GSK's "scary" HIV ads are ok with me

The Wall Street Journal (Glaxo's HIV-Drug Ads Draw Critics) and Wall Street Journal Health Blog (Are Ads for HIV Drugs Too Scary?) wrote earlier this week about consumer-directed advertising for HIV drugs from GlaxoSmithKline (GSK) and Bristol-Myers Squibb (BMS). A GSK ad shows a picture of shark-infested waters and tells patients, "Don't take a chance --stick with the HIV medicine that's working for you." Another GSK ad asks, "Will the HIV medicine make my skin or eyes turn yellow?" In my favorite, a BMS ad shows a toilet with a huge stack of magazines on the back of it. "Living with HIV doesn't mean you have to live here," it says, and urges patients to check with their doctors to see if they can take something that is less likely to cause disarrhea.Some patient advocates and researchers complain that the ads are too frightening or will interfere with the doctor/patient relationship by making patients less receptive to their physicians' advice to switch medications. I know the experts quoted in the story and am sympathetic to their points. They want patients to receive the most appropriate, evidence-based treatment, and not have care influenced by commercial interests.However, from my perspective the appearance of these ads is an encouraging sign. Why? Because it means the companies are viewing HIV as a promising, profitable area that deserves attention and investment. It wasn't long ago that some of the bigger pharma companies --including GSK and BMS-- contemplated abandoning or scaling back their efforts in HIV. That's because being in the HIV business was a headache compared to other therapeutic areas. Companies had to literally give away their products in developing countries and still put up with a lot of external criticism, a problem they didn't have to deal with in other therapeutic areas. It seemed like a thankless business to be in and some of the top bosses wanted out.But things have turned around lately. Much of the change is relative. In other therapeutic areas, high-profile products have failed in late-stage trials and marketed products have been battered by safety concerns, but HIV continues to be a productive area. New classes of drugs continue to be developed and launched, and even "me-too" products in existing classes find a receptive audience. Because HIV patients take complex cocktails of medications, new drugs can be added to the mix without cannibalizing the sales of existing products. And the emergence and proliferation of drug resistance makes the market dynamic. Add to that the possibility of introducing fixed dose combination pills based on older products and it all adds up to a decent market from the drugmakers' perspective.It's good for patients and physicians that companies are seeking to make money in the market. Rather than paying lip service to HIV or treating it as a charitable area, the companies are investing cold hard cash to deliver the next generation of products.Meanwhile, at least the ads have real commercial logic:

• As the WSJ points out, GSK sells mainly older products and doesn't have much in the pipeline. It therefore has the most to gain from the status quo --and wants to encourage patients to stick with what they're using. Hence the sharks-in-the-water approach. Of the 3 ads, this one is the most objectionable because it is really just trading on fear. I can see how people don't care for it.
• The other two ads are more sensible. They both make the point that the drugs advertised lack certain annoying side effects of the drugs' competitors. Sometimes doctors don't take diarrhea and skin-yellowing as seriously as patients do, so it's reasonable for the companies to take their message directly to patients. Let's not forget that physicians themselves are also being influenced by the drug companies and other commerical interests --so it's not as though these ads are the only thing detracting from purely evidence-based approaches

And finally, keeping the big picture in mind, isn't it great that anti-retroviral therapy has reached the point where patients can concern themselves with quality of life issues rather than focusing on mere survival?