The Psychology of Modern Drug Names

Sawbones is a show about medical history And nothing the hosts say should be taken as medical advice or opinion It's for fun Can't you just have fun for an hour and not try to diagnose your mystery boy We think you've earned it Just sit back, relax, and enjoy a moment of distraction from Weird growth Your worth D with the since that has Hello everybody. welcome to Sawbones, Meryl Tur Misguided Medicine. I'm your co host Justin McArooy. And I'm Sidney Mcrooy. And I wanted to talk to you, Sid about a topic that is near and dear to my heart. Branding. Yes. ye. This is true. You know, I love to talk about brands normally it's like fast food, fast casual type brands, but I do I do enjoy branding in the medical world. We've talked in the past about Itasts like NikeQill ' a brand. We've discussed what else Tlenol maybe. I think I did a Tylenol I've done some of other like brand centric episodes I think we've gone through a lot of those. and you ask me questions a lot when we talk about different medications, like not just on the show in real life How in the world did they come up with that name? Like where did that come from And that that's a really good question. And it turns out, Sidney It is a question with a lot of answers Because even though you don't have to be sort of scientist to deduce what some of these names mean Sometimes it helps Some of them are science based, someome of them have nothing to do with science whatsoever Well, I think that's the interesting part of it, right? Be you're asking me a question that I only have part of the expertise to answer because I am not a marketing executive. I'm not a branding expert. I don't I don't necessarily know what sounds will have the best connotation for human brains to decide I need that product. U way back when this all got started when before we had a system for this sort of thing We had the big problem was that you had a lot of different groups that wanted to name this what the things were called, right? So the first sort of loose agreement was the U. S pharmacopia. That's first in eighteen twenty. That's a group of physicians that they got together and they're like, there's a lot of because the medicines were mainly based off of their chemical composition, right? So there was some inconsistencies there and they needed a standard that everybody could kind of agree on, right? So in eighteen twenty the physicians created the US pharmacopeia And that was official formularies, quality standards, things like that and also drug names Um The pharmacists though, in eighteen eighty eight created the national formulary And that covered the preparations that the other book left out And both of these were recognized in nineteen oh six. Now nineteen oh six era. You should know that's usually when we're tied to the beginning of the FDA, a lot of our Right. A lot of the regulatory stuff. Now did the those two books, did they overlap? Did they conflict? Yes. Okay. They and. They overlapped, they conflicted And They were both recognized as law.an I nineteen oh five. I have So one was a bunch of doctors, you said. nineteen oh six, excuse me. nineteen twenty, the US pharmacopeia eighteen twenty. eighteen twenty was physicians. Okay nineteen eighty eight was the national formulary. The one with the physicians, did they just name all the medicines after themselves? because that's our favorite thing to do, doctors is try make something or find something And then name it after ourself. At this point, we are just talking about generics Right. Yeah, But no still, I would, you know I mean, if I had been there. Oh, you're trying to do jokes Is this what it's like to be trying to get through a lot of really important information. Is this what it's like for you? That must be so hard because I have so much incredible information and you're goofing around about it. Is that what's happening right now? just I just meant that if I had been there Aspirin would not be aspirin. it would be Siddney It would be Citsprin That just be Sydney? Yeah. Like give me two Sidney. That's not a good. Okay. so the if you're having chest pain, take four baby sits you're saying The reason this is an important distinction is because that kind of silliness is absolutely allowed later. But right now we're like re trying to create some sort of standard. and what's wild is as of nineteen oh six when the FDA is like. Both of these are good. This is the only country that does that. This is the only country where we have two books that are both recognized as the official So this is not right. And so is it like the formulas contradict in the two of them? L in one you know I mean, I don't know what medic we're talking about all the time, but like penicillin is made like this, but in the other one, penicillin were not the contradictions were not the issue. It was more just that there were two separate bodies that were maintaining two separate records for our standards, right? It was not under a single umbrella. there were two different formularies and that's not the right word Two different bodies that were creating these names, and there was no reason for them to be separate except for the fact that the initial pharmacopeia wasn't comprehensive So the national formulary filled in the gaps, but we had these two things. There also wasn't penicillin yet. That was a bad example. There was definitely not penicillin U I will That makes sense. Yes. Yes. And so then the AMA ran its own drug operation, a cououncil on phharmacy and Chemistry And that was in nineteen oh five the year before the FDA recognized those other two as legitimate. then the council on pharmaceuty and chemistry though was more about weeding out Uh, like fakes and quack remedies, right? So this body is So now we see there's like a third distinction and the AMA is like, okay, you can call them what you want, but these other things aren't drugs. So let's be careful about this. So this is the like so so now we have three conflicting. This body the that the AMA called it the Council on phharmacyry and Chemistry. eventually evolves into what is called the USAN uh, the The United States Adopted Names Council. there is. Okay. this is this evolves into the United States Adopted Names Counil And that is u body from the AMA that eventually is becomes sort of like the the overarching standard. This comes about in nineteen sixty one. It is a a joint operation between the AMA and the U.S. P pharmacopia. U And the Pharmacists Association does join up in nineteen sixty four and it becomes the USAN at that point. And then the FDA gets on board with the USAN by nineteen sixty seven. I should also mention, by the way just to complicate things more In nineteen fifty, the WHO also started to try tried to start its own naming convention. Okay. So there's a lot vying for ition, right? That also has to be why there are different names And this isn't, u you would expect peopleeople who speak different languages would have different names for things. But there are different names for substances even among like the English speaking world Um I always think paracetamol. and acetaminophen is a good example where that's the same thing, but Here, we call it acetaminophen and in the UK they call it pacetamol Um Luckily everybody started to like get on board with the USAN. Everyone was like, okay, this is this is this makes sense So this is the system now. The FDA added a liaison in ' sixty seven. U And by ' eighty four, the FDA lost its own list, dropped its own list and USAN was the official name. So people started to like fall in behind it. It's a private body It's not a government agency. It's a private group. But a drug cannot be sold in the US without a USAN. That's the our name for it. And the u and then the AMA has to approve. And then the so the company The USAN and the WHO's program, which is the international standard, they all have to be Like agree on one single global generic name before it's before it can go out to sale Now some of now you would probably be a lot smarter about this stuff than me. so I would ask for some of your help with this section. Okay. But this is like an example of what some of these Sems mean and how some of these names are built. So you would probably be able to speak to this better than I could. Well, just for some things that are probably familiar to you immmediately. Okay There's an example here of proton pump inhibitors, PPIs. thoseose are medicines for heartburn or acid reflux. A lot of these are over the counter now. You can also get them prescription. And they often if you look at the generic, they often end with Prazool. So omeprazole, isomeeprazole, pantoprazole. There' there's a lot of examples. You probably know them as like U Nxium, Prialusc pre Those are all Prazol. So if I see Prazol at the end of something, I assume it's probably a PPI. Another common one would be beta blockers, metopriol. theseese are medications that can be used for high blood pressure or for specific heart conditions m they end with allL o well oL And if I see A laall. Graan a law, Matoa laall. then I think it made a blogger. And there are a lot of comment now Not all medications have that common end to tell you that they're all in the same family or whatever. But like generally speaking, if I were and I mean, it's not so I've been practicing a long time, but early in my career, as I was first learning all these drugs as a medical student and early in my residency, could use that as a quick hand to say, o, okay, this must be in this family of drugs So yeah and that was really interesting to me. I did not know that. But then when I started thinking about like, oh, you do hear some of the same u sounds, but those sounds are specific and they're talk about the um, function Yeah. And if I see it is, I will say that that skill is still helpful when new drugs come out because Sometimes a new drug is introduced first in commercials almost. L that's where and I don't I mean, we don't I don't see those commercials. So somebody will ask me about, like a patient will ask me about a new drug even before I maybe have heard of it through the usual like doctor channels And I can look it up. and if I see that generic, sometimes the generic name will immediately tell me like, oh, it's in this class. Oh, okay, I at least know what class of drugs this is in and then I can help you figure out what this is Uh, they a company u It takes a while to get one of these names. You apply when the trials start and then it's kind of a back and forth. because it has to make there's a lot of different qualifiers. In addition to the chemical compound, it's got to make sure that it's not too close to anything else. So there is an ongoing uh thing U it can take months to a few years. sometimes they will to differentiate a medicine that is or compound that's very similar to something else or identical to something else, I guess. they'll add like a meaningless suffix to the end of it, just to say that it's different, but like, you know, like D L L E on to the end to say would be. That would be very inconvenient to have to explain to a patient What do those letters mean nothing Sidney, I'm going to ask you a question. What is a monoclonal antibody monoclonal antibody is we have synthesized an antibody that attaches to a specific thing for whatever reason we need to Um Lake Like little heat seeking missiles, we're going to put this antibody that we have made into your body So go out and find something specific and attached to it and then remove it from your body. Okay The WHO in nineteen ninety one added a new suffix map Yes for monoclonal antibodies. Right. And there's actually a syllable in front of it marks where the antibody comes from O is mouse Z is Chameric or Chimeric Chic. Zoo humanized you human That is so they appended those, but in twenty seventeen They actually dropped that and by twenty twenty one, they retired Mab altogether for new antibodies because it got too crowded already eight hundred and seventy nine names that ended with Mab So they had to split it up into tug B Tug, bart, Mig and mint. I don't know why that's funny to me, but the fact that Mab got two full is that they had to have tug, bart, Mig and mint. I gotta be honest, I don't think I knew there were that many Mabs.. I mean, I am familiar with that both the nomenclature and those that what we use those for and such. But I'm not I had no idea there were that many. Yeah. It is not something that I commonly, especially in my practice as a family doctor and doing street medicine, I am not prescribing monoclonal antibodies It's typically. It is illustrative though, I think of These names are not just like I think we think of names It's like different in medicine. It really is like I don't think I can't think of a really good analog because the names are communicating something at the same time as they're identifying something. You know what I mean? Like we're communicating while we're identifying. and it is like the names are only useful for as long as they communicate well The moment that like language changes and they become non specific or less useful Um you know, the whole thing has to shift. So it's it's it's really, it walks the line between I think science and like Well it recognizes that science evolves. I think that it's a way of understanding even as you make the first monoclonal antibody, you are recognizing that there will be many more to come. That is that only makes sense that we will use this technology to do more. So you're leaving space for the future of that specific kind of science, does that make sense? We know that doctors in the future are going to need to know a lot more of this. So we'll use a common, even with the first one, we've already created the root thing because we know we're going to need it. Now, Siddney, this is all of this has been technical scientific medical terminology for things. Yes. None of this Is branding? No. And that's what you want to talk about Look at this. Let's talk about Sky Rizzy. Okay, but not yet I'm going to make you come to the billing department. I said after this do you think the titer this is See this is you got to be careful. try it again. takeake it clean. It's really tough. doing my job and I'm so glad youre you really appreciated that. You ready? Here it goes and segue And this is the billing department. What I don't know what you wanted me to say. It was not clear. You said after this, but we had not Set up this. 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Robert Shaw inaws and they're trying to figure out how to get rid of the goolies and he scractices his fails and, I'll get you gool. He's just standing above the toilet with a haror. I'm just looking forward to you going through the other ways in which W West is historically inaccurate. You know how much movies cost nowadays when you add in your popcorn and your bagel bites and your cheeseitters? You can't go wrong with the Henry Cavle M mustache. Here at Henry Cavtle Mache is the only supplier the fllopouse New episodes every Saturday. Find it at maximumplun. org B brand is a trademark A brand is owned by a company. They don't have to agree with the WHO owned by the company. Now It probably won't surprise you to learn that the companies in question go to other companies and say, why do we call these pills brand Institute, inter brand health in touch. All these like cool operators Ye before it goes to launch, they're like, tellell me about this drug. Let us get our hands on it. Let us smell it. Smelling it is probably not part of it. These agencies will come up with hundreds thousands of names, just like what see what clicks There's a lot of trademark conflicts, as you can imagine that rule out like because if it's too close to something else Uh that that rlles out a lot Um, they also have to check u like When you're making up a brand for these pills, you're almost certainly not going to use a base word. You're going for a like a real word. You're going for a vibe, a sound, right? Right. So one of the big things they have to do is get other u speakers in major markets to like go through to see say like is this does this sound weird? Does this sound like you're cursing? Does this sound like Is this accidentally sound like if it's not in English, what it Is kiss my butt not gonna to do well in America because kiss my butt. Yeah. It sounds like kiss my butt. I got it. That's not a real pill. I actually just came up with that. B But but maybe it will be now. The Brand Initute calls this the disaster cheheck drug and they say that drug names get more linguistic scrutiny than almost any other kind of brand, which make sense to me. We probably do have to be really careful about these. Yeah. Well, you're going to put them in your human body in hopes of achieving some sort of wellness. So Now we we do this is an expensive process. I think hundreds of thousands of to One to one to three million dollars to name these. And because it's notard sorry, this part of it always really Hey, honey. Really That money is not abstract, honey. It's going to brand professionals that work day in, day out to make great brands for us. So we shouldn't market drugs, period. so. Well, okay, but like what I'm saying is our brand professionals look to us for support we also it just be something that happens in the countries where we market drugs though, right? Becauseuse like because you have to have a brand name for the drugs because you're selling them like they still have the brand nameames. So like alleg But they don't do ads for them But they're still on the shelves. Oh, you're talking about OTC over the counter meds. Allegras. fast. in the UK and Australia. Gotcha. And some of them have different like Berlina Briliak across a lot of Europe. Okay. Bk. Lur Derek This is this is what I really like. What does the name What does the name mean though? Like what do these names mean They can't mean anything. This is legally speaking They can't mean anything But they can reference. So this is what it is. They can't claim one but they can im somethingomet adjacent, right Viagra. What's viant? Like Vger And Niagara It's supposed to make you think of Ni. power and vitality. Some also knowe the sand never thought of Niat. Yabra which is Tiger Although Pfizer has never confirmed it. I have never thought of Niagara when I think of Viagara. I think of like I think of virility, vigor, vitality But I never think Niagara, Niagara. It's Vigor in Niagara rightight there That's Lyrica What's lyric for? What do we use lyric? I'm not gonna ask you the meaning but like what'syica for? neuropathic pain. Okayically. It's music. Ease Lyrica You're feeling better, right? You can move. You can dance. Paxel what Paxel do taxels for depression or anxiety Is Latin for peace Zola alsoso, depression or anxiety Loft Lift. So lifft Loft Celebrs for arthritic joint pain. And wouldn't that make you wantan to celebrate course Uh, Xanx for anxiety. Sounds like anxiety. Yeah. Yeah. mean Uh, Halon That's a sleep medication. Halcion. I mean, that's just a sound alike U Or Lunesta. That was the first one I thought of. It's another sleep medicine Some of them are more aimed at the people who prescribe drugs rather than the people who use them like Lipator. which is a combination of lipids and Inhibitor. Oh. So you know Lipidor is lipid an inhibitor. Lipidor. there it's what it is for you. Prozac is another antidepressant or anxiety. Now Prozac is an interesting example because it is a what they call a blank canvas. So that is the the if you want to use these three types of names you would call them let's see, what are these terminologies here Okay, so you would these would roughly be three different buckets, right? Bucket one would be evocative. That's like U Viagra mechanism adjacent like kind And then there's the like kind of a blank canvas. P it up Prozak is like It is intentionally not is like intentionally, um, How would you how would you say like a, um unrelated meaning attached to it. like almost like a meditation. L it's like there's no emot You're not literally pro someone named Zach Yes, right. like like a lot of say by the Bell fans, you are not necessarily prorozac. Can I Can I ask a question about Lppidor As long as you aren't expecting me to know the answer to it, absolutely. I wantan to know about U Lipator is in a family of drugs with the ending statin Okay, they all with end with Statin and in Medicine, we talk about statins that family have gotten tons of There's a lot of conversation about stats because there were guidelines that came out that kind of suggested maybe you know, a billion or more people worldwide, maybe more should be on statins and there was a lot of should everybody be on a statin? And anyway, there's a lot of debate about statins. So we talk about them as statinens. Has that invaded common parlance? Do When I say statin, do you immediately know what I mean? Is that I am not a good person to ask about this because I do this podcast and it married to you. So I hear a lot of talk about statins I just wonder if it my sample off Has Has the generic invaded the public? You know what I mean Because like I know everybody knows Lipator, but Fmatins, you mean? Yeah, like. I mean I don't expect people know Rosuvastatin and Pravastatin, and you know, I don't think you necessarily know the The whole word, but Statin as a You know, Yeah I'm not sure. I hear you say statinough that I think I used. We talk about statins a lot in medicine and in our house Well, J is kind of day to day U So there's a lot of prescriptions every year and the big U I would say the number one thing that all of these names, like if there's an overall thing that you don't want is it just can't be confusing because we've had there have been fatalities in the past that have been linked to medicines getting mixed up. and I'm not just talking about the one that young George Bailey prevented and it's a wonderful life. There's others throughout the. Well, that was pretty clear. He put poison in some empty capsules instead of medicine in the capsules. That's a wild. canan I say that's a wild mixem up That is a wild mix up, I got to say, but he had a rough time, Mr. Gardon. Omeprazol was launched as low sex It kept getting confused with lasx, the diuretic lasx. They looked alike Persive and were both sold at twenty milligrams, and this led to at least one fatality. Oh my go. They renamed the US version Prilasx Rest of the world, LowSc Here's one that was caught beforehand. Celebrex was initially going to be called Celebra And then a pharmacy professor actually told the FDA like, hey, That's going to get confused with Slexa. Yeah. and that's not going that's not going to they agreed and they changed it actually to Celebrax. It didn't But it was still confused with Clexa and Sarah Breck. which is anti seizure drug. Yeah. And so they ran an education campaign for doctors and pharmacists Um, A lot of the issue was hilariously or not handwriting. bad enough that it was too close because people don't didn't take time to, you know, because Dror Hanwrright is so bad. Well, I mean, that's true. I will say that outside of just how bad and it is true. the stereotype is true how bad our handwriting is I live through the switch from written orders, handwritten orders to inputting orders in the computer And what your t shirts says that you're wearing right now. And we grousped about it a lot. God was this last. And I still I still grouse about the transition from handwritten notes to computer generated notes because there's so much trash in those notes now. they're usually useless But pututting orders in a standardized fashion like in a computer is much safer than handwritten orders I saw throughout my career, not that I personally did necessarily, but I was aware of many errors that happened due to notot just handwriting, but like The decimal point was faint and you didn't see it. you know, you weren't sure What does that say milligrams? Is that you what are what is I saw that happen in the hospital through the years. I know those things occurred. And so that definitely is a big problem I can see that being a huge problem. The when the FDA is the FDA still has to approve these brand names, right They can refuse them because they're they're misleading because they're okay, you're implying this is doing something that is not uh, they can imp I'm assuming also this is referring to a functioning FDA that is like be a bullet ight of which there are many individuals working within the FDA who are still hard working, reputable science based. For sure. E if even if our agencies as a whole. are not led by the most reputable people U Now once they have have verified that, we're not we're not, you know, you're not misleading people. There is a software How P OCA that is run by the FDA. And what's cool is or it's probably not cool unless you're me, but you can actually do this search On your own, you can search the phonetic and orthographic compomuter analysis program that the FDA runs. And you can try your own drug names to see if it's too close to another drug. So if you remember earlier you were saying that you wanted to call your drug, Sydney, right? So here's a threshold here and you can search putut in Sydney. Yeah And we search and we see that We're checking to say Okay. It's not bad. The closest is Slind What is slim? I don't know. It doesn't list more what they are. Here's the drug source But if you wanted to call it for like I have never heard of any of those drugs that are listed there. Where are these what's Zydone know Sideck, Kaby Hey, listen, you gotta tryust to take it up to the FDA, lady. I don't know. I don't know what these drugs are. You mean You know too, what's tough is that it may not just be drugs. It could be anything that fidetically could be confusing Lind is an estrogen free, progestine only birth control pill that contains dr Th these are real. I mean, they're real Look, that's a real world Well, you know what, though, I will say from the inside in the medical field Once a medicine has been around long enough that it's generic Often I won't know We won't necessarily, I wasn't even taught some of the brand names. There are medicines that I've only ever known Like we talk about Matopperlaw. I am certain Matopperlaw had a brand name. I've only ever known it asmatopperlol I don't becausecause by the time I started practicing medicine, it had been generic for so long, we wouldn't have known that, right? Right. So there are a lot of old brand names that I amm not familiar with. And then there's also when if you get into like the world of birth control, My concern are the components and doses within the birth control. I am less concerned with what the name of it is. So I am looking to make sure you get the right components, the right doses, and your insurance is going to cover it I don't really care what the brand is So I don't know. there's some medicines like that that I'm so focused on the components and the science of it that I the brand names elude me. I. And there's so many too. Well, it's just interesting that I wouldn't know the name of a birth control pill When I definitely prescribe birth control. Yeah, you haven't refused to cri birth control for months. I mean, it used to be a big problem for you. I know that you used to be like, no way You also have to understand, it depends on where you practice. I have practiced my entire career in West Virginia and the majority of my patients have Medicaid or when I was doing more familyily Medicine, Medicare, I am looking for Medicines that are covered by that insurance. I'm usually using low cost generic medication. Defensiveness. I don't know. But I think it really makes it much more there are probably people who practice in more affluent area eras who know all of these new name brand drugs because their patients can afford them and are.'t Judge Syidney all you fancy doctors, My little country mouse doctor only helps Those without Homes and shows she doesn't know the names of all your fancy drugs.an canan I finish my episode? P please finish your episode Thank you. No one was judging you. Sorry. We all think you're smart Trust me, I promise Syiddney. The other thing this group has to do is they are beyond just checking to see if it's like a conflict, they also write it down with bad handwriting and see how it looks just to see if it's going to be confusing to people. It also can't have a any generic like any of those chemical stems that we talked about earlier, you can't have any of those sounds in a place where it would be confusing, right? So just because it like You've probably internalized throughout the years, people probably internalized certain sounds that they associate with those things, but you have like you willingly have to take those out because you can't have any sort of confusion as to what is the actual function of the thing Now, I think you've probably noticed I want to talk about Sky Rizz because it's ridiculous. And I think that you're you're seeing u So why? I think because a lot of the names are look pretty stupid, I think Uh, and that is not in your head. I tri there was a twenty twenty two study on this and it it said that um letters that are rare in English use of those in drugs are climbing over time. According to one analysis, I saw X turnn X, the letter X It turns out sixteen to thirty times as often in normal English and Z is like thirteen to eighteen times more common in medical names. That's not your imagination. There's a lot of X's and Z's in these guys that's not interesting That is not in your head Part of it is distinctive, it's hard to find a new one. U you can change the spelling of something if you add like Q at the end, you know to, you know, to mix it up that way. Um There is also a lot of Hm Okay, so I'm going to read this part specifically orl also I'm going to confuse myself. Research on sound symbolism finds that particular sounds carry built in associations A twenty twenty study of drug Brown brand names found that voiced consonants The ones that made are made with vocal chords like B, D, G, V, and Z, du vZ make medicine feel more potent and faster acting and raise expectations of how well and how long it would work Z is a voice consonant, so its heavy use isn't only about looking distinctive, it sounds strong And that is how a brand name is formed. It is just How it makes you feel, what you associate with it, what you what you think and as long as it's not confusing It's fine. What do you think though that's a double edged sword because if you take a pill and the sound makes you think it's going like it sets the bar high for it, and then you don't immediately feel way better Yeah, I mean, the but that's, I mean