If It Needs a Sign, It’s Probably Bad Design

If It Needs a Sign, It’s Probably Bad Design

by Lena Groeger

The EpiPen, the potentially life-saving device that delivers a dose of medicine to people having a severe allergic reaction, has been all over the news for its outrageous price spike. Going up 500 percent in just under a decade is upsetting. But even as the company and regulators are dealing with its price, going unaddressed is the product’s significant design flaw.

Despite having pen in its name, the EpiPen isn’t really designed like a pen at all. A pen usually has a cap that covers the pen tip. But the cap of the EpiPen is on the opposite end as the needle tip. Joyce Lee, a pediatrician and University of Michigan professor who also studies patient-centered design, points out that this broken metaphor causes confusion over which end is which – and has led to people accidentally pushing their fingers into the needle. Between 1994 and 2007 there were over 15,000 unintentional injections from EpiPens, including many cases of trained healthcare professionals who accidentally gave themselves a dose of epinephrine in the thumb or finger while trying to deliver the life-saving medicine to someone else.

Unlike a regular pen, the EpiPen has the cap and needle tip on opposite sides  (Kira Stewart-Watkins, Flickr)

The owner of the EpiPen, Mylan, told ProPublica that “Since acquiring the EpiPen Auto-Injector, Mylan has made significant improvements to the design of the medical device portion of the product” and that the design changes were “aimed at making EpiPen Auto-Injectors easier to safely carry, hold, and administer and reduce the risk to users from the device’s needle, which is extremely important to our patients.” The company “encourage[s] all patients and caregivers to receive training on proper administration.” See Mylan’s full response here.

But while in 2009 Mylan redesigned the device, they didn’t change the orientation of the cap and needle. Instead, they colored one end bright orange and gave it the label “Needle End.” No doubt the design tweak helped a little: according to one study, the new EpiPen has a success rate of 67 percent (the old pen had a success rate of 43 percent). But that same study compared the EpiPen to another epinephrine auto-injector, the Auvi-Q, which was recently taken off the market after being recalled for dosage problems. The Auvi-Q is designed with the cap and needle on the same end – and had a success rate of over 90 percent.

It’s not surprising that a new color and a label didn’t stop accidental injections entirely. The EpiPen is just one more example in a long tradition of designers “solving” design problems by adding instructions, rather than fixing the underlying design itself.

Now, it’s true that sometimes instructions are useful and necessary. But in many cases, if it needs a sign, it’s bad design.

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The Role of Metaphor in Design

by Joyce Lee, MD, MPH Physician, Designer, Researcher Promoting a Maker Movement for Health     doctorasdesigner.com

The left-sided photo shows the needle area of the old EpiPen. The right-sided photo shows the needle area of the currently available EpiPen. On both sides of the current EpiPen, there is text on the front and back with the words NEEDLE END in large capital letters accompanied by a large black arrow. A healthcare stakeholder wouldn’t even blink at this detail, but I must quote the great Don Norman, one of the founders of human-centered design:

“Any time you see signs or labels added to a device, it is an indication of bad design.”

If It Needs a Sign, It’s Probably Bad Design