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Talk to some of the big ad-tech firms and they’ll often tout their focus on ensuring ad inventory is brand-safe. They’ll note how their content teams remove any websites that serve risky content from their programmatic marketplaces, and they’ll go on about their efforts to build a safer programmatic environment. 

“Safe” in this context should mean, at the very least, that a brand’s promotional materials won’t appear on websites peddling toxic content, such as child sexual abuse material (CSAM). Yet, in the wake of multiple investigations, programmatic advertising’s reputation for upholding such safeguards seems wobbly at best.  

According to a February report by ad quality firm Adalytics, healthcare brands from Kenvue, Sanofi Consumer Healthcare and Allergan to Medtronic, Reckitt Benckiser and the Leukemia & Lymphoma Society appeared to have had their ads placed on a website known to host CSAM, allegedly by Google and Amazon.  

Some have said the report calls into question the effectiveness of brand-safety verification platforms. And they’re not the only ad-tech players to have been swept up in such probes. 

A 2024 Adalytics study found serious shortcomings in the ability to keep ads from major brands — among them Disney, Google and Procter & Gamble — from so-called made-for-advertising (MFA) sites, despite commitments from demand-side and supply-side providers (DSPs/SSPs) to prevent this. 

Taken together, the reports stand as an indictment of the entire programmatic ecosystem. Critics say the unsuitable placements stem from the complexities and opacity of programmatic advertising, as well as the perverse incentives of what they see as a system rife with arbitrage. 

Meanwhile, as the sector grows all too accustomed to these periodic bombshells and the hand-wringing that follows, some marketers are losing patience. Alex Davis, biosimilars director at Organon and former VP of engagement strategy for McCann Health New Jersey, eliminated programmatic from her budget, a move she disclosed in a March LinkedIn post. MM+M caught up with Davis earlier this year to find out what motivated the decision. 

This interview has been lightly edited. The views expressed are those of the interviewee alone and not the opinions of her company. 

MM+M: You described your decision to turn off programmatic as one that “a lot of brand marketing leaders would never make.” As justification, you cited the potential for inappropriate ads. Can you elaborate? 

Davis: “Sure, a couple of things… I’ve grown up in a digital advertising landscape. I’ve worked for companies like VaynerMedia and have spent time with ad buyers, ad planners and have run lots of programmatic content over the years. One of the things that has always been on my mind is the model is very much based on arbitrage. And that’s how publishers make money. And so as a brand, how do you keep your integrity intact when you’re running a content play that is very broad and can maybe have the right targeting? 

“The other day, I was reading The Wall Street Journal on the effect the tariffs are going to have on the car industry. And a programmatic car ad [appeared] in the middle. Maybe that was [the advertiser’s] strategy all along, to get people to buy cars now before the tariffs affect the car price. But respecting your brand’s integrity is the first and foremost priority. And running an ad that is going to be taken out of context or put into a negative context could be potentially a way to disrupt your brand’s integrity.  

“You never know what’s happening because you’re not necessarily seeing very much about it. And people will say, ‘Oh, we’re just going to run endemic programmatic.’ Okay, what if it’s a favorable article about another pharmaceutical company or a totally innovative product in a different space? I’m not saying programmatic isn’t for everyone. But one of the things we’ve done when we’re working as a team on biosimilars, [where] it’s all about market access and affordability, [is] we are always prioritizing what will drive growth and deprioritizing things that we don’t necessarily have visibility into.  

“And one of the ways you hold partners accountable is by turning off certain ad-buys that are opaque in nature, where you’re just getting high click-through rates — high engagement rates — but you’re not actually seeing the demand those ads are generating from a return-on-investment scale. I’m all for testing and learning and deploying tactics in the digital space, but I want to know what’s working and what’s not working beyond just a click-through rate.” 

MM+M: One ad-tech firm I spoke with recently said the programmatic ad ecosystem you get is the programmatic ad ecosystem you buy. In other words, opacity between an ad-buy and where that ad appears could account for the scenario you described of high click-through but low lift. To what extent can you as a marketer make a deliberate effort to say, ‘Okay, I’m only going to buy where it’s transparent?’ Do you have control over that? How much credence do you ascribe to their statement? 

Davis: “Every single [ad-tech] company will say, ‘We provide transparency when it comes to our programmatic buys.’ But then when you see the [metrics] reporting, it’s very much a universal number aggregating the sum of all clicks, engagements, impressions. It’s similar to the early days of programmatic, what wasn’t really called programmatic.  

“But a true view for YouTube is that there’s quality and then there’s quantity. If you make someone watch a video before they watch as a pre-roll ad — before they get to the content they’re trying to consume — is that a good brand experience? It’s not just about buying eyeballs. When you look at things like programmatic pre-roll, you’re very much focused on the target audience — where the target audience is versus what the target audience is trying to consume in the first place that you’re essentially disrupting. 

“When you boil it down, everything in advertising is a disruption; we are disrupting you from your normal business-as-usual. With programmatic, it’s really hard to be a solution-oriented brand and add value. The best kind of marketing adds value. The question I have is, ‘Do banner ads provide value? Are they Jumbotrons? Does just seeing the logo over and over again get you to say yes to an Organon biosimilars product?’

“It’s going to be more effective when it’s something like an advertorial or a PR campaign about Organon biosimilars and how we’re different. And then you have a 100% share of voice around that advertorial that is talking about your brand and reinforcing your brand because it makes sense in the content they’re consuming. It’s intent-based advertising, and you’re getting a bigger bang for your buck.  

“One thing that [can be] very effective is programmatic in the social space. You’re thinking not just about your target but the content they consume, their lifestyle and behaviors, [and] you’re overlaying that to the physician base you’re trying to reach. And then you’re thinking about the ad within the context of their feed, and you actually start creating contextual media and using an ad-tech firm or your media agency to essentially programmatically buy that media and programmatically deploy it. But it’s within an ecosystem that you have better control over, a better sense of what’s being consumed beyond your brand. 

MM+M: Can you talk about the diligence that you did before making your decision to cut your programmatic budget? It seemed like you were attributing that sort of “annoying ads phenomenon” purely to programmatic, when opting to desist from any marketing tactic is a larger decision that takes a lot of consideration. Talk a little bit about how you came to that decision. 

Davis: “It wasn’t made lightly and, honestly, we’re still evaluating it. But we’re looking at performance across the marketing model mix. One thing we saw was that our biggest brand equity driver was actually our people. At a recent [industry] meeting, I heard, ‘Oh, you’re a biosimilar. You don’t need marketing. It’s just about price and it’s just about access.’ To which I replied, ‘Not necessarily. When there’s 12 of you, there has to be more than price and access.’ 

“Is Verizon Wireless just about price and access versus AT&T or is there a reason why you choose one over the other? Why do some people drink Dunkin’ Donuts and others drink Starbucks? Is it just because of the taste of the coffee? I don’t think so. There’s a brand affinity. And so, how do you build brand affinity in a crowded space?  

“One of the things that we’ve done is to focus on our face-to-face operations. That’s something that we’ve debated for a long time in pharma: Is it more cost-effective to have a rep or to do non-personal promotion (NPP)? We had both running at the same time last year. We saw that brand equity was really built and reinforced with that direct contact. That said, there were really strong indicators that paid search works as well as some of the programmatic. So we said, ‘Okay, well, it’s the same target audience.’  

“Are we actually driving brand choice with a programmatic ad? The answer was, We don’t know. We want to be in a place where we have a clue as to what’s working versus what’s not. It’s not good enough as a brand marketer to just rely on clicks because you don’t necessarily know if that’s something that would have happened in a paid search or not. You can’t attribute it. It’s correlation but not necessarily causation. As long as we were spending a significant amount of our media budget toward programmatic without certainty that it was actually driving conversion, we felt confident that we could reinvest those dollars in areas where we could have more of a sure bet. 

“We could also take some of those dollars and do more innovative direct-to-patient (DTP) marketing at point-of-care, where we know things like ‘What medication I’m on’ or ‘Can I afford that medication’ is more topical than maybe when you’re reading a magazine or even something endemic. 

“So we started investing in DTP marketing to see if that could be a more innovative channel for us because programmatic wasn’t coming up as a sure bet. Then there was the opaqueness. Not knowing is sometimes a good reason to turn something off. Because one thing I do know is that we’ve turned it off and it hasn’t had a negative impact on our sales or our growth.  

“And I see other brands — some that we compete with — that have a significant amount of dollars invested in at least banner ads, and they’re not necessarily someone that we consider a big competitor or threat. And that’s another way where we say, ‘Okay, are we just doing this because it’s in a playbook for every other brand that we’ve ever launched? Or are we doing it because we know it drives growth?’” 

MM+M: Do you think that too many brands in pharma and health are treating programmatic as a cheap way of achieving scale without thinking enough about it in a holistic fashion? 

Davis: “When you think about it, a biosimilar is more akin to Verizon and AT&T because there’s no meaningful difference between a biosimilar and the biologic originator. All you have to work off of is your reputation. That is one reason why branding is so important. In that respect, I’ve actually used less of my pharmaceutical background, even though I do have one, and more of my retail background to design campaigns for the biosimilars we produced. 

“That’s an opportunity to say that just because someone says, ‘You have $1 million for your budget next year; go spend it,’ doesn’t mean you should. Look at what you actually need, what you think is going to drive [performance]. Invest 60% to 70% of your brand [budget] on what you know works and then 30% trying something different with a clear learning agenda as to what you want to take away from it working or not working. If it comes back that you don’t necessarily need a million dollars for a programmatic ad buy, that’s probably a good day for a company.”  

MM+M: Clearly, the programmatic ad-buying system is not without its flaws, including a lack of transparency and a high level of complexity. Those problems have led to revelations that major brands have appeared alongside harmful and inappropriate content or on MFA sites. This year, members of Congress sent letters to major tech companies expressing concern.

Davis: “You’re making me feel better about this decision.” 

MM+M: And some of the brands implicated in February’s Adalytics report were health brands. Do you see a trust issue here? 

Davis: “Absolutely, a thousand percent there’s a trust issue. And one of the ways you take back power is you take back the dollars. As long as there’s a trust issue and you keep funneling money into the system, you are giving over your power to the system.  

“If I was a publisher, I would want to continue to have this model set up the way it is, because think about it. Most news is bad news and that’s what people are consuming online. How do you protect your brand right now? Look at what’s happening in the U.S. It’s really questionable why any brand wants their ads running in some of the newspapers, for example. And so being transparent has been something we’ve been talking about since I worked at VaynerMedia when it was a startup. 

“I haven’t seen a lot of that happening. I’ve seen other things happening that are making it more challenging, such as all the cookie laws and transparency over our privacy and how our data gets shared with these systems that do these ad-buys. But they’re still running them with or without the cookie system. So I would say sometimes the ads are becoming even less relevant these days because you don’t have as much information as to what I’m interested in or what I abandoned in my cart.  

“Everybody’s willing to give up their data if you provide value in return. At least that’s what I’ve always observed in the CRM space. But if there’s no value, that’s when we start to really question why we are doing this. Why am I giving you information about myself if you’re not going to make my life easier?” 

MM+M: What do you think programmatic needs to do in order to become more of a trusted buying mechanism? 

Davis: “Programmatic needs to bring the publishers to the table a little bit more and take a page out of native content’s playbook where we start to think about programmatic as advertorial content and look for ways to use AI to create that content. We know that publishers and others are looking for ways to monetize content, and brands are looking for ways to get themselves in front of those consumers.  

“If there’s a way for programmatic to start working more directly with the publishers to create more content that’s curated, such as a publisher putting its monthly beats into an AI tool and having that AI tool synchronize them to a select group of brands that are interested in purchasing content rights to be promoted alongside that content, then you can start to use AI to promote a brand in a more integrated way within content similar to native. It’s almost like native content needs programmatic. Then, all of a sudden it doesn’t feel so jarring when you’re getting that content while trying to consume an article, because it’s embedded within the article. 

“If I was working for [a DSP], I would look for ways to automate the relationship. Not so much a brand reaching out to a podcaster, for instance, as almost creating a [DSP] service that liaisons between thousands of brands and thousands of podcasters so that you can scale that. Because right now it’s not very scalable. If you’re working with one influencer, you’re getting that one influencer to do a sponsored content on their feed. But there’s a way. TikTok, for example, connects influencers to brands. 

MM+M: When we reveal our media preferences, we reveal ourselves. Have any of your pharma peers started to voice skepticism or do you think you’re the lone voice of dissent with regard to programmatic?  

Davis: “Not on my team. There are a lot of people that are not ready to turn off programmatic, because there’s a lot of pressure from media agencies that it’s the one thing that’s always going to work. What I would say to folks who are all-in on programmatic, and I know most of them, is to turn it off for 30 days and see what happens. In 30 days, if you lose sales and you lose revenue, then you’ll know it wasn’t the best decision.”

MM+M: Do you think this is a moment of reckoning for programmatic advertising in the healthcare industry? 

Davis: “I hope so. It can’t just be the biosimilars doing it. It has to be the behemoth innovators. Because that’s when change is made, when you demand better and you take away the funding. That’s when you start to see people change. We saw it with cookie preferences. The opportunity is to demand transparency in exchange for funding.” 

MM+M: One top-10 drugmaker recently told us that programmatic is still active at their company, and that with the right targeting, creative messaging and ad-quality safeguards in place, it can be an effective way to run targeted digital media.  

Davis: “My question to that person is, how do you know programmatic is directly tied to your sales? If the targeting is so good, are you only running programmatic with your target? What’s the attribution model to it? Maybe you’re just doing programmatic and that’s it, but I doubt that; you’re likely doing other things. 

“Turn it off for one week. We used to do this kind of thing all the time in the CPG space: test and learn by turning one off, turning one on. Have a perpetual holdout in your programmatic — a control and a treat group — and see if those providers stopped writing your drug for those 30 days because you didn’t advertise to them. Then, it was programmatic.” 

Marc Iskowitz is the former editor-at-large for MM+M. 

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