A Critical Look at Pharmaceutical Ads

Last April, the US Food and Drug Administration (FDA) notified eight drug makers that they must revise "misleading" ads for HIV medications. Complaints, primarily from California AIDS activists, AIDS service organizations, and the San Francisco Board of Supervisors President Tom Ammiano, prompted the FDA to order the pharmaceutical companies to tone down ads featuring "robust individuals engaged in strenuous physical activity" and other "healthy-looking individuals" used to imply "greater efficacy than demonstrated by substantial evidence, or minimize the risks associated with HIV drugs." They have 90 days to comply.

You know these ads. You've seen them in gay and lesbian magazines, in publications aimed at people living with HIV and even in outdoor advertising like the posters on those city bus shelters. More often than not, these ads show sexy, young, gym-toned, rock-climbing, sail boating, bicycling people generally blissed out of their minds, enjoying a kind of fantasy existence bearing almost no resemblance to the lives of patients actually battling HIV or AIDS with these medications. If you take these drugs, you already know they're outrageously expensive, have unpleasant and sometimes bizarre side effects, and require a grueling adherence schedule. Yes, committing to combination therapy is kind of like signing up for your own private, ongoing boot camp.

In preparation for this article, I reviewed about four year's worth of HIV-related pharmaceutical ads. The most obnoxious ones, in my opinion, are those ads designed for Merck's Crixivan and DuPont's Sustiva. Crixivan ads typically feature hardy, buffed folks climbing a rocky mountainside, much like Tom Cruise in the opening moments of Mission Impossible 2. The photos, with titles like "Going the distance" or "There's a change in outlook" are accompanied by teeny tiny print full of warnings about kidney stones, changes in body fat, diabetes, severe muscle pain, weakness, and the need to consume at least six glasses of water a day. Where does one pee or pass kidney stones while mountain climbing?

Ads for Dupont's Sustiva are equally contrived and silly. The words "Because Life Goes On" hover over photos of happy, shiny people graduating from college or celebrating a birthday. In the most laughable one, an adoring, impossibly diverse crowd showers a gay male couple with rice after what appears to be a marriage ceremony. Again, take a look at the ad's small print: dizziness, trouble sleeping, drowsiness, trouble concentrating, unusual dreams, severe depression, strange thoughts, angry behavior, and my favorite, "There have been a few reports of suicide, but Sustiva has not been established as the cause." Well, that's reassuring. I took Sustiva for six months . . . six of the longest months of my entire life. I experienced all those side effects and even considered suicide. Certainly no man in his right mind would have married me during those six months, nor would I have been able to plan and execute a wedding, much less remember to show up for it. Sustiva had a profound affect on my personality; I became a disturbed, suicidal zombie . . . with an undetectable viral load.

I realize that for many of us the benefits of these drugs, including longer lives, outweigh the nastiness and complications. I don't doubt that the four (yes, four) drug combinations I've been on since 1997 have helped me to avoid death (well, okay, except maybe Sustiva). Sometimes I wonder what's worse for my body: HIV itself or the medications formulated to combat it. My four HIV drug combinations have taken their toll on my body and each time I've switched my therapy it was solely because the side effects became intolerable. Everybody has his or her own tale of pharmahorror. For instance, I took Viracept for a year and was plagued by diarrhea -- so much so that I could not enter a public place without immediately locating a restroom. The gorgeous models living life to its fullest in HIV drug ads don't appear to be the least bit concerned about having poopy pants.

And that's the problem. See, the usual advertising gimmicks (like using attractive people to sell your product) have been applied to the promotion of HIV medications. Nope, you won't see any humps, sunken cheeks, veiny legs, rash-riddled skin, bellies, glazed eyes, or thinning hair in ads for Norvir, Trizivir, or Combivir because, gosh, that would be so real. Yes, of course, there are attractive people on combination therapy who continue to lead active lives and work full time. I know plenty of people who fall into that category. None of them, however, are happy to have HIV or thrilled over the prospect of taking these drugs for the rest of their lives.

Pharmaceutical companies are typically huge, autonomous, and enormously wealthy. A little research turns up fascinating details: Drug company shares rose more than twice as fast as other profitable industries in the 1980s and 1990s; they spend more to market new drugs than on research and development; they spent $80 million last year -- the record for any industry -- lobbying congress; some drugs have been revealed to cost ten times their manufacturing cost. For the record, let me say that I have no problem with drug companies making a profit. Making money -- this is America and that's what we're all about. But this is really profit mongering at its worst. I would call them pharmawhores, except I don't think that's a word.

Maybe you've read this far and you're still thinking, "What's the big deal? So what if they use pretty people to sell their HIV drugs?" Well, preliminary research published in March suggests that these ads have ramifications.

Dr. Jeffrey Klausner, director of the San Francisco Department of Public Health's Sexually Transmitted Disease Prevention and Control Services reports that men who see these ads regularly have more unsafe sex than men who rarely see them. Klausner's interpretation of these findings is that the ads featuring sexy, robust people contribute to something he calls "treatment optimism." In other words, these so-called "glam" ads lead people to believe that HIV is just a minor inconvenience made manageable by taking magical drugs. Ultimately, HIV drug advertising and promotion dangerously trivialize AIDS. A younger generation of men and women, less familiar with the harsh realities of HIV, may conclude that having this virus is no big deal. No one is saying these ads alone cause unsafe sexual behavior, but we can't deny they feed a perception that AIDS is no longer the threat it once was.

Advertising persuades. Personally, I have ethical reservations about advertising drugs that are available only by prescription anyway. The FDA had the same reservations until 1997 when they relaxed the guidelines of direct-to-consumer (DTC) advertising. Prescription drugs are no longer marketed solely to physicians. Now, drug companies are free to target potential consumers, and that's why you see prescription drug ads in all forms of media. The same dreadful, formulaic hucksterism used to sell cars and beer can be used to promote HIV meds! Five years later, facing criticism and controversy, the FDA has ordered eight pharmaceutical giants to tone down HIV ads. I felt pretty good about that until I saw the front page headline of this morning's San Francisco Chronicle: "Young gays contracting HIV at 'explosive' rate, CDC says." The accompanying article notes that upbeat advertisements for AIDS drugs have helped create a false sense of security among a new generation of gay men.

I don't think it's enough to make the pharmawhores change their deceptive advertising. How could they impress me? Instead of spending $80 million lobbying congress to pass legislation favoring their morally questionable business practices and incomprehensible greed, how about donating the same figure to HIV prevention efforts.