By Steve Cartun, M.D.

Published August 1997

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New indications for old medications have become a staple of psychopharmocology. Prozac, for example, originally introduced as an antidepressant, has since garnered FDA approval for the treatment of obsessive-compulsive disorder. Eli-Lilly, the company that manufactures and holds the patent for Prozac, did not rename it’s product simply because it had earned a new indication. Even though Prozac had been subjected to false and damaging statements, Eli-Lilly chose not to fashion it in newer clothes. The renaming of Wellbutrin by the same company that manufactures it, simply because research studies show that it has a new and valuable use, gravely concerns me.

Marketing is at the heart of a democratic economy, and self promotion is inherently not shameful. Product branding surrounds the consumer from areas as diverse as the grocery store, retail outlets, television stations and entertainment parks. I am not offended when Hershey Candies advertises itself as "the great American chocolate bar." However, I believe that many supporters of Coca-Cola were provoked when that company introduced a new formula, retracted it, and then renamed the old product a "classic." I am not privy to know whether this was a poorly calculated attempt to enhance market share, or a deliberate ploy to underscore the original flavor. I still remember the controversy whenever I purchase a Coke, and, although I am not certain the memory influences my purchasing patterns, I do have a bit less trust for this company that proudly calls it’s product "the real thing."

The health care industry must have the best interests of the consumer—the patient—at heart, and the merging pharmaceutical complex is an integral component of this industry. Why rename Wellbutrin? It is a respected antidepressant and has a unique place in biological psychiatry. Why not claim it can now be used as a medication to help those who are addicted to tobacco? I don’t have definitive answers, but some thoughts bear expressing.

In recent years there has been an unprecedented growth in new psychopharmacologic products. This stems from an increased knowledge base about brain chemistry and from an increasingly competitive industry attempting to adapt to managed care’s expectation for clearer outcomes and shorter, more effective treatments. The patient will benefit from this competition and hopefully be better and more safely treated. True breakthroughs, however, require broad collaboration, great intellectual resources and sound financial capacity. I do not sit on corporate boards, but read enough about the corporate priorities these days to imagine that some products are pushed to enhance market share, and may not all live up to the eager representation that they get from the pharmaceutical representatives that visit physician offices. I am personally disappointed by the performances of some of the panaceas so glowingly marketed at pharmaceutical sponsored events. But at least I know what to call these drugs. Aspirin, after all, is still aspirin, regardless of whether it is prescribed as a headache pill or a pre-emptive measure against heart attacks.

The renaming of medications is a dangerous semantic. While a pharmaceutical company can argue that a new name that gains wider use will ultimately help the patient, I believe that such a measure treats physicians like naive consumers who care more about a logo than the gritty science that logo represents. Perhaps this is an alarming symptom of how trivialized the importance of reality, at the expense of marketing, is becoming. Physicians have already been renamed health care providers. Wellbutrin is now being named Zyban for a new use. An industry insider once told me that the letter "Z" is particularly useful for gaining audience attention. I hope that Zyban gains all the attention it can to prevent this naming process from becoming a trend. Enough misrepresentation. Convolution must be resisted. If it continues, the meaning of health care will become even more lost than it is now.

The decline of any civilization, in my opinion, begins when ideals are recategorized. I am not referring to the cognitive reframing of the term "handicapped" into the label "physically challenged," which offers a new measure of hope. I am specifically describing the subtle dilution of a respected societal framework. This occurs when health care digresses from a right to a privilege, when patients who require excess care are called outlyers, and when potentially life saving treatments are sprinkled with the glitter of Marketing 101. If something is so good, why does it need to be covered up? Like the old adage of a prospective blind date who asks the matchmaker if the suitor is handsome and is told instead that he is so nice, it would prevent a great deal of anguish and markedly increase the relationship’s trust if the object is described as it truly is. Some of the most successful relationships are blind to others because the trust and rapport isn’t blatantly advertised. Perhaps the pharmaceutical industry could learn something from this.

Steve Cartun, M.D., is a psychiatrist in private practice in Pittsburgh.