The unproven benefit of awareness campaigns

As October wanes, so recedes from sight the plethora of pink ribbons, pink merchandise, pink this and pink that—the now familiar symbols of Breast Cancer Awareness Month. That is until next October, when we will be reminded once again to “be aware.” But do annual “awareness” rituals accomplish important health goals?

Congress introduced 145 bills for awareness days in the last ten years. Yet, there is surprisingly little evidence — despite our wishing it so — that awareness in itself leads to action. So, we need to ask ourselves if these campaigns have become primarily opportunities for companies to co-brand in service of their own marketing interests. Are time and money being diverted from actions — education, research and subsidizing costs — that verifiably benefit the promoted cause?

We include health care providers among those who have jumped onto the co-branding bandwagon. Self-promotion used to be held unseemly in the medical profession. Now it is a common tactic to deal with increased competition. It has become normalized in an era of brazen promotion by drug companies, insurance plans and even hospitals.

One recent promotion exemplifies potential problems with awareness campaigns. When mammogram facilities began offering “Mammograms with mimosas and manicures” as part of Breast Cancer Awareness Month, it raised a question: is the implied patient-oriented goal of fostering compliance with screening sullied by the provider’s ambition to vie for customers?

Such self-promotion can have unintended consequences. The casual offer of a perk, like a manicure, can trivialize an important behavior—decision-making. Experts vehemently disagree on the criteria for screening mammography and over-screening is not risk-free. This is not a matter for frivolous inducements and simplistic imperatives: the simplified message of pink ribbon campaigns and incentives of this nature can obscure the complexity of the screening choices that confront women.

The most vocal objections I have heard to what has been called ‘pinkwashing’ come from women. In fact, a female colleague brought this issue to my attention. The medical sociologist Gayle Sulik in Pink Ribbon Blues documents the potential downsides of awareness campaigns, including co-optation by self-serving organizations and the potential to sexualize and infantilize women in the process. The counter culture mantra is ‘think before you pink.’

Aside from this experiential wariness of “all things pink” – Amazon alone lists thousands of items related to the pink ribbon campaign – there is a lack of demonstrable benefit from awareness campaigns. Purtle and Roman, in Health Awareness Days: Sufficient Evidence to Support the Craze?, conclude, after review of seventy-four available articles in the PubMed database, that the answer is—there is not. They warn that “If left unchecked, health awareness days may do little more than reinforce ideologies and the false notion that adverse health outcomes are simply the product of misinformed behaviors.”

This conclusion is supported by a survey conducted by SERMO, the leading social network for physicians. Thirty-four percent of a total 1,574 surveyed doctors noticed an increase in patient questions about the condition spotlighted during a given awareness month. Whether the questions resulted in a meaningful health benefit is not known. In fact, 55 percent of doctors do not believe awareness months/days affect their patients. Only 10 percent reported an increase in office visits related to awareness campaigns, such as Breast Cancer Awareness Month, according to the same SERMO poll.

It is time to rethink how best to allocate the personal and social reserves of time, money and energy devoted to preventing and curing breast cancer—or any of the many diseases with their own day. Several things can be done. Social scientists who study behavioral change can give more attention to the issue. Congress should exercise discretion in promoting awareness campaigns and the organizations conducting them should be subject to oversight.

With greater awareness of our own, we can be more selective when making donations, and avoid those products that are cloaked in pink, blue, or whatever primarily to move merchandise. In the meantime, physicians might do better to stay cloaked in white and continue to objectively curate and explain medical information to patients and society, whether that information comes from scientific studies, advertising, the government — or even advocacy groups.

Dennis Morgan, MD is an oncologist/hematologist currently engaged in writing and software development, after thirty years of practice. He is a member of SERMO’s medical advisory board. He was the founding Medical Director of the Phoenix Community Cancer Center in Connecticut, a past President of the Connecticut Oncology Association and former Assistant Clinical Professor at the University of Connecticut Health Center. He is a graduate of the University of Michigan Medical School and proud to be a former Veteran’s Administration physician. 

The views expressed by contributors are their own and not the views of The Hill.