This Is Why Prescription Drugs Have Such Weird-Ass Names
Get out the party hats and cake, everybody, and get ready to boogie. It was 25 years ago this month that the Food and Drug Administration, in its infinite wisdom, decided to amend its draconian rules on advertising for prescription drugs, which is why today, the TV airwaves are chock-full of people with dire diseases dancing and smiling to celebrate the fact that for the mere cost of the annual budget of a mid-size nation, they can live a few months longer or cease suffering from excruciating pain or even — even! — put on a bathing suit and appear in public without fear of being accosted by other people saying, “Holy shit, man, what’s wrong with your skin?”
That means this is also the 25th anniversary of drug side-effect-and-complication disclosures delivered by bland male voices at the end of said ads at speeds unintelligible to most human beings, but especially to those who are old and somewhat hard of hearing, a category that nowadays, alas, includes me. How, you may ask, did Americans ever survive without being pummeled every few minutes by TV ads imploring them to ask their doctors whether they might be one of the .00000001 percent of people worldwide who are suffering from a certain obscure disease and, if so, whether a $32,000-a-month injectable made from the tears of virgins might provide relief? Let me tell you, kids — it was a grim, benighted era before prescription drug ads, when all we had to divert us was the Alka-Seltzer jingle and the occasional tum-tum-tum-tum-TUMS.
The drug industry has an interesting history in this country. Back in the bad old days, anybody could concoct a potion and promote it for use in treating anything from languishment to hair loss. This was in the era of patent medicine, a.k.a. the Age of Magnificent Quackery. Patent medicines weren’t protected by chemical patents, which only became a thing in the early 20th century; the name comes from the old-time “letters patent” that accompanied royal endorsements of elixirs like Mug-wump, which assured that it could “cure and prevent” all venereal disease. You could put anything you wanted in a patent medicine, which their concoctors did, including opium and cocaine (which would make one feel better — at least, temporarily), arsenic (which wouldn’t), and, of course, snake oil, as in from actual snakes. (It wasn’t just meds, either; you likely already know about cocaine and Coca-Cola, but the soft drink 7UP contained the mood-stabilizing compound lithium citrate until 1948. Emphasis on “up.”)
Enough people were poisoned (or perhaps merely unhelped) by the likes of Mrs. Winslow’s Soothing Syrup (a baby comforter complete with booze and morphine) and Pemberton’s French Wine Coca (an early product from Coke’s morphine-addict inventor) that the U.S. government felt compelled to step in, first requiring, via the 1906 Pure Food and Drug Act, that patent medicines disclose on their labels whether they contained alcohol or narcotics, then banning such ingredients in 1936, thereby severely curtailing consumers’ over-the-counter options. Drugs became something you visited your doctor to procure, via a prescription. That meant such medications were now advertised not to consumers, but to doctors; pharmaceutical companies employed “detail men” who called on physicians and personally explained the benefits and uses of their wares. As St. Joe’s University marketing professor David Allan, who’s written extensively on pharma ads, explains, “They’d go to the doctors offering beers and lunch. In the early days, that could involve golf trips to Palm Springs. The FTC put an end to that.” (Cue sad medical trombone.)
Back then, patients, far from being encouraged to ask questions, were purposefully kept in the dark regarding what was in the medications they were taking. Up until 1963, the American Medical Association’s Council on Drugs didn’t require consumer labeling — and in fact described circumstances under which it would behoove the patient not to know what he or she was being prescribed, including if a drug contained opiates or barbiturates or said patient believed the medicine was a “magical potion.” Keep their simple faith alive!
Some of the magic wore off in the early 1960s, when the anti-morning-sickness drug thalidomide caused some 10,000 babies to be born with severe birth defects. A swelling patients’ rights movement, a rise in medical malpractice suits, and a general loss of trust in institutions contributed to legislation and regulations governing those dense fine-print enclosures that accompany your prescription drugs as well as the sorts of claims drug companies could make. And it was in the 1960s that the AMA and the United States Pharmacopeial Convention got together to establish a procedure by which drugs would be named. Their goals included having standard monikers for drugs worldwide (so if you traveled abroad and lost your suitcase, you’d know what to ask for to replace your meds) and avoiding drugs with names that were too similar, to ward off pharmacy and physician mistakes.
Just like most people, drugs have a first name and a last name, in their case a generic one and a proprietary one. The generic is assigned by the U.S. Adopted Names Council, or USAN, and is based on the drug’s chemical action or structure — for example, a “caine” suffix, as in lidocaine, indicates a local anesthetic, while “nazole” (miconazole, fluconazole) means the med’s an antifungal. Onto this “stem” get tacked multi- or mono-syllable prefixes that differentiate it from other drugs in its “family.” Believe it or not, this system was intended to prevent unmanageably long and difficult-to-pronounce names. You can judge its efficacy by a 2016 article in Pharmacy Times listing 12 “names that may require some practice,” among them idarucizumab, ixabepilone and eszopiclone. Yep, rolling right off the tongue. Despite this streamlining system, the Institute for Safe Medication Practices feels it necessary to regularly produce and circulate lists of “Confused Drug Names” to alert doctors and pharmacists to potential candidates for muddling, like chlorpromazine and chlorpropamide. Perusing these lists is guaranteed to make you wonder how any of us are still alive.
Then there are the proprietary or “brand” names, which are a lot more fun — so much fun that in order to come up with them, pharmaceutical companies employ teams of consultants that include copywriters, linguists, “verbal identity specialists” and even poets, who brainstorm ideas inspired, according to one such consultant, by “thesauri and Google, of course, but also cowboy dictionaries, surfer dictionaries, encyclopedias of drugs and minerals, Sanskrit rhyming dictionaries, and the big book of sports metaphors.” (It rocked my world to learn that cowboy dictionaries exist.) The consultants produce a list of as many as a thousand possibilities, which the pharma company must winnow down first to a few finalists, then to the name it feels is most likely to survive the FDA’s convoluted approval process, intended (again) to prevent drug confusion but also overblown promises, or even intimations thereof. (In other words, “Besdrugeva” won’t fly.) The FDA’s Center for Drug Evaluation and Research goes so far as to examine “the orthographic appearance of the proposed name using a number of different legible handwriting samples,” because apparently that old saw about doctors’ penmanship is absolutely true.
All of this explains why in a subreddit for “pharmacists, pharmacy students and anyone else in the pharmaceutical industry,” there’s a hilarious thread titled “Worst drug brand name” where comments include:
— Migranal. You’d think it was a rectal suppository for migraines.
— For when your migraines are a pain in the ass.
— Bloxiverz. It’s like they let a 13-year-old create the name.
— Acyclovir. I once pronounced it “assy-clover” … will never live that one down in the pharmacy.
— Phosex. Pfizer really missed out on that one when branding Viagra.
— All these brand names people are saying here sound like Pokémon.
The first print drug ad for consumers was placed by Merck, in 1981, promoting a pneumonia vaccine. The first consumer-aimed TV ad, for a pain reliever known as Rufen, appeared two years later and was promptly ordered off the air by the FDA, which demanded revisions and eventually issued an official statement calling for a one-year moratorium on such ads until it could figure out how to set standards for them. (One former FDA official has said he was concerned such ads would “play on emotion as opposed to rational positive benefits.” Imagine that.) The earliest on-air ads were so non-specific that it was hard to tell what the drugs were intended to treat. Their big refrain was “Ask your doctor,” which led to a campaign by the AMA to have all consumer ads for prescription drugs banned, for the sake of doctors’ sanity. No dice. Big Pharma had tasted the future, and it was huge. Today, there are exactly two nations in the entire world that allow prescription drug ads directed at consumers: New Zealand and the United States. Yay us!
Last year, Big Pharma spent almost $7 billion on such ads. As of 2019, we consumers were paying $67 billion a year out of pocket for prescription drugs, or nearly 12 percent of all health-care costs. The price of the insulin drug Humulin rose from $67 in 2012 to $1,512 as of January 2022 — a 1,070 percent increase. Oh, and lookee here at the 15 Congress members taking the most money from drug companies for their election campaigns! We see you right at the top, Chuck Schumer! There you are, too, Kyrsten Sinema and Tim Scott!
But I digress.
In 2018, the USAN assigned names to 198 substances. (Since its establishment, it has christened more than 10,000, with the numbers going up as time goes by.) Of those 198, 72 were tumor-attacking cancer drugs; the next largest categories treat genetic disorders (23) and neurological conditions like Parkinson’s and Alzheimer’s (22). That’s a subtotal of 117, or nearly 60 percent of all new drugs named that year. In contrast, there was one new compound to treat arthritis and one for cholesterol. As the AMA Journal of Ethics notes in an article on the subject, “Relatively few drugs (or none) were named for common conditions affecting large numbers of patients, such as diabetes, depression, or high blood pressure,” adding that pharma companies “might find it more financially viable to develop drugs when there is less competition from low-cost therapies.” Ya think?
Drug nomenclature is further complicated by the fact that a brand name is used worldwide, which means creators need to avoid the sorts of cross-cultural mishaps that once led Pepsi to be marketed in China as a soft drink that would “bring your ancestors back from the grave.”
Speaking of the grave, direct-to-consumer prescription TV ads appeared to be dead in the water in their earliest iteration thanks to those lengthy disclaimers drug companies were required to air, which had to include “a brief summary of the drug’s side effects, contraindications, warnings, and precautions”; they also had to “provide ‘fair balance’ between the drug’s risks and benefits.” That didn’t leave much space for jaunty jingles or sunlit scenes of family outings. The companies circumvented these conditions either by sticking to print, where they could use minuscule type for warnings, or keeping their TV commercials vague enough that the disclosure rules didn’t apply (i.e., more “Ask your doctor” appeals than info about what drugs actually did). But ads really work best when they slam us upside the head, so in August 1997, the FDA, under industry pressure, loosened up its guidance rules to only require that a list of “major risks” air with TV ads, giving us the anniversary we celebrate this month.
A few years back, biotech journalist Luke Timmerman ran an online survey asking readers for their favorite and least favorite new drug names. The winner for best name was the prostate-cancer-fighter Provenge — “the revenge of the prostate,” as one voter said. Worst choice? Xgeva, a “bone-modifying agent” used to treat cancer patients. My personal favorite is Voltorb. Oh, wait — that one really is a Pokémon.
You could wonder what drug names have to do with drug ads, but you’d be showcasing your naivete. Nobody gave a rat’s ass what drugs were called before everyday consumers became their target. No one was matching them up with 1970s pop songs, like Sonny and Cher’s “And the Beat Goes On” (Novartis heart drug Entresto) or the Jackson Five’s “ABC” (GlaxoSmithKline’s allergy med Trelegy). St. Joe’s David Allan, who’s also written on the use of music in commercials (he was for many years a local DJ), tells me there’s a job known as “sonic specialist” — consultants who make a living matching advertising scripts to music. In the case of drugs, that music is often aimed at us old folks, because, well, we take more drugs and visit the doctor more. The songs tend not to have been super-hits, because those often raise issues, Allan says: “The older demographic is typically okay with a song if it’s just a memory. But if it was your wedding song or graduation song and it’s used about kidneys that aren’t functioning properly, that’s not so good.” His research also shows we oldsters resent a musical choice in a pharma ad more if its lyrics are changed to accommodate the drug’s name or actions: “If it’s a classic ’70s rock song in an ad for an impotence drug, that’s not so bad. But changing the lyrics to ‘Stairway to Heaven’ — no pun intended — can have a counter-effect.” (Young people, Allan says, typically don’t harbor such resentments about commercial reuse of music: “I figure they just grew up with it. It’s the reality of what they know.”)
There are further potential pitfalls in direct-to-consumer advertising for drugs. At one point a few years back, the FDA sent letters to the makers of Toujeo, a diabetes drug, and Otezla, which treats psoriasis, warning that their TV ads made “false or misleading representations about the risks associated” with those drugs, noting that the on-screen visuals and music “made it difficult for consumers to adequately process and comprehend the risk information.” In the case of Toujeo, “compelling and attention-grabbing” footage of a dude dancing to the Earth, Wind & Fire song “Let’s Groove” was deemed too distracting; in the Otezla ad, “a loud brass interjection” into Katrina and the Waves’ “Walking on Sunshine” was to blame. Similar warnings have been sent regarding other drug ads; the Nasonex bee’s buzzing once prompted an FDA study on distraction in pharma TV ads, in case you ever doubt the power of your tax dollars at work.
When a colleague of mine found out I was working on a story about prescription drug names, he sent me a list of 72 of them he’d compiled while watching TV during the pandemic. (COVID. It made us weird.) They range from Austedo for tardive dyskinesia to Kisqali for breast cancer to Phexxi for contraception to Zeposia for multiple sclerosis, and the chances are pretty good that you, too, have seen ads for them all. According to a study by the Congressional Budget Office, there are nine times as many prescriptions written for new drugs propped up by direct-to-consumer advertising as for new drugs without such ads. In 2017, 72 percent of all commercial breaks on the CBS Evening News contained at least one ad for a prescription drug. And it’s only gotten worse.
Advertising works. These ads do exactly what the pharma companies intend them to do — they make us wonder whether we, too, might be candidates for $74,159-a-month Myalept, or $46,828-a-month Takhzyro, or 30 days’ worth of Mavenclad at $60,371 a pop. Or, as Steve Woloshin of the Center for Medicine and Media at Dartmouth Institute told Consumer Reports: “They increase patient requests and prescriptions for advertised drugs, even when there are lower-cost alternatives.”
So next time you’re being bombarded by annoyingly upbeat ads for Skyrizi and Tremfya and Dupixent, console yourself by remembering: They’re providing jobs for poets and linguists. Who else is gonna do that in this day and age? And however dumb you think the names Xeljanz and Opdivo and Rexulti are, imagine how awful the hundreds and hundreds of other proposed names for those drugs — the ones that got rejected — must have been.
I have a modest proposal for Big Pharma and the FDA: Why don’t you start a new network that shows nothing but prescription drug ads and get them the hell off everywhere else? The hypochondria-prone among us could then watch that channel 24/7, ask their doctors about AcipHex and Addyi, and leave the rest of us alone. You may protest that nobody would tune in to such a channel, but you’d be wrong. I recently stumbled on another ad for the psoriasis drug Otezla (“Show more of you!”) on YouTube. To my astonishment, it had more than 14,000 views — and tons of comments, too. Most of them had to do with one of the actors in the ad:
— That woman in the yellow swimsuit is so cute ❤️❤️❤️
— Those legs. That smile. She looks so amazing!!!!
— Baby doll
— Omg that woman in the yellow swimsuit has beautiful feet
Believe me, somebody will watch. You’ll see.
Published as “The Real Drug Wars” in the August 2022 issue of Philadelphia magazine.