Health care today is an individually-consumed good that produces benefits for everybody.

But there is a problem–”health” is subject to interpretation. By the patient. By the doctor. By the nurse. By the judge or the lawyer or the jury or the neighbour or the parent or the secondary school counsellor or the teacher or the boss that sends/does not send the kid home.

Health care consumers know this. That’s why individual consumers are taking ownership of their health care-online. They post and participate in sharing side effects, suspicions, and successes with medications, diets, and treatments.

Online, there are no national boundaries limiting the information about medicines and health care services. Consumers price shop, compare experiences, and exchange advice. But not with everyone. Consumers prefer to talk to each other-consumer trust other consumers, in health care as in all other consumer goods.

Consumers do not trust the professionals-at least, not directly. Direct to consumer (DTC) advertising is despised. Expertise is suspect.

But experience is king. If a pharmaceutical has good word of mouth online, it attracts a dedicated and appreciative following. Consumers are “pulled” to the medication by positive reviews, rather than pushed a drug by DTC.

Each Friday I plan to feature a social media campaign measured using Attentio’s tools. These won’t be clients–I’ve set up projects to follow campaigns featured in the online news, like the Cheetos Underground ad campaign and Nissan’s viral video campaigns, also linked to NBC’s Heroes.

This week, I want to play on a theme introduced in the last blog. Social media and government–in this case, social media and statehood.

Edward Bernays, the alleged “father of public relations”, thought that to successfully rule the people, government had to be hijacked by a skilled elite. Then this elite needed to successfully sell themselves to the people.

Bernays did not believe debate and measured opinion equalled votes or even effective government. A former propagandist for US President Wilson during World War II, Bernays thought it best to appeal to the irrational masses, not the rational individual citizen. Earn their appreciation and acquiescence, then do what’s best for them. After the war, Bernays went into business and branding. He was incredibly successful.

Veton Surroi, a Kosovo statesmen, told The Economist that earning national sovereignty–the recognised right to govern yourself–requires a certain amount of nation branding a la Bernays. Prior to setting up a government for the people, most of the people must buy into the idea that the nation exists. This means marketing your nation to the international community as well as the people that must eventually make up the nation. Kosovo is a controversial brand at the moment. Not even the European Union can afford the new nation, although some nations have made an early investment.

Rather like some populations and national leaders begun investing in the new hot nation-brand, Tibet. While no one can afford to isolate the established brand that is China, Tibet has picked up an impassioned consumer base–on the ground and online. There are hundreds of websites and many more blogs closely following the territory and its people’s movement for independence. Tibet has sailed past Kosovo as the poster child of national independence. And other groups are Buzzing about more autonomy as well—who will be next to adopt the trend towards statehood? Time will tell which state sells its sovereignty with the most success.

Let’s be honest. Spin is essential to a Brand’s reputation. While it may have a poor reputation, spin is not the sadistic misuse of naive consumer content. Consumers are far from naive, if their content has anything to say about it. Spin recognizes that while you can’t be in control of the content, you can impact where the content is going.

Spin is listening to what consumers say online and responding with the targeted information that consumers want. Spin is putting a positive twist on UGC (user generated content). Successful spin keeps the big players on the court and in the game. (Just ask the NBA sultan of spin and former Rookie of the year, Chris Paul). Spin is about more than balls–you have to be a team player. Monitoring and managing spin is important in the uber market created by the worldwide web. Successful Brands and Companies engage with consumers online rather than lose influence in the conversation.

They listen to the user generated content (UGC), evaluate the impact on their brand, and spin the results back to the consumer. If the spin has merit, the consumer content will receive the spin. The consumer will play with it. If the spin doesn’t respond to the UGC, if it’s strictly the company talking to itself—well, a bad spin in the social media can spiral out of control.

All professional bloggers know that there is money to be made in creating controversial content that people flock to read. But what about forums? Attentio just finished up a project in which it tracked a few popular posters (with their consent, of course–this is Europe). These posters initiated discussions, wove in and out of threads, and increased the traffic to some of their favourite links.

If athletes earn commission on the number of times they showcase a Brand name or product, why not let expert consumers introduce or promote a purchase? Rather than hiring the all-to-obvious fake poster to “create Buzz”, find a poster that attracts Buzz. These posters are legion, and each has his or her own niche of expertise and attendent acolytes and followers.

Approach her, the way one might a popular blogger, and discuss product samples. These posters are professionals about their topics. They can assess a product objectively, and most have already built a reputation online doing just that. Merchandisers or marketers need only supply the access and incentive for the popular poster to explore and evaluate their product.

Blunt celebrity endorsements are on their way out, according to market experts. Ads are dividing between the subtle suggestion and the frank discussion. Forums are famous millions of frank discussions dissecting everything from eye liner to the rims on Audi models. Pick a winning poster and the next market-moving discussion could involve your product.

The US Superbowl is this Sunday. Advocacy groups can’t wait.

Last year, General Motors featured a suicidal robot in its 60 second 5 million dollar ad. The robot’s portrayal of mental health offended a loud percentage of viewers. This prompted the huge corporation to publicly apologise to the American Foundation for Suicide Prevention for its distasteful machinations.

Snickers featured two masculine auto mechanics that shared a moment of physical intimacy over a candy bar. After realising their “mistake”, they attempted to out-compete each other in displays of stereotypical masculinity. They pulled out their chest hair. This insensitive portrayal of chauvinistic male pride offended the Human Rights Campaign, a gay advocacy group. Mars sincerely apologised only days after the ad aired.

Online viral videos–that is, user made or modified or just uploaded video content–generates huge audiences, and even its own content. Note the viral videos spiraling through the blogosphere for Nike. The brand showcased commercials featuring the hip hop basketball free stylings of streetball unknowns. Students, B-ball fans, and online netizens flocked to the YouTube and the search video sites to watch the show again and again. There were no famous celebs, no hulking (highly-paid) professional athletes. Just a bunch of kids and a ball in nicely woven montages that generated more wall-paper/screen-saver madness than ever before seen. People commented on and tried to copy the videos using their own computer equipment and inspired skills.

Ads today aren’t made for a small space of air time. Like the French ad art nouveau posters from the early 1900s, ads today are cultural icons. They are copied, modified and re-spun, carrying the Brand, Product, or Name along with them into the virtual homes, hearts, and minds of millions of online viewers. They elicit comment and commentary. Pundits mention the most memorable in news and spoofs, both on and offline. Marketeers can find themselves prolonging pain or profit through the creation of one noteworthy 30 second video spiel.

On the other end of the spectrum of the GM debacle, in the 2007 Superbowl spectators gave Nationwide insurance an extra 24 million dollars into unpaid media exposure, according to USA Today estimates. Nationwide featured the infamous Kevin Federline as a wannabe rapper working at a fast food restaurant. The National Restaurant Association trade group complained, but their bickering earned the general amusement of the public rather than supportive condemnation. What had been a short commercial in a long line-up of expensively packaged product teasers suddenly became a national sensation. Online, people posted the ad to their webpages. On YouTube, uploaded versions received over 600,000 views.

This year, family, female, and gay rights advocates are already stocking up on potato chips and broadband in anticipation of a new line up of expensive commercials. One isn’t exactly sure what to expect. Sure, the Superbowl is a family event, but advertisers know its not the acceptable ads that generate the additional free revenue. Advocate groups are equally aware that platforms for controversy are great marketing tools. As the two sides martial millions of spectators around the television, both may be hoping for a memorable post-season play-off.

The traditional corporate model places a high premium on sales. In fact, industry sectors sometimes complain that salesmen and women push systems and merchandise that haven’t been created yet. The favourite Dilbert commercial shows the hapless IT guy complaining to a sales guy, “you sold a system that won’t be invented for the next two years! What do you think that means?” The sales guy replies, “it means that I’m a fantastic salesman and you are a terrible engineer!”

Where this is the case, the company’s reputation is at risk. As competition heats up and the rush to force early systems adoption slows down, even monoliths like Microsoft begin to emphasise compatibility. This means that the sales guy that promises a product not yet on the market will be known as a hack rather than a hot-shot.

Salespeople (like politicians) are quickly becoming the menace of the marketing world when they promise products that don’t deliver. Online, the social media results of these transactions can unravel expensive and carefully planned marketing campaigns. Consumers go to the web to vet a potential purchase–this goes for individual shoppers as well as corporate customers. Complaints and compliments are out there online. They are accessible, accessed, and more and more used in assessing a potential purchase.

This is where marketers salvage the purchasing power that many over-enthusiastic salespersons spin out of control. Marketers collect the complaints and the compliments, pinpoint the issues, and repackage the relevant information where clients and customers can access it–without suffering the innate suspicion experienced by any person undergoing a sales routine. Marketers online have renewed power, if they have the technology and skill to access it.

Presidential candidates in the US race have spent a mere five percent of their campaign money online. Yet this five percent, “experts” argue, may prove to be the most effective money spent swaying undecided voters. Candidates can geo-politically target potential voters with information that is judged to be of immediate concern to the voter’s profile.

CNN reports that if a Democratic candidate discusses a penalising tax for SUV drivers on a morning TV show in Ohio, GeoVoter technology can identify all the SUV drivers in the area of the show’s broadcast. Within hours of the show’s production, a Republican campaign can send each of these drivers an email designed to pique the interest (and, it is assumed, the anxiety) of these potential voters.

The Internet is an amazingly well-informed “invisible hand” that marketeers and their companies (or candidates) are increasingly adept at manipulating. But does this really mean that they manipulate the market? I would argue that we haven’t quite come to that, and perhaps never will.

Internet use is increasing apace, and studies demonstrate that more and more people spend time surfing the web. (This is probably a byproduct of the fact that few jobs allow employees to leave their computer space during the course of the work day. Even the guy who runs my gym spends 60 percent of his work time at his desk. And I suspect he is not looking at the spreadsheets covering the expense of the gym equipment–at least not the whole time.)

Further studies (and there are always further studies) determine that most surfers are looking at content, not receiving or sending information. Being an avoider of email myself, I can identify with this. People are not paying a lot of attention to the arrows that the advertisers send to their inboxes. For most of us, it’s all we can do to peruse the email from the people we care about, much less the people that care about us (or our money/vote, etc.).

What’s a poor marketeer to do?

Target the content, not the consumer. Consumers look at content, consumers love content. They seek it out. They do not seek out emails, or sms, or targeted advertising. Quite the opposite in fact.

Know your consumer, your voter, okay. Know what they like to read, watch, and listen to online. Then put the add or the information there. Let people discover what they want to care about rather than tell them what their consumer/voter profile tells them they should care about. Anybody in the virtual world or the real world can report that profiling is far from popular these days, most especially by those that are profiled.

This is still targeted advertising. But it targets content, a far less threatening concept to most consumers. No one wants to be a target, especially for technologically guided SPAM designed to conform to your profile.

Consumers personally engage with content, they duck impersonal bullet points. The most effective marketeer is the one that engages in return.

Every marketeer needs a medium.

Social media is a vast and growing landscape.

It is so difficult to know all of social media, the abyss being so wide it is hard to see the bottom. Because of this marketeers need their W.H. Russell, their man in the trenches, up close and interviewing the parties most concerned with a particular industry in a certain market. Russell, the Irish Times reporter, wrote the interviews and the war stories that inspired one of Tennyson’s greatest poems. The words of which used a suicide charge to market the chivalry and sentiment of English valour to middle-class Victorians with immense success.

Russell wrote good stories, accurate stories because he went where few reporters had thought to go. He went to the hospitals and he interviewed the men. He traveled to the battlefields and took accounts from the common soldiers as well as the officers. Russell was the best kind of social analyst, specialised in knowledge of his audience and expertise of his media. Russell was the medium of the war machine that was the British army, and as a result of his analysis, politicians, physicians, scientists, industry experts, and poets were able to alter the way that their markets perceived war, and even society.

The role of any successful analyst is expertise. It is that expertise that enables a marketeer to craft the campaigns that are most effective. Politicians and industry experts today have a lot of information and (hopefully) sufficient wisdom to know that information of any kind requires analysis to be meaningful, to be effective. This role is something still carried out in the trenches, but not the trenches of the geographical landscape today so much as the infinite highways and byways of the net. Markets voice their concerns and audiences acquire a character through their social media.

Knowing where to look, what to measure and who to believe is the realm of the social media analyst. The best analysis makes the best pitch possible, and the best pitch can turn a terrible mistake into a call to arms.

Transparency is an Internet Buzz word these days. Any curious kid with access to a search engine can price shop, product compare, and peruse quailty reviews with a few clicks. All this leads some to believe the Internet has somehow empowered the consumer, putting them in charge of finding the best of whatever they want for the best price. Any lies will be routed by the power of the social media! All false promises will be exposed! The masses will not rest until their voices are heard! The truly democratic media has arrived.

But anyone who’s lived in a democracy knows it has very little to do with transparency. Transparency is a myth. Bias is ubiquitous. Just read Blink, by Malcolm Gladwell. Decisions are frequently the result of a steady exposure to whatever cultural cocktail makes up your daily diet of sight, sound, taste and touch. You know what you know because somebody told it to you. Maybe not in words, but your ideas were communicated to you by your environment in some capacity. Blonde is beautiful. Tall is powerful. Red is tasty.

What does this mean? Consumers are culturally biased. They are not necessarily in control of what they think. Consumers believe what sounds right, and the facts, the multitude of facts found via the Internet, can usually agree with them, in sight and sound if not in words. Because as much as consumers online may value transparency, its the packaging that they buy.

Let me explain. One of the most ubiquitous biases in all attractive Western media these days is the athlete–the lean, sculpted, healthy body dedicated to the pursuit of sport. In the age of the sedentary office lifestyle, practicing sport is a passionate past-time that is reflected in any successful advertising campaign. Think of the popular Mazda6 campaign only two months ago. Acrobats flipping and flying around a sexy speeding car. As a product, a car may be far from aerobic (consumers can’t burn calories pressing a gas peddle). But the fastest selling cars in all the European markets are the “sportiest”.

A car can be efficient, economic, eco-friendly (another contradiction in cultural understanding) and rank high in consumer-reviewed online blogs, but it is the “sporty” vehicle that draws the consumer’s eye and subsequent word of mouth. Yes, we even describe it to each other in our cultural lexicon. The Fiat drives like a sports car. The Kia c’eed has a “sporty wagon” to carry all the buyer’s potential athletic equipment (rather than groceries).

Logically, consumers know that not since the Flintstones have cars required athletic stamina, but our subconscious is so inundated with the importance of sport that we will gravitate towards the illusion. Marketeers are quick to pick up on this, photographing and filming car ads the same way sports reporters and action films shoot matches or breathtaking stunts. Of course successful marketers use the social web to corroborate with consumers and then everyone should get what they want…

The Net Promoter has been hot recently. Simple to measure it is a loyalty score which is supposed to signal future sales and correlate to value creation. Defined, it is a simple sum of the number of people that promote your brand minus the number of brand detractors. Companies that use it, like it because it is straightforward and requires just one question to their customers - “Would you recommend us to a friends or colleague?”

Originally conceived by loyalty consultant Fred Reichheld and supported by Bain and Satmetrix it has whirlwinded into the minds of CEOs with companies such as GE and American Express using it and apparently on conference calls with analysts. Although it is intuitive that knowing recommenders and detractors has value, it does seem to ignore other factors for market success or value creation. What about slightly important issues such as context of recommendation, pricing, market timing, supply, competition, availability of substitutes, advertising etc. What is seems to suggest is that all of these factors cancel each other out or are set to zero?

Although I am sceptical of the value of the measure in isolation, I go along with the hypothesis that identifying recommenders and detractors is important (in our case finding this in an online context). However over at IPSOS-MORI, they are completely dismissive. Once they put the score to scientific scrutiny (with help from Vanderbilt University,Norwegian School of Management & Koc University) they showed the measure to be largely spurious and even less predictive of future value than the American Customer Satisfaction Index (ACSI) - this is especially controversial as Reichheld states their examination shows that ACSI has no correlation with firm growth…

Conclusions from “The Net Promoter Debate” - an interview with Tim Keiningham Senior VP, Ipsos loyalty (May 2007). Full version downloadable here.

1. “Simple put, we found no support for the assertions attributed to Net Promoter. Our research clearly shows that claims of Net Promoter’s superiority in predicting firm growth, or in predicting customers’ future loyalty behaviours are false. Based on the evidence we’ve compiled, it’s hard to imagine a scenario where Net Promoter would be classified as a superior metric”

2. “As complaints about the effectiveness of Net Promoter have begun to surface, supporters argue that detractors are missing the point; Net Promoter is simple and gets companies to focus on customers. That may well be true, but the research used to support Net Promoter focused exclusively on growth… in particular, Net Promoter’s superiority in linking to growth. Few managers would adopt a metric just because it is simple. Simple and wrong is simply wrong.”

OK, so this debate is hardly new news, with plenty of heated discussion around the topic, but it is scary if the conclusion is that a score presented at calls with analysts is proven to be baseless. In my opinion it should at least get a more thorough review regards predictiveness and although companies should measure who is recommending them (and why) and who detracts them (and why) it may be prudent not to rely too much yet on just one number…