How Do Drugs Get Named?

A reader writes:

My wife and I watch Jeopardy religiously, so we suffer through the commercial breaks on the show. About half the commercials, it seems, are for medications for a variety of unusual ailments, and some pretty esoteric drugs are featured. I started noticing that besides the brand name for these drugs, the generic name is also listed, and many of these seem to have endings like “mab,” “lib,” and “fil”. So I got to wondering how the drug companies come up with these names. As far as I can find, it’s not one that has been explored much in linguistic circles.

So it turns out this is a two-fold process. The brand names, or trade names (Advil, for example) are selected for marketing purposes and go through a vetting process with the FDA. There’s a bit of a creative process involved.

He provides Timothy O’Shea’s Pharmacy Times piece “15 Rx Drug Name Origins“:

Naming a new prescription drug is a long and complex process, costing upwards of $2.25 million.

“Coming up with a brand name used to be an afterthought,” said Bill Trombetta, professor of pharmaceutical marketing at St. Joseph’s University in Philadelphia. “But today, pharmaceutical companies realize that they need to brand drugs as early as they can and build equity in that brand.” By the time a drug has completed phase I clinical testing in humans, most companies are already working to develop a brand name. To do so, drug manufacturers often work with branding agencies that use large databases to help them generate unique names. The generated names often use linguistic tricks such as plosive letters (P, T, D, K, Q, and hard C) to convey power, or fricative letters (X, F, S, or Z) to imply speed.

But authority over pharmaceutical trade names ultimately rests with the FDA and the US Patent and Trademark Office. The FDA prohibits names that imply efficacy or are associated with the intended indication. As a result, marketers often look for names that subtly and indirectly convey an idea, suggesting improved quality of life. Still, the FDA fully rejects one-third of the hundreds of names proposed annually.

There follows the list of 15 commonly prescribed drugs with the origins of their names. And for the generic name, we have Gail B. Karet’s August 2019 AMA Journal of Ethics article “How Do Drugs Get Named?“; abstract:

Since the 1960s, the United States Adopted Names Program has been assigning generic (nonproprietary) names to all active drug ingredients sold in the United States. Pharmaceutical names are assigned according to a scheme in which specific syllables in the drug name (called stems) convey information about the chemical structure, action, or indication of the drug. The name also includes a prefix that is distinct from other drug names and that is euphonious, memorable, and acceptable to the sponsoring pharmaceutical firm. Drug names are the product of complex, multiparty negotiations in which the needs and desires of various stakeholders (patients, pharmaceutical firms, physicians, pharmacists, other health care professionals, and US and international regulators) must be balanced.

A sample:

Many of the oldest drugs were named by shortening the systematic chemical name for the compound. However, the AMA-USP Nomenclature Committee quickly realized that a different way of naming drugs was needed and published a list of guiding principles to systematize nomenclature and move away from names derived from the chemical name of a substance. […] Consequently, most USAN [United States Adopted Names Program] now include a stem. A stem consists of syllables—usually at the end of the name—that denote a chemical structure, indication, or action at a specific receptor. For example, in the name imatinib, the -tinib stem refers to the drug’s action as a tyrosine kinase (TYK) inhibitor. Occasionally, a substem is used to further classify a drug. Thus, -citinib refers to drugs inhibiting a specific family of TYK inhibitors, the Janus kinases. There are currently over 600 stems and substems that have been defined for classes of drugs.

A 1- or 2-syllable prefix at the beginning of each name differentiates each drug from other members of the same class. The most important concern in choosing a prefix is patient safety—specifically, reducing the risk of medication errors, which are a common and long-standing problem in medical practice. For this reason, the USAN Council avoids prefixes that will create new names that are too similar either to other drugs in the same stem class or to names in other stem classes that might look or sound similar to the new name. This means comparing drug names against lists of names for existing drugs. The USAN Program carefully screens prefixes using searches of databases of existing drug names and Phonetic and Orthographic Computer Analysis (POCA) software. The USAN Program, as much as possible, also avoids creating new drug names that begin and end with letters shared with existing generic or trade names for drugs or that have been found to have strong conflicts with other names in the POCA analysis. An analyis of trade-name pairs prone to look alike-sound alike medication errors found that these pairs often had shared strings of 3 or more letters in the prefix and POCA scores that indicated a conflict.

Thanks, Martin!

Comments

  1. Having worked on antibody discovery, I can attest that there is a system in place for derivation of antibody drug names, with the stem being -mab (standing for monoclonal antibody), with an infix denoting whether its species of derivation, general class of action, and a disambiguating (but likely meaningless) prefix.
    For example, adalimumab (Humira): ada- (prefix), -lim- (immune modulator), -u- (human derived), -mab, monoclonal antibody.
    I believe some changes have been made to the system since I started working in a different subfield a few years ago, but that’s the gist of it.

  2. Martin Langeveld says:

    Luke, I think Humira is the one that got me Googling about this. It is frequently advertised on Jeopardy. “Citrate-free!”

  3. David Eddyshaw says:

    [Humira] is frequently advertised on Jeopardy.

    Astonishing, to a dweller in this land of Socialist Medicine©, where we Medical Commissars decide who lives or dies with our Death Panels (presumably something like Ouija Boards.)

    Who is it being advertised to? “Ask your physician if this is the right drug to meet your major-league immunosuppressant needs”?

  4. marketers often look for names that subtly and indirectly convey an idea, suggesting improved quality of life

    I guess that explains Improvil – combined oral contraceptive pill from Australia.

  5. I believe that Chantix (the smoking cessation aid) was originally to be marketed as Champix, but that was struck down as overly suggestive of a good outcome.

  6. Yet somehow Effexor doesn’t suggest efficacy?

  7. Fun game: when you see the name of a generic pharmaceutical, imagine how it would be pronounced and written in Hawaiian.

  8. I believe that monoclonal antibody name conventions were conceived to yield names resembling Babylonian kings or Aztec deities. Although sometimes I wonder whether the -mab part isn’t rather the Welsh word for “son”.

    (There is the Drug or Pokémon quiz, which I would not be surprised if it were discussed on this site earlier. Unfortunately, there is probably not a “Monoclonal antibody or Nahuatl curse” quiz yet.)

  9. “Ask your physician if this is the right drug to meet your major-league immunosuppressant needs”?

    That’s exactly right. All the drug ads on TV include the magic phrase (I don’t know who came up with it and if they get royalties) “ask your doctor if [insert drug name here] is right for you.”

    As well as being advertised to treat specific conditions, many drugs are aimed at those taking chemo for cancer, to reduce side effects/infection risks etc and generally allow a person to romp in the fields with spouse and dogs, climb mountains, go white-water rafting and so on. Those are the types of activities gleefully depicted in the ads.

  10. January First-of-May says:

    There is the Drug or Pokémon quiz

    I’ve seen it before but forgot where. I’ve also seen a similar “Drug or Tolkien Character” quiz several years ago, which was actually pretty neat except some of the drug names were too obviously not from Tolkien.

    EDIT: found the quiz, and also a much harder quiz that includes both obscure drug brand names and obscure Tolkien characters.

  11. Astonishingly, I got 17 of 24 on the much harder quiz. Much luck was involved. (The royal line of Gondor is now my least favorite dynasty.)

  12. Trond Engen says:

    15/24. That was hard.

  13. …Ask your physician if this is the right drug…

    It mystifies me that advertisers would expect patients to ask their doctors about such abstruse matters as chemotherapy drugs. It reminds me of the ads that used to appear in Nature, featuring a model dressed as a lab assistant next to some $500,000 machine. Did they really expect lab managers to say, “I like her, I’m going to write a grant proposal to buy that NMR spectrometer”?

  14. You’d be surprised. People, even lab managers, do not operate on logic, though the STEM-educated ones like to pretend they do.

  15. I can’t do this quiz. It makes me laugh too much.

  16. David Eddyshaw says:

    17/24 (not bad given my Tolkien-blindness!)

    But Sildenafil is so much an elf name.

  17. I don’t believe chemotherapy drugs are advertised. That’s a case where even Big Drug seems to think that specialists should be making the decisions. But there are plenty of ads for cancer-related drugs–to ease secondary conditions, reduce side effects, minimize the chance of recurrence and so on (at least that’s what the ads claim).

    As much as I dislike widespread advertising of prescription drugs, I have to admit that one drug I take was influenced by tv ads because of its supposed effectiveness against a somewhat related condition. And when I asked my doctor, as instructed, if [drug name] was right for me, she agreed it was worth trying. And indeed it has worked pretty well for me. But it’s available as a generic, so I don’t have to live with the feeling that I fell victim to the wiles of the brand-name manufacturer.

  18. David Marjanović says:

    Alas, no time for the quizzes right now. But I’ll forward them all to my sister the Dr. med.!

    Who is it being advertised to? “Ask your physician if this is the right drug to meet your major-league immunosuppressant needs”?

    “Insist to your physician that this is the right drug to meet whatever you believe your needs are, and keep whining till the physician convinces your health insurance to contribute to its costs or lobbies their congresscritters to get Medicare/Medicaid to do that”.

    In my very limited experience, Americans really do know a lot about a lot of drugs, while the European attitude is ignorance this side of aspirin and blind deference to physicians and pharmacists (…who have a MSc degree in pharmacology, unlike, one presumes, cashiers at Walgreen’s).

  19. J.W. Brewer says:

    In the olden times when it was not the done thing to advertise prescription drugs directly to potential consumers in the U.S. the pharma companies instead spent lavishly (not that they don’t still do this as well) on marketing them to the physicians who might be convinced to prescribe drug A rather than a competitor’s drug B to patients. Since that was a smaller target audience where each individual prospect was more lucrative (because a “sale” could lead to hundreds or thousands of prescriptions) it was, and still is, more cost-justified to give them freebies and promotional swag (and/or anything from free lunch up to hookers ‘n’ blow at professional conventions etc).

    This same sort of thing happens when someone has a new invention (esp of a chemical-type nature) outside pharmaceuticals. If you can patent it, you have a monopoly until the patent expires, so you want both a catchy name (like “NutraSweet”) and a dull/ugly generic chemical name (like aspertame, or, subsequently, neotame). This is thought to protect your trademark rights against genericization because you have give the competitors who will emerge once your product goes off-patent an available alternative to describe what it is that they’re selling even though most consumers will use the monopolist’s designed-to-be-catchier brand name to describe the product “generically” when the monopolist is its only producer.

  20. David Eddyshaw says:

    In the Good Old Days, the label on the medicine bottle simply read “The Mixture.” It is not for the patient to know the Mysteries of Aesculapius.

    For the less trusting patient, there was always the more informative and reassuring “The Mixture as Before.”

  21. I got 22/24 on the harder quiz, which I guess is pretty good—although I am a serious Tolkien nerd (even if, as I have mentioned, I have only read bits and pieces of the History of Middle-Earth). As I was going through it, I thought that including the diacritical marks on the names of some of the elves was making it too easy, but then they managed to find an antidepressant name with an accent mark, which I thought was pretty impressive.

    Direct-to-consumer advertising of prescription drugs was legalized in America in the 1990s. The head of the Food and Durg Administration at the time David Kessler,* was opposed to legalization at the time, but he later decided that it had been, on balance, a positive development. My father said that he mostly encountered the effects of the advertising through patients’ parents asking him about more expensive new drugs that were still under patent protection, as opposed to the older drugs that he would normally be inclined to prescribe. However, he said that on rare occasions, people did point out directly-advertised medication options to him that he might not have otherwise considered.

    * Kessler has long been one of my heroes. He has amazing credentials, having somehow attended both law school and medical school at the same time, and he was unquestionably the most active and influential FDA head ever. In high school, I was friends with a distant cousin of his, and I hoped that I might get to meet him, but I never did. Kessler has recently been in the news again, as he is working in the Biden administration on overseeing the vaccine development program.

  22. but then they managed to find an antidepressant name with an accent mark

    Yes, they got me with that one. Bastards.

  23. John Cowan says:

    The National Library of Medicine’s official list of stems, which are obviously in linguistic terms affixes. Note that they may be prefixes like arte- ‘antimalarial artemisin derivative’, suffixes like -bufen ‘non-steroidal anti-inflammatory’, or infixes like -axo- ‘monoclonal antibody made from a rat-mouse hybrid’ (these also end in -mab ‘monoclonal antibody’).

    There are also affixes with relic internal morphology, like -decakin ‘analogue of interleukin-10’, -elvekin ‘analogue of IL-11, -exakin ‘analogue of IL-6’, -eptakin ‘derivative of IL-7’ (the source language is obviously psilotic). Irregularly, IL-2 derivatives end in -leukin and IL-1 derivatives in -nakin. Given -ermin ‘growth factor’, -nermin ‘tumor necrosis factor’ might be thought a mere negation, but we also have -sermin for ‘insulin like g.f.’ and -termin for ‘transforming g.f.’, so these are extreme examples of elision, and it turns out that the first morpheme in -nermin is nal- ‘normorphine-type opioid agonist or antagonist’. This last is not in use as a suffix, though the similar-looking and perhaps related nab ‘cannabinol derivative’ is both a prefix and an infix. The longest monomorphemic affix on the list is -imepodib ‘inosine monophosphate dehydrogenase inhibitor’.

    Alas, there are no known circumfixes.

  24. My life got so much better when I realized I don’t need to watch the commercials. I can read a book instead, or do the dishes during the commercials break.

    I got 22/30 on the easy quiz, and 16/24 on the hard quiz. Most annoyingly, one of the names I got right the first time, and then I managed to choose the wrong one in the next quiz.

    From what I heard about advertising, the point of most advertisements is simply to make sure the potential customers hear the brand name. It’s not so much about convincing people as about familiarity.

  25. Stu Clayton says:

    Alas, there are no known circumfixes.

    Parentheses circumscribe, in order to fix parse ambiguities (or mark parenthetical comments).

  26. All the drug ads on TV include the magic phrase (I don’t know who came up with it and if they get royalties) “ask your doctor if [insert drug name here] is right for you.”
    Perhaps they’re obliged to include it. In Germany, all adverts for over-the-counter drugs (advertising prescription drugs is not allowed) always contain the phrase “Zu Risiken und Nebenwirkungen lesen Sie die Packungsbeilage und fragen Sie Ihren Arzt oder Apotheker” “Concerning risks and side effects, read the package insert and ask your doctor or pharmacist”, which is obligatory by law. It has become a jocular catch phrase in response to recommmendations in all fields of life one is a bit doubtful about.

  27. Don’t take flondemidefil if you are allergic to flondemidefil or to any of the 6-hydroxy-isopheno-zincdiapoloids. Do not take flondemidefil if you or any family member are lawyers…

  28. David Marjanović says:

    Bei Risiken und Nebenwirkungen fressen Sie die Packungsbeilage und erschlagen Sie Arzt und Apotheker.

    “In case of risks or side effects, eat the package insert and beat the doctor and the pharmacist to death.”

  29. Heh, hadn’t come across that one yet.

  30. John Emerson says:

    I am just starting several new medications, and am being reminded that every drug has at least two names and usually several. I don’t complain about alchemical holdovers (muriatic acid for HCl, which is not a medicine anyway) but the new coinages annoy me.

    It’s also very difficult to find the price of a prescription drug anywhere before buying it.

  31. I used to work as a copyeditor in a pharmaceutical advertising firm (great money, lousy job) and had to edit those tiny-type inserts, always bearing in mind that a typo could kill people or (worse) get the company sued. On the other hand, I did get a car service home when they made me work until 2 AM.

  32. Lars Mathiesen says:

    I think I once read a Tolkien pastiche where the elf was in fact named Sildenafil. (Because of course one of the elves has to be “the elf”).

    IBM adverts also had a mandatory blonde in a skirt holding a binder with the instructions to the room full of blue cabinets, or looking at the system messages printer with rapt attention. I probably saw them in SciAm issues from the fifties, I spent a happy few months in 8th grade reading all the back issues at my local library (two issues a day after school, since I had to pass the library on the way to the bus).

  33. It’s also very difficult to find the price of a prescription drug anywhere before buying it.

    Some years ago, before my first hip replacement, I was going through the American ritual of trying to guess what my insurance would pay, which doctors and hospitals were in-network (beware the hospital that’s in-network that employs an anesthesiologist who’s out-of-network), similarly which physical therapists my insurance would pay for and how many home visits they permitted, etc etc. I was talking about this with a friend of mine whose 20-something son, an avowed libertarian, asked me why I just didn’t call up hospitals and doctors to see who had the best rates. Oh, how we laughed.

  34. John Emerson says:

    David L: You can take comfort in knowing that the universe remains stable and that nothing has changed on drug costs.

    The contract they gave me to to sign explicitly mentions out-of-network providers, and my earlier medical emergency involved at least one of them.

    And also collection agencies, and experts to help me decide what my monthly copay should be.

  35. David Eddyshaw says:

    Is it just me who cannot help but think when reading the title of this post, “How is babby formed?”

    Just me, then …

  36. Daddy attaches a suffix to mommy’s… oh, never mind.

  37. Dmitry Pruss says:

    I get chemotherapy drug ads all the time. Perhaps the system knows that I am professionally involved in it, or perhaps they deduce it from my group memberships. I used to get ads for cancer quacks too, and sometimes complained about it. It was pretty dispiriting, actually. I believe that advocacy groups made at least some of this horror go away.

    Some patients do press their doctors about specific drugs. Some of these patients are even doctors or pharmacists themselves, so why would you be surprised?

  38. experts to help me decide what my monthly copay should be

    I’m thinking of George Raft or Joe Pesci

  39. David Eddyshaw says:

    Now we see the violence inherent in the system.

  40. I just remembered this SMBC.

    This further reminds me that my freshman English teacher loved making jokes about how Friar “I’ll send a friar with speed” Laurence was running a meth lab (back before meth labs were a commonplace punchline).

  41. A freier, perhaps?

  42. Allan from Iowa says:

    Y, that’s not a suffix, it’s an infix.

  43. Trond Engen says:

    On no demand whatsoever:

    Pre-Indo-European Blues

    or,

    The Horse, the Wheel, and Language Blues

    Trond Engen, 2008-02

    Ain’t got no horses, ain’t got no wheels,
    ain’t got no wagon, ain’t got no wheels.
    Must keep up with them Protos on my heels.

    “Give your daughter a pony,” my wife says to me,
    “And your son wants some wheels,” my wife says to me,
    “My mother said, you could do better than a Pre-.”

    My woman met a horseman, I feel I’m gonna lose.
    My woman’s on a wagon, I know she’s running loose.
    I got the Pre-… Indo-European blues.

    I hear them conjugating, I want her to decline.
    He’s giving her an infix, she’d better soon decline.
    Her verbs are getting stronger … every time.

    Ain’t got no horses, ain’t got no wheels,
    ain’t got no wagon, ain’t got no wheels.
    Must keep up with them Protos on my heels.

    When my daughter gets older, I know who she’ll choose.
    And when my son gets older, I know what tongue he’ll choose.
    Left in the Pre-… Indo-European blues.

    I thought I’d posted it here before, but apparently not.

  44. n̥dʰgʷʰitom!

  45. Dont the Americans use the word ‘medicine’ or ‘meds’??

    With title of this topic, one could be misled into expecting a discussion of how the names ‘smack’, ‘ganja’, ‘crack’ etc. came about.

  46. Dont the Americans use the word ‘medicine’ or ‘meds’??

    No, when we’re talking about the pills and injections doctors give us to ward off disease we call them drugs.

  47. John Emerson says:

    When I was doing hospital work “meds” was the routine term: e.g “It’s time for your 2:00 meds”.

  48. David Eddyshaw says:

    “Drugs” is usual in UK medicalese; however, in UK Common Speech the word has got skunked by its common collocations with “dangerous” and/or “illegal” and only refers to the Bad sort. We don’t have “druggists” or “drugstores”, unlike those depraved Americans: we have properly alchemical* Chemists (where you go for your “medicines.”)

    In the interlanguage with which doctors speak to patients, “medications” is used here too. During drug rounds (sic) on the wards, you will indeed tell the patients it’s time for their medication.

    *In Welsh, they are actual Virgiliaries (fferyllfaoedd.)

  49. When I was doing hospital work “meds” was the routine term

    In the interlanguage with which doctors speak to patients, “medications” is used here too. During drug rounds (sic) on the wards, you will indeed tell the patients it’s time for their medication.

    Yes, shockingly it is the fact that doctors talk differently from other people. They also use “we” as a second-person pronoun (“How are we feeling today?”).

  50. David Eddyshaw says:

    I think of this as the Microsoft Windows “we” (“We need to fix a problem with your settings.”)

    Now I think of it, the phrase has potential in medical usage too.
    “Well, Mrs Evans, the scans show that we need to fix a problem with your settings.”

  51. I use ‘meds’ pretty often for drugs I take myself, and also for the drug my cat takes (not voluntarily).

  52. My wife does too, but she’s spent a lot of time in hospitals and with doctors in recent years. I suspect such home use (as it were) is often a carryover from medical jargon, just as people who spend a lot of time around linguists may start talking about language change in a way that other civilians don’t.

  53. John Emerson says:

    Meds, unlike drugs, are not BAD. And tobacco is neither a drug nor a med, even though it’s addictive and kills more people than all the bad drugs put together.

  54. Also on Language Log (Nov 2020): Bamlavininab

  55. @John Emerson: Regulating tobacco as a drug was one of the things that Kessler tried to do as head of the FDA. Based on the way the governing legislation (the Food, Drug, and Cosmetic Act) was worded, tobacco (or its addictive component, nicotine) met the criteria to be regulated as a drug. However, the legislative history of the Food, Drug, and Cosmetic Act (and other laws, going back to the 1906 Pure Food and Drug Act) equally clearly indicated that Congress had not envisioned tobacco regulation as part of the FDA’s remit. The result was that the question of the FDA’s authority eventually had to be decided by the Supreme Court. Whether the precise wording or the legislative intent should be controlling ought to have been decided on the basis of judicial philosophy, but it ended up instead being determined purely by the judges’ political preferences. In particular, Antonin Scalia—who ostensibly did not believe in ever using legislative intent to overrule the wording of an act—voted against the FDA’s authority. However, the ruling was overruled by the 2009 Family Smoking Prevention and Tobacco Control Act, which did not, strictly speaking, specify that, e.g., cigarettes were a drug delivery system, but which did give the FDA some authority to regulate them.

  56. We don’t have “druggists” or “drugstores”, unlike those depraved Americans

    Here too, there are no (well, maybe a few) drugstores. There are pharmacies and pharmacists. Many are also labelled аптека, which I learned a few years ago derives from “ἀποθήκη”; “apothecary”.

    The Russian is common enough that even non-Russophone pharmacies want the word on their awnings. However, at least one such pharmacy (or the sign-maker for the pharmacy) was confused as to what the word actually was, and as a result, they used ANTEKA instead.

  57. David Eddyshaw says:

    Well, old remedies are often the best.

  58. It’s also very difficult to find the price of a prescription drug anywhere before buying it.

    I was using goodrx.com for a while. Does that work for you?

    Hm, I see it doesn’t work outside of the USA, so maybe not. Could there be a non-US equivalent?

    Sometimes the variation in price from different places can be astounding, especially between the amount for 30 days vs 60 or 90 days. Crazy thing, medication prices.

  59. Meds, unlike drugs, are not BAD

    Yes. Urban DIctionary lists meds, as in “I hate these fuckin’ meds”, so I would say it is not confined to doctors, hospitals, and patients, except insofar as we are all patients these days.

    depraved Americans

    I would say that in These States druggist is now archaic, having been replaced by pharmacist, and that drugstores need not contain a pharmacy (that is, they may sell only over-the-counter remedies as well as cosmetics, shampoo, etc.), but typically do.

    My go-to pharmacy if I need an unusual drug or dosage is C.O. Bigelow, Apothecary, Est. 1838, which claims to be the oldest still-operating pharmacy in NYC. It is one of less than ten compounding pharmacies in Manhattan (for humans, that is), though they do a large non-compounding and indeed non-pharmaceutical business, as well as retailing medical devices (I also go there when I need a new CPAP mask or tube). The other compounding pharmacies are variably Pharmacy, Apothecary, or even Chemist, whether nominative or Saxon genitive.

  60. David Eddyshaw says:

    I am gratified to hear that Americans are becoming less depraved. It just goes to show that it is unwise to write off any group of human beings prematurely. I feel that there is a lesson for us all here.

  61. It’s something new to learn, locked up inside all year.

  62. Lars Mathiesen says:

    In countries like Denmark where the social medicine system has the freedom to negotiate prices with producers for all supplies to pharmacies and hospitals, brands are usually within 5% of each other (strange how that works innit) but you only get health care support for the cheapest one — and your pharmacist is required by law to tell you if there is a cheaper generic substitute for the one your doctor specified. So nobody sees the need for a price comparison service. Also prescription drugs cannot be advertised to consumers, though there are sites that you can look at to get ideas now that the Pharmacopoea Danica is not published any more.

    Personally I hate blister packs so I don’t mind paying a little more to get my pills in those little canisters. Prices are renegotiated every two weeks so sometimes that’s even the cheapest option.

  63. Yes. Urban DIctionary lists meds, as in “I hate these fuckin’ meds”, so I would say it is not confined to doctors, hospitals, and patients, except insofar as we are all patients these days.

    Your last clause is the clincher. We are all patients these days, so we are collectively absorbing medical usage. I most easily imagine “I hate these fuckin’ meds” as said by someone lying in a hospital bed.

  64. John Emerson says:

    The drugstore / pharmacy connected to the hospital I just was in called itself an apothecary. Never saw that before IRL.

    We have not become less depraved, we just buy our dope at legal retail operations called dispensaries.

  65. As DE will be the first to tell you, depravity is total.

  66. J.W. Brewer says:

    Even if many of them don’t personally use the jargon-word on a free-standing basis, I daresay most AmEng speakers these days are familiar with the idiom “to be off one’s meds.”

    https://idioms.thefreedictionary.com/off+one%E2%80%99s+meds

  67. Of course.

  68. John Cowan says:

    your pharmacist is required by law to tell you if there is a cheaper generic substitute for the one your doctor specified

    Here in New York, at least, the pharmacist will simply dispense the generic automatically, unless the prescriber has initialed a “Dispense As Written” box on the form.

  69. @John Cowan: Yeah, that’s the norm all over America, I think. However, there can be peculiar situations when an insurance company might only cover a brand name drug, rather than the generic. Illogical as this may seem, it does happen, and I can imagine how agreements between insurance carriers and drug makers might lead to it. I am actually in this situation with my colchicine—although I think in this case it’s actually just due to a clerical error.

  70. John Cowan says:

    depravity is total

    Well. Pelagians, Semi-Pelagians, and some but not all Arminians believe in limited depravity: that all humans, while unable not to sin, have the inherent ability to accept Jesus Christ’s offer of salvation. Methodists, while as modern Arminians rejecting this kind of limited depravity, do not accept total depravity in full either:

    First. We do not think that all men continue totally depraved until their regeneration. Secondly. We think man, under the atonement, is not, properly speaking, in a state of nature. He is not left to the unalleviated evils of total depravity. The atonement has not only secured grace for him, but a measure in him, by virtue of which he not only has moral light, but is often incited to good desires, and well-intended efforts to do what is perceived to be the divine will.

    Both kinds of Christians hold with conditional election (that God saves those whom he foresees will have faith in Christ, rather than those he chooses arbitrarily for his own inscrutable purposes), unlimited atonement (that Christ died to save us all and not only the saved from before-the-dawn-of-time), and prevenient or preceding grace (that it is God’s pre-existing grace that allows us to turn to him and so is offered to all, rather than the Calvinist irresistible grace which is provided only to the saved aforesaid and which saves them whether they like it or not).

    The Lutheran Flacius and his followers, however, held that by sin even the image of God was lost, that human beings after the Fall are entirely corrupt and in the image of Satan, and that man’s nature was sinful per substantiam and not merely per accidens. This pushed the Flacians far beyond any Calvinist position, never mind Lutheran, and they were ejected from the Lutheran Church, which otherwise was quite careful to avoid theological schisms.

  71. I’m not talking about all them heretics, I’m talking about the One True Religion. Ask DE for details.

  72. David Eddyshaw says:

    Totally.

  73. John Cowan says:

    “The phrase infamous heretics was heard about once per sentence.” —L. Sprague de Camp, describing a bar fight in 6C Rome

  74. David L says:

    Well, Mrs Evans, the scans show that we need to fix a problem with your settings.

    I presume the first line of treatment would be to put Mrs Evan under general anesthesia, wait 30 seconds, revive her, and see if her settings have returned to their defaults.

  75. David Eddyshaw says:

    Yes, this often works, and means we don’t need to get into the challenging process of debugging.

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