He's not a doctor, or a research chemist, or even much of a marketing specialist. But when a multinational pharmaceuticals firm wants to launch a major new drug, James Dettore often tops the list of people to contact. Dettore, president and chief executive officer of the Miami-based Brand Institute, charges companies including SmithKline Beecham and Glaxo Wellcome up to $100,000 a time to perfect something that is fast becoming almost as crucial to a drug's success as its very clinical effectiveness: its name.
Christening a new treatment used to be a straightforward undertaking. The remedy synthesised by the German chemist Felix Hoffman in 1899 to alleviate his father's rheumatism was called aspirin, simply because it consisted of acetylsalicylic acid based on extracts from the spirea plant - and, until even recently, it seemed strong sales of any new anti-constipation powder could be guaranteed merely by appending "lax" to the name on the packet. But now - amid a boom in lifestyle drugs such as Viagra and the baldness treatment Propecia, and with record numbers of British people asking their GPs to prescribe specific treatments - the naming of drugs has ballooned into a global, multi-million-pound industry, with consultancies springing up across Europe and north America to lavish upon newly developed products all the care and attention of parents naming a newborn baby.
Dettore and his industry rivals frequent a bizarre parallel universe of strange prefixes and suffixes, of names that hint at miraculous curative properties without incurring the wrath of regulatory agencies by explicitly claiming powers they do not possess. All new drugs receive a generic name, subject to final approval by the World Health Organisation, but it is the trade name, owned by the manufacturer and under which the product is marketed, where naming consultants come into their own. The list of drugs approved in recent months by the European Union and the US Food and Drug Administration sounds like some kind of medieval incantation: Nutropin, Synercid, Ciclopirox, Avelox, Nasonex, Lipitor, Aleve, Aggrenox, Curosurf...
The process, which typically lasts around three months, begins with some high-intensity brainstorming sessions among pharmacists, physicians, nurses and consumers, explains Dettore, whose creations include Propecia, the controversial flu drug Relenza and the cholesterol treatment Lipitor. There are some basic rules at Brand Institute: the perfect name is held to consist of 10 letters or fewer, and no more than three syllables.
But much depends on changing fashions. Where once drugs companies chose chemical and latinate names that blinded the public with science, the turn of the century is witnessing a shift in the direction of airy, abstract names embodying hope and wellness and the promise of transformation. "In most cases, companies are now leaning away from names that are compound-driven and derived," says Dettore. "In the late 1980s, the US tendency was to use names indicative of the product's attributes and benefits, but the UK has always used this more arbitrary, personality- driven strategy. It's an attempt to invoke an essence of the brand."
Some of the drugs at the forefront of these changing trends make bold, brash claims for their own efficacy: Zyban, an anti-depressant aimed at people trying to quit smoking, overtly implies that it will "ban" their habit, while the name of stomach-acid treatment Prevacid is essentially self-explanatory.
Some seek out favourable euphonic associations, as in the vigour and virility of Viagra, or the implictly miraculous powers of the Parkinson's drug Mirapex. Others opt for an altogether more subtle approach. The antibiotic Vantin hints at advantage, while Prozac, naming consultants insist, carries the suggestion of the "exact" targetting of brain functions. And that upbeat prefix "pro" never goes amiss: "There are currently more than 4,000 'pro' prefix names in the various registries," Dettore says, despondently: every one that is already registered is another that he cannot use.
Adopting a ruse beloved of taxi operators, pharmaceuticals firms frequently opt for names beginning with A (recent examples include the insomnia remedy Ambien and the asthma treatment Accolate) so that they are placed near the beginning of drugs formularies. The especially devious seize the opportunity to piggyback on existing brands by borrowing parts of their names; Dettore cites the case of Abbot Laboratories' Aids drug Norvir, with its echoes of Glaxo's AZT brand Retrovir. "You have to ask yourself whether you really want to develop a truly unique name, or use a me-too strategy, to try to link to an existing market and ride on the coat-tails of another product," he says.
Devising an evocative name is only the first hurdle. Once it has been formulated, the consultancies call in linguistics experts to check that names are pronounceable worldwide and don't have obscene or embarrassing meanings in other languages: nobody wants a repeat performance of the brand-namers' favourite fiasco, the Vauxhall Nova - a car whose name means something close to "doesn't go" in an uncomfortably large number of tongues.
But by far the costliest part of the exercise involves hiring armies of lawyers to sift through trademark registries and medical regulations across the globe, to make sure that the name does not contravene consumer legislation or infringe existing marks - of which there are more than 1m in the relevant category in the European Union alone.
Choosing a name too similar to an existing one can bring more than legal pitfalls. Confusion between Merck's gastrointestinal drug Losec and the antihypertension treatment Lasix, manufactured by Hoechst, caused sufficient concern in the US for the FDA to order Merck to change it to Prilosec - though some American doctors are now reporting potentially hazardous mistaking of Prilosec for Prozac. Unsubstantiable claims can also lead to conflict: it was the FDA, again, that scuppered Pharmacia and Upjohn's plans to market its minoxidil baldness treatment as Regaine, on the basis that it didn't really stimulate permanent hair regrowth, and the name was changed to Rogaine. By contrast, in Britain - where the regulatory framework consists of a mishmash of agencies including the Medicines Control Agency, which has the main responsibility for authorising trade names - minoxidil is still available as Regaine, and Losec and Lasix continue to be distributed under their original names.
Despite the regulatory maze that multinationals must negotiate, consumer groups fear too many names still make significantly misleading claims for the efficacy of their products. "What the companies have tried to do is come up with a smooth-sounding name, overstate the benefits and understate the risks," Sidney Wolfe, co-founder of America's Public Citizens Health Research Group, has said.
"Naming is becoming more and more complicated," says Dettore. "Increasingly, in trying to create unique names, firms come up with words that aren't scriptable, or that no one can pronounce, so it's sometimes easier to take an existing root than to try to create an entirely new identity.
"A lot of people are saying we might even run out of names," he adds, with just a hint of worry in his voice.
