Ask Your Doctor About

This episode of 99% Invisible, hosted by Roman Mars, delves into the perplexing world of pharmaceutical brand names with reporter Sean Cole. Cole aims to uncover the logic behind these often strange-sounding names, questioning if they are designed, necessary, or simply marketing blunders. He promises to reveal an unexpected "poetry" in their creation. Cole interviews Scott Pierrosci, head of creative at Brand Institute, a company responsible for naming over 75% of new drugs on the market annually. Pierrosci explains that the naming process is far from arbitrary, contrasting it with a humorous scene from the movie "Brain Candy," where a drug name is conceived by chance. In reality, it's a rigorous and time-consuming process. Brand Institute teams initially generate 300-500 name ideas, a significant number given how few are ultimately selected. Clients often request easy-to-pronounce names but frequently reject them, feeling they don't fit the product. Historically, name ideas came from diverse sources, including foreign language dictionaries and specialized dictionaries like "cowboy dictionaries." More recently, Brand Institute has adopted an AI platform called Brandy to assist in the initial brainstorming phase, though human creativity remains central. Naming teams might explore palindromes or anagrams. A common exercise involves imagining the drug as a Time magazine cover story and molding the potential headline into a name, such as "Altacourse" for a drug that alters one's life course. They also consider the hopeful outcome of taking the drug. For example, Lunesta, a sleep aid named by Pierrosci's company, draws from "lunar" imagery and the suffix "esta," suggesting restorative sleep, similar to "siesta." Other sleep aids like Ambien (from "ambient" for morning) and Belsomra (from "somnus," Latin for sleep) also reflect their intended effects. Drug names can also incorporate elements from the generic name or active ingredient, such as "Wellbutrin" from "bupropion hydrochloride." For cancer drugs, the focus shifts to the scientific mechanism of action, as the primary audience is often the doctor rather than the patient. These names aim to highlight the drug's unique scientific properties. An example is "Mydeltra," an "MDL3 immunotherapy," where the double 'L' and 'TR' elegantly suggest "three," representing the mechanism of action. However, not everyone agrees on the elegance of such names. Arlene Tech, a legend in pharmaceutical branding with over 30 years of experience, criticizes "Mydeltra" for its awkward appearance and pronunciation. Tech's approach to naming often involves working independently on projects, unlike Brand Institute's team-based structure. Tech shares the fascinating origin story of Viagra. In 1992, she was tasked with naming a drug for benign prostatic hyperplasia (BPH), or enlarged prostate. During a focus group with urologists, one doctor's comment about a patient's recovery – "Visualize a strong stream" – sparked an idea. Connecting "strong stream" to "vigorous" and then to "Niagara" (known for its powerful waterfall), she combined them to form "Viagra." Interestingly, the drug Viagra is known for treating erectile dysfunction, not BPH. Tech explains that her proposed name, Viagra, was not used for the BPH drug for various reasons. Companies can "bank" names for later use if a better fit arises. Around the same time, Pfizer was testing a completely different drug for angina (chest pain). While ineffective for angina, it had a notable side effect: "lumpy trousers." Realizing its potential for erectile dysfunction, Pfizer sought a name. Their own focus groups yielded names that were either too overtly sexual or not masculine enough. They then retrieved the banked "Viagra" name, which Arlene Tech had conceived, deeming it a perfect fit. Tech humorously remarks on the experience, stating her husband used to call her "the Viagra woman" and that she has a "one-word resume." This anecdote, Mars notes, is strikingly similar to the "Brain Candy" movie scene, where a seemingly random event leads to a drug name. Mars questions why not all drug names are as approachable as Viagra or Lunesta, referencing the prevalence of names like "Skyrizi" or "Wegovy." Cole explains that the "big bang" of pharmaceutical naming occurred in 1988 with Prozac. Prozac was a short, punchy, "blank canvas" name focused on marketing rather than describing the drug's function. Its success made it a household word, and its namer, David Wood (Arlene Tech's mentor), is in the Medical Advertising Hall of Fame. Wood aimed for a semi-abstract name, with "pro" suggesting positivity and "zac" being a sharp, attention-grabbing syllable. The number of FDA-approved drugs has significantly increased since 1988, from 17 to nearly 50 last year, driven by industry growth and advancements, particularly in cancer research. This proliferation, combined with a finite alphabet, makes naming increasingly challenging. The FDA plays a crucial role in regulating drug names, primarily to ensure patient safety and prevent misleading claims. Two main rules govern approval: 1. **No big claims:** Names cannot imply miraculous results. For example, "Flomax" (for BPH, meaning "maximum flow"), approved in the late 90s, would likely face challenges today due to its suggestive nature. Naming experts like Pierrosci are careful to avoid direct claims, using circumspect language when discussing connotations. 2. **No lookalike/soundalike names:** To prevent medication errors, which can be fatal, new drug names must not sound or look too similar to existing ones. A notorious case involved "Lasix" (a diuretic) and "Losec" (for ulcers). A nurse mistakenly administered Lasix instead of Losec, leading to a patient's death. The FDA intervened, leading to Losec being renamed "Prilosec." However, Prilosec later faced confusion with Prozac. To further differentiate names visually and prevent mix-ups, the FDA also considers the physical shape or "silhouette" of a name. Names are encouraged to have a mix of ascending (e.g., L, T, H), descending (e.g., P, Q, G), and flat letters (e.g., A, E, S) to create a unique visual profile, like a city skyline. This variation makes names less prone to misreading, especially in handwritten prescriptions. This requirement also explains the use of visually distinctive letters like 'Y' (which has a downstroke) or 'Z' and 'X', contributing to the "kooky" appearance of many drug names. For instance, "Tryptyr" uses a 'Y' for a 'I' sound, enhancing visual differentiation. Cole notes that naming professionals are aware of public amusement at drug names. Pierrosci acknowledges the "sci-fi character" comparisons but explains that the constraints of a 26-letter alphabet, the need for distinctiveness, and the path to global regulatory approval necessitate these unconventional names. He accepts the "gut punches" of criticism, understanding that the names are a product of a complex process, even if some become "instant hits" and others are disliked. Beyond the pragmatic challenges, Cole highlights an artistic and poetic aspect, particularly in Arlene Tech's work. Tech, a haiku poet, initially separated her poetry from drug naming but conceded that in both, the "sound of the thing" and tonality are paramount. She advocates reading drug names aloud to ensure they "fit in your mouth" and "flow in conversation," like "Viagra," which is easy to say, unlike "Mydeltra." Tech even "sings" names to herself, believing that if a name is easily singable, it's easily pronounceable. She cites "Toujeo," an insulin shot for diabetics, as an example. Tech explains that "Toujeo" (an insulin shot effective for 30 hours, longer than its predecessor) emerged from a creative prompt: "your friend for life." This sparked a romantic narrative in her mind about young adults gaining freedom and spontaneity by not having to worry about frequent insulin shots, enabling them to enjoy evenings out. The name "Toujeo" comes from the Haitian Creole word "toujou," itself derived from the French "toujours," meaning "always." Tech aimed to embed this narrative and feeling of "always" into a musical word, without needing people to know the backstory, just to feel its resonance. This, Cole concludes, is the true poetry of drug naming. Tech describes the moment of conceiving a successful name as a "mental orgasm," a profound feeling of knowing something is good, where it "sings and it looks good and it's going to work." Pierrosci, while more reserved, also finds satisfaction in creating "great names at scale" and admits to having favored names he hopes make it through the approval process, even having a jingle for a current weight-loss drug awaiting regulatory feedback. The episode concludes with Mars expressing his hope to see the ad for this weight-loss drug and recognize Pierrosci's creation.