Lung Cancer Alliance's New Lung Cancer Ad Campaign - 1246438

Thanks Laya, I hadn't seen it. We know why they chose to be as shocking as possible and I like the talk it's causing. It doesn't bother me that hackles are raised. The first comment below the article is what disturbs me.

bump anyone?

I thought about posting on it. It's definitely controversial, and it has plenty of shock value, but I'm not sure that in the end it'll lead to the right kind of discussion. I'm not sure people will get from the shock and awe of the ads to the resolution that "I guess I shouldn't be dismissive of lung cancer based on smoking status" without pausing for a long time at "this is really an obnoxious advertisement".

I'm certainly interested in what others think.

-Dr. West

I think that most people won't be able to get pass the "what an obnoxious ad" to think about how lung cancer can affect everyone - smokers and nonsmokers.

ssflxl

I think it's interesting that other behaviors that affect health weren't included, like morbid obesity or unhealthy eating. Much less stigma is associated with diabetes or heart disease, compared to lung cancer.

I do think there's plenty of negative societal views toward obesity, often associating it with many other disrespected characteristics, like being lazy or stupid or just the goofy loser.

I don't want to suggest that we should play "blame the victim", but as someone struggling to change my exercise and eating habits, a challenging overhaul, I feel the association of "if I find myself in an ER, getting an emergent EKG while I grip my chest, it's my own damned fault", similar to what many longtime smokers have said to me, with resignation. I think the idea of anyone "deserving to die" is hyperbole, but the bigger challenge is the question of ownership of a lifestyle, a series of longstanding behaviors, that lead to markedly increased risks. "You reap what you sow" cuts across many behaviors -- not only smoking and lung cancer -- including my own failed lifestyle changes over too long a time. (Though I'm doubling down on changes I'm working to implement.) But I do think one reason they don't have posters saying "do fat people deserve to die?" is that there would be plenty of people who would pause and think about it, as some probably do about smokers, rather than feel instant revulsion.

-Dr. West

Dr. West, thank you for being so candid about your struggles with weight and exercise. I have two very close friends who go through the same struggles and know that it isn’t easy. I agree that there are entirely unjustified negative societal views toward obesity. However, I don’t think that these views affect donations to the American Heart Association or the American Diabetes Association, although I could be wrong. However, as you know, the stigma of smoking and “deserving to die” is so closely associated with lung cancer that it affects fund raising efforts and, consequently, the amount of money available for research. It doesn’t seem that any advertising efforts to date have been very effective in overcoming this problem. And, unfortunately, I have found out that there are people who think that smokers or ex-smokers with lung cancer deserve to die and that money for research and treatment shouldn’t be wasted on them.

follansbee

Thank you Dr. West for your candor. I've fought fairly successfully all my life with food. When I realized D wasn't eating (before dx and since) I started buying and preparing anything I thought he may eat. When he didn't I ate it. I stop being as active too. Boy after 2 years of that I was in bad shape and I'm sure some things just aren't gong back to where they were. On the up side I've been doing yoga 3x/week with a good friend and a dvd and "finally" am getting somewhere. The point is that even after 6 months we are both surprised at the end of every workout that we did it. It's incredibly difficult. Almost as difficult as stopping smoking is working out or not eating that thing.

I have come to respect and accept the add campaign. It took tons of courage to move forward with it. Can you imagine the discussions? But no one has been successful in getting people out of the closet about this problem. I hope it works.

Well, it's promoting conversations, which is a big part of what I'm sure they were hoping to do.

-Dr. West

Interesting - thanks Laya. From my distant island, I find myself slightly mystified by this. Is it a cultural thing? The ad seems to me not so much obnoxious as obscure. It's also not particularly helpful in encouraging people who are smokers and do have lung cancer to give up or cut down.
I don't think I have ever heard anyone suggest that smokers with lung cancer "deserve to die". The debates in Britain are about whether moral judgements should influence the allocation of healthcare resources: surgeons refusing to operate unless someone stops smoking; alcoholics not being able to get liver transplants. That's not the same as saying these people deserve to die: the issue here is whether a publicly funded healthcare system can reasonably require changes in lifestyle. It sounds as if the US ad campaign is being framed more as an issue of discrimination/prejudice, or have I got that wrong?

I think the cerebral arguments are really framed in exactly what you described for the UK: that it's a question of whether to prioritize limited resources to be allocated to disease that are largely (though not exclusively) related to lifestyle decisions. In practical purposes, when you have 10x the amount of money per cancer-related death going toward breast cancer compared with lung cancer, though, it's hard not to feel both stigma and a sense that lung cancer patients are being consigned to death. And while there has recently been a lot of education centered around the sympathetic case of a 50 year old never-smoker getting lung cancer, this invokes action at a cost of implying that people who smoke deserve their cancer, while the never-smokers don't. So I think this campaign is really an outgrowth of a mindset that money, sympathy, and all good things should be offered comparably rather than relegated selectively only to people who can't be implicated for causing their disease.

Perhaps one difference between the US and the UK is that the US sociopolitical system tends to reward creating more heat than light, so a controversial but emotion-inducing campaign might well be preferred over one that creates thoughtful discussion.

-Dr. West

I am sure there is a similar disparity here between funding for lung cancer and breast cancer here (though I don't know the ratio). So perhaps those attitudes are just more latent in this country - underlying rather than explicitly expressed. The stereotypical distinction I am more conscious of is (to put it crudely), old man with a hacking cough with lung cancer vs young mother with breast cancer. I suppose the old man's hacking cough implies smoking, but it is sort of wrapped up in the stereotype, rather than spelt out and singled out for blame.