Healthy Skepticism Library item: 1020

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Friedman R.
Do Spelling and Penmanship Count? In Medicine, You Bet
The New York Times 2003 Mar 11
http://www.nytimes.com/2003/03/11/health/cases-do-spelling-and-penmanship-count-in-medicine-you-bet.html

Full text:

What’s at stake in a name? When it comes to prescription drugs, sometimes your physical or mental health. Just ask my patient Lisa.

For nearly half of her 40 years, Lisa struggled with bipolar disorder and had finally been stabilized on a number of medications, including the mood-stabilizing anticonvulsant Lamictal. Two weeks after a routine office visit, she called complaining of irritability and insomnia, early warning signs of a relapse.

When I saw her the next day, she was testy and agitated. She pulled all of her medications out of her backpack, slammed them on my desk, and dismissed the treatment as useless. To my surprise, she had a bottle of medication labeled Lamisil. It sounds a little like Lamictal and is even a round white pill like Lamictal, but it could not be more pharmacologically different.

By accident, the pharmacist had given my patient Lamisil, an antifungal drug, instead of Lamictal for her bipolar disorder. In essence, she lost the therapeutic effect of Lamictal for two weeks and was beginning to get sick because of confusion about the name of a drug.

Lisa’s mishap is hardly rare. Mix-ups over drugs with similar spellings and similar sounds accounted for 15 percent of all errors reported to the United States Pharmacopeia Medication Errors Reporting Program from 1996 to 2001. Common examples include: Cerebyx (an anticonvulsant) and Celebrex (an anti-inflammatory); Zyrtec (an antihistamine) and Zantac (an ulcer drug); Sarafem (an antidepressant) and Serophene (a fertility drug).

Because some prescriptions are phoned in and others are submitted in writing, often in a physician’s notoriously bad handwriting, both spellings and sounds matter tremendously.

Sound-alike and look-alike drugs are such a problem that the Food and Drug Administration has appointed a panel of experts to review proprietary drug names. According to Jerry Phillips, a pharmacist and associate director of the agency’s Office of Drug Safety, 600 sound-alike or look-alike drug pairs have been identified as possible sources of error since 1992. That is substantial considering that the United States has about 15,000 registered drug names. As a result, some of these medications are renamed. For example, the new ulcer medication Losec was being confused with the diuretic Lasix, so it was renamed Prilosec.

The drug agency reviews some 300 new drug names each year and rejects one-third of them before they ever come to market, mainly because they sound or look too much like available drugs, Mr. Phillips said.

Just this year, for example, the agency asked Eli Lilly to change the name of its new drug for attention deficit disorder from tomoxetine to atomoxetine because of concern that it would be confused with the anticancer drug tamoxifen.

The agency even has a panel of pharmacists and nurses who try out drug names, going through the motions of filling prescriptions to see if problems arise.

Still, mix-ups over drug names can be lethal. From 1993 to 1998, a total of 52 deaths resulting from drug name errors were reported to the drug agency, Mr. Phillips said. And these are only the reported cases, so the true number of deaths related to confusion over names is almost certainly higher.

But how do drugs get their names in the first place? It is a mix of marketing and psychology. Most drug companies hire marketing consultants who come up with brand names. The typical cost of developing a drug name is about $1 million, much of it the legal cost of registering a brand name, according to Rebecca Robins, global director of marketing at Interbrand Wood Healthcare. But there are important linguistic and psychological factors too, she said.

The meteoric rise of drug advertising directed at consumers has changed the whole strategy of developing brand names, Ms. Robins said. Because of that focus, the companies want to avoid drugs with clinical sounding names; instead, they opt for names that connote empowerment, positivity and enhancement of life, she explained.

So drug names have to at least sound nice and maybe even evoke an image that underscores the effects of the drug. Take Claritin, for example, the allergy medication with a name only a step away from clarity that evokes an image allergy sufferers long for – a clear day. Or Viagra, the impotence remedy, which conveniently rhymes with Niagara. Take Viagra, the name seems to imply, and you will perform sexually with the vigor of Niagara Falls.

Of course, not all drug names are so felicitous. Years ago, I took part in a focus group to name a new antidepressant that was to become Zoloft.

Just for fun, when my turn came I offered an absurd hypothetical name for the drug Plotnase, which sounds like something designed to make a person sink into the mud. The group erupted with laughter and agreed it was a terrible name for a pill that was supposed to lift your mood.

But why do so many drugs sound alike? It turns out that not all letters or sounds are created equal. Names that start with z or x are popular because they convey a sense of dynamism and the future, according to some branding experts. And no drug name nowadays will contain super or excel to avoid the appearance of hyperbole or exaggerated claim.

So if all new drugs have to have sleek and sexy names that may sound alike, the least patients can do is ask their doctors to write their prescriptions legibly – maybe even print them. If you cannot read your physician’s handwriting, what makes you think your pharmacist can?