Truvada for HIV Prevention
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An FDA advisory committee voted that Gilead's Truvada is a safe and effective way to prevent HIV infections in high-risk individuals. The FDA will weigh the advisory committee's vote and is expected to make a final decision by June 15. If approved, Truvada will be the first drug to protect healthy people from acquiring HIV infections through sexual activity in what is called pre-exposure prophylaxis (PrEP). For instance, if one sexual partner has HIV but the other doesn't, the healthy partner can take Truvada every day to avoid becoming infected with the AIDS virus.

What is interesting is how many people argued against using Truvada for PrEP. For the most part, the logic of the critics was flawed. Consider the following analogy:

Many people eat hamburgers for lunch. Health advocates say these people should really be eating steamed vegetables. A new, healthier hamburger comes along (perhaps one that is made of lower fat beef or maybe half beef and half grains). Will these health advocates embrace this healthier hamburger? Probably not; they still want people to eat steamed vegetables for lunch.

What logical mistake are they committing? As David Henderson and I point out in our book, Making Great Decisions in Business and Life, they shouldn't compare reality with fantasy because fantasy is impossible. The only choice we have is between imperfect but feasible alternatives.

The fact that people eat hamburgers for lunch proves that they prefer hamburgers to steamed vegetables. A healthier hamburger, while not perfect, is a step in the right direction. It is an unrealistic position to put our foot down and try to keep the healthier hamburger alternative off the market in the dogged hope that people will eventually accept steamed vegetables.

With Truvada for PrEP, some health experts are bemoaning the fact that people are not using condoms. To them, any alternative, other than the "ideal" one of using condoms, is a step in the wrong direction. But they are comparing reality with fantasy. It is pure fantasy to expect all high-risk people to use condoms. And not even condoms are perfect. Truvada is a step in the right direction because it can lower the risk of HIV infection by as much as 94 percent. While not perfect, it is a better alternative. And that's reality.


Full disclosure: Gilead is a client of my company, Objective Insights, and I own some Gilead stock.

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