The jury’s decision to award the top prize at the Lions Health creativity festival to a humorous campaign about a pair of fish talking about triglyceride levels answered the question of what a Grand Prix in the pharma category looks like. But it also raised eyebrows among some skeptical US agency executives.

Lions Health, now wrapping up its second year, is the pharma and health version of Cannes Lions. It kicked off two days before the week-long Cannes Lions festival of creativity, now underway in the south of France.

Several healthcare agencies had advocated for the creation of a separate event focusing on healthcare creativity, in part driven by stricter regulations governing the way that the makers of drugs, medical devices and diagnostics can communicate with patients and doctors.

The jury last year declined to name a Grand Prix in the pharma category. That decision prompted calls for stronger creativity in healthcare, especially among US agencies. But this year’s winning entry, “Take it from a Fish,” developed by New York-based Publicis Groupe agency DigitasLBI for AstraZeneca, which makes a prescription fish-oil drug that helps reduce triglyceride levels, did little to stem those calls.

“I’m not sure a Grand Prix should have been awarded this year,” said John Cahill, president and CEO of Interpublic Group’s McCann Health. 

The jury’s decision to name the DigitasLBI campaign was questioned by other agency executives, as well. For one, it’s a humor campaign, which seems to conflict with an ideological perspective that pharmaceutical creativity should be about saving lives, or at least dramatically improving them. It’s oft-cited that creative excellence in healthcare advertising depends on stirring the emotions of the viewer and tugging the heartstrings enough to spur some kind of action.

“Sal and Marty, our ‘spokesfish’, were pivotal to the success of this campaign,” Ronald Ng, DigitasLBi’s chief creative officer in North America, said in an email. “They were not preachy; fish just don’t know how to do that! They were witty and even silly. They threw insults at each other, not the audience. And indirectly, the banter between them became the storytelling device for AstraZeneca.”

Ng said he’s not surprised by the debate about his agency’s work winning a Grand Prix, noting that creativity is subjective.

“It’s our job to try our bloody hardest to justify their time with groundbreaking and engaging ideas,’ he said about the campaign’s patient audience. “And based on the phenomenal results for the ‘Take it from a Fish’ campaign, it looks like we addressed these issues.”

During the awards presentation Friday night in Cannes, some of the biggest cheers came for winning entries with simple and powerful messages that are literally saving thousands of people’s lives and changing the culture in some communities.

Many agency leaders, for instance, cited the “Lucky Iron Fish Project,” which garnered a Gold Lion and a Silver Lion in the health & wellness category. To address iron deficiency in Cambodia, the organization created an iron fish that people can drop into a cooking pot. Doing so helped reduce iron deficiency in 46,000 people so far, but the decision to shape the iron into a fish was crucial because fish are considered lucky symbols in Cambodian culture and helped encourage more people to use the iron fish. The campaign was developed by Geometry Global and Memac Ogilvy, both in Dubai.

Rich Levy, chief creative officer of IPG’s FCB Health, saw that campaign as a call for better creativity for pharma products that also save lives. “We are not talking about a lucky iron fish,” he said. “We have drugs that cure hepatitis C.”

Levy, who served as a judge in the health and wellness program, also noticed that this year’s winners in both Lions Health categories were not only simple, straightforward ideas, but the vast majority of them also carried positive, hopeful messages.

The inspirational value of this is clear for Lions Health attendees, but there is still confusion about what good looks like for branded pharma campaigns, and how the US fits in.

“Take it from a Fish” was developed by AstraZeneca, a brand drugmaker, but the education and services campaign was unbranded and focused on raising awareness about high triglyceride levels. Those levels can be treated by prescription fish-oil drugs, a highly-competitive class that includes AZ’s Epanova, which received FDA approval last year.

Multiple sources said they applaud the company for taking a risk on a humor-based campaign while also investing in an unbranded, market development initiative at a time when advertising and marketing dollars are being slashed across the pharma sector.

But that didn’t stop the debate about what a pharma Grand Prix should be, and—whatever that standard is—whether a branded campaign can ever measure up.

“We’re being disingenuous about why Lions Health was created,” said Matt Brown, CEO of Guidemark Health.

Drug marketing in the US differs from other countries, mainly because the US and New Zealand are the only two countries in the world that allow direct-to-consumer advertising. Because DTC is allowed in the US, drugmakers are less likely to choose to invest in market development or awareness campaigns because they can directly market the product they are selling to consumers. “Our only avenue is not disease education,” Brown added.

Still, Brown, McCann Health’s Cahill and others are quick to note that regardless of how US agencies performed in the eyes of the judges, the festival continues to spur a level of inspiration and energy that drives creativity long after everyone leaves the south of France.

And perhaps more US drugmakers need to be willing to take a chance, like AstraZeneca did, on creativity that is not tied directly to product promotion.

“If I make changes that lead to life-changing behavior,” Brown said. “Isn’t it safe to assume that my brand will do better?”