Does anyone deserve to die of lung cancer?
The No One Deserves to Die ad campaign gets credit for shock value. For reducing stigma against lung cancer patients, not so much.
Does anyone deserve to die of lung cancer?
Jonathan Purtle, Doctoral candidate in public health. Works at Drexel's Center for Nonviolence and Social Justice
By Jonathan Purtle
There we stood in front of the bulletin board at the Old City coffee shop Fork:etc — perplexed, trying to decipher the meaning of the ad. Hipsters Deserve to Die, it said, over a picture of a young African American man wearing glasses and a scarf. My girlfriend works in marketing, I work in public health, and together we couldn’t quite figure out the intention of the Lung Cancer Alliance's most recent social marketing campaign. The supplementary text — “lung cancer doesn’t discriminate, neither should you” — wasn’t particularly instructive. A visit to the organization's website provided some clarity.
The purpose of the No One Deserves to Die campaign is to “defeat the stigma and blame associated with lung cancer.” The site makes that point that many people believe individuals with lung cancer did something (i.e., smoked cigarettes) to deserve their fate despite findings that a significant minority of people with lung cancer (the 2006 National Health Interview Survey puts it at 18 percent) have never smoked. An alliance fact sheet notes that lung cancer was the leading cause of cancer mortality in 2009 — responsible for 158,158 deaths, more than those caused by breast, prostate, and colon cancer combined. In terms of cancer incidence, or new cases, lung cancer was second to prostate cancer among men and second to breast cancer among women in 2008. Despite this, lung cancer is the focus of substantially less federal research than other cancers.
According to the alliance, $231 million was spent on lung cancer research compared to $354 million for colon, $378 million for prostate, and over $1 billion for breast cancer in fiscal year 2012. While not overt, the subtext in these materials is that the funding disparities are the result of lung cancer being perceived as a self-inflicted cancer, and that those who develop it are not considered worthy of federal research dollars.
Founded in 1995, the Lung Cancer Alliance is dedicated to providing support and advocacy for people living with, or at risk for, lung cancer. Based on its website, increasing early detection and improving treatment for lung cancer are the organization’s top priorities. While the alliance has centralized some smoking cessation resources, preventing lung cancer appears to be of secondary concern. The organization's annual report indicates that it collected over $5.5 million in revenue in 2011. Among its major donors are GlaxoSmithKline, Lilly USA, OSI, and Pfizer —all of which market drugs to treat lung cancer.
The series of No One Deserves to Die ads — among them are a middle-aged woman stating that “Cat Lovers Deserve to Die” and a tough-looking man stating “The Tattooed Deserve to Die” — started popping up in cities across the United States in early July. The campaign was developed by the ad agency Laughlin Constable with the intention of striking a visceral chord with viewers and invoking the response that, indeed, no one deserves to die — particularly people with lung cancer.
If prompting an emotive response is a metric of success, the campaign appears to be a hit—some media coverage includes reports of the ads being angrily torn down. While the ads are shocking, however, are they likely to produce benefits for public health?
The campaign’s explicit purpose of “defeat[ing] the stigma and blame associated with lung cancer” is a worthy and laudable goal. Stigma is an enemy of public health, regardless of the condition. Stigma discourages people from seeking care, negatively impacts the quality of health care provided, and can cause psychological distress that adversely affects disease trajectories. A recent systematic review of research on stigma and lung cancer provides empirical evidence for the alliance's claims that people with lung cancer are judged for their disease. Numerous studies in the review found that health care workers held negative perceptions of lung cancer patients and that these perceptions translated into poorer quality of life and greater psychological distress among patients. I believe there is a disconnect, however, between the campaign’s aim of reducing stigma and the takeaway message from the “Deserves to Die” ads.
The campaign includes no facts or figures about the pervasiveness of stigma, discrimination, or perceptions that people with lung cancer “deserve to die.” Even if most people truly do discriminate against those with lung cancer, I doubt that they’re conscious enough of this bias to make sense of the ads. The message is novel and complex, and, as the trade publication Ad Week notes, the campaign may struggle to convey this message with such cryptic images and minimal text.
The fact that nearly one in five people who develop lung cancer have never smoked, perhaps the campaign's most compelling fact, is not even a prominent feature. It is not stated on any of the ads I've seen on walls or the web, and is available only to the über curious individual (i.e., a public health blogger) through a fact sheet online.
How about the alliance's suggestion that lung cancer research is underfunded because people with the disease are not perceived as being worthy of precious research dollars? Perhaps. History has shown that politics, advocacy, and ideology, not data, often shape funding decisions. Still, we know more about what raises the risk for lung cancer (smoking) than probably any other cancer. So it makes sense that funding would be directed toward research on the causes of other common cancers about which we know less.
To be sure, people with lung cancer do not deserve to die, be stigmatized, or treated with any less empathy than those with another condition. Nevertheless, I believe that the No One Deserves to Die campaign misses the mark. The ads are unclear, unpersuasive, and insensitive to the cat lovers, tattooed people, and other archetypes that are used to deliver the message. There is already too much hatred in America, without posters proclaiming that people “deserve to die” plastered all over public spaces.
That said, the campaign had enough shock value to get me to write about it — and to promote its message as a result. Is that a good thing?
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Interesting challenge for media types: simultaneously care for people with lung cancer, while reminding those without it that they can cut their risk dramatically (~tenfold) by not smoking. It's pretty similar to the challenge of simultaneously caring for diabetics and discouraging obesity.— Maia Smith- Thanks for taking the time to write about our “No One Deserves to Die” campaign, Jonathan. We appreciate you supporting our message that people with lung cancer do not deserve to die, be stigmatized or treated with any less empathy that those with another condition. The campaign was created to fuel conversation about a disease that has been so stigmatized that people are ashamed they have it and lawmakers choose not to appropriate funding to seek a cure for it. Yes, smoking may be one factor, but 2/3 of people with lung cancer are either former smokers or people who have never smoked. Lung cancer is the leading cause of cancer death in the U.S.; 160,000 Americans will die of lung cancer this year. There is a lot of opportunity to raise awareness and funding to help put an end to the stigma and the disease.— Lung Cancer Alliance
- Your representatives in other videos have said these are billboards that are staements which are absurd. How is the public supposed to know that? Your billboards are confusing and are of threatening nature to the six personalities on your list.
I am sure you are getting your stimulating conversations, but at what cost?? Have the donations doubled or dwindled since this campaign began? No one should boycott a lung cancer charity due to this negative campaign, but they certainly can give to other lung cancer charities such as The American Lung Association. They take a positive approach. I love cats and my dear daughter has an ankle tattoo. My beloved father had arm tattooes he had done while serving our country in WWII. I feel offended at the thought of billboards saying we deserve to die. Build support groups for the victims who have a difficult time dealing with the inevitable question, "did you or do you smoke?" Let these support groups help the victims while your charity educates the public. Don't go after innocent persons in our society. These six personalities have done nothing to deserve to be on your billboards let alone be told they deserve to die. When you must bring forth the CEO of Lung Cancer Alliance in her own video to convey the message you have posted everywhere...time to start over.— mrmaverickcat - My g/f best friend, co-worker has end stage lung cancer and given a maximum of 6 months to live. He was so stigmatized by his family and friends that he never reached out to her. We need less criticism and more funding.— starlight
- I think the campaign billboards are awful. Why did this charity choose these particular personalities? I think their donated money would have been better spent on research and educating the public in a positive way. If this charity had used the word "don't" on these billboards they would have sent the same message without causing concerns for one's safety if you are a target of their confusing message. I would like also to have seen this charity use their funding to start support groups that may help victims overcome the adversity they encounter like the person in the "starlight" comment. Having this cancer would be devastating, being alone and not feel like you can reach out to your own family would be the ultimate of devastation. Support groups....not demonizing billboards.— mrmaverickcat
- It is very sad to find that the Lung Cancer Alliance has now felt the need to remove the many negative comments found on the catlovers deserve to die video and the August 14th posting of no one deserves to die campaign. Now you must have a comment that meets their approval before they will allow. So far for freedom of speech unless it agrees with their point of view.— mrmaverickcat
