I recently read Peggy’s Orenstein’s thought-provoking New York Times article, “Our Feel-Good War on Breast Cancer,” and I’m hoping every social marketer will read it too. It has sparked widespread dialogue within the social marketing community, and left me feeling unsettled and with many questions about the meaning behind my work.
The article suggests that the spectacularly successful pink-ribbon campaign has ultimately made women less conscious of the facts surrounding breast cancer, “obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating ‘cancer survivors’ who may have never required treating”. Orenstein — a breast cancer survivor who benefited from early detection — suggests that the very notion of early detection contributing to a cure is actually a mis-truth or oversimplification.
Orenstein did a thorough job of sharing facts and statistics that were very surprising (to me at least). For example, I didn’t realize that since mammograms/screenings have been introduced there haven’t been corresponding decreases in incidence of metastic cancer. And, that while there has been a 25% drop in breast-cancer death rates since 1990’s, many researchers attribute those declines to treatments, not screenings. Apparently mammograms are not as good at detecting the most lethal forms of breast cancer at a treatable phase. There was much more in the article, and I learned a lot about the history of breast cancer science, treatment, and prevention.
Still, the article was not just about the science behind breast cancer – it analyzed the marketing of the awareness of this disease and definitely took the stance that awareness initiatives like Komen’s pink-ribbon contribute toward overselling “both the fear of cancer and effectiveness of our prevention and treatment”. It posits that being over-aware of our risks for breast cancer can lead to unnecessary screening and preventive treatments. Orenstein goes on to suggest that while fear of cancer itself is legitimate, how we manage that fear, responses to it and emotions around it, can be ‘manipulated, packaged, marketed and sold’. The suggestion is also made that many social marketing/public health initiatives (prostate cancer’s Movember, testicular cancer’s yellow bracelet, heart disease’s red dress) all share a similar superficiality in terms of the response they require from the public.
Paul Holmes recently made a similar argument in an article for The Holmes Report, in which he references the New York Times article and indicates that social marketing interventions may have “ taken a huge step backwards in recent years.”
I bristle at this perspective. I’ve worked on social marketing initiatives for more than a decade, and know the rigor of behavioral theory and planning that is at the heart of much of this work. By applying behavioral science, we drive actual changes in behaviors, beyond simply creating awareness of an issue. Maybe the issues I work on are different by their very nature, where there is no one screening to detect, etc. Still, Orenstein makes a very strong argument for how, in the case of the pink ribbon and breast cancer, the level of awareness does seem to contribute to heightened levels of screenings and diagnoses that may not in fact require treatment.
So, I am left with questions. Are the initiatives we intend to be preventive actually doing harm? How do we protect against that and ensure they are not having a backlash that is unintended or expected? Is raising awareness as a first step toward behavior change justified, as long as the ultimate goal is an actual behavior change? What implications does this analysis hold for our work?