January 14, 2004

Dr. John Leonard
Vice President, Global Pharmaceutical Development Abbott Laboratories
100 Abbott Park Road
Abbott Park, IL 60064-3500

Dear Dr. Leonard:

Anyone who cares for HIV infected patients is well acquainted with the ups and downs of the history of this disease, from the development of HAART to the recognition of the multiple metabolic complications associated with HAART. In the past few years, nothing has shaken the HIV community more than the actions recently taken by your company.

Nobody will argue about the value of ritonavir in current treatment paradigms, but the decision of Abbott Laboratories to increase the price of ritonavir (Norvir) by an astronomic 478% is setting a devastating precedent that will have unfortunate consequences in the pricing of anti-HIV drugs in the future. We take issue with the recent stated justification of the price increase and the impact that the price increase will have on patient access to future treatments. In response to your letter, we disagree with the justifications of your company for the following reasons:

1. Ritonavir was not developed for its current use. It is a drug that it sells itself, not because of potency, but because of the unavailability of a better boosting agent.
2. The HIV community quickly embraced the use of low dose ritonavir for boosting purposes, initially without an FDA indication. In fact, most of the data collected for boosted PIs have come from the effort and investment of other companies such as Roche, Merck, GlaxoSmithKline and Bristol-Myers Squibb.
3. After the development of a soft gelatin capsule in 1999, 5 years ago, Abbott has not experienced any more problems with the production of ritonavir, nor has the cost of drug manufacturing or marketing significantly increased. This increase in price is not justified by manufacturing cost.
4. The use of boosted PI’s is so widespread in our clinics that the use of ritonavir today is probably higher than the use of ritonavir when it was prescribed at a full dose.
5. Kaletra is the #1 selling protease inhibitor. It is clear that any market increase in the use of any new PI’s will compromise the sales of Kaletra and will reduce profits for Abbott.

Regarding your development program, we believe that the cost of a new formulation of Kaletra should not come at the expense of patients needing other PI boosted therapies. We also have not heard any company public announcement committing the profits of the recent increase in ritonavir price toward that creation of a new formulation of ritonavir, which supposedly is already under development. Research and development of new drugs is something that most HIV committed companies have on their current agenda, yet we do not see other companies, with even less HIV market share, hiking the prices of already FDA approved drugs to fund their research and development programs.

We want to make you aware that Abbott’s actions are perceived by many healthcare workers and organizations as a way to force the use of one drug over another. It is also seen as an outrageous behavior, extremely disappointing from a company that was at the vanguard during the early stages of the HAART era.

As the gatekeepers between patients and the pharmaceutical industry, we cannot allow this to happen. For the reasons stated above, the signatories to this letter are requesting physicians nationwide to join an immediate and formal boycott against Abbott Laboratories already started by other private practices. The actions we will take include the following:

1. We resign as members of the Abbott advisory board and lecture faculty.
2. Abbott representatives, commercial or medical, are no longer welcome in our offices.
3. We refuse to attend any Abbott-sponsored lectures or advisory board meetings.
4. We will not participate in any new Abbott sponsored clinical trials.
5. We will continue to prescribe lopinavir/ritonavir or other boosted PI’s in the best interest of our patients, but we will actively consider other treatment options, when medically appropriate.
6. We will extend this boycott to other branches of Abbott Laboratories, such as antibiotic, gastrointestinal and cardiovascular drugs, nutritional supplements and any other Abbott related products. When other treatment alternatives are available for our patients we will avoid the use of the following products: Biaxin, Erythromycin PCE, Omnicef, Prevacid, Tricor, Depakote, Flumax, Hytrin, Mavik, OraQuick, Advera, Ensure, Glucerna, Pro-sure, and Pulmocare.
7. We are actively encouraging other physicians and organizations to join us in these actions.

This boycott against Abbott Laboratories by all of us will become effective immediately. Many more will join our cry for help, in the name of protecting our patients by safeguarding the well-being of the entire healthcare system. Because of our strong ethical and philosophical objections to your corporate strategy, we demand that Abbott Laboratories rescind the increase in Norvir price.

Sincerely,

HIV Healthcare Providers

HIV Healthcare Providers
Brady Allen
Leslie Baken
Kiran Belani
Steven Boswell
Dorothy E. Bulgin
Winston Cavert
Edwin DeJesus
Michael Dunn
Richard Elion
Jason Flemm
Ken Greenberg
Howard Grossman
David Hardy
Martin Harold
Trevor Hawkins
Keith Henry
Lynne Hopkins
Harold Martin
Dorry Norris
Roberto Ortiz
Bill Owen
Andrew Pavia
Gerald Pierone
Frank Rhames
David Rubin
Philip Sanchez
Robert Schwartz
Peter Shalit
James Shearer
Charles Steinberg
Corklin Steinheart
Douglas Ward
Benjamin Young
Temesgen Zelalem