Warning!

My gym's exercise equipment has warning labels pasted inches from the floor and printed in 8-point type. If you lie next to the machine and take off your glasses, you can make the words out. Nobody ever does that, but the manufacturer can always claim that they warned us if we're injured.

My electronic health record has a module for electronic prescription approvals. New pop-up warnings must now be addressed before an approval goes through. For instance, you can check, "benefit outweighs risks," or else, "advice from consultant." Since I'm the consultant, I often click this box to verify that I accept my own advice.

Here are some of the EHR warnings, followed by my grateful reactions:

• Clobetasol Propionate External Solution 0.05% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Warts are a more specific form of Viral Infection, the same precaution may apply.

Oh my gosh! You mean I shouldn’t use clobetasol in Systemic Viral Infection? I had no idea! And not even for warts?

• Clobetasol Propionate External Cream 0.05% should be used carefully in Viral Infection, especially in Systemic Viral Infection. Since Actinic Keratosis is a more specific form of Systemic Viral Infection, the same precaution may apply.

No clobetasol for viral Actinic Keratosis either? (By the way, what’s with the capitalization?)

• Clobetasol Propionate External Cream 0.05% should be used cautiously in Fungal Infection, especially in Systemic Fungal Infection. Since Dermatophytosis is a more specific form of Fungal Infection, the same precaution may apply.

You’re killing me! Well, at least clobetasol is okay for funguses if I use it cautiously.

• Efficacy of Minocycline HCL Oral capsule 100 MG against Helicobacter pylori is not impaired by food.

This is great news for my hungry acne patients with Helicobacter.

• Triamcinolone Acetionide External Cream 0.1% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Actinic Keratosis is a more specific form of Viral Infection, the same precaution may apply.

If I can’t use either clobetasol or triamcinolone, how am I supposed to treat Systemic Viral Infections like Actinic Keratosis?! Can I use the Internal Cream instead of the External one?

• Since Rubella-Like Rash is a more specific form of Viral Infection, the same precaution (re: using topical steroids) may apply.

May apply? You’re not sure? How Rubella-Like do they have to be? Extremely Rubella-Like? Moderately? How about Measles-Like? Coxsackie-like?

• The sedative effects of HydrOXYzine Oral Tablet 10 MG may be enhanced by quantities of alcohol contained in alcoholic beverages.

Alcohol in alcoholic beverages? Who knew?

• Betamethasone Dipropionate External Cream 0.05% should be used with extreme caution in Skin and Skin Structure Infection. Since Cellulitis is a more specific form of Skin and Skin Structure Infection, the same precaution may apply.

First you won't let me use steroids for Viral Infections. Now you won't let me use them for Bacterial Infections. What am I supposed to use steroids for?

• Betamethasone Dipropionate External Cream 0.05% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Condyloma Acuminatum is a more specific form of Viral Infection, the same precaution may apply.

That's it, I’m through! Go ahead and withhold steroids from Genital Warts and let's see how well you do!

• Tazorac External Gel 0.05% should be used with extreme caution in Eczema.

Okay, okay. Can I use it for acne or psoriasis, the conditions for which it's indicated?

• The combination of MetroNIDAZOLE External Lotion 0.75% and Ethanol may produce alcohol intolerance reactions. Topically applied metronidazole would not be expected to produce this reaction based on data indicating lack of absorption. Intravaginal metronidazole may be absorbed and could potentially lead to this reaction.

Now you've GONE ToO FAr. (I MEan wiTH the CAPitals.) Can't I just make sure that my rosacea patients don’t apply MetroNIDAZOLE intravaginally?

Honestly, who writes this stuff? More to the point, is the world a better place because they do?

A friend in environmental consulting said that in his line of work, bureaucratic form increasingly trumps substance, forcing people to spend time following quality regulations instead of actually improving quality.

Like gym equipment warnings, drug warnings are fine in theory. But what are they worth if their content is dubious if not laughable, and you don’t really need to read them, just click a box that says you did?

My gym's exercise equipment has warning labels pasted inches from the floor and printed in 8-point type. If you lie next to the machine and take off your glasses, you can make the words out. Nobody ever does that, but the manufacturer can always claim that they warned us if we're injured.

My electronic health record has a module for electronic prescription approvals. New pop-up warnings must now be addressed before an approval goes through. For instance, you can check, "benefit outweighs risks," or else, "advice from consultant." Since I'm the consultant, I often click this box to verify that I accept my own advice.

Here are some of the EHR warnings, followed by my grateful reactions:

• Clobetasol Propionate External Solution 0.05% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Warts are a more specific form of Viral Infection, the same precaution may apply.

Oh my gosh! You mean I shouldn’t use clobetasol in Systemic Viral Infection? I had no idea! And not even for warts?

• Clobetasol Propionate External Cream 0.05% should be used carefully in Viral Infection, especially in Systemic Viral Infection. Since Actinic Keratosis is a more specific form of Systemic Viral Infection, the same precaution may apply.

No clobetasol for viral Actinic Keratosis either? (By the way, what’s with the capitalization?)

• Clobetasol Propionate External Cream 0.05% should be used cautiously in Fungal Infection, especially in Systemic Fungal Infection. Since Dermatophytosis is a more specific form of Fungal Infection, the same precaution may apply.

You’re killing me! Well, at least clobetasol is okay for funguses if I use it cautiously.

• Efficacy of Minocycline HCL Oral capsule 100 MG against Helicobacter pylori is not impaired by food.

This is great news for my hungry acne patients with Helicobacter.

• Triamcinolone Acetionide External Cream 0.1% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Actinic Keratosis is a more specific form of Viral Infection, the same precaution may apply.

If I can’t use either clobetasol or triamcinolone, how am I supposed to treat Systemic Viral Infections like Actinic Keratosis?! Can I use the Internal Cream instead of the External one?

• Since Rubella-Like Rash is a more specific form of Viral Infection, the same precaution (re: using topical steroids) may apply.

May apply? You’re not sure? How Rubella-Like do they have to be? Extremely Rubella-Like? Moderately? How about Measles-Like? Coxsackie-like?

• The sedative effects of HydrOXYzine Oral Tablet 10 MG may be enhanced by quantities of alcohol contained in alcoholic beverages.

Alcohol in alcoholic beverages? Who knew?

• Betamethasone Dipropionate External Cream 0.05% should be used with extreme caution in Skin and Skin Structure Infection. Since Cellulitis is a more specific form of Skin and Skin Structure Infection, the same precaution may apply.

First you won't let me use steroids for Viral Infections. Now you won't let me use them for Bacterial Infections. What am I supposed to use steroids for?

• Betamethasone Dipropionate External Cream 0.05% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Condyloma Acuminatum is a more specific form of Viral Infection, the same precaution may apply.

That's it, I’m through! Go ahead and withhold steroids from Genital Warts and let's see how well you do!

• Tazorac External Gel 0.05% should be used with extreme caution in Eczema.

Okay, okay. Can I use it for acne or psoriasis, the conditions for which it's indicated?

• The combination of MetroNIDAZOLE External Lotion 0.75% and Ethanol may produce alcohol intolerance reactions. Topically applied metronidazole would not be expected to produce this reaction based on data indicating lack of absorption. Intravaginal metronidazole may be absorbed and could potentially lead to this reaction.

Now you've GONE ToO FAr. (I MEan wiTH the CAPitals.) Can't I just make sure that my rosacea patients don’t apply MetroNIDAZOLE intravaginally?

Honestly, who writes this stuff? More to the point, is the world a better place because they do?

A friend in environmental consulting said that in his line of work, bureaucratic form increasingly trumps substance, forcing people to spend time following quality regulations instead of actually improving quality.

Like gym equipment warnings, drug warnings are fine in theory. But what are they worth if their content is dubious if not laughable, and you don’t really need to read them, just click a box that says you did?

My gym's exercise equipment has warning labels pasted inches from the floor and printed in 8-point type. If you lie next to the machine and take off your glasses, you can make the words out. Nobody ever does that, but the manufacturer can always claim that they warned us if we're injured.

My electronic health record has a module for electronic prescription approvals. New pop-up warnings must now be addressed before an approval goes through. For instance, you can check, "benefit outweighs risks," or else, "advice from consultant." Since I'm the consultant, I often click this box to verify that I accept my own advice.

Here are some of the EHR warnings, followed by my grateful reactions:

• Clobetasol Propionate External Solution 0.05% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Warts are a more specific form of Viral Infection, the same precaution may apply.

Oh my gosh! You mean I shouldn’t use clobetasol in Systemic Viral Infection? I had no idea! And not even for warts?

• Clobetasol Propionate External Cream 0.05% should be used carefully in Viral Infection, especially in Systemic Viral Infection. Since Actinic Keratosis is a more specific form of Systemic Viral Infection, the same precaution may apply.

No clobetasol for viral Actinic Keratosis either? (By the way, what’s with the capitalization?)

• Clobetasol Propionate External Cream 0.05% should be used cautiously in Fungal Infection, especially in Systemic Fungal Infection. Since Dermatophytosis is a more specific form of Fungal Infection, the same precaution may apply.

You’re killing me! Well, at least clobetasol is okay for funguses if I use it cautiously.

• Efficacy of Minocycline HCL Oral capsule 100 MG against Helicobacter pylori is not impaired by food.

This is great news for my hungry acne patients with Helicobacter.

• Triamcinolone Acetionide External Cream 0.1% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Actinic Keratosis is a more specific form of Viral Infection, the same precaution may apply.

If I can’t use either clobetasol or triamcinolone, how am I supposed to treat Systemic Viral Infections like Actinic Keratosis?! Can I use the Internal Cream instead of the External one?

• Since Rubella-Like Rash is a more specific form of Viral Infection, the same precaution (re: using topical steroids) may apply.

May apply? You’re not sure? How Rubella-Like do they have to be? Extremely Rubella-Like? Moderately? How about Measles-Like? Coxsackie-like?

• The sedative effects of HydrOXYzine Oral Tablet 10 MG may be enhanced by quantities of alcohol contained in alcoholic beverages.

Alcohol in alcoholic beverages? Who knew?

• Betamethasone Dipropionate External Cream 0.05% should be used with extreme caution in Skin and Skin Structure Infection. Since Cellulitis is a more specific form of Skin and Skin Structure Infection, the same precaution may apply.

First you won't let me use steroids for Viral Infections. Now you won't let me use them for Bacterial Infections. What am I supposed to use steroids for?

• Betamethasone Dipropionate External Cream 0.05% should be used cautiously in Viral Infection, especially in Systemic Viral Infection. Since Condyloma Acuminatum is a more specific form of Viral Infection, the same precaution may apply.

That's it, I’m through! Go ahead and withhold steroids from Genital Warts and let's see how well you do!

• Tazorac External Gel 0.05% should be used with extreme caution in Eczema.

Okay, okay. Can I use it for acne or psoriasis, the conditions for which it's indicated?

• The combination of MetroNIDAZOLE External Lotion 0.75% and Ethanol may produce alcohol intolerance reactions. Topically applied metronidazole would not be expected to produce this reaction based on data indicating lack of absorption. Intravaginal metronidazole may be absorbed and could potentially lead to this reaction.

Now you've GONE ToO FAr. (I MEan wiTH the CAPitals.) Can't I just make sure that my rosacea patients don’t apply MetroNIDAZOLE intravaginally?

Honestly, who writes this stuff? More to the point, is the world a better place because they do?

A friend in environmental consulting said that in his line of work, bureaucratic form increasingly trumps substance, forcing people to spend time following quality regulations instead of actually improving quality.

Like gym equipment warnings, drug warnings are fine in theory. But what are they worth if their content is dubious if not laughable, and you don’t really need to read them, just click a box that says you did?