satan.jpgA couple of weeks ago, I got a tattoo of a punk rock devil on my left forearm. Today, I met with the pharma corporate devil, or at least his lackeys.

Not really. I met today with Abbott- who have, to put it mildly, a poor standing amongst activist folks. Their infamous quadrupling of the price of their protease-inhibitor-turned-booster, Norvir (ritonavir) was a true low-water mark for drug pricing. They have done other things we haven?t liked, but this was the biggie.
The price hike was so egregious that many activists, and more than a few docs, began a boycott of Abbott. This boycott was nearly universally supported at the time, as a show of public disfavor with the community.

As time went on, some questioned the utility of continuing the cold shoulder approach. They argued that Abbott, which also makes Kaletra (lopinavir/ritonavir), was still a major player in HIV and not talking to them was having the unintended consequence of leaving them immune from community input and pressures.

Many remain unconvinced.

Abbott was eventually taken to court over the price hike (and a few other things). In the course of this ongoing trial, internal Abbott documents were made public. These documents confirmed many of the worst perceptions that we had about the company and its decision makers. The case is ongoing.

So, why did I meet with them? I tend to agree that it is most often better to be talking to industry than not. In the absence of ?street activist? type movement, face-to-face meetings with pharma are often the only influence we have over their activities.

I also am not convinced that Abbott is much worse, or maybe any worse than their competitors, who I meet with. While you won?t see me jump to their defense, they have plenty of company in the pharma-acting-bad club.

Most importantly perhaps, we have things to talk to them about- particularly their slow-as-molasses development of a heat stable formulation of Norvir. It has been close to 3 years since they gained approval for the meltrex- or heat stable- tablet formulation of Kaletra. A heat stable formulation of Norvir would benefit anyone on a boosted PI, but could make the biggest difference in the developing world, where difficulties maintaining a cold chain have limited the availability of boosted PIs.

Confidentiality agreements prohibit me from sharing much of the content of the meeting- but you aren?t missing much. Nothing stops me however, from me sharing my major piece of advice to them: don?t abandon HIV drug development.

It has become almost fashionable to talk about the dizzying array of options on the HIV pharmacy shelf. While there are over 2 dozen products approved for HIV treatment, far fewer are widely used. Moreover, as I wrote here, the HIV drug pipeline is thin and unimpressive. Our ?market?- their word, not mine- may appear crowded and competitive- but many of the products are barely used and good molecules tend to rise to the top.

Abbott, their missteps aside- is the kind of company we need in HIV- large enough to handle the vagaries of drug development, with the financial, structural and intellectual resources to make a real difference.

Or maybe not. We have few effective mechanisms to keep companies in check, and Abbott has shown itself capable of seriously bad behavior. They get something out of meeting with us, or they wouldn?t do it. What? A combination of honest counsel from people like me who sit in hotel bars chatting about HIV drugs, and maybe a heads-up on how we might react to decisions they make.

As I type this in O?Hare?s C terminal, my new ink is itching- is it the normal healing process or is it something more? Is my cartoon devil nagging at my conscience, or is it just the histamines?

Hell if I know.