San Francisco Chronicle - Saturday, May 26, 2001
George Raine, Chronicle Staff Writer

It wasn't pretty. These were not the faces of the pretty boys in all those ads selling drugs for people living with AIDS.

The people Devlin met told him they did not see themselves in those images, certainly not in Merck's ad for its drug, Crixivan, in which four hikers -- they're the picture of health -- have climbed to the top of a peak.

"I told Agouron there was a gaping hole in the communication of AIDS drug advertising," said Devlin, the creative director of a small New York ad agency,

CCA Advertising. "What was missing was a sense of reality and a sense of honesty," in a business in which hyperbole rules, Devlin said.

Agouron, a division of Pfizer, thought Devlin had an intriguing point. The company gave him the $5 million account for advertisements for its anti-AIDS drug, Viracept, and the result is a series of photographs of patients who appear to have been caught in reflective moments. HIV, the patients told Devlin, brings tough choices. They said it transforms people.

The campaign began in mid-April. It was fortuitous timing, because on April 27 the Food and Drug Administration told Agouron and seven other manufacturers of anti-AIDS drugs that much of their advertising is misleading. The agency said the ads don't adequately convey that these drugs neither cure HIV infection nor reduce its transmission. The drug companies have until July 27 to make changes to the ads.

The order, from Thomas Abrams, the director of the FDA's Division of Drug Marketing, Advertising and Communications, came after complaints about the unrealistic advertising. The concerns were given added weight by a survey of San Franciscans that suggested such advertising could lead some to have unprotected sex.

"They're using sex to sell medication for sexually transmitted disease infections," said Dr. Jeffrey Klausner, director of the San Francisco Department of Public Health's Sexually Transmitted Disease Prevention and Control Services.

Statistically, Klausner has shown an association between the ads and unsafe sex, but has not proven a causal link. He said there's something there to suggest that "these ads may be having an adverse effect on sexual health," he said.

Klausner has nearly completed a survey of 1,000 people who use the services of a public health clinic and found that more men who see the ads regularly have unsafe sex compared with men who never or rarely see them. "In public health we have to act on that," said Klausner.

Overly positive drug advertisements portraying robust and sexy men contribute to what is called "treatment optimism," or the belief that HIV/AIDS is a manageable, treatable disease, said Klausner, who fears uninfected people are at risk when HIV/AIDS is wrapped in glamorous images.

Ads from GlaxoSmithKline show a handsome fellow with bedroom eyes after a workout with the message "Living Proof" to promote Combivir, and Bristol-Myers Squibb shows a cheery, nice-looking guy saying, "Zerit works for many of my friends. I gotta believe it can work for me, I'm positive."

MERCK PULLING AD

Telephone calls to officials at Bristol-Myers Squibb and GlaxoSmithKline were not returned. Skip Irvine, speaking for Merck in Upper Gwynedd, Pa., said yesterday that Merck is withdrawing the mountain-climbing ad that appears in gay publications.

AIDS drug advertising, of course, is not alone in the use of attractive people at play in a perfect world shaped by pharmaceuticals.

"There's a whole category of dreadful formulaic advertising with lame vignettes and disclaimers," said Jef Loeb, who heads Brainchild Creative, a San Francisco ad agency, and who disagrees somewhat with Klausner. "I think the danger posed is more prevalent through free media, on the Internet, for example, than through bad advertising of this nature," said Loeb.

On the other hand, a younger generation is at risk. "They are not sensitive to the reality of HIV/AIDS and feel that it can be cured or easily managed with new drugs," said Greg Stern, president of Butler, Shine & Stern, an ad agency in Sausalito that has done pro-bono work for Klausner. "If that type of advertising contributes to that misconception, then certainly it is misleading. "

Rules were relaxed

The misleading ads are produced under the guidelines of direct-to-consumer, or DTC, advertising, rather than filtering through physicians. The FDA relaxed those rules in 1997, which opened the floodgates, ad executives said.

"It was a giddy time, and advertisers came charging through, without the usual discipline of advertising, which is, 'Does it stand out from competition? Is it respectful of the consumer? Is there an idea there at all?' " said Millie Olson of Amazon Advertising in San Francisco.

"These ads are done without a great deal of thought," she said of the AIDS drug images, seen almost exclusively in gay publications.

Olson, however, asked rhetorically whether the FDA is guilty of over- regulation, whether there is any value to portraying life as depressing and hopeless.

"The order will have the effect of putting worse advertising into the world, " she said. "I think these ads are more guilty of lack of imagination than some sort of malicious intent."

David Stewart, professor of marketing at the University of Southern California, said that while DTC advertising has helped inform consumers, "They've got to be careful about crossing the line and suggesting through images and language a drug can do something it cannot."

NO MOUNTAIN CLIMBING

Jeff Getty of Oakland, who heads an activist group called Survive AIDS, was one of the early voices complaining to the FDA about the visually misleading ads.

"These drugs are known for causing severe diarrhea, so unless there are Porta Pottis up and down the mountain we're not going mountain climbing," Getty said.

What is more, said Getty, if people are to believe the young models in the ads have HIV disease, it follows they must have been infected at age 10 or 11. That's not believable either, he said. "They are exaggerating the confidence of survival."

Getty, Klausner and other advocates helped force the FDA's hand, but activists have assailed the drug ads for years.

"These ads have been terribly misleading and have contributed to the inaccurate perception that HIV is now a manageable chronic condition," said Cleve Jones, the founder of the Names Project, which displays quilts honoring the memory of people who have died of AIDS-related diseases. "I've had three different combinations of drugs since 1994 where the side effects range from constant diarrhea to mornings when I feel I'm coming off a bad acid trip. It's delusional to think these drugs are the answer."

Catherine O'Connor, manager for consumer marketing at Agouron in La Jolla (San Diego County), said the company added this language to its new ads to satisfy the FDA order: "HIV drugs do not cure HIV infection or prevent you from transmitting the virus."

"This is a hideous situation," said Loeb of Brainchild Creative. "We're not spending enough money on the disease. It's fraught with social overtones. It's no wonder advertisers are standing on shifting sands."

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