Someone once defined insanity as doing the same thing over and over again and expecting different results, says Jack Fisher, chairman of Corbett HealthConnect, a full-service, worldwide health care communications agency located in Chicago.

If what you're doing isn't working, try something new. And, even if what you're doing is working, how do you know something else wouldn't be even more effective? Direct marketing is the most measurable of media. Take advantage of its measurability and you won't have to believe me or anyone else about what works--you can prove it with your tests.

Mind Your P's Test one element at a time. To test teaser copy, get an A/B split from your list provider, develop two versions, code your reply device, track response, and see which worked best. But don't change anything else, or you won't know which variable accounts for the difference.

Test every big thing, not every little thing. Teaser copy, first-class meter vs. stamps, handwriting vs. typewriting, postcard vs. envelope, and almost anything to do with the outer envelope is worth testing. Offers certainly merit testing. But focus on the big stuff--like price, for example. It's one of the "four P's" of marketing: the others being product, promotion, and place. Review the market price. Test a higher price, a lower price, a tiered price (e.g., special rates for various segments). But pricing schemes can backfire. When developing new marketing ideas, beware of adverse reactions from your members. Keep in mind the first principle of medicine: primum non nocere--first, do no harm.

Avoid Adverse Side Effects An example of unforeseen pitfalls can be found in the June 5, 2000, issue of Medical Economics. In the "As I See It" column entitled "Let's S Subsidizing Lawyers at Medical Meetings," Charles Davant III, MD, decries the practice of granting reduced rates to "all others," including to "slimeball plaintiffs' attorneys," easily recognizable at a cardiology conference he attended by their telltale yellow legal pads. If you offer trial lawyers discount rates to attend seminars where they can learn how to sue doctors, your irate member physicians may cast aspersions on your programs or s attending your courses. Some organizers hope that customers won't talk to each other about fees. But people do compare the prices they pay for items.

One good prophylaxis for such adverse side effects is market research. Prior to testing your ideas, seek input from program committees, advisory forums, and friendly faculty. Or you can use more formal means, such as convening focus groups or conducting surveys. But remember, people don't always do what they say they'll do, so after you've screened out the land mines, you should still test before rolling the idea out, especially if you're promoting to big audiences such as primary care.

Overcoming Resistance When a new antibiotic comes into the bloodstream, bacteria succumb in droves. Then they develop defense mechanisms and the magic bullet loses its magic. A newer antibiotic must be developed.

So it goes with direct marketing. A new, different, and compelling format or medium comes into the communication stream. People respond in droves. Then the clever recipients begin to recognize the new technique, especially as more and more direct mailers emulate it. At this point, another innovative format must be developed. So test for success. It's an extra step that involves short-term pain, but it has the potential to yield long-term gain when the results are subjected to the right analyses--the sixth and final key to direct-marketing success, the subject of my next column.