It’s easy to paint identifying the best DTC pharma and healthcare TV ads as a depressing exercise. The grievances practically write themselves: The ads employ the same imagery. They elicit the same tone. They’re set in the same environments.

If all traces of product names were vanished, the argument continues, viewers wouldn’t be able to differentiate between one brand and the next — hell, between one therapeutic category and the next. Ads for asthma drugs sound and look like ads for diabetes drugs and psoriasis drugs and cancer drugs.

But look past the homogeneity of the most heavily advertised categories and you can find spots that are alternately challenging, catchy, and even clever. Hence our decision to balance the list differently than we did in years past and instead feature an equal number of good and bad ads.

For the purposes of this exercise, we considered pharma and healthcare ads that, per iSpotTV, started airing no earlier than January 2017. Plus, the two usual caveats: One, that patients and caregivers likely perceive these ads in a vastly different manner than do healthy individuals; and two, that this ranking represents just one guy’s opinion, and that one guy just took his kids to school wearing two similar but different sneakers.

The year’s best DTC ads

Acadia Pharmaceuticals (unbranded/for, Secret Visitors

Has a pharma ad ever conveyed a genuine sense of menace? Has a pharma ad ever tried to convey a genuine sense of menace? Secret Visitors, which visualizes the hallucinations and delusions often experienced by Parkinson’s disease patients, pursues and achieves a vibe more often associated with horror flicks.

“They appear out of nowhere, my secret visitors, appearing next to me in plain sight,” rasps the narrator as people and pets show up and vanish willy-nilly. Only toward its end does the clip let in any sunlight. Not every ad has to convey a sense of uplift and can-do spirit. Sometimes a darker approach can far more effectively convey a message, branded or otherwise. Here’s hoping Secret Visitors kick-starts a trend toward the latter.

AbbVie (unbranded),

Pharma marketers love to rhapsodize about how their DTC spots give patients the confidence to engage in difficult conversations with their healthcare providers — a curious boast, given the great majority of ads feature roughly two seconds of a patient sitting across from a physician, who merely points to a ginormous computer screen with the name of the brand being shilled. 

That’s why Endometriosis connects: It devotes the entirety of its 30 seconds to a patient’s internal dialogue around the vague answers she gives to her doctor’s pointed questions. It articulates its central message — “speak up!” — without resorting to gimmicks or inscrutable metaphors. This isn’t rocket science.

Astrazeneca (Symbicort),
Wolf: Huffed and Puffed

Stick around past the cornball setup and you’re treated to a genuinely creative use of animation, the sort rarely deployed to good effect by marketers in pharma or anywhere else.

Don’t buy it? Check out the bemused expressions on the faces of the three little pigs when they realize that COPD wolf can’t blow a piece of paper across a desk, much less blow their hut off the face of the earth. Plus, you got to love that AstraZeneca sticks with the animation through the de rigueur conversation-with-physician component of the ad — Dr. Wolf is a total badass. More playfulness such as this, please.

Tina Skeete 

Consider the inclusion of Tina Skeete as kind of a lifetime achievement award for NewYork-Presbyterian’s elegant, straightforward series of patient testimonials that double as ads. Time and time again, NYP has managed to succeed where other self-styled storytellers have failed.

The formula is simple: The ads train what appears to be three cameras on either a patient or a caregiver, then lets the individual tell his or her tale without artifice or excessive visual styling. Tina Skeete does its job almost too well: I find myself wanting updates on the child’s condition, even after her appearance in the ad suggests a happy ending. Thirty or so spots into the campaign’s run, this particular NYP ad treatment continues to simultaneously surprise, inform, and touch. That’s no easy feat.

United Healthcare,
Taming the Inner Hulk 

At a time in which our divisions are more pronounced than ever before, there are but a few commonalities around which we can unite — such as hating insurance companies generally but health insurers with particular ferocity. That’s why United Healthcare’s gambit in Taming the Inner Hulk is so clever: It plays off these perceptions about health insurers, acknowledging a reality that precisely zero other insurers have admitted exists. 

A guy calls United Healthcare for an appointment and, in anticipation of getting delayed or ignored, transforms into the Hulk. But just as quickly he de-Hulks when the United rep manages to schedule an appointment for him within the next two weeks. He starts to boil again when the rep mentions that he’s due for a colonoscopy, then relaxes when he’s told that he won’t be charged for the procedure. Would a pharma company ever be as willing to play off the industry’s lowly rep in a manner similar to what United Healthcare does here?

The year’s worst DTC ads

AbbVie (Humira),
There for Them 

Guilt trips visited upon parents by their children: Not a lot of fun! Heaven knows some of them are richly earned, like the time kid number two withheld hugs after I somehow managed to lose his special weekend cookie — but not his brother’s — between purchasing it at the bagel store and bringing it home. 

Compare this with the guilt trips imposed by the two children in There For Them, who appear to be aggrieved because their parents miss out on basketball games and family kitchen mirth due to complications from their Crohn’s disease. The message, as I interpret it, is that patients should feel bad about being ill. That’s an insane premise and I imagine the creators of the ad would frame it differently. But if there’s even a wisp of a possibility that your spot can be interpreted in a manner that assigns blame to patients for their disease symptoms, you’ve flunked Medical Marketing 101.

Janssen (Stelara),
Face Off 

Defiance is good. Defiance is brave. Defiance is productive, especially in times such as these. But there’s “standing in front of a tank in Tiananmen Square” defiance and then there’s the type of defiance showcased in Face Off, in which model-pretty actors effect defiant stares with their pretty model faces while solemnly intoning fighting words like “Crohn’s, you’ve tried to own us, but now it’s our turn to take control.” Then the actors stare cracks into superimposed panes of glass displaying symptoms including flare-ups and abdominal pain. 

The clip’s setting — it appears to have been filmed in an abandoned latex factory — doesn’t exactly enhance the desired tough-patient attitude. Somebody needs to slap a restraining order on whoever art-directed this one.

Takeda Pharmaceuticals (Entyvio),
Time for a Change 

Speaking of approaches that are begging to be retired or at least reimagined, I present to you yet another spot organized around the time-tested theme of “patients who like to do things can’t do things because of their condition.” This one checks off all the boxes. Frowny faces and put-upon sighs? Happy-healthy-active-people activities such as “live jazz on the pier” wiped off the calendar? Lab-coated, marvelously coiffed doctor displaying a screen featuring nothing other than a brand name and product attributes? Check, check, and check. The moral of this story is that lazy ads are just as unappealing as stupid or incomprehensible ones.  

Novartis (Cosentyx),
Clear Skin Can Last 

Me, while watching this ad: Oh, look, a patient. And there’s another patient. Hey, was that Cyndi Lauper? I suppose she’s a patient as well, then? I wonder if the psoriasis is keeping her from performing? Nope, looks like she’s heading out on the road this summer. 

“Money Changes Everything” was quite the power-pop jam back in the day. Didn’t she used to manage a wrestler? Plus there was the Broadway show and all the advocacy. That’s an amazing 30-plus years in the spotlight. Wait — why am I thinking about Cyndi Lauper now?

Glaxosmithkline (Breo),
Sam’s Tex Mex

The central conceit here — that Breo is the missing piece to the asthma treatment puzzle — has promise as a metaphor. But an unfortunate visual treatment, in which puzzle pieces are literally added to and subtracted from the screen, serves to distract attention away from the messaging.

And while I understand that GSK likely can’t show the Ellipta administration device in action, that’s all I want to see after the camera lingers on it for seconds at a time. Is it possible to remix commercials the way DJs and producers remix songs? This spot demands a remix.