New research finds that when generic pills don’t share the colors given them by their original makers, patients stop renewing their prescriptions at a higher rate than if they just kept taking the old-style, brand-name medicine. “The color of a pill does have clinical relevance,” The New York Times quoted the study’s lead author, Aaron S. Kesselheim.
Given that generics are cheaper than OEM pharmaceuticals, and that presumably the patients has gotten in the habit of both taking their medicine and renewing their prescriptions, the change in color (and shape, to a much lesser extent) seems a bit counterintuitive. But flashes of color pop up routinely—and surprisingly—in driving how humans respond. We’ve looked at a couple of colorful experiments over the years:
- Green can spark creativity. German researchers found that people looking at numbers on a green background found more ways to either make use of a tin can or draw different objects using a specific geometric figure than those exposed to white, gray, red, and blue cues. As they wrote in the Personality and Social Psychology Bulletin: “Green facilitates creativity performance, but has no influence on analytical performance, whereas red undermines analytical performance, but has no influence on creativity performance.”
- Ah yes, that old devil red. It gets blamed, or credited, with lots of influence. Hotness, for one. Women in red, and men, and even animals are seen as more sexually desirable when they have some red on ’em or near ’em. While it signals sensuality, red can also signal danger, both overtly (“Red means runs, son,” as Neil Young told us) and subconsciously. And red also empowers: teachers armed with red pens graded more sternly than those wielding blue ones.
- Perhaps we can make the point more black and white. Perhaps taking their metaphorical components too seriously, humans—or at least university undergrads—see sin in black and purity in white, while a black-and-white frame leads them to make black-and-white decisions. (And it’s not just undergrads. Refs in a once-played sport known as pro hockey penalize players in black jerseys more severely than players clad in other colors.)
Color is a less-than-subtle indicator in human interaction and for life in general—think honey bees and coral snakes signaling their cantankerousness. To those who might suggest lots of these results are obvious, keep in mind that these are all instances where the color was tangential at best to what was going on—and yet it appears to have affected the outcome.
In the pill study, reported in Archives of Internal Medicine, for example, the patients were drawn from more than 60,000 people taking an epilepsy medication. The eight anti-seizure medications in the study came in 37 colors and four shapes. Overall, a change in color saw about a 20 percent additional likelihood that a prescription would lapse (there was also an increase when shape was changed, but the change was statistically too small to matter). Note that this doesn’t mean one in five of the patients didn’t renew their prescriptions, but among the very small number who didn’t renew, the percentage was greater when a new color was introduced.
Again, the actual number were small, and the journal reportedly wavered on whether the incremental difference in an absolute sense merited publishing the paper. There is also some concern that what’s true for epileptic drugs may not be true elsewhere. But as Dr. Kenneth Covinsky, the journal’s associate editor, explained in a commentary accompanying the paper:
Ultimately, though, the editors agreed that this perhaps academic discussion of risk magnitude was missing the crucial point: Subjecting patients to this risk is absolutely senseless and absurd. With all the hurdles patients face, how on earth can we justify confusing by needlessly changing the appearance of their medicines? Equivalent generic medicines should be required to look like their brand-name counterparts.
And so the authors call for new regulations that would require “bioequivalent drugs” to look similar.
But I’m also interested in a broader question, of why color mattered in the first place, whether it was the break in routine, the hint of confusion, or the same reason I buy the blue and green bargain shampoos but not the white ones, even though they’re probably all the same except for their FD&C additions. That’s not Dr. Kesselheim’s goal—his noble effort is looking at the safety of generics, not our mental quirks. But color matters.
