Chapter 1 Birth of a notion.............................................1Chapter 2 A case study..................................................5Chapter 3 Why 'itis'?...................................................11Chapter 4 The detail that goes into saying nothing......................17Chapter 5 The silent killer.............................................23Chapter 6 Harley Street meets Sesame Street.............................31Chapter 7 Creative stem cell research...................................39Chapter 8 Creative preventive medicine..................................47Chapter 9 A prognosis for healthcare advertising........................69Creative Clinician's Grand Rounds........................................77

Chapter One

Advertitis[TM] is by no means a bona fide medical term. In fact, until the conception of this book, it didn't even exist. However, you may be surprised to learn Advertitis is not only highly contagious - it's worryingly widespread throughout the world of pharmaceutical advertising. What is Advertitis? And exactly why is it something we should be so concerned about?

One not so extraordinary day, a medical director was watching his creative director deliver a short, albeit pithy, presentation. The compelling demonstration showed how a powerful, single-minded advertisement could, through off-hand cursory remarks and ill thought-out opinions, quickly develop into a perplexing mess of tangled messages. The creative moral seemed simple enough. However, through the medical director's eyes, a very different story was being told. The creative director's few PowerPoint[R] slides weren't so much describing the gradual communication breakdown of a world-renowned advertisement but the gradual inflammation of extremely delicate tissue. To the physician the swelling was the result of an infiltration of a multitude of unrelated opinions that were infecting and beginning to tear the tissue beyond all recognition. The fact that an advertising concept is often called a tissue during the early stages of development made the medical director's observation all the more astute. Further discussion exposed and then centered on a disturbing truth. Today's pharmaceutical advertising is in the most fundamental sense an often-confusing mix of messages and claims with little priority in terms of importance. You only have to flip through the pages of JAMA to see how challenging many ads can be to decipher. It's not uncommon to witness half a dozen messages screaming at you at once. A place where clichd happy smiling patients, animals on skateboards and the ubiquitous boxing gloves all scrap for attention. Few ads cleanly state in a memorable manner one single differentiating claim - a real life-and-death state of affairs in a highly competitive and crowded marketplace.

As the creative and medical partners began to debate the reasons for this fundamental communication breakdown, they also questioned how they could buck the negative trend in a consistent manner. Undoubtedly, in many cases, ever-stricter regulatory guidance, limitations and mandates often temper the creative solution and completely suffocate any compelling communication. Obviously these layers won't disappear so the real challenge is to work within this complexity and penetrate the dense set of constrictions. The partners came to the conclusion that the conception and development of single-minded creative ideas rely on several critical factors: The creative has to be rooted and grounded in the medical and scientific rigor of the product and disease state. It has to be synthesized into a compelling, simple vision. To bring this into effect both creative and medical have to be joined at the hip every step of the way - not just by a cursory dialogue at the start of the project and then again at the end. Both concluded that without an innate connection between the two skills sets, truly compelling, medically relevant creative solutions would continue to be elusive. Without the insights into the minds of physicians, patients and customers, you can't take full advantage.

In many cases it is, at best, a piecemeal process, fragmented with no real consistency. Perhaps if a definitive set of criteria were proposed and adhered to, then every tissue would have the opportunity to thrive into a powerful piece of communication. The authors clearly believe this is the case and to reflect this important alliance they propose new titles be given to all creative and medical directors. It's the reason why the authors choose to call themselves Creative Clinicians.

Chapter Two

I was called to an emergency by my staff to respond to a serious incident that needed my immediate attention. When I arrived all was utter chaos. Confusion and disorientation swept through the room as many bystanders looked on this very tragic and traumatic scene.
I tried to get as much history as possible, rapidly and efficiently, from those huddled together amidst the panic. It became clear that there had been considerable past history of this type of presentation before.

As I focused on the task at hand, it was immediately apparent that the victims were unresponsive and motionless, barely hanging on to dear life. I quickly assessed vital signs that revealed a weak and thready pulse, shallow breathing and extremely elevated pressures. Reflexes were exceptionally blunted, central cognition was impaired and posturing was setting in among those affected. Amidst all this commotion, I suddenly noticed the horrific sight of exposed tissue that was severely inflamed and damaged beyond recognition. The body of tissue was grossly compromised: extremely friable, and swollen with obvious distortion.

I immediately requested a number of stat consults and began securing central lines to the victims. In the end, after reviewing the findings on physical examination, incorporating relevant history and expert opinion from a number of consults, I determined that the victims were suffering from a severe case of what we call . . . moderate to severe Advertitis.

Chapter Three

Advertitis[TM] (in case you were wondering), is not just a silly name for a book. 'Itis' by its very definition means inflammation. The condition occurs anywhere in the human body, be it an organ, tissue, joint or a nail. Dermatitis, for example, is the inflammation of the skin's dermal layer. Appendicitis is the inflammation of the appendix. Therefore in the minds of the Creative Clinicians, no word is more appropriate. Advertitis is defined thus: the inflammation of the creative tissue, which over time swells losing its integrity and purpose, due to external forces. Instead of simplicity, it's toxicity. In place of compelling, is swelling. The visceral reaction of the by-standing team in the previous case study is typically how customers react to the majority of published pharmaceutical advertisements (eliciting no response, thready pulse and hardly breathing). Right from the onset, opinion after opinion completely transfigures the delicate, native creative tissue. Every subsequent well-intended compliment (internally at the advertising agency and then externally at the client end) rips and tears the delicate structure, making it friable (bleeds easily) and unable to withstand scrutiny and pushback.

The Big Four

Typically, a physician defines inflammation by indicators known as the big four: rubor, calor, tumor, and dolor (red, hot, swollen, and painful.) A fifth sign of chronic inflammation called functio laesa, literally translated means dysfunctional tissue or organ. This is the point of no return as all sense of purpose is lost. Similarly, as opinions and conjecture attack the creative tissue, they display the very components or signs of acute inflammation. No longer are the creative tissues robust, full of valor, humor, and color. The Creative Clinician's equate several (though not inclusive) qualities to compelling concepts.. They believe the trigger for this inflammatory process in creative tissues is two-fold:

1) Initially, because a best practice process is not followed routinely, there is a lack of compliance or poor use of the tools available to help guide the creative work.

2) The driving force behind this is a cascade of compliments. Inherent in the physiologic process of creative tissue mutation is the sequence of mediators or compliments that drive inflammation.

The Compliment Cascade

The complement cascade, (in medical terms), draws some interesting parallels with the creative evaluation process. These are the very inflammatory factors that amplify response and activation of tissue-killing defense mechanisms, or cascade. In other words, here is a built-in, innate defense mechanism (a double meaning if you will), that both recognizes and subsequently binds to infectious/contaminated components or insult driving inflammation. Go figure! Okay, let's apply this hair-brained biological methodology to advertising. Anyone working in pharmaceutical marketing will testify to the frustration, systematic push back, and various immovable stances taken by all stakeholders. This slow, progressive infectious process inflames the creative tissue to such a degree that the very integrity of the idea is lost. Only until the tissue contains everyone's ideas - and conversely no one's - is agreement "reached" (with a huge collective sigh of relief!). This end result, however, is rarely a happy median.

Chapter Four

So let's go back to the beginning. The creative tissue, a beautifully crafted yet simple idea starts life as no more than a sketch and a few words on paper. If it's truly a great idea it will eventually have the ability to engage the minds of millions and drive them to purchase the advertised product. A tissue drawn out for the first time is an exciting moment because at this precise instant it has infinite potential. Here lies the competitive edge - the creative means to outmaneuver and defeat the competition.

Once the creative team has landed on several concepts an internal presentation is held. For the first time the tissue is open and exposed to the environment that lies outside of the incubation unit - the creative office. In these vulnerable moments of life, the tissue, newly conceived is proffered up to an assembled agency audience of varying backgrounds. This is the single most important meeting in the life of a tissue because this is the moment in which it will either thrive or, as is often the case, be subjected to highly invasive and extremely wide-ranging deliberation. A whole multi factor of influencers - or compliment cascade - will descend on the single-minded thought. If the forthcoming discussions and opinions are not managed in a way that enables the idea to grow and flourish, the body of the tissue will quickly be attacked, becoming compromised and inflamed. As contamination persists, so the tissue continues to lose all integrity as debate, positioning of opinion and posturing all kick in. With the inflammation and compliment cascade in full force, defense mechanisms, compromised positions, barter and negotiation all take precedence over the creative evaluation. Remarkably, even the creative team, whose concepts they are, is wide now open to change. There is now an almost frantic need to make the concepts more correct. In fact, making the concepts more correct has become the whole goal! We're almost there ... a few more tweaks ... hey, we're on a roll! Sound familiar?

Of course, many more rounds of debating and postulating are assured. Agency, client and the subsequent cycle of research will all continue in their quest to make the concepts more correct. So by the time it reaches the hallowed glossy interiors of the medical journals it'll be a perplexing mess of countless message points. Paralysis from the headline down, eyebrows, subheads and tag lines will grapple for the reader's attention. Eyeballs will juggle with an information overload. It's new, it's improved, it's longer lasting, it's almost always the #1 physician prescribed and of course it provides the tolerability patients need and the efficacy they deserve. Now void of sensation. It reads like an epitaph rather than an advertisement. This is the detail that goes into saying nothing.

Chapter Five

Never shy of an analogy, the Creative Clinicians present one that truly bats the proverbial ball out of the legendary park. Looking closely at this slow, incendiary pathology they discovered a profound parallel with an equally inflammatory viral infection called chronic Hepatitis C (HCV). Here the smoldering process damages the liver tissue, distorts and scars the architecture and ultimately affects the overall functionality of the liver. In many instances, it's not known where, how or when the actual infection arose. Yet due to its nature, the course of illness is nearly always protracted. Often those affected don't know it for decades. The very same signals and red flags that are the hallmarks of chronic HCV infection are central to the briefing, conception and subsequent evaluation of the creative concept. Silent, slow, progressive tissue damage which over time continues to impede the intended communication.

Of course, the liver is, by its very nature pretty resilient in terms of function. This is because it has a lot of reserve, bags of capacity. Incredibly, 75% of the liver could be knocked out before its function even begins to be compromised. Unfortunately, by then enough damage has occurred that cognition becomes impaired and confusion holds sway. This is encephalopathy associated with end stage liver disease, where circulating toxins run unfiltered and create havoc through the system. Inevitably, the sufferer becomes more and more confused as toxins and waste products circulate unfiltered and unchecked as functionality continues to fade. The sufferer is thinking, I don't understand what you're saying. I don't understand what it is I'm not doing. In this case, the organ has been chronically injured to the point of dysfunction readily seen as confusion. Communication is irrevocably compromised and impaired.

The Broca's and Wernicke's Advertisements

The classic medical description of compromised communication is aphasia (loss or impairment of comprehending words or processing communication) and is commonly divided into two specific types related to the area of the brain tissue affected. The first is Broca's aphasia, an expressive aphasia, where the sufferers have every intention of expressing themselves, want to say something, but cannot perform the actual output of communication. The other is Wernicke's aphasia, a receptive aphasia, where they are able to say all kinds of things but in no coherent order. None of it makes any sense whatsoever. They confabulate. They talk gibberish. Interestingly, both types of aberrant communication are the result of severely damaged inflamed tissue that draws some interesting parallels within marketing. The Creative Clinicians have termed this atypical marketing communication as creative aphasia. This new nomenclature has in turn been broken down into two types: 1) The Broca's advertisement, where the reaction is that the ad says absolutely nothing to the observer or customer; 2) The Wernicke's advertisement where the ad is saying innumerable things but none of what's being said hangs together. There's nothing receptive at all. It's like a word salad - all chopped up and thrown together. In both cases, the result is an inability to communicate the simple single-minded message. You can test this theory by flipping through a few medical journals. Very quickly you'll discover that many so-called communications are simply not fulfilling their purpose.

High-Risk Lifestyle

So, what are the causative factors for creative aphasia? Who are the guilty parties? Can it be quarantined? Is it even curable? Again, the answer can be found in the chronic HCV analogy. Chronic HCV is a viral infection and insult to the organ that can be due to a risky lifestyle or a life of indiscretion, (what physician's call indiscretions of youth). Pharmaceutical marketing often practices in a fragmented, splintered way, and while there are tools or other systematic ways to ensure quality control rarely are they being used in the most effective manner. Is the correct dialogue happening at the beginning of the process? Are the processes and the tools being used in a judicious manner? If not, it's simply system du jour. And that's risky. In essence, this is analogous with the high-risk lifestyle chronic HCV patients tend to lead. How many get liver disease? How many know how or where they contracted it? Well guess what? Those that contract HCV commonly have a high-risk lifestyle, often unclean needles, and drug abuse - hanging with dodgy crowds. Admittedly, there are others who contract HCV who don't have this lifestyle as a risk factor but it's a lower percentage. Fundamentally, the risk increases when you are not following good, healthy practices.

(Continues...)

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Advertitis

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