Concept Diagnosis

Taking the pulse of the worst & best in healthcare advertising

Author: Dr. J

Beware of Paper Tigers – Their Cut is Worse Than Their Bite

In the world of healthcare advertising, if you can think it, it’s probably already been done. Make sure to do your homework because even the most uncommon ideas, like say…origami animals, have been unfolding in pharma for years, becoming yet another cliché.

AMITIZA1AMITIZA2AMITIZA (lubiprostone) is a treatment for chronic idiopathic constipation. It increases fluid secretion in the intestines, which increases intestinal movement, which helps make it easier to have bowel movements. This MOA seems to be represented in their logo, a tight blockade of rectangles that start to dissipate and turn into flying birds. If there is one brand in pharma that has the rational excuse to use origami in their marketing, it would probably be AMITIZA. Those rectangles become paper transforming into origami birds, which is exactly what we find in a 2007 ad. Here, the AMITIZA bird is made of green branded paper singing branded paper musical notes. In the AMITIZA convention booth, the origami icon comes to life above its audience.

SeroquelThis 2012 ad for SEROQUEL (quetiapine) from Australia bears a strong resemblance to the AMITIZA birds, this time with flying origami crane. Yes five years have passed, yes it’s on a continent on the other side of the world, yes it’s in a different therapeutic category, but why would you still use an icon that is strongly tied to another global pharmaceutical brand? Maybe they should have created origami jailbirds because it’s a crime!

Picture 44A 2010 ad for SANDOSTATIN (octreotide) and a Portuguese ad for PEGASYS (peginterferon alfa-2a) are almost identical. Both use printed clinical data to create their origami animals, a rhino for SANDOSTATIN and the iconic Pegasus for PEGASYS. The PEGASYS headline reads “Clinical studies and a lot of research transformed into life.”origami_pegasys_42x30_02_o_905 The big question is, which one would win in a fight, the rhino or the mythical Pegasus?

ZPAKThe brand that did it first and probably the best using paper sculptures, was ZITHROMAX (azithromycin) promoting the Z-Pak in 2002. Not only did it emphasize its excellent efficacy using animal predators, but created them using the purple Z-Pak packaging. The Z-Pak was a unique marriage of dosing regimen and marketing. Even today, patients still request Z-Paks from their physicians. Hopefully no fingers were harmed or cut creating these ads.

It’s a constant battle of creative wits to be original, not only when you’re competing internally with other creative teams for the big idea, but competing with creative healthcare history….just be careful you’re not repeating it.

Lions and Tigers and Metaphors, OH MY!

The most used metaphors in the history of pharmaceutical advertising come from the animal kingdom, and probably none more so than the members of the genus Panthera: the tiger and the lion.

What’s not to love about these feline icons? They’ve been featured prominently in ancient mythology and folklore for thousands of years. They appear globally on many flags, coats of arms and as mascots of sports teams (especially if you live in Detroit). They are majestic animals and powerful, fierce hunters. You can find “a tiger in your tank” (Exxon), in your bowl of cereal (Frosted Flakes) or roaming the sales materials of representatives in doctors’ offices. Here are just five examples.

Tygacil2007TYGACIL (tigecycline), a broad-spectrum hospital anti-infective from Wyeth, was approved in 2005. The launch ad depicts TYGACIL as a tiger, “A POWERFUL NEW PARTNER”, walking alongside a doctor through a hospital corridor. Obviously the doctor now has a manageable, yet fierce, antibiotic to fight resistant pathogens. While I don’t condone the use of endangered species in pharma ads, I could see the lure of reinforcing TYGACIL’s name recognition with a tiger at launch.

ValcyteVALCYTE (valganciclovir) is prescribed for the prevention of cytomegalovirus (CMV) disease in high-risk adult and pediatric transplant patients. In this multi-page ad, one of the indicated pediatric patients is depicted as a tiger cub, helpless and possibly within the sights of a predator. “WHEN THE RISK IS HIGH”, you need “THE POWER TO PROTECT”. We get it, VALCYTE is now the tiger because there is no fiercer animal than a tiger or lion momma protecting her young…’nuff said! But it’s still just a stock shot of tigers as I’m waiting for Marlin Perkins (google him, kiddies) or Jeff Corwin to narrate this documentary.

In the pharma world, 2009 must have been the Year of the Lion because we were introduced to two lion campaigns (not be confused with Cannes Lions).Combigan

Allergan’s COMBIGAN (brimonidine/timolol) treats pressure in the eye caused by glaucoma. The brand is depicted in their ad as a lion comfortably sitting on a couch (probably watching Born Free…google that too, kids!) next to a patient reading the Global Times. “POWER YOU CAN BE COMFORTABLE WITH”, until you get mauled to death in the comfort of your own living room or by a tiger in the hospital cafeteria.

Nucynta10.2009The creative brief for painkiller NUCYNTA (tapentadol) probably had two words leaping off the page for the creative teams: gentle strength. That would explain why we see a Casanova King of the Jungle with a rose in his mouth ready to lure you into a lascivious tango or to be his dinner.Humira2012

Abbott, makers of HUMIRA (adalimumab) turned the tables in 2012 and made these animals a vicious threat as we see a leopard coming out of the darkness eyeing us like a gazelle with gout. No headlines are necessary here because in healthcare advertising no one can hear you scream (unless you see an ad using red boxing gloves, but that’s a topic for another article). Turn the page and you can hear HUMIRA shouting, “Honey, I Shrunk the Cats!” as a tiger, a lion and the leopard now conveniently fit in your palm but still large enough to gnaw the fingers from your hand.

Those were just a few examples, but there are many more. We haven’t had any lion sightings in a while, but those big cats are lurking out there, waiting to be used as an icon for your next client. Fight the urge and make these metaphors extinct.

Don’t Pull That Cliché Ripcord…until the last possible moment!

When you’re making that creative leap, your first few rounds of creative should always avoid the expected pharma metaphors and clichés. Only as a last resort, after the client has rejected 101 brilliant concepts, is it appropriate (yet painful) to pull your metaphor safety cord.

Here are three global ads that use parachutes as their visual hook. Which of the ads is unlike the other?

Konverge-12011KONVERGE is indicated for hypertension in patients whose blood pressure is not adequately controlled on olmesartan medoxomil or amlodipine monotherapy. This 2011 ad from A. Menarini Pharmaceiticals Ireland and Daiichi Sankyo depicts two special forces commandos in branded parachutes on a mission into hostile territory, “combining forces in hypertension control.” The only surprise here is that the client approved the use of military images, usually a polarizing issue in the global market, and normally seen as US-centric because of our perceived “war-mongering” ways.

TresibaApr2013-TRESIBA, a new-generation once-daily longer-lasting basal insulin that increases dosing flexibility for adult patients with type 1 or type 2 diabetes, was launched in the EU in 2013. Here we see three consecutive parachutes carrying HbA1c numbers, coming in for a targeted landing next to a smiling, satisfied patient because we’re getting “HbA1c down with control.” There are no special ops forces depicted, but because of the brand’s color, the green parachutes and the patient’s requisite green branded sweatshirt, it gives the ad that military camouflage wartime feel.

Dukoral-112011Lastly, from Quebec, comes an ad for DUKORAL, an oral vaccine for protection against travellers’ diarrhea. While the execution and design could be stronger, here the parachute is situational rather than metaphorical. Parasailing on vacation, “This is not the right time to have travellers’ diarrhea.” We get it, Montezuma…a real situation that makes your sphincter tighten up at the thought of it.

SAMSo just remember that even though you strive for brilliance, there will come a time in the creative process that you’ll have to jump and open the metaphor chute. Think of it more as a free fall, finding your parachute bag filled with camping equipment, as you watch your creativity plummet and then splatter on the earth below…but at least you’ll end up with a cliché-happy client and a portfolio of brilliant comps.

Birds of a feather flock together

“Let the pigeons loose!” I think of that phrase every time I see a pharma ad using birds as a visual. Children of the 70’s might remember the demolition derby episode of Happy Days with the Fonz and Pinky Tuscadaro versus the Mallachi Bros…it was Count Mallachi’s signature line. He said it over and over and over again across a two-part episode. Birds also appear in pharma advertising over and over again, “Let overused metaphors loose!”

requipBack in the day when GSK was SB (SmithKline Beecham), they launched REQUIP for Parkinson’s disease using a white dove released from its cage. The dove, flying upward at full wingspan, signified hope from the constraints of Parkinson’s.

Luvox_If there was a pharma creative statute of limitations, Jazz Pharmaceuticals was probably safe from getting a phone call from SB or GSK. About ten years later in 2008, LUVOX for social anxiety disorder (SAD) and obsessive compulsive disorder (OCD), launched the brand using a white dove being released from its cage. Same white dove, same perspective, same full wingspan, same coloring and same background, going from dark blue to purple to white. The only difference was that the image was pulled back to put emphasis on the birdcage with the effects of the disorders spelled out on the bars of the cage. We’re told that “Patients can often feel caged in” and now they can “Experience a new release.” I feel bad for the parakeets at my local pet shop.

AMITIZA-7The “freeing the caged bird” theme continued with the DTC ad for AMITIZA, indicated for chronic idiopathic constipation in 2007. This time a green sparrow is freed from its gold prison to the exclamation of “Predictable relief may help you break free.” I’d love to see the insight research that showed patients connote having a bowel movement with birds escaping jail.

AnoroBirdcages appeared again in a Canadian HCP ad for ANORO ELLIPTA, a bronchodilator for COPD. The twist here is that two cages hang from one chain simulating human lungs. Both doors are open freeing dozens of white birds with the tagline: “Breathe”. While it’s still another birdcage metaphor, at least it’s more apropos to COPD than to constipation.

While we’ve hopefully seen the last of birdcages, a Hitchcockian cloud seems to still hang over our industry. One of mankind’s greatest mysteries (or at least to the several thousand people in the healthcare & healthcare advertising industries since 2012) is Lilly & BI’s TRADJENTA campaign, indicated for glycemic control for patients with Type 2 diabetes. The launch ad shows a yellow bird building a nest with the headline “Focusing on what matters”. What matters? Building a nest? Protecting baby birds? How does building a nest connect with type 2 diabetes? What type of bird is this? Do I need to be an ornithologist to understand what’s going on? More riddles here than the Sphinx!TradjentaUS

Many hours have been spent in healthcare agency kitchens and conference rooms trying to decipher this concept. How did doctors in market research, who are notorious for not wanting to think when they view ads, choose this one? THEY got it? It doesn’t make sense or does it?

TrajentaCAUpon deeper investigation, we learn several things. This is a global campaign and a co-promote which means there are four clients for the agency: Lilly US, BI US, Lilly global and BI global, usually a difficult recipe for creating campaign consensus; and two audiences, US and ex-US physicians each with their own cultural tastes. In addition, thought had to be given to how the branding would extend to the launch JENTADUETO (linagliptin with metformin) that would follow shortly after. Perhaps this campaign was the one of least resistance. Only the parties involved know how it went down. If we start looking at some of the global work over time, we find a clue…a blurb about the Ploceidae family of birds next to the image, which then leads us to Wikepedia. We discover that the Ploceidae are also known as weaver finches, because of their elaborately woven nests. Is that what makes TRADJENTA special, because it allows physicians to take special care and better control of the intricacy of type 2 diabetes? Is the elaborate nest a testimony to efficacy? Wow, mystery solved, Scooby-Doo! I think. So much for the three second takeaway. (We’ll save the discussion about the ex-US superhero logo icons for another time). Call me the Birdman of Linagliptin!

Kyprolis-40875-hcpUSALastly, in the “What are the chances that two brands simultaneously launch with the same icon?” category, we present KYPROLIS, a second-generation protease inhibitor from Onyx Pharmaceuticals and BETHKIS for cystic fibrosis from Chiesi Farmaceutici. While they both launched in the spring of 2014 and are each indicated for completely different diseases and audiences, they both use a hummingbird as their icon. As to why the hummingbird, please do your own Google search!djs_chest_145_5_cover.indd

“I think we’re in real trouble. I don’t know how this started or why, but I know it’s here and we’d be crazy to ignore it… The bird war, the bird attack, plague – call it what you like. They’re amassing out there someplace and they’ll be back. You can count on it…” So if you’re compelled to use BIRDS for your next concept, just think of what happened to Tippi Hedren in the movie of the same name.

Oncologists Get Their Orca On

KILLERwhaleCOMETRIQ is indicated for the treatment of patients with progressive, metastatic medullary thyroid cancer. Prognosis is poor when the cancer has metastasized beyond the thyroid gland. In clinical studies, COMETRIQ helped to delay the growth of MTC tumors in some people and shrink MTC tumors in others.

The creative teams were tasked to bring COMETRIQ’s unique triple action MOA to life. Somewhere between the first internal creative review, several rounds of client presentations and multi-city qualitative one-on-ones, the creative process got beached.

Would you trust Jacques Cousteau with your thyroid cancer?

The first person I think of to treat thyroid cancer is a marine biologist. Why else would I see three killer whales attacking a school of fish in this communication to endocrinologists and oncologists? Killer Whales? Cancer? How is it relevant? If Jacques Cousteau were alive, he would explain to us that killer whales are sometimes called the wolves of the sea, because they hunt in groups like wolf packs. Large school of herring are often caught using carousel feeding – the killer whales force the herring into a tight ball by releasing bursts of bubbles and then slap the ball with their tail flukes killing up to a dozen fish at a time. “Wow, much like the way COMETRIQ inhibits the activity of MET; VEGFR-1, -2, and -3; RET; and other receptor tyrosine kinases, in vitro!” said no one ever, except maybe the client’s medical director and brand manager.

While there hasn’t been another “killer whale” ad in pharma (at least none in captivity), why jump to borrowed interest? Did the creative director approve this or was the metaphor thrust upon the agency by the client? In today’s “legally driven, risk-adverse, keep the client happy so we keep the business, dumb it down for doctors because they don’t want to think when they see an ad” environment, it is very tempting to succumb to the mediocre metaphor. As creatives and as agencies, we must persevere to create provocative and engaging communication and educate clients to its benefits.

Now, if you have to use a borrowed interest cliché or metaphor, push it – put a little spin and surprise on it. In 2005, TITRACE ran a “Whale” ad of its own so engaging it would warm even Captain Ahab’s heart.

TITRACETITRACE was an ACE inhibitor that also reduced the risk of MI, stroke or CV death in vulnerable patients. The main message the creative team had to deliver was: TITRACE saves lives. Rather than depict patients in a somber tone to reflect the seriousness of the disease, the agency used humor to create more impact. Under a call to action headline, “Save the Whale”, was an image of an overweight patient in the bathtub spouting water from his mouth. “Save the Whale” was the first in a campaign of overweight patients as endangered species, followed by Save the Panda, Penguin, Walrus and Tiger. Jon Watson, the TITRACE Creative Director at Lowe Azure UK put it simply, “A big message, softly spoken, often has more impact than one rammed down the reader’s throat.”

It was brilliant, but not without risk…risk of offending doctors and overweight patients, and risk of pissing off Aventis. The client felt it was worth taking a chance and market research confirmed that it was very relevant to physicians. As a result, the campaign had an 80% spontaneous recall with docs and the brand exceeded sales.

Save the Panda

Save the Panda


Save the Walrus

Unfortunately if the TITRACE campaign were presented today, 10 years later, it probably would never make it past the client. In the lawsuit-happy world we live in, where the easily offended use social media as a pulpit, it is doubtful that there is a brand manager willing to take the risk of calling their patient a whale and then seeing the outrage trending on Twitter the next day (Calling them pandas? Maybe. Everyone likes cuddly pandas). And remember, the Med Legal Gods don’t like definitive words like “Save” and “Proven”. The headline would be modified to read, “May Save the Whale” or “Assist the Cetacean-like Patient” and the tagline, “Proven to save endangered lives” would become too long to be considered a tag.

Screen Shot 2014-11-15 at 11.12.26 PMYes children, today’s creative teams wear med legal handcuffs, but that’s no excuse not to strive for brilliance and at least try turning a metaphor on its head to engage your audience. Don’t let your creativity become an endangered species!

Giving MS the finger



GILENYA was a transformational advance as the first oral treatment for people with relapsing multiple sclerosis. With no more painful injections to take on a regular basis, patients could forget about their disease while its efficacy got them back to leading active lives. Novartis launched GILENYA in 2010, and was followed by Sanofi’s AUBAGIO and Biogen Idec’s TECFIDERA.



As a game changing oral therapy, it was logical that the GILENYA launch campaign focus on the convenience of the pill, as well as the benefits of its efficacy. The global HCP communication depicted an active patient viewed through a visually prominent opening between two fingers holding the pill. It was a new perspective on MS therapy.

Physicians around the world recognized that this icon conveyed efficacy and tolerability delivered by an oral treatment. The DTC campaign continued the strong branding with its “Possibilities” ad. Here we see the same hand from the HCP campaign holding the pill as the letter “I” in the headline, with the patient in the background. GILENYA makes a strong case study of true global branding, spanning multiple cultures and audiences.



One of the basic ground rules of concepting is to analyze the creative competitive landscape – what visuals and icons are your competitors owning and what branding and messaging are physicians exposed to. This way you can avoid branding repetition and confusion and ensure that your brand is positioned uniquely.


HCP launch ad

So then in 2013 along comes TECFIDERA, third oral to the MS market. The HCP launch campaign was your basic announcement ad with branded colors and capsule shot. A year later, a DTC ad appeared touting TECFIDERA as the number one prescribed pill for relapsing MS with…wait for it…two giant fingers holding a green capsule simulating a bridge as a patient walks across it over a stream! TecfideradtcAt a quick glance, this could be another GILENYA ad. Was this intentional? Did the agency not do their homework? Did Biogen Idec not care? Yes, it’s been three years since the iconic GILENYA launch, but has that time wiped the branding from the audience’s minds? And even if it has, this concept still feels like borrowed goods. On principal alone, why would you use a direct competitor’s visual icon? Remember, if it feels like it’s been done before, it probably was. If I was Novartis, I’d be calling the concept cops because they were robbed! I’m giving this TECFIDERA ad the finger – a thumbs down for unoriginality.

My Knight In Tainted Armor


The creative team is gathered at the Round Table. Before them is their quest, two words written on a brief: POWERFUL PROTECTION. Where for art thou, Sir Metaphor??

What’s not to like about Knights? They fought bravely, wore cool protective armor, held shields branded with their own personal logos, they jousted and lived by a moral code of chivalry. Knights are the epitome of “powerful protection”. There are many drugs on the market that also offer powerful protection. “Hey, let’s use an ancient medieval icon to represent our modern therapy”, said too many agency creatives (and probably a few brand managers).

Velcade-2008How will this icon represent the brand? Will it make an emotional connection with physicians and be imprinted in their minds and hearts or will it quickly say “powerful protection” for a fleeting moment until a journal page is turned or an iPad screen swiped?

VELCADE (multiple myeloma) has its purple knight poised for battle with rays of hope beaming through a rather large transparent shield. If you look closer, it may not be a knight at all, but rather a member of the riot police about to beat down an insurgent crowd. Regardless, a physician will only spend 1-3 seconds taking it all in, so for practical reasons, let’s say it’s the Purple Knight.

There is promise on the horizon (note the rising sun) with DEXILANT (GERD). This knight, glistening in highly polished armored, proudly displays anDexilant2012 infographic shield. Take heed, your strongest icons are singular in focus. Here, the DEXILANT knight is attempting multiple messages, “power, day and night.” Just to make sure the reader gets it, “power” is highlighted in bold lime green in the headline. And in case you don’t associate knights with heartburn, the indication is presented in 700pt type. My only question is, “Where is the fire-breathing GERD dragon?”

REYATAZ (HIV) gives you double protection with two layers of knighthood, but only if you’re wearing a branded sweater.


PerjetaEvery knight knows that you are vulnerable if you leave the castle wearing only your “chain mail” (the layer of tiny metal ring linked together in a mesh pattern). Right before your eyes, PERJETA (breast cancer) transforms gold mesh into gold-plated armor for gold standard protection!

If you have a gun (or a sword) to your head and have to use a metaphor, a rule of thumb is do something to it to make it unique, so that it stands apart from its clichéd predecessors. Does it make the concept any less pharma-cheesical? No, but at least it won’t be a carbon copy of another brand’s used icon, which is what INCIVEK (Hep C) did with their knight.

Incivek2012INCIVEK supersized their jousting knight with “SPEED, POWER and PRECISION” by putting him on a high-tech motorcycle, lance in hand and branded cape flying, having just pierced and destroyed a Hepatitis C cell. Is it memorable compared to other knight icons? Yes. Is it still a cliché? Yes.


The motorcycle jousting scene

knightriders_ver2_xlgWhile I’m still not a fan of this concept, there is a special place in my heart for this particular icon because it makes an emotional connection with me. Why? It takes me back to 1981, to a movie from my youth that I fell in love with but haven’t seen in decades. If you like Arthurian legends, then you must check out Knightriders, directed by George Romero and starring a young Ed Harris as the leader of a group of traveling knights who compete in jousts on motorcycles at Renaissance Fairs. It was a current take on Camelot, although 1981 is already feeling like the Middle Ages. I’ve always wondered if the creative team was “inspired” by this movie, with its knights on bikes, and if I was the only one this icon made a human connection with? Want to use metaphors? “We are the Knights who say NO!” (Monty Python & The Holy Grail reference).

“…going off the rails on a crazy train”


Ozzy Osbourne was right. Creativity can go off the rails pretty quickly. The problem with most metaphors is that they’re not ownable, especially in HCP communication. The more you use them, the greater the chance of a train wreck, as we witness with these four campaigns.

Four different agencies each had a creative brief with these words, most likely, as the main point: RAPID & POWERFUL.  What happened behind closed agencies doors is known only by the creators of these campaigns.  Were the concepts agency driven or client driven?  Did they start off as insight driven communication that made an emotional connection with the healthcare professional or did the client ask for an icon to tell a two-part story? The stories behind campaigns are endless and unique. For all we know, these campaigns may have been the most successful in the brands’ history, and hats off if they were!  Or, perhaps conveying information alone wasn’t enough to change customer behavior.

The lesson here is exercise caution when using metaphors. If you’re going to go down that road (or those tracks), check to make sure they haven’t been done before or recently. While one could argue that they’re for different indications and don’t compete directly with each other, a physician may be exposed to all four. Cover over the logo on each of the ads and the visual becomes generic. “Generic? But they’re branded!” Yes, they are. PICATO (for actinic keratosis) is the high-tech train of the future; RAPAFLO is branded blue for the watery world of BPH and it would seem that the AFINITOR (oncology) and STRIBILD (HIV) trains came off the same production line. At the end of the day they’re just locomotives parked in the West Side Rail Yards at Penn Station.


Hippocrates“It is far more important to know what sort of person has a disease than to know what sort of disease a person has.” -Hippocrates

Even the Father of Medicine felt it was important to “walk in the customer’s shoes”.


You may have a mild case of the Pharma-cheesical

Is your latest concept depicting boxing gloves to address your brand’s “one-two punch” strategy? Do you see hour-glasses when you think of time or lions when you envision power?  Well I’m sorry to inform you that these are just a few of the signs and symptoms of the “Pharma-cheesical” virus.

Pharma-cheesical is a medical term referring to the cliches of healthcare advertising that causes communication to be bland and anemic, lacking personality or insights. This is often accompanied by the use of rehashed, ridiculous metaphors that have no emotional connection to the patient or physician. The Pharma-cheesical virus may also cause you to depict patients gardening, kayaking or taking relaxing strolls on a beach…because all seniors on therapy partake in these activities every day.

We’ve all been afflicted by this creatively insidious virus maybe once or twice in our careers. It’s very contagious, often spread by clients who are uncomfortable with provocative ideas and doctors in market research who don’t believe in marketing but whose comments are taken as law. Young creative teams are also susceptible to Pharma-cheesical while searching for inspiration on stock image sites.

There is no preventative vaccine. Washing your hands with soap and water several times a day won’t help. The only way to protect yourself from the Pharma-cheesical virus is EDUCATION. Know the signs and avoid them, pure and simple and boost your conceptual immune system by understanding what great looks like and why.



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