It is one thing to cover the news and science related to cancer. It is something different when your organization and you personally become the news. Such is the situation with an article that appeared yesterday in the New York Times.
The focus of the article was an American Cancer Society public service announcement about skin cancer that has run the past two summers in several magazines read by young women.
First, some background.
The American Cancer Society has been concerned about skin cancer and the risks of sun exposure for many years. Our website has information on sun-safe behaviors, and our Cancer Facts and Figures publications talk about the risks for developing skin cancers, including the role of sun exposure.
Our basic protection message is “slip, slop, slap,” which translates into: slip on a shirt, slop on the sunscreen and slap on a hat to protect yourself when in the sun. Wearing sunglasses with ultraviolet protection is also important, as is avoiding the sun during the peak hours of the day, usually from 10AM to 4PM.
Our concerns regarding skin cancer and sun exposure are shared by many other organizations, including the National Council for Skin Cancer Prevention, of which we are a core (or, founding) member.
Skin cancer remains a major health issue in the United States and elsewhere in the world, especially Australia.
We estimate there are over 1 million new cases of squamous and basal cell skin cancers diagnosed in this country every year.
Although squamous cell and basal cell cancers are considered generally less aggressive, the reality is that they can cause occasional deaths and when ignored can require extensive, disfiguring treatment.
There will be an estimated 59,940 new cases of melanoma in the United States in 2007 according to Society estimates, and 8,110 people will die from melanoma. There will be an estimated 48,290 cases of in situ (or, non-invasive) melanoma diagnosed in 2007.
Although recently there have been decreasing rates of melanoma diagnosed in men under the age of 65, melanoma has continued to increase in women under age 65, rising about 0.5% per year between 2000 and 2004. Over time, that increase is significant and cannot be ignored.
In part, this is because young women continue to view tanning and sun exposure as a healthy lifestyle behavior. They are following a cultural norm that suggests a tan is healthy, and they seek tanning through outdoor sun exposure and tanning beds.
Many experts and advocates are very concerned about our failure to effectively reach this population and establish a different norm that emphasizes the long term skin-aging effects and cancer risks of these behaviors.
This brings us to the article that appeared in the New York Times and on some blogs, including a posting yesterday on the Wall Street Journal health blog.
Several years ago, the American Cancer Society established a formal marketing relationship with Neutrogena with the goal of promoting our common concerns regarding the risks of sun exposure. This relationship is not unlike the handful of other cause marketing efforts we have with other organizations.
Organizationally, the Society is very careful in how we establish and structure these relationships and with whom we decide to engage in these efforts. We are committed to meeting accepted business and ethical standards in these relationships, including full disclosure of how the Society stands to gain from these endeavors. We clearly disclose the relationship, and use the monies we receive to support our cancer education and awareness, advocacy, research and support services. We adhere to the Better Business Bureau charity standards, which can be found at www.give.org.
As part of our relationship with Neutrogena, the American Cancer Society logo appears on some of their sunscreen products, along with a disclosure about the nature of our relationship. Specifically, the notice states that we do not endorse a specific product and that a royalty fee has been paid for the use of our brand logo.
The companies we work with do not have special access to our scientific or research programs, and strict rules forbids their engagement in any discussions that might relate to our content, our research, our guidelines or any other activity we engage in.
Two years ago, Neutrogena offered to help us develop a public service campaign to target young women regarding the risks of skin cancer.
This was not a new consideration for us.
I personally had participated in discussions with various other non-profit advocacy groups seeking a way to promote messaging targeted to young women on the risks of sun exposure, for the reasons noted above.
During those discussions, we heard from the Legacy Foundation about their very successful campaign to reduce smoking among young people. The message from those discussions was that the advertising, in order to be effective, had to very edgy to get the message to break through the clutter and effectively influence the behavior of the intended audience.
The Legacy campaign was edgy, it was effective and it was expensive.
The money eventually ran out, and so did the intense public service campaign. But it was a model of what could be accomplished if the resources were available.
Shortly thereafter, Neutrogena suggested that we work together to produce such a public service campaign targeted to young women.
Focus groups were conducted, and a print public service announcement was developed.
The focus groups told us that a certain message resonated with the audience, namely that young women were impacted by the loss of a loved one from skin cancer.
The print announcement was developed, and in the summer of 2006 ran in 31 women’s, health, and fashion magazines, viewed by millions of readers.
It showed only the American Cancer Society logo, since it was an American Cancer Society public service announcement, advancing the American Cancer Society’s skin cancer awareness message and carried free of charge by the magazines. The PSA did not promote a consumer product. It did not promote specific company or its views. Plus, if the Neutrogena logo had appeared, there would have been a perception of implied endorsement, and would in essence be serving to increase Neutrogena sales, something it was not designed to. (Another skin cancer organization is currently running a similar ad, paid for by another cosmetic company and carrying the logo of that company.)
The core issue is that this is a message that many advocacy groups and interested medical professionals and their organizations feel has to be delivered to these young women to avoid the risks of skin cancer and melanoma later in life. It is a message the American Cancer Society has been delivering for years.
What was different here was that we worked in partnership with a company that could give us the credibility and the visibility among publishers that we cannot obtain otherwise.
Because of the campaign’s success, the decision was made to run the same type of announcement again this year. So far, 14 magazines have agreed to run the public service announcement.
Clearly, the campaign has touched a nerve given the interest of the various media organizations described above.
Some of the criticisms center on the scientific evidence behind the relationship of sun exposure and melanoma, and the role of sunscreen in preventing melanoma.
Other criticisms have included allegations of conflict of interest in that we did not disclose Neutrogena’s participation in the campaign, or that we even have a relationship with Neutrogena.
The edginess of the ad has drawn some comment as well.
These are, for the most part, the same questions we asked ourselves about these very issues long before the current discussion.
Some of these questions—such as conflict of interest issues—are germane not only to the American Cancer Society but to many non-profits who have to make decisions about the funding they seek, how they use those funds, and how to balance the needs to advance organizational missions as opposed to not being able to accomplish some important goals.
From my personal perspective, there is no conflict of interest in these public service announcements.
Our message about skin cancer prevention is indeed our message. It has been our message for years, and will likely continue to be our message for the foreseeable future. It is legitimate and appropriate for interested parties both within and outside the organization to have a discussion on the topic, and have different points of view. But our message has not changed, and has not been influenced by an outside company in this case.
Whether the tone of the public service announcement was appropriate is also a topic of legitimate discussion. I have already described the events leading up to the creative decision. This is not a new advertising approach, and it has been proven effective in the past.
What about the comments that melanoma is not associated with sun exposure? That is a topic of scientific debate, and perhaps sun exposure is not as closely linked to melanoma incidence as previously thought. But there is still a substantial body of evidence and expert opinion that indicates there is a definite and strong relationship between sun exposure and melanoma incidence, especially between sunburns in childhood and young adult years and the risk of developing melanoma later in life.
Having been involved in various discussions relating to this topic over the past several years, I find myself trying to sort out the various comments that suggest there has been something nefarious in our corporate relationship, or that we somehow had our message or our mission subverted.
We have a message about skin cancer, we promoted that message and we hope that someone will hear the message and change their behavior. That is what cancer prevention is supposed to be about.
Are there scientists who do not agree with our position? Yes, there are—just as there are scientists and researchers who have differing opinions on a wide variety of medical issues and treatments. And, there are many health experts and professionals who completely agree with our position.
These and other questions are appropriate for discussion and consideration.
But it’s the part that suggests there was some organized effort to be misleading or mischaracterizing that has me so personally disturbed.
You may not agree with me, but that’s ok. I accept that as part of public discourse.
But please do not assign or assume motives without an understanding of what was done and why.