I’ve got pneumonia—pass the Gravol!

Something happened today that was disturbing. My wife had a migraine. It was a little different from her usual . . . she had some facial numbness, a headache, but none of the classic visual aura. She even noted some confusion and not surprisingly, some anxiety. She took some fluids, some sugar, and an Imitrex, and went to bed. A few hours later she joined us for dinner. Suddenly she said, “Oh, I can only see half your face. So, it is a migraine! Glad I took a pill three hours ago.” She went back to bed, and I checked the bathroom counter. A blister pack of Imodium was sitting there. In her confusion, she hadn’t taken Imitrex, she had taken Imodium. The boxes they came out of were covered in fine print detail that made them look very similar. So here is my point. Do the pharmacy colleges and the Health Protection Branch see the importance of packaging and information transfer, in times when we are dealing with an aging population—who may be on several other drugs? My wife is a nurse, who knows her drugs and what they do. But when a migraine came on, how successful was she in recognizing a triptan from other pills in the drawer? Read Dr. Baillie on: Isolation and the elderly Surely all that needs to be on the front of a box of migraine pills is the word “Migraine.” The box should be bright red. The pill needs to be easily accessed you should not have to struggle to remove it from its plastic cocoon. It should dissolve under the tongue for rapid action. It should not look similar to other common medications. So, my wife took Imodium, haha. Glad it wasn’t Methotrexate. When I think of the problems the elderly have with medication, I am drawn to comment on the package insert. It does not list the incidence of potential side-effects (so many patients assume these are inevitable). It does not describe the expected benefits (which may vary between individuals, therefore might be tough to generalize). Adverse outcomes are written in small print. I assume this allows one to cram as much detail in as possible, thereby satisfying the regulatory authorities. Is this information tailored to the 70-year-old with limited medical knowledge, failing vision and poor comprehension? No. Why is this important? Patients have to trust that their doctor is prescribing a medication that will—in the long term or short term—will be of benefit. Trust. This value judgement might have been a given 20 years ago, but with the explosion of the internet, and maybe the COVID pandemic, trust is a commodity in short supply. When I have a patient on three medications for hypertension, they pay big money and risk potential side-effects to bring about a reduction in, say, their risk of STROKE. Why don’t I get a letter from my patients saying, Thanks for preventing my stroke this year”? Because preventive medicine doesn’t work that way: Recognition is more predictable when one alleviates pain and suffering. So, they have to trust in my judgement that this pill is right for them. Dispensed properly. And safe for them. Patients will, quite understandably, become skeptical of their physician (and maybe their pharmacist) if they are told to take medication with a panoply of side-effects. We must be clear that the pill’s benefits markedly outweigh the risk, something professionals understand after carrying out rigorous research and testing. Do patients have the medical knowledge to understand that lowering LDL 20% reduces MI risk 50%? Or achieving target blood pressure halves one’s stroke risk? If I was a retired hypertensive plumber, aged 77, with little knowledge of science or medication, would I be prepared for words like hypokalemia, hypomagnesemia, gout, pancreatitis, osteoporosis—or would I just hope my family doctor knew the relative risks and benefits when he gave me hydrochlorothiazide? How many people READ a package insert given that—like most legal looking documents—they are largely unintelligible. I don’t. And if something does go wrong, have we undermined TRUST, something we built over decades? My plea to drug makers, and the pharmacy colleges, is to put a name, date, DIN number or whatever else—on the BACK of the box—and the drug name and its indication for use in BOLD letters on the front. Secondly, package inserts should mention the incidence of the commonest side-effects, weighed against the drug’s expected benefits. A URL to a drug database would satisfy those who need to know more. This isn’t rocket science. It’s about safe practice and clear messaging. As my wife proved today, a little confusion or some visual disturbance can put the wrong drug into the mix. As our population ages, this will become an increasingly avoidable risk. Let’s fix it. ADDENDUM I got to thinking about other issues regarding communication. When I have a shower, I don’t wear my reading glasses. With water in my eyes, I reach out for either the shampoo or the conditioner (the containers are identical) and try to read the name of whatever I need for my head. Even with glasses on, it seems there is a conspiracy to make the names look (a) faint (b) illegible (c) indiscernible from one another. Why do shampoo makers not just put a big black C or S on the front, and the useless advertising on the back?

I’ve got pneumonia—pass the Gravol!

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