Sexy names sell products.
Ipod, Spanx, and Twinkle Toes are sexy names. Their products sell.
Prescription drugs are no different.
I don't know who comes up with the brand names for new drugs, but they must have a high-stress job. The profitability of a drug seems to be directly proportional to the sexiness of its name. Imagine your job depends on picking the right name for a new drug. If you pick a good one, profit soars into the billion dollar per year range. If you choose a dud, millions of dollars in research and development are flushed straight down the toilet.
I've noticed a trend in the brand names for new drugs. Apparently the letters x,y, and z are finally getting the attention they deserve. And apparently Americans think there is something sexy about them. Take the following examples from recent years:
Ah yes, but I've intentionally left out the most popular of them all for dramatic effect. Not only does it have an incredibly sexy name, but it comes in its very own package! You guessed it - in fact you may have gotten one from your PCP recently. It's the Z-pak.
The generic name for the Z-pak is azithromycin. Zithomax is the brand name, and it's packaged in a neat little box and marketed under the name Z-pak. Azithromycin isn't too bad in and of itself, but nowhere near as sexy as Z-pak. The popularity of the Z-pak is tied to nothing other than its name. Whoever thought of that one is now probably living comfortably on a Carribean island. They scored big time - hit the ball out of the park. Would it have achieved the same level of popularity if was called a P-Pak? Or how about an A-Pak? No way! The Z was genious.
There aren't many prescription drugs that people ask for by name. Z-pak is at the top of the list (with oxycontin following close behind). Why don't people ask for clarithromycin or erythromycin? These are both very similar drugs in the same class - for all intents they are chemically the same compound. They would likely work equally effectively as well. But Z-pak is just sooooo much cooler.
Now let me tell you a dirty little secret. Ready? This might sting a little - I hate the Z-pak.
What? You're kidding, right? How can you say such a thing? They work so well!
No, I'm not kidding. I really don't like the Z-pak at all. I love azithromycin, but I despise the Z-pak. Azithromycin - the generic name of the drug - is actually a wonderful drug. I commonly use it for pneumonia and it works wonderfully for certain bacteria. Regrettably, I also prescribe it commonly for sinus infections, which is why I hate the Z-pak.
Confused? Let me explain.
Somewhere along the line, the Z-pak became the main go-to for treating patients complaining of acute sinusitis. I'm not sure if this was excellent marketing or what, but somehow all of us just started using it years ago for upper respiratory symptoms. And why not? It is easy to take, has relatively few side effects, and is covered by insurance. There are only 6 pills - two the first day, then 1 per day for the next 4 days. Patients liked it. In fact they liked it a little too much.
Let me tell you another dirty little secret. Acute sinusitis, the condition that all of you have taken a Z-pak for at some point, is caused by a virus approximately 98-99.5% of the time. And guess what? The Z-pak is and anti-bacterial drug. That means it has NO effect on viruses whatsoever. So 98-99.5% of the time you've used one, you didn't even need it.
But what do you do when you get sinus pressure, greenish-yellow snot, and a fever? You go to the doctor and secretly hope he recommends a Z-pak. It's so innate to your thought process that it's like wanting water when you're thirsty of food when you're hungry. And if the doctor doesn't give you one, you'll politely remind him that the amazing Z-pak has cleared up your symptoms every time you've taken one in the past. And if he still doesn't give you one, you may even be so bold as to demand one. After all, you paid money to see him and you feel like you have to get something out of this deal. Chances are, he is so far behind in his schedule and tired of having the same conversation that he rolls his eyes and just gives you one. That is why I hate the Z-pak.
The very name itself has empowered my patients to demand it by name. It has imbued them with striking confidence - almost as if their medical knowledge is somehow better than mine. No longer am I the physician who has spent my entire adult life learning when and how to use this drug - now I'm nothing more than a Z-pak dealer.
Truth is, 98-99.5% of acute sinusitis will go away within a week without any treatment at all. The official recommendation is to not even consider treating for bacterial sinusitis until you've had symptoms that are 1) persisting greater than 10 days; or 2) symptoms worsen after day 7. And guess what the recommended drug for treating bacterial sinusitis is? Not the Z-pak! Good old fashioned amoxicillin is the recommendation. Why? Because bacteria, thanks to gross Z-pak overuse in the past 20 years, are becoming more and more resistant to azithromycin. Don't believe me? Look at this article and read the studies for yourself. Resistance is as high as 30%!!! Anecdotally, I was told recently that the rate is approaching 40% now - but I don't have a source for that (omg doctor you are soooo not evidenced-based).
But doctor, I swear the Z-pak helps!
There's an old saying in medicine - you'll get better in 1 week if I prescribe medication, 7 days if I don't. Fact is that you're getting better because you would have gotten better even without the Z-pak. It's coincidence. Still don't believe me? This has been demonstrated over and over and over again in randomized, controlled trials. Still don't believe me? Then go get your Z-pak from someone else, because I'm done being your dealer.
So enjoy your life in the Caribbean, Mr. whoever created the Z-pak, because you've done your job and you've done it well.
Next time you go to the doctor for sinusitis and he prescribes a Z-pak, surprise him and ask him if you really need it, or if you can just wait it out and see if it clears on its own. I know you don't like taking all the other medications I prescribe for you, so why should the Z-pak be any different?