Treatment Issues, Vol 11, No. 4/5;- April 1997
Karen Kuller

Once lured to court AIDS and gay community groups because of their wide consumer reach, drug companies are resorting to more traditional methods of direct-consumer marketing as competition among the protease inhibitors heats up. The market's dominant player, Merck, has felt this pressure the most.

Its newest and fiercest rival, Agouron, launched an aggressive campaign to publicize Viracept's low toxicity and ease of use upon its approval in March. Only one month later Viracept represented 23% of new protease inhibitor prescriptions, according to one analyst report.

With an estimated 10,000 new prescriptions being filled each month, drug companies are becoming more and more anxious to get the message out that theirs is the superior product by whatever argument they can advance. The irony is that the messages conveyed about HIV through the media continue to reduce the disease to mere imagery, even as treating it grows more medically complex. Such imagery includes the notion of a war being waged in the blood where billions of T-cells are destroyed every day, says Joseph Sonnabend, M.D., and that "now we have drugs that can stop it all." In Merck's ad, phrases like "battle against HIV" and the tagline "focus on the rest of your life" are typical of ideas feeding the popular perception that AIDS is a manageable, even curable disease. Roche's tagline "consider a protease inhibitor you can live with," which accompanies pictures of happy, smiling people, strikes a particularly ironic chord: though perhaps tolerable, the product in its present formulation and dose does little to reduce viral load.

All ads include the highly technical patient package insert as required by the FDA. The duality of advertisements, where self-promotional imagery juxtaposes objective information, is reflective of the larger issue that is at stake with this approach to disseminating information on the treatment options available to people with AIDS. "Maybe these companies are reaching people who aren't getting this information elsewhere, and maybe they're giving them very useful treatment information," says Spencer Cox of the Treatment Action Group, "On the other hand, these people may be getting information that is not accurate or which they can't evaluate within the appropriate informational context."

Indeed, if raising awareness about HIV and combination therapy among the public-at-large can be construed as one advantage of mass-advertising, then the consequences of increased brand-name recognition should be construed as a disadvantage. Given the highly complicated regimens that characterize triple-combination therapy, using potent imagery and slogans to describe a protease inhibitor can seem oddly inappropriate. "This is not Rogaine or an antihistamine," says Jeanne Bergman, a policy analyst at Housing Works, "I find it peculiar to see ads for such heavy, heavy drugs."

With this comes the fact that combination therapy is still a matter of choice best addressed through active dialogue between a patient and his or her physician. Brand-name recognition should carry no clout in a decision-making process that involves individual considerations for physician and patient alike, including patient history and ease of use. As Spencer Cox put it, "I'm not sure that engendering consumer confidence is the most effective way to ensure the best healthcare." Rather, says Mark Snyder, M.D., an infectious disease specialist with the Mid-Atlantic Permanente Medical Group in Washington, D.C., the advertising can do more harm than good by "creating the belief that one drug is superior to the others when, in fact, it is not."

But creating that impression seems to be what the pharmaceutical industry is focusing more of its efforts on doing. With analysts predicting that the protease inhibitor market will exceed $2 billion by 1999, protease inhibitors are becoming a promising commercial enterprise indeed (Alex Brown Report, April 29, 1997). Concerns about cross-resistance are further supporting the ambitions of companies like Merck, Abbott, Roche, and Agouron to make their protease inhibitor first in line for inclusion in triple combination therapy. Drug resistance is a completely unsettled field that lends itself to widely different spins by the various protease inhibitor manufacturers.

The AIDS community has been insisting that drug companies proactively communicate information about their products since the beginning of the epidemic. "PWAs revolutionized the way medicine is practiced in our country," says Joy Schmitt of Agouron, "They are our most educated consumers, and the industry has responded to that." Yet information about just how these new drugs will affect the future of people with AIDS or HIV remains scarce. HIV therapy has come a long way since the introduction of AZT and ddI. Today, the only thing that is definite about HIV treatment is the dissenting medical opinion on when to initiate therapy, and the plethora of possible combination protocols. Observes Harold Grossman, M.D., "The truth is always somewhere between what all the companies tell you."

As Abbott, Agouron, Merck and Roche ponder their response to each other's latest ads, the bottom line is that clinical data remain the sole basis for judging the value of their products. Generating solid, clear information on potency and durability of effect is the best marketing technique there could be, whether that information is communicated through patient education material, community groups -- or ads.

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