insulin) implicated in U.S. emergency room visits—we expected clear and consistent warnings and instructions across the board. Instead we found critical information that was confusing, hidden, or missing.
On the bottle from Target, which improved its labeling in 2005, were four clearly conveyed warnings. Walgreens also had four warning stickers; CVS had three, Costco had two, and Walmart had none. (Bottles from two later visits to Walmart displayed three warnings each.)
Why the variation? There's no nationwide standard like the "Nutrition Facts" on food packages or the "Drug Facts" on over-the-counter medication. Although the Federal Food, Drug and Cosmetic Act requires details such as the patient's name and dosage instructions to appear on labels, other details can vary by state. The Food and Drug Administration doesn't monitor labels; rather, each state's board of pharmacy is responsible for their content.
Our findings suggest that the additional information stuffed in or stapled onto pharmacy bags might be as variable as the labels. Only Costco provided an FDA-approved medication guide that's required for certain drugs, including warfarin. Representatives of Target and CVS told us that their pharmacies automatically print medication guides for patients, but those did not make it to our staffers' packages. Walgreens and Walmart did not respond to our queries.
All five pharmacies provided inserts with drug information, including the important "black box" safety warning for warfarin, but the inserts differed from the FDA-approved guide. Some small type was hard to read, side-effect information was inconsistent, and confusing medical jargon was used.
Bottom line
U.S. Pharmacopeia, which sets voluntary standards for prescription drugs, and the Institute for Safe Medication Practices suggest that drug labels contain the following:
- Easy-to-read type, with the patient's name, drug name, and instructions in the largest letters.
- Warnings typed directly onto the label in a large size.
- The drug's generic and brand names.
- An image or description of the pill.
- No extra zeroes on the dosage, to avoid confusion (for example, 2 mg not 2.0 mg).
- Pharmacy information at the bottom of the label, leaving space for instructions.
If the instructions on the label aren't clear enough for you, ask your doctor or pharmacist for specifics.
A free guide to Medicare
A new Consumer Reports brochure, "Medicare: 6 Things You Need to Know Now," covers how the health-care law passed in 2010 has affected Medicare and consumers' benefits. Free copies are available for download at www.ConsumerReportsHealth.org/Medicare (in English) or at www.espanol.ConsumerReports.org/salud/Medicare (in Spanish).
