"Molecular Semantics: Naming the Drug, Notating the Score"

By Bil Smith

---

For most of my working life I’ve had two desks. At one, I name medicines. At the other, I take music notation apart and put it back together wrong, on purpose. People assume these are separate lives. They aren’t. I’ve just never found a good way to explain that at dinner parties.

When we named Remicade, we weren’t decorating a molecule. We were building something that had to survive a pharmacist’s handwriting, a lawyer’s search, and a frightened patient saying it out loud for the first time. Every sound was argued over. Did it feel trustworthy? Did it hint at what the drug does without promising too much? Could a doctor say it twenty times a day without tripping? Evenity, Vyondys, Veozah: each one went through that same slow, obsessive tuning. The weight of a vowel. Where the hard consonant lands. How it ends in the mouth. I’ve spent decades listening to names that way, and somewhere along the line I stopped being able to listen to anything else that way too.

So it’s no accident that my scores have names like Ablutorax for Septal Loops or Extylphex Miasma for Atonal Conduction. They sound like medicines because I think like someone who makes medicines sound right. They don’t mean anything in the dictionary sense. They’re meant to land somewhere in your chest before your brain catches up. A good drug name does the same thing. It suggests. It doesn’t explain.

Every name I’ve ever proposed has been picked apart by regulators. The FDA and EMA look for confusion, sound-alikes, anything that could lead someone to take the wrong pill. There’s even a computer score for it. I find that oddly moving: an entire system built around the fear that a word might be misunderstood. My scores go through their own review. Musicians read them, argue with them, misread them, and make something I never imagined. In medicine, misunderstanding is the danger. In my music, it’s the point.

That’s why my pages often look like they came out of a pharmacy. Blister packs. Boxed warnings. Dosage tables. Patient information inserts. I’m not being clever. I genuinely believe music is something you take. It goes into the body and changes it for a while, and then it wears off, and sometimes it doesn’t.

Over the years, Brand Acumen has created more than a thousand drug names, from Abilify to Atripla. I used to think of that list as a client record. Now I think of it as the longest piece I’ve ever written. Each name is a tiny composition, performed every time a doctor writes it on a pad or a patient repeats it in a waiting room, quietly, to make sure they’ve got it right.

So when someone performs one of my scores, I don’t really think of it as playing music. It’s closer to administering something. You’re giving the room a dose. You’re taking the risk that someone will hear it wrong. You’re putting a name on something that has no body.

No agency regulates my scores. Only attention does, and attention is a much harder reviewer to satisfy.

If both of my desks have taught me one thing, it’s this: the words are the active ingredient. Everything else is how they reach you.