Photo used under CC Some Rights Reserved license; by jypsygen

When you have a medicine with an instruction like, “do not take with alcohol?” or “tell your doctor if…,” do you really know why, or how serious the consequences of not following the instruction could be? The drug label and insert are unlikely to offer further detail, but I always wonder just how seriously I need to take those warnings. Knowing why I’m being warned, and how likely and severe problems might be, would go a long way in convincing me to actually follow the instructions.

To use a common example, a new medicine, whether over-the-counter or prescription, that instructs “do not take with alcohol.” I want to know – is it because I might feel stronger effects of the alcohol and need to moderate my drinking? To me, that’s a different issue than, “3 out of 10 patients will have irreversible, severe liver damage.” I might just assume the first, less bad consequence is the real one, and only follow the “do not” instruction until I feel that I know how the combination of the medicine and alcohol affects me. If I knew that a more serious consequence was a reality, I might take the directive more seriously.

I need details. I want to know, “What’s excessive sunlight? How much water is plenty? By ‘take with food,’ do you mean a snack, or a meal? What are the consequences if I ignore this, and how serious are they?”

What if the medicine is short-term (like a week of antibiotics) vs. longer-term (like an antidepressant or birth control)? Sure, you might follow a “do not” instruction for a week, but for months or years? I personally can’t tolerate simply following an instruction without context – it’s a characteristic that has gotten me into more than a little trouble over the years.

Yes, I know – drug labels are already confusing, and adding more information to them as they are designed right now maybe wouldn’t help matters. Perhaps something clear on the insert – the little brochure that comes with your medicine – would be a good alternative. In general, I’m all for redesigning drug labels, packaging, and instructions (especially when more than one medicine is needed) so they are more useful and less confusing. There are some serious issues around language, literacy, and design that might make adding more information problematic, but it’s a worthwhile challenge if it results in people actually having a better understanding of instructions and their relative importance.

And, yes, that’s what pharmacists are for, and perhaps people should ask them these questions more often. So often, though, you have to make a special request to actually talk to a pharmacist, and the question – “Hey, can I ignore this and have a margarita at happy hour?” – might not be one that most people are comfortable asking. It’s also rare to have real privacy when speaking to a pharmacist – those little plastic nowhere-near-a-walls don’t quite do it for me.

The bottom line is that I’m inclined to ignore any instruction that doesn’t come with an explicit rationale and some indicator of how seriously I should take it, and drug labels are one important place where that’s a problem. Anybody else similarly inclined? What would you like to know about the various warnings that come on OTC and prescription drugs?

Filed under: Drugs

With the current car-free situation, I have been walking at least 2.5 extra miles each day, often more. This is objectively good for me – as long as I avoid cars that don’t bother to stop for pedestrians and too much sun. It’s a positive thing.

Based on my recent experience with folks whose job it is to motivate people to be healthier, I should just be worried and OMG and am practically about to drop dead. Because my blood pressure was 120/70.

No, really. It was a weight and blood pressure check thing, and I was curious about whether the walking had changed my weight any. I should have known better. I already know what ZOMG-GONNA-DROP-DEAD! BMI category I’m in. So this lady looks at my weight, and immediately asks, before the blood pressure cuff even went on, “Do you have any problems with hypertension?” You know, ’cause I’m fat.

I told her no. She took my blood pressure, which was respectable. Especially after this lady’s attitude. Did she ask me if I’d taken any cold medicine or other drugs, like birth control? If I’d had a high sodium meal? If I was a smoker? Did she take a second measurement? Nope. She just told me repeatedly that the top number, 120, was “right on the line.” That’s right on the line of the lowest value of possible “prehypertension,” by the way.

It’s true that the current guidelines now suggest that the top number should be “less than 120.” With a second measurement, mine might have been lower or higher. I’ll be happy to get it measured every so often to make sure it’s still in a decent range, and not higher. But having someone – who is not my care provider, who does not even bother to ask relevant questions – tell me *three separate times* that my blood pressure is “right on the line?” There was no discussion of the bigger picture of my health, just a subtext of “overweight, so let me be smug while looking for something else problematic I should be finding.”

That makes me think that somebody just doesn’t know what to do with somebody who is higher than normal weight yet not explicitly way hypertensive and ZOMG BOUT TO DIE! And it makes me question whether the folks doing the measurements have my actual health in mind or might be fat-phobic a-holes who need to find something, anything, to be judgey about if a person is not a BMI-chart-normal-weight. That’s not exactly a charitable reading, but I can’t properly convey to you the “looked at my weight on a card, and then thought they knew everything there was to know about me” exhibited in this brief interaction. In just a short minute, instead of forming a partnership in which my blood pressure could have been calmly monitored for more information, a hostile relationship was created in which I assume the measurer and her cohort are more interested in stereotypes than health.

Not much good for patient engagement, that.

Filed under: Heart Health