New Lung Cancer Alliance Ad Campaign Trying to Dissociate Lung Cancer from Smoking

Rivka Weiser of the American Council on Science and Health has exposed a new advertising campaign by the Lung Cancer Alliance -- a national nonprofit organization dedicated to advocating for people living with or at risk for lung cancer -- to try to increase funding for lung cancer research by emphasizing that most patients who are diagnosed with lung cancer are not smokers. The advertisement, featured in Tuesday's New York Times, has a picture of a lung cancer victim with the text: "This lung cancer patient can't stop smoking. Because she never started."

The main ad text states: "There’s no question that millions of lung cancer patients have died because of smoking. But it’s also true that over 50 percent of the people now being diagnosed with lung cancer are non-smokers or former smokers. In spite of this, the stigma of smoking
is still so great that lung cancer is underfunded, under-researched, and generally ignored by Congress." It concludes: "It’s time to treat lung cancer research with the same urgency that we bring to every other major cancer. Because the most lethal cancer in the country can no longer be hidden behind a smoke screen."

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While the goal of this ad campaign is laudable and more federal funding should be placed into lung cancer research, including its prevention, detection, treatment, and cure, I agree with Weiser that the advertisement may be misleading to the public. The ad headline refers to an individual whose lung cancer is unrelated to active smoking. But the subsequent text lumps together nonsmokers and ex-smokers in order to be able to attribute the appearance (i.e., diagnosis) of lung cancer to people who do not smoke. Thus, the reader is, I think, led to believe that the majority of lung cancer cases are unrelated to smoking. This is quite misleading, as 85% of lung cancers are attributable to smoking.

Presumably, the premise of the ad is that lung cancer is underfunded because smoking has a stigma attached to it and since most lung cancer is associated in the public eye with smoking, the disease as a whole is viewed as basically a disease of smoking and therefore the smoking-related stigma is hurting lung cancer research funding. So to avoid this problem, the ad aims to dissociate lung cancer somewhat from smoking. It aims to portray lung cancer as something other than a smoking-related disease. It aims to avoid the smoking-related stigma and thus increase funding for lung cancer.

Unfortunately, I believe both the means and the ends of this approach are flawed. The means are problematic because however important lung cancer research may be, it does not seem appropriate to use an approach based on misleading people to achieve that end.

The ends themselves, however, are flawed in two ways. First, by working to dissociate the public perception of an integral link between smoking and lung cancer, the ad is undermining decades of efforts of public health professionals and organizations to establish a clear association between smoking and lung cancer in the public's mind (which is essential, since lung cancer is an epidemic caused by smoking and a clear public perception of the overwhelming link between smoking and lung cancer is essential for efforts to prevent and reduce smoking). Thus, the overall message is inconsistent with public health efforts to tie lung cancer and smoking inextricably in the public's mind. At worst, the ad is reminiscent of tobacco industry efforts in the past to undermine the link between smoking and lung cancer. Although this was obviously not the goal, the fact that the ad may have this unintended consequence suggests that the approach taken in the campaign is not appropriate.

Second, by implying that funding for lung cancer research is justified specifically because most people affected do not currently smoke, the ad actually increases, rather than decreases the stigma associated with smoking and reinforces, rather than dubunks the view that funding of research for diseases should be based on the overall impact of the disease and not on how society views the behaviors or other factors associated with the disease.

So instead of saying, "Hey - smokers are human beings who have equal right to research and treatment for their diseases regardless of whether smoking is viewed as being socially acceptable," the ad is basically taking as a premise the fact that smokers are somehow lower-class citizens and their diseases are not equally deserving of research and treatment, but "Hey - most people who are diagnosed with lung cancer don't smoke at the time of diagnosis, so can't we just ignore the fact that they probably smoked in the past?"

There is no reason why society should devote less research funding to smoking-related diseases because they are caused by an unpopular behavior, nor is there any reason not to devote research funding to AIDS due to the stigma associated with the behavioral risk factors for that disease, nor should we reduce research funding for any disease because of any stigma attached to its underlying risk factors. It's time to end the stigma - period. Or at least to force policy makers to ignore societal stigma in making their funding decisions.

Feeding into these destructive stigmas may have short-term funding appeal, but I do not think it is the best long-term solution.