Ask Your Doctor About

Introduction

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Show Introduction

1:03This is 99% Invisible. I'm Roman Mars. Roman, what prescription drugs do you take? Well, I, I, I don't... Do you take Jernavex? This is Sean Cole, everybody. He's an old friend of mine, a friend of the show. Or Extensor. Do you take Extensor? I don't think I want to discuss, you know, like... Or Zyaflex. What is going on? Ask your doctor. Ask your doctor about Xdenvi. Ask your doctor about Nexplanon. Ask about Repatha. Ask about Nucala. Ask your doctor about Kaplida. Help see more of the light inside of me.

Pharmaceutical Names

1:34Okay, Sean, why are we talking about this? So the reason I'm sitting here with you today can pretty much be boiled down to the Seinfeldian question, what is the deal with pharmaceutical brand names? It's like watching TV in the middle of the day can make you feel like you've had a partial stroke that scrambled half the words on the screen, which is ironic considering that that's probably what some of the drugs they're advertising are supposed to prevent. Once Monthly, Ebglis is a treatment that can be used with or without topicals.

2:04Dupixin can help you stay ahead of excellent. Inreza. Fimzelex. Kobanfi. Pristique. Kaplida. Kapvexid. Kabanuva. Jardians. Maybe we don't need a pill for everything. You can say that again, Kenan Thompson. But for managing weight, there's Rogovic, the first and only... And it's funny that Kenan did a real pharmaceutical ad, given that he was also in this Saturday Night Live sketch about a fake hormone supplement for women. There's a new drug for gals over four. It's called the JJ. I think it's for Jordan. Whatever, just dance.

2:36So we all laugh about these drugs, but the question becomes, why do they all sound like Star Trek villains? Is that by design? Is it necessary for some reason? Is it simply wrongheaded on the part of the marketers? I mean, those are a lot of questions, but do you have some answers for those questions?

Naming Process

2:51Yes. I got to the bottom of it. And I'll just say, underneath the noisiness of the names is not just a logic that you'd never guess is in operation. In a lot of cases, there's, I know how this is going to sound, an actual poetry going on that I never imagined. And that I now want everybody else to be thinking about the next time they see one of those ads. That is, that's a big claim when you're talking about brand names of drugs. Okay. But just hear me out. We'll see what you think at the end.

3:23But just to start at the beginning.

3:26Hello? Scott? Yes, Sean. Hi, how are you? This is Scott Piergrosi, who is in practically every article you read about pharmaceutical brand names. And there's a reason for that. He's the head of creative at the Brand Institute, which is kind of a clearinghouse. They help name more than 75% of the new drugs on the market in a given year. 75%? One company? Yep. At least according to them. 75% of both brand names and generic names, too, which are even longer and wilder sounding,

3:57as you know. They have a separate department for generics or non-proprietary. They get upset when you say generics. Non-proprietary names. But we are focusing on the brand names. The Brand Institute names. Can I also respectfully correct you and say it's just Brand Institute? I'm sorry. I'm sorry. Yes. Lose the the. It's cleaner. That's right. That's right.

Brand Institute

4:19Scott's been at Brand Institute for more than 20 years. And I just asked him to, you know, take me through the process from the beginning. Like, where do they even start naming a drug? Have you ever seen the movie Brain Candy? No. Should I? You should see it. Absolutely. This is a Kids in the Hall movie. That's Kids in the Hall, the sketch comedy troupe from Canada. And Brain Candy was about a new antidepressant drug that came to market. Hmm. So, but they have a scene where the marketing guy comes into the boardroom and he tells the story of how he thought of the name.

4:50Okay. I was driving around last night in my $62,000 car and I'm trying to think up a name for the drug and suddenly it hit me. The name? No, a bird. It hit my windshield. When that happened, I got depressed. Not you, Cisco. Yeah, even me. But as soon as I got depressed, I got undepressed. Because as I was cleaning the gleaming guts of that bird off my windshield, I thought of the name for the drug. And he says, Gleamanex. And everyone does like a slow applause.

5:23And it's the opposite of how it actually works. How it actually works is much more rigorous and time consuming. They meet with the client, be it Pfizer or Amgen or whomever, kind of get a sense as to what they're thinking. And from there, Brand Institute assigns a small team to come up with an initial list of like three to five hundred ideas on their own. Five hundred names. That's a lot of brainstorming for names that will not get used. It's amazing. It is. And at that point, the job is pretty much just figuring out which ones are actually viable

5:58and good enough to test out with the client. It's funny because clients will say, just give me an easy to pronounce name and we'll call this a win. And then we present a slide, let's say, of 25. And we'll be lucky if we get to retain two of them. Oh, really? They are all solely easy to pronounce. And the client just like, meh, I just don't like it. And I'm like, but that's what you asked for. Just remember that. That's what you asked for. Because why don't they like those ones? Like, what is it when they say no? They can't see it. They can't see it as the product. It doesn't fit.

6:28And how are they generating these ideas in the first place? Like, when they're coming up with all these ideas, where are the ideas coming from? Well, historically, how it worked was everybody was just sort of forging omnivorously anywhere and everywhere for different combinations of words and letters. Magazines, foreign language dictionaries, another company I read about. So not Brand Institute, but a competitor. So they sometimes leaf through cowboy dictionaries and surfer dictionaries. What's a cowboy dictionary? I looked it up.

6:59There's one from 1968 called Western Words by Ramon F. Adams. I see. A little hoss is soon curried.

7:11Well, I'll take your word for it. Brand Institute has also started using an AI platform called Brandy. Cute. That's just helping out with the initial phase of the process. Scott says a lot of the work is still done by humans. You might explore types of names like palindromes or anagrams. One of the more helpful exercises we do is we try to get the client to state, like if it's on the cover of Time magazine, for example, what would the headline say? And then we actually might even try to mold that expression into a name.

7:45Hang on. So you would try to take that sentence? Yeah, so let's say a drug alters your course in life. AltaCourse. So that name is... I want a drug that does that, by the way. If I could take AltaCourse, boy, oh boy. AltaCourse. Or they could look at the drug and say, okay, what is the hopeful outcome of taking this thing? And then explore that from a bunch of different angles. So, for example, sleep aids. They could say, okay, this is a drug that helps you stay asleep through the night. Or this is a drug that leaves you feeling refreshed in the morning.

8:18Same section of the drugstore, two different ways of looking at it. So, for example, there's Lunesta, a drug that Scott's company named. The reason Lunesta works is because of the lunar imagery. The suffix, esta, has an inference of restorative sleep. As in C-esta. Ah, okay. Very cool. See what they're doing there? But really the lunar is what anchored it. So, nighttime sleep. Within the category, you have Ambien. What is Ambien? It's A-M-B-N.

8:48Good morning. So that's the good morning. Then you have newer products like Balsamra. That's a beautiful night's sleep with Balsamra. Bel-som is somnus, which is sleep in Latin. Then there's other sources of little name-building blocks. They might grab a few letters from the generic name of the drug or the active ingredient. For example, bupropion hydrochloride. That's the active ingredient in the antidepressant Welbutrin. And then sometimes the name is derived from the science of how the drug works.

9:20A lot of cancer drugs are like that, Scott says, because the audience is really more the doctor than the patient in those cases. So oftentimes we want to highlight what's unique about that product from a scientific standpoint because that'll resonate with oncologists. And about half of new cancer therapies are derived from the mechanism of action. So the science behind the drug. That is what the drug is actually doing and to what part of you. So there's this one drug called Imdeltra. It's I-M-D-E-L-L-T-R-A.

9:51Imdeltra is a D-L-L-3 immunotherapy. Well, of course. I mean, everybody knows about that. So the double L's and the tra suggesting three is so intentional to represent the mechanism of action of the product quite elegantly. And if Scott Piergrossi sounds ever so slightly defensive about the name Imdeltra, it's because another drug namer I talked to did not agree with him. It satisfies a meaning, but look how it looks.

10:23And that doesn't really look that good. Imdeltra. It's hard even to say. OK, so who's this? I am Arlene Tech. I have worked in brand naming for 30 plus years. Most of those naming pharmaceuticals. Arlene is kind of a legend in pharmaceutical branding. And once I learned a little bit about her and her background, I couldn't not reach out to her to get her perspective on how prescription drugs get their names.

10:54And does she sort of predate the Brand Institute style of naming? Yeah, she's like an OG. And unlike Brand Institute, with its teams of 15 people or whatever, the places Arlene's worked, people tend to tackle projects on their own.

Arlene Tech

11:09And just to give you another picture of how drug names are invented, there's this one drug she was assigned back in 1992 that was for benign prostatic hyperplasia. Enlarged prostate, basically, which makes it difficult to pee. In trying to figure out what to name this drug, Arlene ran a focus group with a bunch of urologists. And this one doctor in particular said something that stuck with her. It was at the end of the group, and I asked the doctor, what's it like when the drug worked and the guy got well?

11:39And the doctor said, visualize a strong stream. A strong stream of urine. Yeah. So when I was home and I was writing the notes up, I thought to myself, well, a strong stream, that would be vigorous. And the first thing I could think of that was a stream like that was Niagara. No. Yes. So I put vigorous plus Niagara equals Viagra. Oh my God. I know. I met the woman who named Viagra.

12:10She gave me her pen. I'm going to keep it forever and ever. But wait a second. So Viagra is for erectile dysfunction, not like the enlarged prostate that makes it hard for you to pee. So what is that about? It is. And this is where this naming business gets even more complicated. Super interesting trick of the industry, just to digress here for a second. So Arlene came up with the name Viagra for this drug to treat prostate enlargement. But for a lot of complicated reasons, they didn't end up using the name Viagra for that benign

12:43prosthetic hyperplasia drug. And as far as Arlene knows, they just held on to the name. It's true that companies can bank names in certain circumstances and use them later when a better fit comes along. And around that same time, Pfizer was testing a completely different drug, which had nothing to do with the prostate, that drug was supposed to treat angina, which is chest pain due to a heart condition. And the test was very successful. Everybody was complying with it. And some of the guys came back and asked for more.

13:16Because, well, it didn't work very well for angina. It did have this crazy side effect. I think the medical term for it is lumpy trousers. And so they thought, well, that would be a much better way to sell this drug if it did that. And they tried to do the whole thing right. They tried to have a focus group. A focus group to name their new miracle erection drug. And the names that came up just weren't that good. They were either too overtly sexual.

13:49And then some of the names were just not male enough. If you want to sell a drug to Treat E.D., it should have a pretty masculine name. And they just so happened to have the one that Arlene thought up stored away. So they went with that. So how does it feel to have named Viagra? Different. Different than having not named Viagra? Well, as my husband always used to say, I'm married to the Viagra woman.

14:17That could mean a lot of things. Yes, it could. Well, I have also told people that I have a one word resume.

14:27You know, what's funny about that story is that it really is a lot more like that scene in the kids in the home movie where the guy comes up with gleaming X. I mean, she was just like trying to think of a name for a drug. And then this thing happened and it made her think of another thing. And it led her to the name Viagra. It really is much more like that. Yeah. So why can't all drugs, you know, have that same approachability? Like Viagra is a very approachable name. Lunesta is an approachable name. But why aren't they still? Like when you started, you started naming all these things like Skrillex or something,

14:59you know? Skrillex is a DJ. I think you mean Sky Rizzy. Okay. Sky Rizzy. And, you know, Wagovi, whatever. Like, how do we get to there? Okay. So just to start back in time a bit, even farther back from when Arlene named Viagra. So the big bang of pharmaceutical naming, as Scott Piergrosi calls it, comes in 1988 with the introduction of Prozac. That was the first real blockbuster name. It's short, punchy, and it was all about marketing as opposed to even indicating what

15:31the drug did. It was what they now call a blank canvas or empty vessel type name. Obviously, it caught the public attention, became a household word. The guy who named it, David Wood, is now in the Medical Advertising Hall of Fame. There's actually a Medical Advertising Hall of Fame. Of course, there's a Medical Advertising Hall of Fame. Nice. David Wood died in 2007. And Arlene was really a protege of his. She worked really closely with him. Basically, I think he was trying to do a name that was semi-abstract.

16:03Everybody knew that the word pro meant something positive. If you were for something. And the zac was simply a syllable that woke people up. It's like zap, zang, zip. Well, the K sound on the end, zac, had a sharpness to it. You know, a sharp sound might indicate something that was more targeted. So that year, 1988, only 17 drugs were approved by the FDA for therapeutic use. So 17 prescription drugs that needed brand names. And that number has just trended upward over the years.

16:37So last year, almost 50 new drugs hit the market. Number of letters in the alphabet, still 26. And like, why are there so many more drugs being approved now? Just sheer growth in the industry, for one thing. More and more drugs being developed. Especially with cancer. There's a big push on that front. And then a few other reasons that, believe me, are too wonky even for this show. I'm going to try not to take that personally.

FDA Regulations

17:00Please don't.

FDA Regulations

17:00Meanwhile, the Scots and the Orleans of the world are trying to accomplish something that, in this climate, just gets harder and harder. I mean, in every case, they want to come up with something totally new, if they can manage it. A singularly unique name is the goal. Why? Trademarkability, for one thing. And just plain marketability. They want the product to stand out. But the main factor driving this ceaseless crusade for nominal innovation, Roman, is the FDA.

17:32And so why does the FDA do this? Like, what are the rules? So, two big things to focus on here. Number one, what a drug seems to be promising. The FDA doesn't want a name to sound like, oh, this is some miracle drug. So, no big claims in the name. I'm sure you're familiar with Flomax. Sure. I don't remember what it does. Flomax is for BPH. That is benign prostatic hyperplasia. That same enlarged prostate condition that was the very first inspiration for the name Viagra. So, maximum flow.

18:03God. Flomax. Simple, right? Simple. So, that name was approved in the late 90s, I believe. And that name is an example of one that probably today would be more challenged. Oh. Because, and this is me speculating, I have no data to say this, but based on the guidance, you know, what is maximum flow, right? What is that? I know how to determine maximum flow. Go ahead. Pissing contest. Oh, geez. Sorry. Anyway, that's why Scott, when he talks about these drugs, is he's pretty circumspect.

18:36Like, he'll be like, he'll name a drug and then be like, it comes from this. I mean, if you were potentially able to extrapolate that connotation, because nobody wants to come right out and say like, you know, take, you'll definitely sleep through the night at all. Oh, I see. So, it's on sale. You know, they want some plausible deniability. Another thing the FDA very much wants to avoid is christening a new drug with a name that sounds or even looks too much like a drug that's already out there, which is a big deal in terms

19:08of our actual physical safety. Medication errors kill people. And sometimes it's because of that look-alike, sound-alike problem. And there's this sort of poster case that people point to regarding that kind of mix-up. There were two drugs. One was called Lasix, L-A-S-I-X, which I believe was a diuretic. And the other one was called Losec, L-O-S-E-C, which helped people with ulcers and different

19:38types of heartburn. In short, this one patient was admitted to the hospital, this was like the late 80s, early 90s, had a lot of health issues, including an ulcer for which the doctor prescribed Losec. But the attending nurse gave her Lasix, and the patient ultimately died. So, the FDA got involved and said, you know, you got to change one of these names. And somehow it was decided that Losec would be the one to change. So, Losec came to David Wood and said, we need this help.

20:12And David Wood realized that there was already a lot of investment in the name Losec. Doctors all knew it. And if there was too much change going on, doctors wouldn't recognize it, might not prescribe it. The company would lose sales. So, what he did was he left Losec the same and added a three-letter prefix. It became Prilosec. Prilosec. Oh. Yeah. You've heard of Prilosec. Yeah. Yeah. It's a better name, I think. Yeah. I think so, too. Yeah. Prilosec works. I remember it.

20:43And I don't remember a lot of drug names. Yeah. Problem being that then Prilosec started to become confused with Prozac. Oh. True story. Maybe it's why I like it, because it sounds like Prozac. That's right. Also, to point out, with the Lasex and Losec example, the doctor had written a prescription by hand, so it was a visual mix-up, which namers try to avoid by honing in on the physical shape of the name.

21:14It has to have ascending and descending letters. If it doesn't have that, it doesn't get approved. It has to have ascending and descending letters? Because other than that, the silhouette of the name would be flat. But describe this, the silhouette of a name. So, if you picture, like, a city skyline reflected in a river, you can think of that's what the name looks like, right? Yeah. There's skyscrapers, and there's little low warehouses. And these are all built out of lowercase letters.

21:43And you have letters that stick up. Like L, T, and H. Letters that stick down. Like P, Q, and G. And letters that are flat, you know, like A, E, S, and all that sort of thing. And if that silhouette was just a flat thing like that, that's easily confused. There are too many other flat things like that. So, you have to have, you know, the silhouette would have something that goes up someplace, something that goes down someplace, you know, and then you get a different perceptual silhouette.

22:14Now, strictly speaking, there are names that get through without sticky up, sticky down letters. But it is true that variation helps a lot in terms of approval. Which, when you think about it, is another huge reason why the names are so kooky. If you want a C sound, sure, you could use a lowercase C there. But you could also use a lowercase Q, which has the tail that sticks down. Or, instead of the letter I, you could use a lowercase Y.

22:44Scott really likes a lowercase Y. Y is the only vowel that has a visually differentiating quality to it. A, E, I, O, U all exist in the same visual plane. And here comes Y with that downstroke quality to it. So, now you're seeing Triptir, I believe, was last year's approval. T-R-Y-P-T-Y-R. That's like a double whammy differentiation visually. So, yes, 100%. Give me a B, give me a K, give me a Z, give me an X. What's that spell? But B, yes, and that name was approved last year also.

23:24So, putting this all together, again, no big claims, no look-alike, sound-alike names, a stricter enforcement of those rules, which means the goal now is to come up with something completely novel in an age where there are more and more new drugs coming out all the time. And this, I think, is where the artistry of drug naming really comes to life. But let's talk about that after this break. Sounds good. Consider the impact of thoughtful design on your life.

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Conclusion

28:00Okay, we are back. And Sean, one of the things that I've been wondering for the sort of Scots and Arlanes of the world, do they really know how much people are scratching their heads and maybe laughing at these funny-sounding names that they've come up with? They do. Okay. They do. I talked about that a lot with Scott. I even went down the list of last year's approved names with him and was like, you know, this one's crazy. And these are drugs that Brand Institute named. I'm like, are you aware

28:31that people are comparing these names to sci-fi characters? That is absolutely something that we hear. But understand that where we are is the result of there being 26 letters in the alphabet, right? And you have to combine them in a way that is distinctive and differentiating and contending with this path to a global regulatory approval for the same name across the world. And this is oftentimes the type of names that come out of that process. So that's why I don't get too offended

29:03when people say, oh, you know, they joke about drug names. It's like, well, I completely get it. It's like a couple gut punches, but then you get over it, right? Because as a creative, you want your work to be lauded and everyone to love it. And you do get names that come out and they're like instant hits. They instantly, people love saying them and then you get other ones where nobody even wants to say it. But that's all just part of the job. And it is a job. But like I was saying at the beginning, there's also this distinct artistic and even poetic aspect to it that I wasn't expecting

29:34and that I think is apparent in some of the things we've talked about already, but especially as regards Arlene, because Arlene, as well as inventing drug names, writes haikus. She's a poet. She's a poet. As are you, you're a poet. As am I. And at first, she insisted, insisted that her drug naming and her haiku-ing have nothing to do with each other. But finally, she conceded that yes, in both pursuits, the sound of the thing is really important,

30:06the tonality. You should read your haikus out loud when you're writing them, she says, and you should do the same with a drug name. It has to feel like it fits in your mouth. It has to flow in conversation. So when you tell somebody, I am taking Viagra, you know, that's an easy sentence to say, not awkward. It's not like you're going to try to say, I am taking Imdeltra. God, she really hates the name Imdeltra. She really does. What I would do is I would sort of sing them to myself.

30:36Sing them? Sure. If a name can sing for you, if it's easily singable, that means it's easily pronounceable. You're saying literally sing. Well, not like operatic. But, Tujeo, Tujeo. I see. Is that a real drug name that she's singing? Tujeo? It's a, yeah, it's an insulin shot for diabetics. Huh. And it's with Tujeo that I think you can really see the poetical nature of Arlene's thinking when she sits down to name a drug.

31:07So explain what you mean. So the thing about Tujeo is that it's longer lasting than a similar drug that came before it. Instead of 24 hours, it's effective for like 30 hours, give or take. And as Arlene and her team were brainstorming, they developed this, they do this sometimes, they developed a prompt. They call it a platform. This prompt to riff off of. And the prompt was, your friend for life. And from there, Arlene unspooled this whole story in her head.

31:37A kind of romantic story about young people, young adults, just beginning their adult lives.

31:45Imagine, you know, especially when they're going out to working in their first jobs and they're meeting new people, there's always the idea of after work, the spontaneous sexual flirtation. But if you're worried about having to take your next insulin shot, you can't be spontaneous. Unless, again, that shot lasts long enough to give you the freedom to stay out later. So that if somebody wanted to go on a date after work, you know, they'd simply have to get home before four o'clock in the morning or something like that to get their shot. It'll become your friend for life

32:17because it will permit you to enjoy your evenings if you want. Tujeo. It came from the Haitian Creole word tujeo, T-O-U-J-O-U, which came originally from the French word toujours, which means all the days, always. And tujeo was the Haitian Creole version of it, always. So she's got this whole narrative arc that she wants to express somehow in a word,

32:49in a musical word. She doesn't need people to know the story. She just needs them to feel its resonance. I see. So that's the real poetry of it. That's right. A whole story, a whole world, that you just need to feel the underlying resonance of in the music of a word. When you're naming drugs, and you've named a lot of them, how did, like, how did it feel when finally it was out on the market? Was there a thing where you're like,

33:20oh man, I'm immortal, like I'm, like I'm in people's households? No, what the feeling was, not then. It was when I originally came up with the name and wrote it down on paper and I said, this is going to be a good one. That's when I had the good feeling. Say more about that. Well, it was like a mental orgasm.

33:42You, you get something that you know is good. You've, you know that you've done other things not that good and here comes this and, you know, when it sings and it looks good and it's going to work, you know, and all that, it just lights you up all over. I'm a little more reserved in my feelings, I'd say. I'm also a little more pragmatic. Scott doesn't even like to talk about himself as an autonomous being in this regard. Like, like, he's all about the team and the partnership and literally will say

34:14that he gets his pleasure out of creating a lot of great names at scale. But there are those ones, there are those names that he favors in his heart. Sometimes there's a good name and I'll say internally, I'm like, what's going on with that name? Is it still alive? Has it died yet? What's going on? How can we keep it in? I do keep an eye on some projects and I say, oh, that makes it. We do have one coming up for a weight loss drug that I'm very excited about. Can you say, can you say? Oh, absolutely not. Can I say? I like my job.

34:46No, we do have, we do have one or two. A lot going on in the weight loss category. But, you know, I hope it works. We're waiting regulatory feedback. So it's still like up in the air. And I have a jingle in my head for it too. Dude, if this name passes, I am so going to ask you what was happening. I will, I'll let you know. Okay, please do. And I'll just say this, I'll just say this, this name and the jingle or the song associated with it will be so obvious if and when the name gets approved,

35:17you'll text me. I get it. I get it. Okay, you're right. I'll leave it at that. And I'm sitting here like I never thought I would be hoping for the moment that I see a TV ad for a weight loss drug with one of those names and I'm like, that's the one. I really hope that happens. I hope so too.

35:43You see, this is why we love to have you do stuff for this show. This was so great, Sean. Thank you. Always a pleasure, Roman. 99% Invisible was reported this week by Sean Cole, produced and edited by Christopher Johnson, mixed by Martin Gonzalez, music by Swan Real, fact-checking by Naomi Barr. Like I mentioned earlier, Sean is a longtime friend of the show and a friend of mine. He's been doing stories for us for like more than a decade.

36:13So go to our website and check out all of his greatest hits, including one on how to hack your Ikea furniture, the one on cow tunnels that everyone loves. They still mention it to me to this day and my personal favorite about the album art of Devo. Check them out. Kathy Tu is our executive producer. Kirk Kolstad is the digital director. Delaney Hall is our senior editor. The rest of the team includes Chris Berube, Jason DeLeon, Emmett Fitzgerald, Vivian Leigh, Lasha Madon, Joe Rosenberg, Kelly Prime, Jacob Medina Gleason, Talon and Rain Stradley

36:43and me, Roman Mars. The 99% Invisible logo was created by Stephan Lawrence. We are part of the SiriusXM podcast family now headquartered six blocks north in the Pandora building in beautiful uptown Oakland, California. You can find us on all the usual social media sites as well as our new Discord server. There's a link to that as well as every past episode of 99PI at 99PI.org.

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