Licence plates for drugs
CMAJ 1997;157:1739
In response to my earlier recommendations on drug ergonomics in the letter "Drug packaging" (CMAJ 1997;156[6]:764-5 [full text]), Dr. Noel A. Rosen made some important comments about drug labelling problems in his letter "Action long overdue on drug labelling" (CMAJ 1997;156[10]:1383-4 [full text]): "Perhaps the most useful recommendation is to include the generic name, perhaps in abbreviated form, as well as the strength, on each tablet or capsule." I write to further comment on this concept, which I sometimes lightly call "licence plates for drugs."
I recently examined a variety of solid and liquid dosage forms to determine how much information could be printed on tablets, ampules and the like. For some very small products, such as nitroglycerin and lorazepam tablets, labelling of this type appears impractical. However, many products apparently allow for a special labelling code (the "licence plate").
Consider first a 4-character code to identify products. If each character could be 1 of 36 letters or digits, there would be 1 679 616 possibilities. If, to save space, a smaller 3-character code were used instead, 46 656 combinations would still be possible. Even a 2-character code, for very small tablets, would generate 1296 different combinations. Larger numbers of unique codes could be achieved by allowing special typographic characters, such as & and *.
Next, suppose that some agency were to be given responsibility for managing the system. The agency would accept code requests by email from manufacturers and maintain a computer system linked to the Internet to provide drug information. Physicians and other caregivers could go to a special Web site, where they would use the unique code to obtain information about the drug, such as generic and brand names, route of administration, concentration and strength, and warnings, notes and precautions, perhaps even a photograph of the product.
I invite stakeholders to consider the advantages and disadvantages of such a system. Given that more and more health care providers are using the World Wide Web, this would appear to be a potentially invaluable service that could be used worldwide to get quick information on registered products.
D. John Doyle, MD, PhD
Department of Anesthesia
The Toronto Hospital
Toronto, Ont.
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