"If Hep C was attacking your face instead of your liver, you'd do something about it," the ad reads. "Ready to fight back?"
While Navarro and other experts applaud the ads for raising interest in the viral disease, they think the campaign by drug-maker Hoffmann-La Roche Inc. could cause unnecessary alarm, in part because the vast majority of hepatitis C patients will not die from it.
Roche's drugs, which are improvements over previous medications, also work on only half of all patients, and cause considerable side effects. The campaign could leave those who cannot benefit believing they will wind up like the man in the ad.
The ad is also part of a larger marketing effort by Roche quietly to sponsor hep C seminars for the public and support patient groups and many liver physicians. Ethicists say the financing raises questions about whether advice at such seminars can be objective.
Roche spokesman Mike Nelson said the company simply is trying to get out the word about the disease so more people can be helped. Nelson says nearly 600,000 hepatitis C patients have been diagnosed but haven't been treated. Nelson also said the ad was meant to be strong "to break through the clutter."
Roche officials would not disclose the cost of the campaign, which will run through July, but such large newspaper ads cost as much as $50,000 a day.
Questionable motives
Leonard B. Seeff, who oversees hepatitis research at the National Institutes of Health in Bethesda, Md., originally thought the ad came from an advocacy group.
"I think the ad is awful. Patients with hepatitis C do not look like that," said Seeff, who has been working on a study partially funded by Roche. "On the other hand, if you're trying to get the message across, one way is to make it look bad."
Seeff, who said his opinion does not reflect that of the NIH, said he was also concerned because only a few people will die from hepatitis C.
Some doctors and advocates see a strong profit motive behind the campaign. "Ultimately it sells more of their drug," said Sidney M. Wolfe, director of Public Citizen's Health Research Group.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said it is not good policy for the United States to rely on companies to sponsor public health campaigns. These efforts tend to go to diseases for which companies have developed drugs while other needy areas are ignored, he said.
Not often fatal
Hepatitis C is a viral liver ailment that is the most common, chronic blood-borne disease in the country.
The NIH estimates about 4 million people have hepatitis C in the U.S. That number is expected to double in the coming decade as more people learn they are infected.
Many people got the disease from receiving tainted blood or organs before adequate tests were developed in 1992. Most new cases are caused by intravenous drug use. A few contract the disease through high-risk sexual behavior, according to the federal Centers for Disease Control and Prevention.
Most people don't know they have been infected because the disease often doesn't cause symptoms for decades. The only way to confirm a diagnosis is to take a sample of the liver and examine it for scarring.
Only a fraction of those infected - from 1% to 5% - die of the disease. Yet it remains the No. 1 cause of liver transplants.
About 70% to 80% of those with the liver disease suffer from a stubborn genetic variant of the disease called genotype 1 that resists treatment.
The cocktail of antiviral drugs works in only 30% to 40% of cases and even less often in blacks, according to the World Health Organization.
For the remaining 20% to 30% who have genotype 2 or 3, treatment works about 80% of the time. Averaging the two groups means that treatment only works in half the cases.
While most insurance covers the therapy, uninsured patients must weigh that success rate against the cost, which can run up to $64,000 per year. The drugs are given several times a week, for 24 to 48 weeks.
Still, hepatitis drug sales and advertising have been brisk. Over the past five years, drug company spending to advertise interferon, including Roche's drugs, has jumped from $14 million to $75 million.
The push has paid off. The company sold $1.4 billion of its hepatitis C drugs, according to its 2005 annual report.
Some hepatitis C activists, including those supported by the company, say the ads may seek to take advantage of a small window of opportunity. Roche now controls more than 60% of the hepatitis therapy market, but that could change as other companies win approval for new antiviral treatments.
"We have been advising most people that they should probably wait for the next class of drugs," said Michael Ninburg, president of the National Hepatitis C Advocacy Council and executive director of the Hepatitis Education Project in Seattle, which gets funding from Roche. |
