If We Didn't Advertise We'd Go Broke Treating the Poor Print

Cover06.24.09(San Diego Reader June 24, 2009)

Many of us watched the Chargers’ season-ending run this past winter and, amid the cheers and groans, saw a 30-second TV ad starring LaDainian Tomlinson. Well-dressed and calm, he’s holding a postgame news conference.

A reporter asks, “L.T., what got you the win today?”

“There’s three things you got to have to be successful,” L.T. says. “There’s planning, teamwork, and constant communication.”

Cut to designers huddling over architectural plans.

“What’s the key to team success?”

“Well, you got to start with the right foundation. That’ll get you through the season and beyond.”

Cut to hard hats pointing at blueprints and standing before a giant pit and an earthmover hoisting a shovelful of dirt.

“So, L.T., what do you see looking forward?”

“Great things are happening.

You just got to execute the plan.”

Out pops L.T.’s million-dollar smile, and a companion glint flickers off his diamond ear stud.

Cut to a graphic artist’s computer rendering of a giant new building.

An athlete putting his name on stuff is hardly surprising. What is surprising is where the ad ends. The heraldic music rises to a crescendo to deliver the last five-second punch: “Palomar Pomerado Health. Specializing in You.”

A hospital? Not a car or jewelry or shoes or Viagra or ESPN’s SportsCenter. But a hospital. Why does a hospital have to advertise?

When I phoned Don Stanziano, public relations director for Scripps Health, and asked that question, he turned it back on me: Why wouldn’t we? As in, doesn’t everybody? As in, the only way to distinguish your product and service (as well as your brand) in the competitive health-care world is to aggressively market what you have and who you are. Who would know we exist if we didn’t advertise?

The short answer to why hospitals must market is roads. Gone are the days when a hospital served only its immediate geographical area. Now, freeway-linked, a person living in Rancho Bernardo does not feel obliged to go to Palomar hospital in Escondido but can shoot across Highway 56 to a heart program at Scripps Green on the coast. Facing knee-replacement surgery—as expensive as it is painful—the smart patient goes hunting. Some insurance providers allow her to shop for nonemergent care, and shop she will, getting second and third opinions, seeking the most competent doc and one with whom she’s most comfortable. For choosy consumers, it’s a feast of movable options.

To attract the choosy, hospitals must market. To survive in the competitive health-care field, they must fill their beds, which means selling their services, which means branding their names with catchphrases and slogans. UCSD: “The Power of Academic Medicine.” In addition, hospitals are held captive by health-care consumers’ expectations. Reacting to the publicity new hospital programs generate in the media, San Diegans want what they believe is already available elsewhere. We should have the new prostate-cancer treatment that New Yorkers have. What’s more, consumers require that their health system offer fast, accessible, topflight care, no matter the ailment, no matter the cost.

Because health care also seeks the elective-surgery crowd, it must finance fancier offerings and charge customers extra. When I was young, a hospital was a place where the sick lay bedridden amid the drab purgatory of beige walls and industrial views. These days the hospital is (sold as) a homey institution, located on a campus, sporting a park and work-out track. The contemporary medical center may include the resort’s fitness room, the spa’s Jacuzzi, and the luxury suite’s state-of-the-art TV, video conferencing, toilets for the disabled, and beds whose built-in computers monitor the patients’ vital signs.

Catering to our expectations and keeping pace with their competitors, hospitals now and those planned for the future, specialty clinics and cancer programs, weight-loss centers and robotic-surgery units are all muscling themselves into our consciousness, marketing the likes of LaDainian Tomlinson as well as patient video testimonials. If you haven’t noticed the extent to which hospitals are slipping slick radio ads into your drive time and infomercials onto your late-night TV, then you’ve been hunkered down in the backcountry far too long.

San Diego’s Big Four

Along with Palomar Pomerado Health, San Diego’s big hospital systems are Sharp HealthCare, Scripps Health, and UCSD Medical Center. But note: these systems have two or more hospitals, medical groups, and specialty clinics. Two, Sharp and Scripps, are comparable in size, budget, and market share, each having about a quarter share of the market. Together, these four serve 66 percent of San Diegans and their medical needs.

At Sharp HealthCare, there are four acute-care hospitals, three specialty hospitals (among them Mary Birch Hospital for Women, which sets the annual California record for births), two affiliated medical groups, three skilled nursing facilities, 2600 affiliated physicians, and more than 14,000 employees. Sharp is the largest private employer in the county. Most San Diegans know Sharp Chula Vista, Sharp Coronado, Sharp Memorial, and Sharp Grossmont, the largest with 481 beds. The Sharp Health Plan has 45,000 members, one of which is the City of San Diego.

Scripps Health has five acute-care hospital campuses, ten Scripps Clinic locations, and nine Scripps Coastal Medical Center locations. The Scripps Mercy trauma center, located in Hillcrest, is placed south of I-8, where almost half of the county’s trauma occurs. Scripps employs 12,000 and has 2600 affiliated physicians.

The Palomar Pomerado system comprises Pomerado Hospital with 107 beds in Poway and Palomar Medical Center with 319 beds in Escondido; there are also outpatient centers and satellite sites, like the PPH expresscare clinics operating inside Albertsons in Rancho Peñasquitos and Escondido. Palomar Pomerado employs 3700 and has 700 doctors. The service area for Palomar Pomerado is 800 square miles, much of it in the county’s sparsely populated backcountry.

Finally, UC San Diego Medical Center includes schools of medicine and pharmacy on the University of California campus as well as two hospitals, whose employees total 5200. One medical center, Thornton Hospital, is on the UCSD campus, and the other is in Hillcrest. Both are served by one faculty medical group, some 800 physicians, most of whom practice, focus on research, and teach at the medical school. There are a few primary-care and specialty clinics, like the Eating Disorders Clinic, the Shiley Eye Center, and the Moores Cancer Center.

Inpatient discharge data, compiled by the California Office of Statewide Health Planning and Development, is used to measure market share among hospitals. As one marketer told me, “We watch it like hawks.” In 2007, Sharp applied for—and won—the Malcolm Baldrige National Quality Award, given by the president to recognize “performance excellence” in health care, education, and business management. In the application, Sharp reported comparative market shares for San Diego health systems. As of 2005, Sharp had the largest market share at 27.27 percent, followed by Scripps at 22.18, Palomar Pomerado at 10.68, UCSD at 6.51, and all others at nearly 34, including Kaiser at 9.62 percent. Kaiser is a member-based health-care organization that has almost 3.3 million subscribers in Southern California as well as 22 hospitals, clinics, and medical offices in San Diego County.

Compared to the thousands of doctors and nurses and administrative staff, the marketing and communications staff in each health system is small, at best, a few dozen employees. Marketing, as defined by the American Marketing Association, is an activity that creates, communicates, delivers, and exchanges “offerings that have value for customers, clients, partners, and society at large.” The four marketing departments focus their “offerings” on advertising, web design and operations, customer strategy, media relations, multicultural relations, physician liaison, and more. Not counting call-center personnel, Sharp employs 55 people, 15 of whom design and run its website as well as produce its videos, perhaps the biggest new thing in hospital marketing. Scripps marketing has 51 employees, Palomar Pomerado has 11 full- and part-time people, and UCSD has 20 employees. Their marketing budgets are also small, in the range of $1 to $2 million, much less than the usual 3 to 5 percent of profits spent on marketing at multibillion-dollar companies such as Budweiser and Home Depot.

Revenues of the four health-care systems are huge, ranging from $1 billion to over $2 billion annually. All profits from any not-for-profit hospital are reinvested. None of it goes to award shareholders, owners, and executives as it does at for-profit hospital chains. The three largest hospital systems are defined as not-for-profit corporations. Only Palomar Pomerado is a nonprofit community hospital with a publicly elected board, financed through taxes, bond issues, patient revenues, and donations. The not-for-profits are self-supporting: patient revenues, foundations, and donations from estates and annual parties or balls sustain them. They must, as one marketer told me, “attract a favorable payor mix.” Payor money comes from patients, insurance companies, and Medi-Cal and Medicare reimbursement and has to compensate hospitals for those they serve who can’t pay.

Tomlinson Scores Big with Palomar Pomerado

The guy who signed up L.T. with Palomar Pomerado is Gustavo Friederichsen. He’s also the marketing guru behind the system’s “Hospital of the Future,” coming to Escondido in 2011. The 50ish Latino possesses abundant energy, talks inveterately, and is, in his words, “involved with everything.” Before he got to Palomar Pomerado in 2004 as chief marketing and communications officer, he was the marketing head at Scripps and Sharp, five years at each.

On board, Friederichsen was expected, he says, to campaign for “community health improvement, prevention, education.” To understand his client base, he began with focus groups and in-house interviews. He found three concerns: the managers were “too conservative” and the marketers “risk-averse,” the latter doing little more than profiling doctors poring over X-rays in magazine ads; too few in the community had a clear idea of what the hospitals did, where they were located, and how to pronounce the name; and the foundation wasn’t bringing in enough money.

What troubled Friederichsen was that the system had “zero brand equity. If I put us against Sharp or Scripps, we lose every time.” Focus groups said they wanted a spokesperson with whom to identify. They recommended that “I get a face, an image, a something.” He remembers one person saying, “I don’t know what you stand for.”

His solution: brand the hospital.

So, in 2007, Friederichsen sought the superstar running back of the Chargers, coming off his greatest year ever. Friederichsen persuaded the season’s most valuable player to become the hospital spokesperson for five years. “It’s not just a strict endorsement deal, where he’s just pitching. He’s doing a whole lot more.”

L.T. is paid $400,000 per year—the hospital’s marketing division pays him $200,000; human resources, $100,000; and the foundation, $100,000. In turn, L.T. raises money, hosts TV and radio spots, recruits new doctors and nurses, visits patients, and talks to kids at schools about health. Friederichsen says that the reason L.T. signed up was, “He gets it. He has a family history of illness—stroke, heart disease, diabetes. Mother, father, grandmother.” Kids love him, he’s got a famous San Diego face, and he’s amenable.

The health system’s gala fund-raiser is called Night of Nights. Friederichsen says that L.T. has to raise “half a million dollars every year, minimum; it’s in his contract, recession or no recession.” He’s especially proud that the event with L.T. last year brought in $642,000; the highest total for a previous fund-raiser had been $30,000. This, as well as all the other educational things the running back does, justifies his salary. Yes, he says, “There’s a culture here that thinks we can’t pull the LaDainian thing off.” This is the old guard, who says to every (costly) innovation, “We can’t afford it.”

In short, Friederichsen needs to justify the L.T. expense.

How? He’s selected a number of standards for measuring the campaign. One is the number of diabetes patients admitted to the emergency room. L.T. talks to the public, mostly fifth-graders at school, about diabetes; he’ll present information about lowering their risk and changing their diet. After 24 months, Friederichsen will look at whether the number of diabetes patients coming into the emergency room has dropped. If it has, he’ll use the data as proof (mostly to the board) that his marketing strategy has legs. Already, he says, he’s gotten a call from a nutritionist who is treating “her first 300-pound Latino fifth-grader.”

I asked Friederichsen how an ad campaign might reverse the eating patterns of Latino boys, who many surveys suggest are addicted to fast food and soda. He says it’s not that ambitious, although he believes prevention is the way hospitals will care for patients in the future.

Friederichsen ran the 30-second L.T. spot, called “You just got to execute the plan,” during the playoff games (one win, one loss, and out) for $20,000 (he got two free runs when one of the games went to overtime). He’s mum about the cost of his other ads, which include other 30-second TV and radio spots, Union-Tribune and Chargers Media Guide ads, signage in Qualcomm, movie theater and online videos, transit posters, and bus tails (people stuck in gridlock need to look at something). He won’t discuss costs because “I’ve got a lot less [money] to work with than Scripps and Sharp do. I wouldn’t want a competing health-care system to know what Gustavo is spending on TV, radio, and print.” It’s all negotiable and, he says, suddenly cheap in a recession. If his negotiated price is exposed, Scripps and Sharp will renegotiate theirs. Ad venues don’t like that, he says.

He is spending more than the annual $250,000 that his predecessor spent on “showcasing physicians surfing or playing golf because their campaign stressed they were ‘normal’ folks.” His budget, he says, teasing me with a near figure, is 30 to 40 percent less than what his competitors at Sharp and Scripps spend.

Sharp Hospitals and the Sharp Experience

On Sharp’s website is the real-life video clip “Emergency Heart Attack at Sharp Grossmont.” A woman is being helicoptered onto the Sharp hospital roof. Though she’s suffering grueling chest pains, once in the emergency room she’s quickly stabilized. Soon, she’s on her way to the cath lab for angioplasty, one of the most common surgical procedures in medicine today. In the short procedure, her artery, which had a blockage, is ballooned opened, and she’s out of danger.

The video resembles an episode of the television show ER, with much of the frenetic activity but minus the actors and the fiction. It’s all real, the family arriving and looking bewildered, the husband wiping back the tears, the fast unfolding of the cath procedure, the doctor and nurses and technicians speaking to the camera during the procedure. A nurse says, “I feel so grateful to do what I do every day.” A doctor testifies that “every day I know I’ve made a difference; every day you’ve touched a life.”

Later, the woman’s recovery is filmed with triumphal musical flourishes. Son kisses mother. “She was going to leave us.” He cries. The doctor smiles. Love, like a glass of wine, is raised all around. A viewer can’t help but be touched by a tragedy undone.

Part of the savvy behind these spots is six-year Sharp veteran John Cihomsky, senior vice president for public relations and communications. He’s a youthful-looking, smartly dressed executive whose rapid-fire marketer’s tongue is endemic to the biz. In 2000 and 2001, just before Cihomsky began, Sharp conducted more than 100 focus groups to assess patient preferences. Cihomsky says that though responders expected superlative care at all San Diego hospitals, they rated each hospital the same: average. “Sharp is okay. Scripps is okay. UCSD is okay. They didn’t feel any difference with health-care providers. And, they said, ‘The state of health care isn’t so great.’ People said they weren’t treated as a person, didn’t feel their pain was well-managed, didn’t feel their loved ones were kept in the loop. We learned,” Cihomsky says, “that we have a lot of room to improve.”

The upshot was to launch the Sharp Experience. “Stories of the Sharp Experience” profile “real people, real experiences.” Short clips, like “Emergency Heart Attack,” are strung together into 28-minute-long hospital infomercials, shown on late-night TV. The idea is “to capture our people in action” who are “role-modeling behavior.” Is this information- or image-based? Cihomsky sees little distinction between the two. No matter the ad, there’s always “educational information embedded in those segments.”

“The Sharp Experience” is a phrase printed on most every marketing item Sharp produces. Cihomsky says that he knows the campaign is working well when people call or email to say, “I want to tell you about my Sharp Experience.” It’s a brilliant marketing ploy. Is this too slick? Cihomsky says no. “It’s very personal. We’re not talking about what brand of soda to buy. We’re talking about relationships. A relationship with a caregiver over a long period of time.”

In attaining its top market share, Sharp, like all hospital systems, targets women more actively than it does the two other main audiences: seniors (65-plus) and Spanish speakers. Most health-care choices are made by women who consult with family and friends about their options. (One marketer told me that to be effective with men and their prostates, “You don’t talk to men; you talk to the women in their lives.” Another marketer wrote an ad claiming the sexual advantages of a healthy prostate for the wife.) The entry point to hospitals for most women, Cihomsky says, occurs just before childbirth. Prenatal care is so important for women that given a good experience, “We are very likely to hold on to that entire family as patients. If they don’t have a good experience, we won’t, and they will tell ten friends.”

For female consumers, Cihomsky fashions English- and Spanish-language programs as well as two annual health conferences focused on education, with keynote speakers and local physician presenters. To measure their interest, Sharp surveys attendees’ satisfaction: a complimentary gift often assures a response. And yet, measuring outcomes is difficult and complex for any marketer. Cihomsky says that since women face a bewildering array of “access points—getting into the system—it’s very challenging to chart a woman who registers for an event and then shows up six months later in Dr. Smith’s office.”

Scripps—A Venerable Name Playing Catch-up to Sharp

“Just think about the name ‘Scripps,’ ” says Jean Hitchcock, Scripps’ corporate vice president for marketing and communications. She’s a 28-year veteran of marketing whose bluntness is enjoyable in the sometimes hemming-and-hawing world of marketing-speak. The “Scripps” brand conjures up the trust of science and medicine, the oceanographic institute, the publishing family descended from E.W. Scripps, the Scripps Howard news syndicate, the 1924 establishment of Scripps Memorial Hospital, even the family home, Scripps Ranch, which became a bedroom community. “We have an excellent brand,” Hitchcock says. “We tested it. People say that it’s high quality, very respected, and traditional in the sense of the pillars of health care—research, education, and treatment.”

What are the marketing priorities at Scripps? Hitchcock says it’s a question of “appealing” to different audiences, whether it’s selling Scripps’ bariatric surgery programs to obese people on diet websites via “search-engine optimization” or its obstetrics care. (Hitchcock is “incredulousness” that young women will shop for a hospital “based on ambience and gifts, not if there’s a neonatal unit.”) Scripps concentrates on obstetrics because the program faces stiff competition from providers and brings lifetime loyalty from women.

She says that even in a new hospital, “where each bed costs about $3 million” to build, the hospital still loses money. It loses money even when every bed is full.

Consequently, Hitchcock’s focus is on marketing programs and services in which Scripps has “clinical experience” and which “make money.” She is quick to add that although Scripps makes “money in trauma, we don’t want people to be traumatized.” Advertising a trauma center, she notes, is not easy. Marketing is a “very delicate dance you have to do, legally and ethically.”

After working in Chicago, where she saw up to 20 hospitals advertising in the Sunday papers, she sees San Diego as “a little sleepy giant. The competition here is mild compared to other big cities.” Why so sleepy? “We’ve been the poster child for managed care,” she says. Originally, San Diego, like most health-care markets, was “underbedded and underphysicianed. If you built a bed, you filled it.” Things changed about 1989, when the HMOs arrived and hospitals needed to court them. Joe the Health-care Consumer picked not a hospital or a doctor; he picked a system. He got everything at Scripps, for example, because by then Scripps was full-service. From this one-stop-shop approach to medicine came the for-profit hospital chains that built their empires on the systemic idea: an HMO or hospital system would negotiate the best contract for each group.

A new program Scripps and other big hospitals are marketing is robotic surgery. Hitchcock says the secret to advertising this program is not to “market its technology, because technology is only as good as the people who know how to use it.” She’s speaking of the $1.4 million da Vinci robotic system, a surgical technique that uses micro incisions. Each big hospital bought a da Vinci robot “to be competitive with each other. We’re not selling the robot, but some people are.”

As for where to advertise robotic surgery, Hitchcock rules out TV and newspapers: “There’s too much overlap, and they’re too expensive. TV’s [costs are] obscene.” She says TV rates here are as high as in the Chicago and New York markets, way out of line for hospital-ad budgets. As for the Tomlinson TV spots, Hitchcock says, “Shame on them. Those were tax dollars. They didn’t ask the people they taxed if it was okay to spend $2 million on him.” Scripps, she says, has taken care of four San Diego Chargers who “offered their services for free, but we had to pass because of L.T.” Other “free” celebrities include Tony Hawk and George Winston, the piano soloist, who does an annual concert at Scripps Encinitas for the patients. Neither man is paid and neither wants his appearance advertised, though mentioning them here exposes both.

Hitchcock likes billboards and radio “because people are in their cars so much,” and she likes the web and its social networks, Facebook, Twitter, MySpace. She says Facebook has become the number one place to look for new hires, especially nurses, who are always in demand. A viral site like Facebook spreads an ad via the profession’s social network.

Should a health-care marketer build brand or business? Name recognition or clientele? Hitchcock, who teaches a class in marketing at UCSD Extension, says, “I always say that in not-for-profit health care, you better do both or else you’re wasting money.” Still, the “tightness” of her budget precludes anything but following the dictates of the “strategic plan,” something every health-care organization is tied to. For Scripps, it’s ramping up a new heart program and a new cardiac center—not a surprise—new doctors, new technology, new facilities. She’s spending the marketing dime on attracting patients to heart programs because Scripps “already serves almost half the heart patients in the county. If you already have the market and you’re doing really well and you’re recognized for your clinical strengths, of course you’re going to put your effort there.”

One of Hitchcock’s primary jobs, besides offering external programs meant to “educate consumers,” is an internal one: to make physicians happy. “It’s the physician-relation thing,” Hitchcock says, echoing Bush 41. “You’ve got to have happy docs to have happy patients.” The doctors need to know “where we’re going as an organization,” so Hitchcock spends lots of dollars on talking directly to Scripps’ physicians about how they can navigate the system and why it’s important to support the technology.

Hitchcock says her core marketing focus concentrates on the quality of the patient experience. Patients evaluate not the health-care building or technology but the person: “The nurse responded to the bell. The doctor listened to my call. The real simple things turn it. Some health-care systems have gotten away from the basics.” She says she can’t help but “get bristly when I see people promoting buildings and technology. What does the patient get out of it?”

In each of the last five years, Hitchcock says, her budget has either held steady or gone down a bit “because we’ve been at capacity.” The way she’ll “grow market share” is by acquiring more facilities and more physicians. Like the other big three, she won’t get into numbers except to say, “We’re not a drop in the bucket” of Scripps’ $2.2 billion annual revenue. Hitchcock says that recently she spoke to a colleague in Columbus, Ohio, at Ohio Health, a highly competitive organization in a highly competitive market, who said just one of her TV ad campaigns cost $1 million. “That’s more than my entire budget for advertising.”

The Academic Brand at UCSD Medical Center

If there’s a field on which the three big county health systems play, UCSD and its two medical centers have yet to join the league. While UCSD has a much smaller market share than Sharp and Scripps, it spends roughly the same amount on ads as its competitors. So says Pam Bylen, who’s headed UCSD marketing for 13 years. Bylen notes that because UCSD concentrates on research and teaching, “our marketing is not geared to what the other hospitals are doing but to our own needs.”

Bylen and her staff market UCSD’s academic credentials. “To advance research and education, to provide leading-edge patient care, we offer specialized services that aren’t offered by other hospitals.” The Moores Cancer Center is one of 41 comprehensive cancer centers in the country and the only one regionally. She concentrates on testimonials from patients “who want to share the care they’ve received.” Launching a new campaign, she will place such testimonials—“the patients are our spokespersons”—in print, on radio, and on the website.

Because health care is so competitive, UCSD has to, Bylen says, “educate consumers so that when they’re choosing, they make informed choices.” Does UCSD Medical Center have a brand? “Yes, we use a tagline that says, ‘The Power of Academic Medicine.’ ” What does this suggest to consumers? “Academic medical centers are typically on the forefront of research and clinical trials. So when a patient experiences treatment at an academic medical center, they are being treated not just by a physician but by groups of physicians and researchers who look to the best course of treatment for that patient. They’re collaborating all the time with colleagues, not only within UC San Diego but with other colleagues all over the country in other academic medical-center settings.”

Does Joe the Health-care Consumer know this? Do you have to sell him the idea?

“It’s why we advertise. There may not be an overwhelming knowledge base. We do find that people who move here from the East Coast are more aware” than San Diegans “of the benefits of going to an academic medical center.” Places like New York City or Boston or Chicago, Bylen says, “have five academic medical centers, and people are aware of the benefits.”

Bylen notes that “because we care for 38 percent of the indigent in San Diego County,” she needs to market to the insured customers, i.e., the paying customers, to get their business. “It’s critical for our financial solvency that we have the right patient mix. To maintain our buildings and facilities and to actually grow and serve the community.”

Outcomes are measured when she looks at calls made to an 800 number, inquiries that come into the website, and the number of new patients. “The volume growth of new patients” tells her when she’s being successful. She says that “patient satisfaction does not drive marketing. The strategic plan drives the marketing.” In a follow-up email, I asked for details about the “strategic plan.” “This plan is an on-going plan,” she replied, “and is proprietary information, [and] therefore is not available.”

Bylen believes that “our marketing is successful” because UCSD has “a payor mix that allows us to be solvent. When I first joined the university 13 years ago, the medical center was about to lose money. That has completely turned around. In 1996, UCSD Medical Center was $20 million in the hole. That debt is gone.”

UCSD is also going the way of the personal-testimony video clip. A new one shows a young woman who needs her gall bladder removed but doesn’t want embarrassing stomach scars. “We are one of the few hospitals,” Bylen says, “who remove gall bladders through the vagina or through the mouth.” This procedure should bring in lots of paying customers.

As Palomar Pomerado’s Gustavo Friederichsen noted, hospital marketers prefer not to disclose media purchases. Payments made to advertisers are “trade secrets,” in part, to preserve competitive advantages. Nevertheless, the Reader filed a Public Records Act request for media-purchase records from Palomar Pomerado and UCSD, institutions that receive public funds. Both complied, but Palomar Pomerado redacted what they paid for their media buys.

UCSD Medical Center’s marketing department pays Sexton Communications to produce ads for radio, TV, billboards, and print. Media-buy records show that a purchase order issued to Sexton in 2005, with “change orders” in 2006, totaled $2.4 million. One email dated December 3, 2007, says that UCSD has been “averaging about $90,000 each month with Sexton on ads.” For 2007 and 2008, the total was $1,808,557.

Among the most costly invoices were ones for the June 2008 radio campaign promoting “The Power of Academic Medicine” at $53,253 and the October 2008 print ads in the Union-Tribune, San Diego Magazine, the La Jolla Light, the North County Times, and other coastal and inland North County newspapers at $40,342. Other ads included “Salute to Nurses Week,” “UCSD Healthy Heart Expo Campaign,” and the “Lap-band Campaign,” an ad for a new weight-loss surgery in which an adjustable band around the stomach helps control appetite. I counted 16 lap-band invoices for radio ads in 2007 and 2008; the cost was as low as $2400 for November 2008 and as high as $19,337 for February 2007.

Marketing Public Health

One marketer who has thought a lot about the morality of marketing is Justin Campfield, the founder of Campfield Public Relations, a marketing and communications company in Vermont. Impressed by his recent article “The Ethics of Hospital Marketing,” of which he is a coauthor with William Nelson, I phoned Campfield and asked him why, when I asked the marketers about ethics, they seemed reluctant to comment. “In a lot of cases,” he said, hospital marketers “weren’t doctors and nurses to begin with. They’ve been a marketer their whole career and been in industries completely different from hospitals. Who knows where they came from? They’re marketers first before they’d view themselves as a health-care professional.” Marketers, Campfield said, need to be reminded of the creed of the American Marketing Association: “honesty, fairness and avoiding conflicts that promote the organization’s interest over consumer needs.” He also noted that the association issues strict ethical guidelines for ads: no “unsubstantiated, false, deceptive, or misleading” claims.

I asked Campfield whether hospital marketers, in general, put the health of the organization over the health of the community. He said they sometimes get “too zealous” with their time and money on advertising specialized care. But, for Campfield, the marketer’s job is vital to the community’s health. New hospitals, more beds, more technology, more public awareness, more control over indigent and emergency-room costs, more diversity in the payor mix—all of it, Campfield said, enhances public health. Whatever enhances public health, he noted, must be sold to the community through whatever means the public can understand. “Sometimes that means using a football player as a healthy role model.”