A Dose of Creativity

Creatives working in healthcare advertising are the first to admit that the visual vocabulary driving most direct-to-consumer pharmaceutical work has been woefully afflicted by clichés and all too unimaginative.

“Until a year and a half ago, almost all DTC advertising was a formula,” says Anne Devereux, president of BBDO Health, a division launched by the Omnicom shop in February. “It was all smiling old people, happy children, dogs and green fields of grass. You could pretty much edit those four elements together for whatever drug—whether it was for an allergy, gastrointestinal problems or depression.”

And if it wasn’t frolicking families and rolling meadows, there were also the blue skies with soft trails of puffy clouds, pills that appeared to be imbued with magic and women in slow motion on swings, celebrating relief from whatever ailment troubled them.

The all-too-earnest pabulum—”odious,” as described by one source—is in large part a product of copywriters’ and art directors’ struggling to balance creative wants with the Food and Drug Administration’s must-haves. But five years after the FDA revised its rules on prescription drug advertising to permit broadcast work, agencies are finally finding ways to bring storytelling, bold visuals and even humor to the category.

The work now has more in common with other consumer advertising than the dry medical-trade executions that originally dominated the category. And industry observers say that as more general- market agencies with creative expertise tackle the business and intensify the competition, it will only get better.

“There is definitely a trend toward more risk-taking and fresher creative,” says Karin Miksche, co-creative director of Grey Healthcare in New York, pointing to New York agency Deutsch’s work for Pfizer brands Zyrtec (black-and-white spots in which people define themselves by their allergies) and Zoloft (an animated orb dispels the rain cloud over its head thanks to the depression medication).

“[Deutsch] handled the obligatory product demonstrations and fair balance in innovative ways, proving you can indeed meet the constraints of this discipline in a creative way,” Miksche adds. “Granted, it’s a big challenge to do that and to continue to push the envelope, but it can be done.”

Other industry observers also point to Deutsch’s work for its former Pfizer client, along with Merkley Newman Harty & Partners’ Lipitor campaign and Cline, Davis & Mann’s Viagra ads as indicators that pharmaceutical advertising is entering a new chapter. These agencies, among others, have shown that good work can emerge from a conservative environment that’s fraught with complex regulatory issues and heavily dependent on consumer testing. “If you ask too many people, everything migrates to the middle. Who doesn’t like happy children and green fields?” notes Devereux. “Clients are recognizing that if they are going to spend $60 million on a campaign, they have to be relevant.”

“More and more general agencies are taking on these accounts and combining the expertise of DTC with the expertise of general consumer advertising,” adds Tod Seisser, chief creative officer of Saatchi & Saatchi in New York, which produced a 2000 campaign for the Glaxo-Wellcome flu medication Relenza with Seinfeld’s Wayne Knight as the pesky virus that won’t go away. “More agencies are doing more consumer-focused, less medically focused-type work. It’s becoming more insightful and consumer friendly.” For example, the agency’s most recent work for AstraZeneca’s Nexium, from Saatchi & Saatchi Healthcare, takes the purple pill out of the metaphorical world of bubbling craters to depict real-world scenarios faced by heartburn sufferers. When a waiter recites specials in one spot, all the patron hears is, “It’ll give you heartburn so bad, it’ll melt the buttons right off your shirt.”

General-market agencies see the drug sector as one of the ad industry’s few financial bright spots. Last year pharmaceutical firms spent $2.5 billion on DTC advertising, a dramatic climb from the $662 million spent in the sector in 1996, before the FDA changed its guidelines. “There is a great deal of opportunity here,” says Merkley acd Kirk Mosel, who works on Pfizer heartburn drug Prevacid. “Like radio was a few years back, [the drug sector] was considered a forlorn area because no one who thought of themselves creatively driven wanted to work on it. The economics of the industry are such that you can no longer afford to turn up your nose.”

In the Prevacid campaign, which broke in the spring, Merkley used a split screen to emphasize the drug’s green and pink colors and present the mandated medical information in a palatable way. While an acid-reflux sufferer describes the remedies suggested by family and friends on the left, graphics on the right portray the oddball recommendations with funny graphics.

With creative progress comes work that takes some chances. “The biggest risk is just to do bland advertising that doesn’t touch the consumer,” says Dorothy Wetzel, vp of the consumer market group at U.S. Pharmaceuticals, a division of Pfizer.

For a recent campaign touting Novartis’ Lamisil, which treats nail fungus, Deutsch created a yellow gremlinlike critter called “Digger” to convey that the infection that causes toenail discoloration is actually alive. “He’s polarizing, but you can’t not notice him,” says Kathy Delaney, managing partner and executive creative director at the agency. While previous ads, from Lowe in New York, focused on testimonials, the latest spots show Digger and his friends burrowing into the tissue under the nail bed.

Last week, Deutsch broke a national effort for Novartis’ Zelnorm, which treats irritable bowel syndrome in women, featuring scrawled handwritten messages such as “I’m all twisted inside” and “I’m sick of feeling constipated” on women’s stomachs. Delaney declined to comment on the work. “We don’t and have never approached it as pharmaceutical advertising,” she says of the shop’s philosophy on drug work. “I just treat it the way we treat any other brand: It’s coming up with human relevance and letting a creative idea spring from that.”

Yet getting that work developed, produced and on air can be a much more difficult, wearying process than it is for other products. While agency creatives must routinely contend with difficult clients and rounds of consumer testing, those on pharmaceutical accounts have to clear not only traditionally conservative companies but close scrutiny from legal departments, medical boards and the FDA.

The creative is so encumbered by internal and external regulatory processes that the One Club, the New York-based sponsor of the One Show, is touting its new awards dedicated to DTC and professional pharmaceutical work with an entry form that beckons: “Your work made it past the FDA; now the hard part. Introducing One Show Rx.”

“The game is automatically rigged against you,” says Jonathan Isaacs, evp and creative director at Merkley Newman Harty Healthworks in New York. “The whole process is designed to take bites out of the work along the way. To maintain a high level of excellence, you have to be resourceful—truth in advertising takes on a whole new meaning when you’re working with the FDA.”

The FDA can take issue with anything from casting to editing—whatever it finds misleading or a distraction from information the ad must relay about the drug. For example, Merkley’s Lipitor team originally pitched a thirtysomething Brooke Shields type to play the fit-and-fabulous yet cholesterol-prone character who would be the focus of commercials for Pfizer’s cholesterol-lowering drug. The actress would convey the agency’s primary strategy for the brand: that fighting cholesterol can take more than a good diet-and-exercise regimen. But when the FDA’s Center for Drug Evaluation and Research reviewed the idea, a standard step in the development and production of pharmaceutical ads, the agency was told the casting had to skew about two decades, reflecting the average age of participants in Lipitor’s clinical trials.

Merkley’s campaign, launched in late 2001, now stars attractive and shapely salt-and-pepper boomers—to illustrate the hidden need for the drug, a diva takes a tumble on a red carpet, and a swimmer belly-flops into a pool. In a recent ad, a pair of twins walks through a gym as graphics note statistics about their health; one brother, who crashes up against a glass wall of the building, has high cholesterol.

For fair balance, every product claim has to be supported by results of a drug company’s clinical trials. The main side effects discovered in those trials must be mentioned, which can take up about 20 seconds of a 60-second commercial, and ads have to lead consumers to their doctors and additional sources of information (such as “See our ad in Shape” or mention of an 800 number). In print, this translates to a full page filled with these details. (Reminder ads that don’t specifically discuss what the drug does, or disease-awareness ads that don’t mention a brand name, need not include a fair balance statement.)

“Generally speaking, [FDA overseers] do not like a great deal of cuts over the fair balance statement—they don’t want the visualizations or the action of the commercial to distract the consumer’s attention,” says Kathy Jenkins, chief creative officer of The Quantum Group in Parsippany, N.J., a unit of WPP’s CommonHealth. The shop’s most recent spot for allergy drug Clarinex features the B52’s “Roam.” “You have to have a creative idea that is really elastic enough to embrace the requirements. We’re still in our infancy in terms of the architecture of these commercials.”

The fear-inducing litany of side effects is a creative nightmare. “By the time you’re done with listing the side effects, all I’m left with is liver cancer, diarrhea and some other diseases—I don’t remember anything that came before that,” says Cheryl Berman, chairman and chief creative officer at Leo Burnett, Chicago, which handled advertising for Celebrex and Prozac until two years ago. “It’s incredibly hard to do great creative in pharmaceutical.”

The “80-step” process to get an ad in front of the public is so belabored that “the average first assignment to put something on air takes eight months to a year,” says Isaacs. “You’ve got to have patience, and you have to pick yourself up and dust yourself off multiple times.”

Recruiting production and postproduction talent who can deal with the delays can also be difficult. Editing on a campaign can take four to six weeks.”You need editorial partners who won’t jump out the window on the 10th change,” says David Fowler, executive creative director at Ogilvy & Mather, New York, who works on allergy drug Advair and cholesterol medication Zocor.

Despite the hurdles, Fowler says the work can be stimulating. “If you like the craft of making advertising, and you can appreciate the complex puzzles, then this is a very interesting category to play in,” he says. “We’re talking about creating a compelling message for a cancer medicine or asthma relief—that’s a really interesting, complicated, multilevel problem to solve, and that’s not for everybody. “

To reward those who take up the challenge, One Show Rx will dole out Pencils decorated with medical symbols to work that “rises above the norm in terms of creativity and innovation.” Says the organization’s executive director, Mary Warlick: “We know the restrictions they are working under, which no other vertical market has to work with.” Members of this year’s One Show jury, as well as creative directors specializing in healthcare, will evaluate both direct-to-consumer and professional ads for the show, which is set for November.

“To anyone who is a student of advertising at large, a lot of the healthcare/DTC stuff doesn’t register on the creative Richter scale,” says Joshua Prince, managing partner and creative director at Cline, Davis & Mann, the New York agency that had Bob Dole discussing erectile dysfunction in a 1999 Viagra spot. A recent ad shows co-workers unable to figure out why a Viagra user looks suddenly different. “It’s terrific to have a forum where you can highlight work for its creative and understand that it is somewhat different from general advertising.”

“Generally speaking, healthcare is to advertising as military music is to regular music,” adds Isaacs. “But the work is getting better, and the fact that The One Show is actively interested shows there’s finally enough cachet in what we’re doing.”

Yet while pharmaceutical advertising is beginning to walk and talk more like the rest of consumer advertising, it may not be producing greater results, cautions Bob Ehrlich, CEO of DTC Perspectives, a consulting and publishing firm in Randolph, N.J. “The ads look more visually interesting, but that doesn’t mean they are more effective,” says Ehrlich, a former vp of consumer marketing for Warner-Lambert division Parke-Davis. “Consumers in some of these categories are looking for straight information. All these things that have been added in the past few years, I don’t know whether they are more effective or not. I don’t know if Dorothy Hamill is better for Vioxx.”

Meanwhile, critics of pharmaceutical advertising argue that it drives up healthcare costs and encourages patients to demand drugs they may well not need. Creatives, in turn, say they are providing a service, giving consumers information that could make a critical impact on their lives. “Any information in any kind of communication that can creatively get consumers interested in bettering their health is a great thing,” says Prince.

“You really are selling help,” adds Jeanie Caggiano, svp and creative director at Leo Burnett, who worked on ads for Prozac before it went off patent two years ago. “I wouldn’t say it is a noble cause, but it’s as close as I got in advertising, outside of pro bono work, that I felt I was helping someone.”