Christmas Offerings Would the pharmaceutical companies please mind their Ps and Qs, and their Xs, Ys and Zs
MJA 2000; 173: 662-663
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Introduction | The proprietary names of new drugs not only lack imagination but, via the mindless assemblage of concatenated consonants, resemble the loser's board in a last round of Scrabble. Disenfranchised consonants, particularly Xs, Zs and Qs, appear in drug names with as much logic as their appearance in a cup of alphabet soup (albeit my second favourite after soup de jour). While prescribing doctors require no scientific proof that there has been a secular change to idioglossia, I explore this proposition scientifically, using the proprietary names of two classes of psychotropic drugs. | ||
Methods | The database for my study was the list of oral antipsychotic and antidepressant drugs in the 1998 MIMS Annual.1 The proprietary names for all currently listed "older" and "newer" (ie, pre- and post-1990) drugs were examined for the relative frequency of vowels and consonants. (See Box for names compared.) | ||
ResultsQuantitative analyses |
I surveyed a total of 33 psychotropic drug names, but was unable to
demonstrate a difference between "old" and "new" drugs by the
chi-squared test (chi-squared = 0.008; df = 1; NS).
It was time for a post hoc ad hoc ergo propter hoc hypothesis,
viz., that there had been an increase in specific letters, such as
V, I and Z. The latter (ie letter) analysis
predictably revealed shifts, with the most notable changes being --
for the consonants -- a distinct increase in the representation of
Cs (from 2% of the letter distribution in the "old"
drugs to 5% in the "new" drugs) and, even more distinctly,
increases in Xs (from 0 to 7%) and Zs (from 1% to 6%). For
the vowels, Is had decreased from 6% to 1%, while Os had
increased from 6% to 13%.
I undertook a validity check by making a comparison with the distribution of these letters in Scrabble, where Cs = 2%, Xs = 1%, Zs = 1%, Is = 9% and Os = 8%. Thus, the older drugs had a distribution of those letters in accord with our Scrabble control, while their current distribution was quite out of kilter and thus, QED, seriously discordant with the English language, the games we play, the rules of sport and the Olympic ideal. | ||
Qualitative analyses | I read the lists to all hospital support staff cleaning the doctors' corridor in spring 2000, with each (n = 2) asked to assess each drug name for resonance, melodiousness, assonance and assiness. Against expectation, they unanimously rated the "newer" drugs far higher. Post hoc analysis determined, however, that both were non-English-speaking, but they did express thanks for trying to talk to them in their own language. I then undertook a second study involving all unit registrars who had expressed (at their appointment interview) a keen interest in undertaking research if offered a position. These 23 registrars were similarly required to rate each drug set on the evaluative parameters. All three respondents rated the older psychotropic drug names as more attractive, with one noting that it was not the price -- but the excess of Xs -- that prevented her prescribing the new atypical antipsychotics, so rejecting the "null" hypothesis that "nothing succeeds like XS". | ||
Discussion |
My study demonstrated an increased use of discordant consonants in
proprietary names for two psychotropic drug classes. Z is
climbing up the alphabet, but its appeal is questionable, as any
parent knows who has asked their child to eat a zucchini. The only
Z that ever had any style belonged to the graffiti artist
Zorro. But Zs for drug names? Perhaps a hypnotic? Zizzzz, or
even Zizzzzzzzzzzzzzz. X has risen from near x-tinction,
C is coming in, and O is on the rise as a leavening vowel.
Current analyses allow the confident prediction that "XOCZ" will be
the proprietary name to be launched next.
But do we want the alphabet-ordered also-rans (the Xs, Ys and Zs) to run? Why not capture the beauty of the English language? How truly evocative then are the names for the new "atypical antipsychotic" drugs -- Clopixol, Clozaril, Risperdal and Zyprexa, which my computer spell-check renders as Claypool, Closure, Dispersal and Pyrexia. Surely, they lack the majestic evocation of the older drug names. Again my spell-check assists us -- Largactil "reframed" as "LargeAction", Anatensol as "Intensely", Navane as "Nirvana", Stelazine as "Stabilize", Anafranil as "Unafraid", Endep as "Endow" and Surmontil as "Surmountable" provide a subliminal message of hope, action and therapeutic success, like the lovely and pleasing word "placebo". Are the "new drug names" not building to treatment resistance? What's in a name? In the old days, lots. The alcohol deterrent drug Antabuse evocatively told us a story. It was anti-abusers and self-abusing, belonged to the right (ie left) end of the dictionary in being close to AA (so assisting prescribing doctors), and was nicely balanced in its mix of vowels and consonants. A fine achievement for a drug that made you vomit. Another example is the hypnotic, Halcion. Only when there was no wind and the waters were quiet and tranquil could the albatross take off, the so-called "halcyon days". Thus was the prescriber encouraged to prescribe Halcion for tranquillity, for wind and for plane phobia. But now we have drugs like Xanax (presumably a computer-driven palindrome). What next? A drug labelled ZZQQZZ? You wouldn't even accept that as a number plate. The rumbelow conjunction of compounding consonants presents the medical profession with a number of deceptively important problems. First, the written equivalent of "Chinese whispers". A handwritten script for Zantac may emerge, after some pharmacist confusion, as one for Zactin, or Zestril, or Zarontin. Second, we are now ankle deep in xenoglossia -- being required to understand a language we have never learned. Third, where is the placebo effect in offering a patient a new wonder drug named "Prozolox"? Fourthly, where is the appeal? What respectable canine, after years of eating affiliative, affirmative and affectionately labelled "Pal", would take a chunk out of a tin labelled Zbra or Quale? What are the marketing and advertising sections of the pharmaceutical companies doing? We know that recognition and verbal learning relate to the pleasantness and association value of words,2 with such research empirically establishing the high appeal of words like "caress", "Christmas", "comfort", "delight", "flower", "kindness", "pleasure" and "sunshine". Presuming that those companies wish us to use their product, are their marketing divisions out to lunch on this issue?  If so, and before they get back from lunch, should we in the medical profession not show some leadership? Perhaps to get the ball rolling, I could offer some suggestions for the next "Drugs R Us" company that appreciates gratuitous advice. A search for appealing words can take many roads. James Joyce held that "cuspidor" was the most beautiful word in the English language, but, despite his genius, his inability to call a spittoon a spittoon confirms that beauty is in the eye of the beholder. We need, then, an author "of the people", someone who could sit comfortably with the "man on the Clapham bus". Barbara Cartland! Dame Barbara once listed the 12 "most beautiful" words in the English language as ecstasy, love, God, divine, pure, innocent, rapture, moonlight, shimmering, radiance, magical and mysterious. What an evocative list, and not a Q, X or Z to be seen! But, returning to psychiatry, we need psychotropic drug names that invoke the domain and the suggested impact, increase compliance, have a placebo component and make us all feel good. Cartland provides a semantic base for a thesaurus search. For an antidepressant, recognising that others have stolen Cartland's suggestion of "ecstasy", why not "Cloud9" or "BlissPill"? For anti-manic drugs, why not "Glidedown" or "Asymptote", and perhaps "Astoic", "Flatline" or "Earthbound" for a mood stabiliser. For antipsychotics, if not "SangFroid" (which might be misconstrued as "Sane Freud"), why not "Equanimity", or "Anodine" or "Chillout"? For an anxiolytic, "C-Rene", "Care-less" or "Earthed", perhaps. Of course, such concerns also hold for other classes of drugs. One of the most successful drug releases in the past decade was that of Viagra. But, as a treatment for erectile dysfunction, it has quite the wrong connotation. Viagra rhymes with Niagara. As in Niagara Falls. An unfortunate choice. How about "PeckUp" (note the neat diffusion into "Pickup" -- suggesting both a tonic and the means of acquiring a partner for the night). It would have been a real sales winner if the naming had been more prescient. I rest my case. | ||
References | |||
Authors' details |
School of Psychiatry, University of New South Wales, Sydney, NSW.
Gordon B Parker, Professor, and Head. Reprints will not be available from the author. Correspondence: Professor G B Parker, School of Psychiatry, Prince of Wales Hospital, High Street, Randwick, NSW 2031. g.parkerATunsw.edu.au ©MJA 2000
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