Working with health planners and physicians over the next few years, I became a very organized person. I learned to break down common sense into series of complicated steps and working documents. I discovered how to back into my conclusions in an appropriately logical way. And although I never learned to work with numbers, I learned how to work with numbers people. In short, I went over to the other side. Today the left brain is winning, and we are all slightly out of whack. I am attending too many meetings, writing too many reports, looking at too many numbers, and we're evaluating far too many programs in the search for a marketing cure. Marketing is becoming a science, even as medicine is dragged kicking and screaming into the great unknown, to the notion that mystery, spirit and emotion lie at the heart of much of our disease.

Today public health, like so many public institutions, faces problems that are systemic, without a single cause. There is no bug or virus to be isolated or eliminated. Our epidemics are violence and teenage pregnancy, sexually transmitted disease, drugs, alcohol and abuse of the environment. These problems are, for the most part, interrelated. Their cause is everywhere at once, with roots in an expanding population, a lack of family structure, a proliferation of guns and drugs, a growing gulf between rich and poor, and a new natural environment of media and mixed messages. These problems, it seemed to me, could never be solved by attacking them head-on, by starting a war against this or that. Our most truculent social problems — and our most important audience, young people — aren't being reached by attacking — them by marketing designed to change attitudes, beliefs, or behavior. Look at drugs. The President and House Speaker recently kicked off a $200 million dollar advertising campaign to "unsell" drug use — primarily among young people. The ad budget may grow to a billion dollars over the next five years. Will it work? Unlikely.

The Partnership for a Drug-Free America spends hundreds of millions of dollars a year in donated fees in media time and space to support some of the industry's more stunning creative efforts. Yet despite many years of great advertising and at least adequate exposure, there is no evidence of any impact on drug use among teens. In fact, drug use has, at times, gone up during the anti-drug campaign's more intense efforts.

And what about teen sex?

What advertising campaign could possibly overpower the pervasive effects of the media, peer pressure, a lack of family structure and the proverbial raging of hormones? Hormones alone are enough to daunt the staunchest advertising advocate.

Chemical onslaughts at adolescence are strong enough to cause some young men to literally swagger. Aside from the more obvious physical changes and sexual urges, the single hormone testosterone, is responsible for foul moods, excessive aggressiveness, irritability, an unhealthy sense of omnipotence, and even the desire to be alone. To change behaviors we have to overcome not only media and peer pressure, but compelling and persistent forces of nature. A tall order for advertising, even if we knew what we were doing; and when it comes to targeting teens, we do not. No advertising campaign or sex education curriculum has been shown to decrease sexual activity among teens.

What about de-marketing tobacco? We have graphically illustrated the effects of tobacco on the lungs, mouth and heart in classrooms starting in the first grade. Every cigarette advertisement, as well as every pack of cigarettes, carries a clear and simple message that cigarettes lead to an early death. Yet more and more teens now smoke. California spent $26 million in one recent advertising campaign to discourage smoking. We have no evidence that the highly provocative campaign was effective with teens. Despite the very justifiable cry against tobacco companies for targeting teens in their advertising, one likely reason cigarette smoking among teens is on the rise is simply the fact that we're so aggressively trying to discourage it.

The advertising wars against tobacco, drugs, and teen pregnancy have succeeded so far in demonstrating only our limitations. We cannot make people do what they don't want to do. We can't make them listen because we know more or because the facts support our story. This is especially true with teens.

There probably is no rational marketing approach to teen smoking or teen pregnancy prevention worth pursuing. Advertising has the impossible task of conveying potential future benefits to a population which by and large has no concept for the very word "future." What's more, when it comes to reaching teenagers, we are dealing with behaviors over which logic may be a last resort. Anyone who is a parent knows this.

And as much as the media has attempted to shed some light on their little corner of the world, theirs is a world unto itself. The lives most teens lead with others, in cars and hangouts, on street corners, at parties, on a date, are not a world we know or can do very much about.

There is no "cure" for teen smoking or teen pregnancy, so we should stop looking for it. There is no single enemy, so there is no antidote or inoculation. And it is unlikely that any amount of evaluation will reveal one anytime soon. The problem is systemic. The science of marketing will have no more success than the science of medicine has had treating other social problems as if they were a disease. And it certainly doesn't appear to help matters when the science of government steps in.

What's more, the advertising system we use to carry our social marketing messages cannot handle our product. This system is largely an economic and distribution system. It has evolved and grown over the years and has become an integral part of our viewing, shopping, driving and working way of life. Products and messages are fed into this system like packages on some super baggage sorting device. This delivery system will not carry our behavior change product, it is lost in the shuffle.

Social marketing advertising messages cannot be easily wrapped up, addressed, or shipped. They deal with issues that are interconnected, tied to one another and tied again to other complex systems like families, employment and education. The message creation and distribution system social marketing uses is not geared to handle systemic change; it is only geared to move the pieces around.