The principal noncommercial reason for advocating the use of propritary names in prescribing is consistency of the product, so that problems of quality, especially of bioavailability, are reduced. There is substance in this argument, though it is often exaggerated.
It is reasonable to use proprietary names when dosage, and therefore pharmaceutical bioavailability, are critical so that small variations in the amount of drug available for absorption can have big effects on the patient, e.g. drugs with low therapeutic ratio, digoxin, hormone replacement therapy, adrenocortical steroids (oral), antiepileptics, cardiac antiarrhythmics, warfarin. Also, with the introduction of complex formulations, e.g. sustained-release, it is important clearly to identify these, and use of proprietary names has a role.
The pharmaceutical industry regards freedom to market proprietary names and to advertise or, as it calls the latter, to 'effectively [bring] to the notice of the medical profession', as two of the essentials of the 'process of discovery in a vigorous competitive environment'.7
The present situation is that industry spends an enormous amount of money promoting its many names for the same article, and the community, as represented in the UK by the Department of Health, spends a small sum trying to persuade doctors to use nonproprietary names. Ordinary doctors who prescribe for their ordinary patients are the targets of both sides.
This state of affairs is confusing for prescribers. Generic names are intentionally longer than trade names to minimise the risk of confusion, but the use of accepted prefixes and stems for generic names
7 Annual Report, 1963-1964. Association of the British Pharmaceutical Industry.
works well and the average name length is four syllables, which is manageable.
The search for proprietary names is a 'major problem' for pharmaceutical companies, increasing, as they are, their output of new preparations. A company may average 30 new preparations (not new chemical entities) a year, another warning of the urgent necessity for the doctor to cultivate a sceptical habit of mind.
The names that 'look and sound medically seductive' are being picked out. 'Words that survive scrutiny will go into a stock-pile and await inexorable proliferation of new drugs'.8,9
One firm (in the USA) commissioned a computer to produce a dictionary of 42 000 nonsense words of an appropriate scientific look and sound. An official said,
Thinking up names has been driving us cuckoo around here ... proper chemical names are hopeless for trade purposes, of course. ... Doctors are the market we shoot for. A good trade name carries a lot of weight with doctors ... they're more apt to write a prescription for a drug whose name is short, and easy to spell and pronounce, but has an impressive medical ring. ... We believe there are enough brand new words in this dictionary to keep us going for years. ... We don't yet know what proportion of names is unpronounceable ... how many are obscene, either in English or in other languages, and how many are objectionable on grounds of good taste: 'Godamycin' would be a mild example.9
For the practising doctor (in the UK) the British National Formulary provides a regularly updated and comprehensive list of drugs in their nonproprietary (generic) and proprietary names. 'The range of drugs prescribed by any individual is
8 Pharmaceutical companies increasingly operate worldwide and are liable to find themselves embarrassed by unanticipated verbal associations. For example, names marketed (in some countries) such as Bumaflex, Kriplex, Nokhel and Snootie conjure up in the minds of native English-speakers associations that may inhibit both doctors and patients from using them (see Jack and Soppitt in Guide to Further Reading).
9 New Yorker, 14 July 1956.
10 Editorial 1977 British Medical Journal 4: 980 and subsequent correspondence.
remarkably narrow, and once the decision is taken to "think generic" surely the effort required is small'.10 And, we would add, worthwhile.
Confusing names. The need for both clear thought and clear handwriting is shown by medicines of totally different class that have similar names. Serious events have occurred due to confusion of names and dispensing the wrong drug, e.g. Lasix (frusemide) for Losec (omeprazole) (death); AXT (intending zidovudine) was misinterpreted in the pharmacy and azathiorine was dispensed [do not use abbreviations for drug names]; Daonil (glibenclamide) for De-nol (bismuth chelate) and for Danol (danazol). It will be noted that nonproprietary names are less likely to be confused with other classes of drugs.
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