"The words on the drug insert are too small!" Aunt Wang, 72 years old this year, said that she went to the pharmacy to buy medicine, forgot the amount of medicine ordered by the pharmacist, so she had to ask her daughter to help read the drug instructions, but her daughter could not understand the "professional" usage and dosage expression, so she had to go to the pharmacy again to ask.

Small words like ants, unfamiliar words, chemical formulas and technical terms make people misty... When it comes to drug instructions, many elderly people feel headaches.

How to make "eye-catching" and "professional" drug instructions more "suitable for the elderly"? What are the current challenges of the relevant ageing reform? Industry experts said that drug inserts cannot ignore standardization and safety, but also consider practicality. To solve this problem, the government, enterprises and all parties in society need to work together to promote it, so that the elderly can not only "see" but also "understand", and effectively ensure the safety of medication.

The drug instructions are "invisible" and "incomprehensible"

"At the moment, the drug instructions are densely packed with front and back of a piece of paper, and the elderly may not be able to see clearly when wearing reading glasses. It is recommended to actively adapt to the needs of the elderly society and improve the drug label in a timely manner. Recently, some netizens left a message on the "People's Network Leadership Message Board", suggesting that the drug instructions should be modified in the process of aging.

Data show that by the end of 2022, there were about 60 million people aged 2 and above in the country, accounting for 8.19% of the national population. With the acceleration of the aging process, the transformation of aging has become a work vigorously promoted by the state in recent years.

In July 2020, the Ministry of Civil Affairs, the National Development and Reform Commission and other nine departments jointly issued the Guiding Opinions on Accelerating the Implementation of Home Ageing Renovation Projects for the Elderly. In November 7, the General Office of the State Council issued the Notice on the Implementation Plan for Effectively Solving the Difficulties of the Elderly in Using Intelligent Technology; The Outline of the 9th Five-Year Plan for National Economic and Social Development and the Long-term Goals for 2020, released in March 11, put forward clear requirements for promoting the improvement of the quality of home life services for the elderly in various places, promoting the age-appropriate transformation of mobile Internet applications (APP), developing age-appropriate technologies and products, and cultivating new formats of smart elderly care.

With the continuous implementation of various policies and measures, China's age-appropriate service transformation has made positive progress. However, compared with China's aging status quo and huge demand for elderly services, there is still a lot of room for development. Especially in the field of health services, drug instructions are "not clear" and "incomprehensible", which is also a common problem reflected by the public, especially the elderly.

The reporter looked up several commonly used drugs and found that the ordinary drug instructions, the bend of a dental floss stick can hold more than 20 words. Prescription drug inserts tend to be smaller and contain more words. And the dosage of prescription drugs needs to consider multiple factors such as the patient's age, weight, etiology, and medication contraindications, if there is no doctor or pharmacist guidance, it is difficult for ordinary people to judge how to take.

Although according to the regulations, patients should buy and use prescription drugs under the supervision and guidance of a doctor/pharmacist, but some commonly used antihypertensive and anti-inflammatory and analgesic drugs, when the elderly want to learn more information through the instructions, the dense, professional and unfamiliar text on them will obviously cause a lot of inconvenience.

In addition, many over-the-counter drugs have less clear words on the labels, such as taking it with caution, caution for pregnant women, and discretion for children. What does it mean to be aborted? How to use it with caution? How is subtraction? It is also difficult for ordinary people to understand.

"Drug inserts seem to be a common small issue in people's daily lives, but they are actually big issues related to the vital interests of ordinary people and their lives, health and safety." Zhang Kanghuai, chief pharmacist of the Second Affiliated Hospital of Xi'an Jiaotong University, said that only by implementing the age-appropriate transformation of drug instructions to meet the actual needs of the elderly can the transformation be changed to the hearts of the elderly.

Experts: Make drug inserts more "smart"

Since the elderly have many inconveniences in using drug instructions, why should the text of the instructions be enlarged and the professional expression "popular", but it cannot be realized?

In this regard, the reporter specially called Northeast Pharmaceutical Group Shenyang First Pharmaceutical Co., Ltd. and consulted the staff of the quality department on related issues. The staff member said that the content of the drug label has been reviewed and approved by the national drug administration, and pharmaceutical companies cannot change it at will. In addition, the current regulations do not have particularly clear provisions on the font and font size of drug inserts.

"In addition to introducing drug information, drug inserts also have legal effect." Zhang Kanghuai told reporters that the state has strict standards for the printing of drug instructions, and the contents that must be indicated in the instructions are more and more and more professional. No matter how small the package is, it also needs to have instructions, in order to accommodate more content and save costs, some pharmaceutical companies can only continue to reduce the font size. The drug insert has a small paper and small font, and it seems that there is a lot of information that should be there, but in fact, the readability and visibility are extremely poor.

In fact, the drug label is not completely unchangeable. Article 49 of the Drug Administration Law stipulates: "The words in the labels and instructions of drugs shall be clear, and the date of manufacture, expiration date and other matters shall be conspicuously marked so that they can be easily identified." "There are no clear rules about font and size.

"If only the font is bold, the font size is increased or underlined, etc. in the content, the company can report it in the annual report, and does not need to be approved." Wang Huiming, director of the Lianyungang Inspection Branch of the Jiangsu Provincial Drug Administration, said in an interview with CCTV.

Since the initiative is in the hands of pharmaceutical companies, why are pharmaceutical companies unwilling to change?

In this regard, Zhang Kanghuai said that the size of most of the current drug instructions has been matched well with the automation equipment, if the font size is enlarged, it may affect the size of the entire paper, and then affect the folding method of the drug insert and the size of the medicine box, and it will be a huge expense to re-modify and debug the equipment.

"If the content of the manual is redesigned, the choice of paper, the transformation of the assembly line, the increase in cost, etc. need to be steadily and actively promoted on the basis of the agreement of all parties, which increases the difficulty of aging transformation to a certain extent." He said.

Zhang Kanghuai suggested that manufacturers can appropriately improve drug instructions by increasing the usage and dosage font size, and underlining or bolding the text describing the applicable symptoms, taking methods, and adverse reactions.

Industry experts said that being able to read the drug label clearly is only the first step, and it is necessary to let the elderly understand the content. On this basis, the connotation of information services can be further broadened and drug instructions more "smart". For example, for the elderly with poor vision, add the QR code voice broadcast function, or make important information of the drug into an easy-to-understand short video, etc., effectively reduce the barriers for elderly patients to read drug instructions.

Age-appropriate transformation still requires the joint efforts of many parties

Promoting the age-appropriate transformation of drug inserts has been widely valued by all sectors of society, and in recent years, the National Two Sessions have put forward relevant suggestions.

In October 2022, the State Food and Drug Administration stated in response to Recommendation No. 10 of the Fifth Session of the 2748th National People's Congress that in order to standardize drug inserts and labels, the Provisions on the Administration of Drug Inserts and Labels clarifies the text expression, written form, important scientific data, conclusions and information of drug safety and effectiveness of drug inserts and labels, and clarifies that the text in drug inserts and labels should be clear and easy to read, and the labels should be clear and conspicuous. At the same time, according to the characteristics of over-the-counter drugs, it is clear that the instructions for over-the-counter drugs should use easy-to-understand text expressions, so that patients can judge, choose and use by themselves.

In addition, the State Food and Drug Administration is studying and carrying out the relevant work of publishing the instructions of approved drugs on the website, further exploring and promoting the application of electronic instructions in the process of patient medication, encouraging enterprises to launch electronic instructions, and reducing the obstacles encountered by elderly patients in the process of reading instructions through voice broadcasting.

In some places, government departments have taken practical actions to promote the age-appropriate transformation of drug labels.

In June 2020, the Shaanxi Provincial Food and Drug Administration issued an opinion encouraging pharmaceutical manufacturers in the province to print the QR code of the instruction manual on the drug packaging label, and patients can scan the code to obtain the electronic version of the manual, and adjust the text size of the instruction manual according to their needs.

Lianyungang City, Jiangsu Province, known as "China Medicine Port", has carried out the pilot transformation of some drug inserts in local pharmaceutical companies since 2022, enlarging the font size of the usage and dosage in the instructions, and underlining or bolding the text describing the applicable symptoms and adverse reactions. At the same time, help desks have been set up in 39 retail pharmacies and equipped with printers to provide enlarged versions of the instructions for the elderly to read.

At present, all parts of the country are constantly improving work processes and optimizing home life scenarios around age-appropriate services. Similarly, in promoting the age-appropriate transformation of drug labels, it is also necessary to cooperate and actively promote the joint cooperation of government departments at all levels, enterprises and the whole society. Let the elderly no longer have to worry about "can't read" and "can't understand" the instructions, and help the elderly to conveniently read drug information and ensure drug safety to the greatest extent.