This law, which is mine, is derived solely from watching the NBC Evening News, which is interrupted by a lot of ads for drugs aimed at older people (for COPD, cancer, dry eyes, heart problems, etc.). That alone tells you who the target demographic is, and also that young people don’t watch the t.v. news (they get it, of course, from social media). Here’s my rule:
It’s coming now. . . .
Here it is:
At least half of new medicines advertised on t.v. have the letters “x”, “y”, or “z” in them.
Here’s a table from Cornell University of the frequency of letters in the English language, based on a sample of 40,000 words. The total frequency with which x, y, or z appear among letters is 1.35%. Calculating the frequency of, say, random six-letter names that don’t contain such a letter would be about (0.987) to the sixth power, or about 0.95, or 95%. But of course that is an underestimate, as a drug name is unlikely to have two or more of those three letters, and it has to have a vowel. I don’t know how to do the proper math, which is impossible given that the names are made up, but I have to conclude that drug manufacturers think their wares will sell better if they have one of the Three Letters.
(There may be some miscalculations here, or other sites may give slightly different )
There was a study that showed people believed medications which had letters from the end of the alphabet were more powerful.
Clearly drug companies have latched onto the concept.
Certainly agree about the demographic for the evening news. And certainly interesting about the perceived power of the end of the alphabet. Because of the rarity of X, Y, and Z?
But which came first, the study or the marketing? Maybe the marketing, but then the public became convinced that XYZ was the mark of effectiveness, and it snowballed. My favorite pills have the letters G E N E R I C.
Cancer chemotherapy protocols often use multiple drugs, the acronyms for which themselves also have to have the right “something”….I think the kids these days call it “riz”. (CHOP for Hodgkin disease is a long-standing favourite.)
A parody published in a medical journal about 40 years ago described a new regimen for cancer of the belly button whose acronym was MZRXCL. (The authors of the article invented five imaginary but credible-sounding drugs that obeyed Coyne’s New Law!)
Unfortunately the results of the clinical trial were disappointing, with very low cure rates. So the Pharma marketing researchers went back to work. Their focus groups told them that “MZRXCL” just didn’t go with that swing, you know? So they got the FDA to let them relicense two of the drugs with different names — that’s two more credible names the authors invented — causing the acronym to now read “MIRACL” The “new” protocol was a smashing success with belly button cancer now chalked up as curable disease.
Said the authors, (I’m quoting from memory).” . . which proves that nothing is so salutary for the health as a good vowel movement.”
Is the 50% number something that you found out by methodically sampling from the advertisements, or just a ballpark guess based on experience? I am guessing it’s the latter, which would be totally cool as an observation anyway.
The reason I asked is because one time I did something similar with the letters on car license plates when I was in Colorado since I noticed some letters such as Q, X, Z occurring at much higher frequencies than purely random chance. To verify if this is my observation bias or a real phenomenon, I wrote down license plate numbers of many cars and then compared these frequencies with what they would have been if all letters were equally likely (kind of like you did). Those letters were indeed more frequent. I still use that data sometimes when teaching probability. There must be a policy that tries to avoid real words on license plates which led to this. But it lead to some interesting abbreviations occurring frequently. I have seen QED on at least 10 cars within a very short timespan.
As you note, it’s new drugs that follow this trend. Didn’t apply to aspirin, or paracetamol (although Tylenol – the North American brand name for acetaminophen – does have a Y). But here is my question – all drugs have two names – I assume you are referring to the brand name (e.g. Humira – fails the test) vs it’s generic name (adalimumab – also fails, but it’s over 20 years old)
But many newer examples Skyrizi, Taltz, Rituxan etc do seem to be on the bandwagon.
Maybe they’re running out of possible words and have to resort to x, y and z to get something not already in use.
I seem to recall that these names are not language specific. They have to make sure the name doesn’t mean something obnoxious in Swedish.
Personally, I think drug companies should turn to Welsh village names for their next round of drugs: “Ask your doctor if Cwmystwyth is right for you.”
LOL!
Also, I looked up and found this: https://pubmed.ncbi.nlm.nih.gov/35706463/
Xyzal hits all the right notes! Vraylar is an also-ran, as it only has the “y.” Jardiance misses the mark entirely, even though (sing it with me) “Jardiance is really swell, the little pill with the big story to tell.” And don’t get me started on Xeljanz (which misses the “y”). Celebrex (neither “y” or “z”) underperforms badly, but I do like having the “x” at the end of the word better than at the beginning.
Good law! Aren’t there some other Coynian laws currently in force? What about the law that every newly introduced “healthy” food eventually turns into a dessert. (I noted that this was the case with yogurt many years ago, before you declared it a law.) We need some sort of numbering system for Coynian laws, don’t we? In lieu of a numbering system, maybe you could provide a reprise of all the laws that remain in force.
Not all medication names are arbitrary. For example, I asked about the etymology of TEVA-FUROSEMIDE and got the AI response below. To the extent chemical composition contributes to names, might need a different database than language. Any database of chemical names to find frequency of later letters? And of course, English isn’t the only language in the world.
Names for generic drugs might differ from brand names. Lasix is one brand name for Furosemide that fits the Coyne rule. But it too is not arbitrary according to google. Lasix is “derived from a functional abbreviation meaning that the drug “lasts six” hours.” Interestingly, number words in English contain may contain later letters more often than non-number words: two, four, five, six, seven, eleven, ….
Here’s the AI response for Teva-Furosemide.
“a brand name for the generic drug furosemide, produced by Teva Pharmaceutical Industries. The etymology of the name breaks down into the manufacturer’s name and the chemical structure of the drug.
Teva: Refers to Teva Pharmaceutical Industries Ltd., an Israeli multinational pharmaceutical company. The name “Teva” is the Hebrew word for “nature” (טבע).
Furosemide: The drug name is derived from its chemical structure:
Fur-: Refers to the furfuryl group (
-furfuryl) contained in the molecule.
-o-: A linking vowel.
-semide: An alteration of sulfonamide, indicating it is a sulfamoylanthranilic acid derivative.”
And then there’s the drug for erectile dysfunction called Coxaflagin.
A bit off-topic yet}Maybe it’s just me (hopefully not), but aren’t the rapid-read disclaimers on the tail ends (and fine print at bottom) a bit unsettling? “Side effects may include…numbness here swelling of … contact your Doctor if… in some rare cases (worse than death sounding scenarios) or death may occur.” In lieu of saying “Ask your Doctor if &$$#&$&$ (pronounced “essentia” or some other nifty acronym name) is right for you!”, ads should state the obvious “Ask your Doctors if they are ready to consider what Malpractice rates might be doing if serious side effects plague their clientele.”
Why did they stop at 40,000 words of English? Oxford English Dictionary contains 500,000 I believe. The larger the sample, the more accurate the count/percentage.
Once you write the program to count frequency, it only has to run a minute (or less) on a Dell desktop to peruse everything.
Give me a table of the 500,000 words and I (or any other database programmer) can write the program in 5 minutes. Grok could write it in 11 seconds.
https://wordfrequency.org/
While I’ll give credit to our host for noticing this, I think it’s been observed for decades by those who were previously the targets of the manufacturers’ marketing, i.e., prescribers. As a practicing physician (now retired), I couldn’t avoid advertising within the covers of medical journals, as well as direct encounters with Pharma reps (mostly pretty knowledgeable and well spoken) who were giving away notepads, etc., at least until they were banned from the campus of our multi-speciality clinic. At any rate I recall discussing this topic with colleagues (and a few reps) way back in the 20th century. As to the why, I’d guess having unusual names/spellings made them more memorable and thus likely to be prescribed (or requested, in current times).
“And the award for most efficient use of end-alphabet letters in a pharmaceutical goes to…XYWAV!”
https://www.xywav.com
So XYWUV is still available? 😁
And it seems ZYWUX hasn’t been used either.
Also fun to note is the deliberate creation of the generic name of any new brand name drug to be as difficult as possible to spell, pronounce, or remember. The brand name is always easier to spell, which generates more “Dispense as Written” scripts for the brand name when the drug goes generic.
For example:
Ixekizumab – Taltz
Rovalpituzumab tesirine – Rova‑T
Retifanlimab‑dlwr – Zynyz
Lebrikizumab‑lbkz – Ebglyss
Generic names aren’t completely chosen by the originator of the drug: the company suggests them, but there are guidelines (set by the World Health Organization’s International Nonproprietary Names group for INNs and the United States Adopted Names group for USANs) and review committees that have to approve them.
For small molecules, the names tend to indicate the mechanism of action or structure; for example imatinib, where the -tinib indicates a tyrosine kinase inhibitor, ibuprofen, where the -profen indicates a phenylpropionic acid.
But for biologicals, such as the monoclonal antibodies Roger mentions, the naming conventions are somewhat different; the -mab at the end indicates a monoclonal antibody, the -zu- or -li- indicates the origin, -zu- indicates a humanized antibody, the portion before that indicates function, and the very first portion is chosen by the company.
The naming guidelines can be found online, and are discussed, e.g., in Wikipedia.
Biological generic names are painful; as a former semi-insider, I at least find small molecule generic names comprehensible.
I asked perplexity.ai how drugs are named. Here is its answer:
This post – and the responses – makes my day. Humans are so good at playing with and analysing language.
Bayer had a big hit with the pain killer brand Aspirin. Once the patent ran out, they came up with an even stronger drug. For the brand name, they combined “Hero” because it was heroic against pain and the “rin” ending of Aspirin. Heroin.
In Ancient Greek ‘hero’ means protector or defender. Hence a superhero is a super protector or defender. Heroin was going to be a super-protector against pain. And indeed it is. Some countries still use it medically.
The Bayer patent ran out prematurely in the US because Congress passed an act forbidding the German company from doing business in the US because of WWII. Police shuttered the buildings.
Bayer aspirin was produced and sold by Bayer everywhere else in the world. In the US, Bayer aspirin was sold through Sterling and Sterling Winthrop, then SW was folded into Miles Pharmaceuticals. By 1995, Bayer regained its status and Miles became Bayer again.
Not exactly. Heroin was developed for cough, not for pain. The pain-killer market was well supplied with morphine, which had been around for a long time, as crude opium going back to antiquity. In more modern times morphine came to be used to suppress the cough of advanced tuberculosis and to ease the distress of drowning in one’s blood at the end. (The “medicine” Colline sells his overcoat to buy for the dying Mimi in La Bohème is undoubtedly morphine.)
Unfortunately morphine (particularly dissolved in alcohol as laudanum) had by then become also a notorious drug of recreational abuse and there were numerous attempts, which continue to this day, to reduce its addictive potential particularly in chronic use (such as the cough of TB. A couple of doses would get you safely through an amputation or childbirth but the long-term cough of “consumption” was a whole other matter.) After they “acetylated” salicylate to make Aspirin (and long before the U.S. government confiscated the patent), Bayer chemists* did try acetylating morphine and thought — totally wrong wishful thinking repeated with OxyContin 100 years later! — they had developed something less addictive as a cough suppressant, which would displace morphine from apothecarists’ shelves and eliminate recreational and abusive use.
Why “Heroin”? In medical use, “heroic” has an obsolete sense of unconventional treatment (such as “heroically” large doses of digitalis or aggressive surgery) that only certain courageous and highly skilled practitioners could use safely and successfully — this was largely self-deception. I’m guessing that the “hero” in Heroin is the doctor, not the drug, a drug that would make even an ordinary doctor into a hero, for helping a TB patient without turning her or the other garret-dwelling Bohemians she shared her supply with into addicts. We’ve heard that story a few times since then.
(* Bayer wasn’t the first to make diacetylmorphine; I’m simplifying.)
I don’t know how you watch TV news – or most TV – at all. Does my head in. For high IQ people able to buffer the stupidity of TV news it has to be a cultural, nostalgia based hobby.
D.A.
NYC
I have to agree with you. I quit TV news around the time that the likes of John Chancellor, David Brinkley, and, my all-time favorite, Garrick Utley, departed. I remember Walter Cronkite’s dismay about surveys that showed most Americans got their news from the nightly half-hour programs. Today you get about half news and half ads. Local news is mostly about the weather. Do they really need five people to tell you it just might rain tomorrow?
Indeed – and a thought just occurred to me :
You know how brand names include a “.” sometimes? This gets under my skin, but the companies must do this on purpose. It adds to printing cost for one thing!
So I thought it’d be amusing to put an imaginary “.” at the end of these pharmaceuticals. E.g. instead of
acetaminophen
It’s
acetominophen.
It gives the name a finality, a decisive finish.
I dread the day Big Pharma starts doing this.
What’s up with the constant conspiracy mongering adding the word “Big” to Pharma? You want to know what “Small” Pharma is?: Martin Shkreli.
New drug development takes money. A whole lot of money – billions of dollars, often, to develop something truly new. The large Pharma companies do a lot of basic research, then have to go through three phases of human trials. Phase three trials are as ridiculously expensive as basic research. And, most of these efforts fail. The failure rate is something like 80% to 90%.
While the Pharma industry has some excesses and problems (like any other industry), and don’t get me started on me-too drugs, people demonize it because they often have to pay out-of-pocket for drugs. Guess who is responsible for that? The medical insurance companies, that’s who.
I get that, but I did not mean anything by it besides the pharmaceutical industry, or at most : as much as “Big Peanut” says anything about the peanut industry – like, I’m not “Serious” in this instance 😁
Not to worry. I didn’t mean to point the finger at you, but at the many conspiracy theorists who rant about the topic. I should have been more clear. 🙂
No third-party payer public or private can afford to pay the asking price for every new drug without limit. Employees pay for medical insurance out of their own wages and salaries — it gets treated as an employer expense to make it tax-deductible on the employer’s books and comes out of the compensation budget, not out of profits. Eventually employers will drop coverage if it makes the employees’ cash wages uncompetitive with firms offering stingier insurance. To deter firms from doing this, the insurance carrier has to say No to very expensive drugs no matter how justifiable the asking retail price is, as you point out. No medical insurance company is making rents. If they were, investors wouldn’t invest in anything else, and competitors would undercut them on price.
Publicly funded socialized systems also find it very difficult to afford new drugs when they are also on the hook for the services by doctors and hospitals (which includes costs for drugs given to hospital inpatients.) Like all modern medical advances, new drug discoveries will not attract the investment needed to bring them to market unless the investors know that some third party (i.e., not the patient) is going to be compelled to pay the price the company needs to earn back its investment. The idea that sick people would pay for a drug that ameliorates their illness is quaint. Only the demand comes from the patient. The money for the price comes from Someone Else.
Ranting about the insurance industry also has some features of conspiracy thinking. In reality it’s that all of us want free stuff and we think we’re being cheated by Big-Something-or-Other when things that cost a lot to develop, manufacture, and deliver still aren’t given to us for nothing. Either “the Government” or “the Companies” should pay, but in the end it’s “the taxpayers” and “the policyholders” who really do pay. No Big Anything. (I suppose you could criticize the wealthy, who pay the vast majority of income and sales taxes, for baulking at paying even more so as to finance free drugs for everyone.)