Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
United States Surgeon General
U.S. Department of Health and Human Services

News Conference Hosted by National Conference
on Patient Information and Education (NCPIE)

Wednesday, September 10, 2003
National Press Club, Washington, D.C.

"Be MedWise" ó The Surgeon Generalís Prescription for
Safe Use of Over-the-Counter Medications

Thank you, Ray, for that kind introduction. (Ray Bullman, Executive Vice President of NCPIE)

Itís great to be here with you and with my friend and colleague Dr. Lester Crawford from the FDA.

Thank you both for your partnership with the Office of the Surgeon General.

Today I will address a topic that is relevant to every aspect of Americanís lives: health literacy.

America has the best health care system in the world. As we enter the 21st century, medical discovery is advancing at a rate unequaled in any previous era.

Yet many Americans do not know how to use these advances to help them and their families stay healthy and safe.

We need to do something to close the gap between what health care professionals know and what the rest of America understands.

When President Bush and Secretary Thompson nominated me to be Surgeon General, they asked me to focus on three priorities to maintain and improve the health of the American people.

Iím fortunate to work with these two leaders who understand the importance of health.

Two leaders who insist that evidence and the best science always guide our policy and what I do.

All three of my priorities are very strongly evidence-based. They are:

  • First, Prevention. ó What each of us can do in our own lives and communities to make ourselves and our families healthier.
  • Second, and new to the Office of the Surgeon General, as none of my predecessors had to deal with these issues: Public Health Preparedness. We are investing the resources at the federal, state, and local levels to prevent, mitigate, and respond to all-hazards emergencies.
  • and

  • Third, Eliminating Health Care Disparities.
  • Woven through all these issues that constitute my portfolio is health literacy.

    Health Literacy

    Right now, thereís a widespread problem slowing down our progress in all three of these priority areas. The problem is low health literacy.

    Health literacy is the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.

    Low health literacy is a threat to the health and well-being of Americans and to the health and well-being of the American medical system.

    Low health literacy costs the health care system $73 billion per year in misdirected or misunderstood medical advice. More than 90 million Americans cannot adequately understand basic health information. (1.)

    Consider this: A recent study of English-speaking patients in public hospitals revealed that one-third were unable to read basic health materials.

  • 26% of the patients could not read their appointment slips,
  • 42% did not understand the labels on their prescription bottles. (2.)
  • Further studies show that people of all ages, races, incomes, and education levels are challenged by low health literacy.

    The greatest challenges are among the elderly and in communities of color, like where I grew up in Harlem, in New York City.

    And low health literacy is a problem throughout our nation ó

  • From Native American communities in the Southwest,
  • To rural areas of Appalachia,
  • To the Anacostia neighborhood right here in our nationís capital.
  • The problem has grown as patients have been asked to assume more responsibility for
    self-care in a complex health care system.

    Another compounding factor is that most patients hide any confusion from their doctors and pharmacists, because theyíre too ashamed and intimidated to ask for help.

    Letís face it, most of us men wonít even stop to ask for directions when weíre lost in a new city, let alone when we have a health question.

    Not every American is a scientist or a health care professional, and we canít expect everyone to understand what it takes doctors, nurses, pharmacists, and other health care professionals years of training to learn.

    My mechanic doesnít expect me to know how to change the transmission in my car. And I donít expect him to know how to perform a tracheotomy or how medicines work in the human body.

    OTC Medications: "Be MedWise"

    There are some simple things that Americans can do to stay healthy and safe.

    We can eat healthy foods, get regular medical check-ups, be physically active every day, and make good choices like wearing seatbelts every time weíre in a motor vehicle.

    Another simple thing we can do for ourselves and our families is to understand that all medicines have risks, as well as beneficial effects.

    Thatís the heart of the Be MedWise campaign that weíre launching today. Letís look at why itís so important to Be MedWise.

    Today, 6 out of every 10 medications that people take are over-the-counter drugs óso-called OTC medicines. These drugs are real medicines that must be taken responsibly.

    So when it comes to nonprescription drugs, hereís what I recommend:

    1. First, talk to your pharmacist or doctor before choosing an over-the-counter medication;
    2. Second, read the label every time you use any medicine, and following the directions carefully;
    3. Third, take only the amount of medicine recommended;

    4. Fourth, make sure that the over-the-counter medication is appropriate and safe for you when combined with any other medicines that you may be taking.

    To put this information front and center, I am issuing this "prescription." This may be the most important prescription Iíve ever written, as I see it.

    It lists some of the most important questions that you should ask about over-the-counter drugs.

    This medical advice is for every person who takes medication, or who has responsibility for choosing medication for someone else, such as a child or an elderly loved one.

    Letís look at one reason why health literacy is so important when it comes to using over-the-counter drugs: The potential for over-dosing.

    When I was a practicing as a nurse, and later as a doctor, I talked with people every day who thought that over-the-counter drugs were not serious medications, but that they were harmless products that they should try at random for a range of symptoms. Well, we know thatís not true.

    Iíll tell you the same thing I told my patients ó many over-the-counter products share the same active ingredient, so you can hurt yourself by doubling or tripling up on different medications.

    Taking medicines without understanding what their active ingredients are and what they can do to your body can result in very serious health problems. So talk with your doctor or pharmacist before taking any OTC medication, especially if youíre taking more than one at a time.

    Finally, let me say that this Be MedWise "prescription" is particularly important today because we rely so extensively on over-the-counter medications to treat ourselves and our families.

    There are more than 100,000 OTC drug products on the market. As a nation, we take nonprescription medications more today than ever before.

    These products make our lives easier and are an important part of American health care. So, letís just remember that theyíre also serious medications.

    The good news is that you have access to all the information you need. Just talk with your doctor or pharmacist.

    The bottom line is what it says right here on this "prescription" ó "OTC drugs are serious medicines that should be taken with care."

    So talk with your doctor, pharmacist, or other health care practitioner about all your medications. Theyíre ready and willing to help with any question you have.

    No question is too large Ö.. or too small. Your health and your familyís health are far too important to play guessing games with this very important issue.

    Thank you.



    1. Kirsch I, Jungeblut A, Jenkins L, Kolstad A. Adult literacy in America: a first look at the results of the National Adult Literacy Survey. Washington: Department of Education (US), National Center for Education Statistics; 1993.
    2. Williams MV, Parker RM, Baker DW, Parikh NS, Pitkin K, Coates WC, Nurss JR. Inadequate functional health literacy among patients at two public hospitals. JAMA 1995 Dec 6; 274(21):1677-82.


    Last revised: January 9, 2007