In January 2005, Canadians awoke to full-page newspaper ads that declared the country is “losing control” of cancer. “Four in 10 of us will get it. In 10 years, it’ll be five in ten. It’s time to start controlling cancer instead of letting cancer control us. If we don’t, more of us will get cancer and more of us will die from it than ever before.” The ads were placed by the Campaign to Control Cancer, a consortium of cancer and health organizations formed to press the federal government to implement a national cancer strategy. All the statements in the ad were true. On current trends, more people would get cancer than ever, and more would die from it. But what the ad didn’t mention is that this is because the population is growing—more people means more cancer—and it is aging, which means more cancer because aging is by far the biggest risk factor for cancer. The ad also failed to note that the death rate from cancer is falling and expected to fall further, nor did it mention that the incidence rates of most types of cancer—after taking population aging into account—are flat or falling.
When Ian MacLeod of the Ottawa Citizen wrote an article laying out these facts in a straightforward, balanced news story, readers were furious. MacLeod was peppered with angry e-mails and phone calls. One man accused him of being “pro-cancer.” A letter to the editor argued, “It is worth the price of a few print ads, and the shock value of some tough language, to draw attention to the patchwork [cancer-care] system we have in place right now.”
Simon Sutcliffe and Barbara Whylie, two physicians with the Campaign to Control Cancer, also responded in writing. They didn’t dispute any of the facts MacLeod presented. “The Campaign to Control Cancer does not deny progress is being made,” they wrote, but the growing number of cancer cases would place terrible strain on the health-care system and much more could be done to ease that burden with simple prevention measures and other strategies. This is true. But the balance and reasonableness the doctors presented in the letter was wholly absent from the ad their organization placed.
In the summer of 2007, the American Cancer Society ran ads in fifteen women’s magazines featuring a young woman holding up the photograph of a smiling blonde. “My sister accidentally killed herself,” reads the headline. “She died of skin cancer.” The ad goes on to say that “left unchecked, skin cancer can be fatal.” It urged young women to “use sunscreen, cover up and watch for skin changes.” That sounds pretty reasonable until you learn that almost all skin cancer deaths are caused by melanoma, a rare type of skin cancer, and that scientists don’t fully understand the relationship between sun exposure and melanoma or what to do about it. “We do have pretty good evidence that sunscreen will reduce your risk of the less lethal forms of skin cancer,” Dr. Barry Kramer, associate director for disease preventionat the National Institutes of Health, told the New York Times, but “there’s very little evidence that sunscreens protect you against melanoma, yet you often hear that as the dominant message.” Dr. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, admitted to the Times that “we have taken some license in taking that message and using it the way we’ve used it because that’s the way to get the message to our target audience.” Another troubling point about those ads: Although the only logo that appears is that of the highly respected American Cancer Society, they were actually paid for by Neutrogena, a company owned by consumer-products giant Johnson & Johnson. One of Neutrogena’s main product lines is sunscreen.
All this is done with the best of intentions. There really are hungry children. Sun exposure really does cause cancer. It may seem pedantic to demand accurate information in messages about such serious problems. Surely what matters is raising awareness and getting action.
That attitude is all too common and the result is a parade of half-truths, quarter-truths, and sort-of-truths. In the mail, I got a brochure from the government warning me that “car crashes are the number one cause of death for Canadian children!” That’s true, as far as it goes. But the brochure doesn’t mention that the rate of fatal car crashes is steadily falling and is now far lower than a generation ago (the number of fatalities dropped 37 percent between 1986 and 2005, despite rising numbers of people on the roads). Nor does it say that car crashes became the number-one killer of children only because the toll inflicted by other causes (notably infectious diseases) declined even more rapidly. It’s no mystery why this good news was omitted. The point of the brochure is to get me to install car seats for my kids, and information that puts the risk of car crashes into perspective isn’t going to contribute to that goal. It’s much more effective to use a misleading factoid to deliver a simple and scary message: Your children are in danger!
Sins of omission are far more common than active deceit in fear marketing, but out-and-out lies do occasionally come to light. Dick Pound, the crusading chairman of the World Anti-Doping Agency, caused a furor when he said one-third of the players in the National Hockey League were using illegal performance-enhancing drugs, so Michael Sokolove asked Pound (for an article that appeared in the New York Times) how he came up with that figure. “He leaned back in his chair and chuckled,” wrote Sokolove, “completely unabashed to admit that he had just invented it. ‘It was pick a number,’ he said. ’So it’s 20 percent. Twenty-five per cent. Call me a liar.’ ” A liar he may be, but Dick Pound is no fool. As Sokolove wrote, Pound is passionate about the fight against doping and he knows that “his best weapon is his brilliance as a formulator of quotes, his ability to make headlines and call attention to his cause.” Pound even wrote a book called High Impact Quotations.
Pound’s “high impact quotations” are one solution to a problem faced by every activist, NGO, charity, and consultant with a cause. To succeed, they need the public’s support. To get the public’s support, people must hear their message. But people are deluged with images, words, noise, and pleas for their attention, most of which is ignored. In that information maelstrom, how do you get people to stop, hear, and think about what you have to say?
Even multibillion-dollar corporations struggle with this, although the dilemma is considerably less challenging for those who have huge quantities of cash and the best marketing expertise money can buy. To an extent, that includes government agencies and the major nongovernmental organizations. They may not have the monetary resources of a Pfizer, but they do have budgets big enough to advertise widely and they can tap into the same pool of expertise used by corporations. In the United Kingdom, the Central Office of Information, a six-hundred-person agency that implements all the government’s public-information campaigns, is the nation’s third-largest advertiser; its CEO is Alan Bishop, formerly the chairman of Saatchi & Saatchi, one of the biggest ad agencies in the world. In the United States, the Ad Council is a privately funded organization that arranges for ad agencies to produce public-service campaigns on behalf of government agencies and others, which it then distributes. Much of the work done in these circles is as sophisticated as anything in the corporate world. Practitioners call it social marketing.