KAI RYSSDAL: Stay with me on this: is it Enjuvia or Januvia? Ritalin or Ritodrine?
Confused? So are pharmacists and hospitals. Drug mix-ups — when your doctor orders one thing and you get something else — cost the health care system millions of dollars in unnecessary care. And people die because of it. There’s a case to be made that the trouble starts with creative types brainstorming the perfect brand name.
From the Marketplace Health Desk at WHYY, Gregory Warner reports.
GREGORY WARNER: Here’s what a name can do. George DiDomizio tells me the story of two drugs. Dyazide…
GEORGE DIDOMIZIO: Dyazide.
Same exact chemical compound.
DIDOMIZIO: Identical. The companies had about the same number of sales people. All reaching the same doctors. Dyazide outsold Moduretic by about five-to-one. And the only difference was the trademark!
Didomizio likes this story because he’s a professional drug namer. He’s the guy who came up with Pepcid, Bextra, Prilosec, and other blockbusters. Naming a drug, he says, is harder than naming a cereal or a car because there’s a whole other agency involved: the Food and Drug Administration. The FDA even has a special unit just to decide if the name over-promises. So, no “Panaciums” or “Correct-Alls.”
DIDOMIZIO: Some years ago I was working with J&J on an hormonal supplement called “Perfest.” P-E-R-F-E-S-T. And the FDA came back and said, you know, that sounds too much like the perfect estrogen. So you can’t have it.
George swapped two letters to “Prefest” and they gave it to him. But having passed that test, he faced another unit at the FDA. It decides if the name could be confused with one of the 300,000 drug names already on the market.
SUSAN PROULX: OK, so you just want me to go through them, page by page? Omacor/Amacar. Celexa/Zyprexa.
Susan Proulx reads from a list of drug names most often confused by pharmacists and doctors.
PROULX: Avista/Evinza. Vytorin/Vicodin.
The FDA is getting stricter about avoiding these potential mix-ups. Last year the FDA turned down almost half of the names they heard. Proulx runs a company called Med-ERRS, E-R-R-S, that helps drug makers test their names before they submit them to the FDA. For drug companies it’s a kind of insurance. It can cost over a half-a-million dollars to create and register a name around the world, only to have it rejected by the federal agency.
Susan Proulx: There’s thousands upon thousands of names that have been considered, look and sound alike.
And then there’s the wild card of a doctor’s bad handwriting. So, imagine your doctor writes Lipitor and the pharmacist dispenses Zyrtec, an allergy drug. That’s right. Lipitor. And Zyrtec. Get confused.
SUSAN PROULX: The L looks like a Z, the Y can look like the downstroke of the letter P, and then at the end T-E-C can look like T-O-R.
GEORGE DIDOMIZIO: So it’s not block letters compared to block letters, to evaluate similarity. Now it’s a potentially scribbled name and scribbles look a lot alike.
The FDA’s new handwriting tests have subtly altered the art of drug naming. You see more names exploring fresh linguistic territory, like names with double X’s or XG, or double K.
SUSAN PROULX: And they feel that, well, if I put two K’s in the word then someone won’t see that one K upstroke when you write it as an L or a T. Unfortunately some of them seem to be very difficult to pronounce. And I think that will make them maybe less prone for confusion, but just harder for people to remember and to say.
DIDOMIZIO: It’s getting to be a little bit like the Czechoslovakian — the Slovak language, where you have a predominance of consonants. Difficult to pronounce, difficult to deal with?
WARNER: That’s cause you old timers used up all the vowels!
DIDOMIZIO: That’s because… that’s right!
At 75 years old, DiDomizio looks forward to that bright day when doctors toss aside their pens and all we have to worry about is typos.
In Philadelphia, I’m Gregory Warner for Marketplace.
RYSSDAL: See for yourself how badly a doctor’s handwriting can mess things up. Watch our video.
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