Helping Patients Fight "Label Fatigue"

Several recent studies have investigated the patchwork of warnings, dosing instructions, and design elements plastered on the boxes of OTC products that line pharmacy and supermarket shelves. Their findings consistently suggest patients may need a third-party interpreter to untangle it all.

“The rheology of OTC labeling has in many cases outrun the available real estate, oozing across carton panels in ways that are hard to predict,” according to Donald Riker, PhD, former associate director and research fellow at Proctor & Gamble and current editor-in-chief for OTC Product News.

In an editorial on “label fatigue,” Riker cited research from the March 2010 issue of Drug Information Journal that found decreasing the amount of text on a package’s surface helps patients locate and comprehend key messages.

Simpler messages inspired diligence as well, encouraging patients to “slog forward,” Riker wrote. Verbosity, on the other hand, caused patients to lose interest—not only in the information contained in the label, but in the product itself. “Verbose labeling can work counter to its intent by creating non-compliance, diffidence, and treatment failure,” he stated.

Joerg Fuchs, the study’s lead author, is also critical of the FDA’s efforts to reduce label complexity by adding a tidy, bulleted list of drug facts in the same location on every box. This solution creates what Riker calls “off-shore, artificial islands of information”—additional, isolated text that simply adds to patients’ confusion.

Other studies corroborate Fuchs’ and Riker’s assessments. A study published in the journal Pediatrics found that FDA labels for children’s OTC cough and cold medicines cannot compete with more subjective packaging elements, such as graphics or branding. In many cases, actual dosing instructions were ignored, influencing parents’ interpretations only 47% of the time. As a result, parents misinterpreted labels more than 50% of the time.

Even clear, conspicuous warnings risk being glossed over, scientists have found. When tracking the eye movements of people as they examined the labels of OTC analgesics, researchers from the National Academy of Sciences found that people tend to spend less time looking at warnings than other components of packaging.

Face-to-face counseling circumvents many of the issues inherent to printed labels, giving pharmacists the opportunity to communicate crucial information that might otherwise be misunderstood, overlooked, or disregarded. By developing a compassionate understanding for the significant challenges patients face in the OTC aisles, pharmacists can help them conduct a thorough, informed, and persistent search for the product that best meets their needs.