The following article is part of The Clinical Advisor’s conference coverage from the 2017 American Academy of Physician Assistants’ meeting in Las Vegas. Our staff will be reporting live on original research, case studies, and professional outreach and advocacy news from leading PAs in many specialty areas. Check back for the latest news from AAPA 2017. 

LAS VEGAS – Many patients cannot identify the intended meaning of United States Pharmacopeia pictograms, according to research presented at the American Academy of Physician Assistants (AAPA) 2017 conference.

Prescription drug warning labels may be harmful to a patient’s understanding of the medication’s instructions, which could affect medication adherence.  Therefore, pictograms are frequently included on medication labels to communicate instructions listed in the text.

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Bradley Marcinek, PA-S, and colleagues sought to determine a highly literate person’s ability to identify the meaning of pictograms from the United States Pharmacopeia database. The study included 94 participants at least 20 years of age who could read at least at a 9th grade level.

The investigators identified 20 pictograms from the database to evaluate participants’ comprehension. The pictograms were displayed in a large or small format, and comprehension of the pictograms was evaluated on a scale from 0 to 5. The researchers used 4 surveys to control for the effects of size and order.

The results showed that 80% of large format pictograms and 90% of the small format pictograms did not meet a standard of 85% comprehension. In addition, 6.5% of the patient responses were considered harmful interpretations.

“The results of this analysis on a highly literate group of adults, combined with similar poor results from studies of low literacy, minority, and pediatric populations, discredit the utility of these pictograms,” the researchers stated. “Pictograms on pharmaceutical warning labels should therefore be avoided to facilitate proper medication use.”

AAPA 2017 continues through Friday, May 19th. Visit for more information.


  1. Marcinek B, Malewicz C, Maloney L, Cecil M, Jackson D. Prescription drug warning pictograms: What are they really saying? Presented at the American Academy of Physician Assistants 2017 conference; May 15-19, 2017; Las Vegas.