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Misleading Advertisement about Lung Cancer
By Rivka Weiser
A prominently placed advertisement by the Lung Cancer Alliance in yesterday's New York Times conveys the important message that lung cancer, which kills more people than many other forms of cancer combined, is worthy of more attention and research than it currently receives. Unfortunately, however, the well-intentioned advertisement is also misleading and has disturbing implications.
The ad features a photograph of a lung cancer patient who has never smoked ("This lung cancer patient can't stop smoking. Because she never started."), and 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 people now being diagnosed with lung cancer are non-smokers or former smokers." However, it is extremely misleading to lump the two groups together by saying that "over 50 percent" of lung cancer cases are diagnosed in non-smokers and former smokers. In fact, since approximately 90% of lung cancer cases are due to smoking, the majority of those in this "over 50 percent" group are former smokers, as opposed to non-smokers. Further, using the word "but" at the beginning of the second sentence implies that lung cancer diagnosed in former smokers is not actually also due to smoking, ignoring the fact that an elevated lung cancer risk lingers in former smokers long after they quit smoking.
The ad continues: "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 then discusses the toll of lung cancer, and 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."
It is odd that the advertisement focuses on the lung cancer cases supposedly unrelated to smoking as the reason that lung cancer should receive further attention and research. Even if all cases of lung cancer were due to smoking, would that make the disease and the more than 160,000 deaths it causes annually in America not as worthy of further attention, research, and resources devoted to its prevention and treatment? The line of reasoning in the ad seems to reinforce the unfortunate stigma on smokers who develop lung cancer as being solely personally responsible for their own demise, their fates somehow less worthy of attention than those of non-smokers or those who were able to overcome their addiction to tobacco.
While lung cancer in non-smokers is disturbing and worthy of more research, it is not the primary reason for the urgency for devoting more attention and resources towards preventing and treating lung cancer. The fact that lung cancer is the number one cause of cancer death in America, and that we know which one specific behavior causes the large majority of its cases, should be enough of an impetus for us to focus more on lung cancer as the urgent public health issue that it is.
Rivka Weiser is a research intern at the American Council on Science and Health.
To view more articles, visit ACSH Health Issues on tobacco.
LGK (May 11, 2005)
The fact that smokers' and former smokers' lung cancer fates are self-inflicted, and the implication by some that "their fates somehow less worthy of attention" is an ethical debate that has several avenues of thought feeding into it, and those seemingly independent avenues are actually deeply intertwined. (1) Is it just, in a day when the hazards of smoking have been known for decades, to steal money from the wise by way of escalating health insurance costs in order to pay for the choices of the foolish? (2) In spite of our good intentions, when will we acknowledge that we possess the medical and technological skills to create therapies and devices that are more expensive than we can afford to give to all who need them, that thusly a covert rationing of health care is already taking place, and that it would be more just to ration health care overtly even if it compels us to logically force-rank which medical needs will be met and which ones won't? (3) Has not the outwardly morally-neutral choice to smoke with its risk of lung cancer come to ride on the coat-tails of the immoral choice to have sex outside of marriage with its risk of AIDS? Is not our making massive expenditures for cures for both AIDS and lung cancer driven more by our base desire to disconnect logical consequences from our choices rather than some noble compassion to reduce suffering?
Dr. Peter Glickman (May 11, 2005)
Your critique of the ad misses the point entirely. Of course we SHOULD prioritize research on lung cancer merely because it kills so many people and is truly a scourge, regardless of whether some of the cases are "self-inflicted". But the reality is that many people believe that lung cancer should not be as much of a priority as other cancers because many victims smoke or have smoked, and have the attitude that victims only have themselves to blame. Pointing out that many cases occur in patients who NEVER smoked is useful because it raises awareness of this fact among those who might otherwise be inclined not to support lung cancer research, and increases the likelihood that more resources will be directed towards finding better therapies. Lung cancer is currently one of the least treatable cancers, probably in part because of the prejudice this ad seeks to correct.
Rebecca Semer (May 11, 2005)
Being one of those non-smokers to have lung cancer, I am for any advertisement that states that non-smokers get lung cancer, too. My 3-5 year old cancer was found the year I caught pneumonia. A cloudy spot in a follow-up x-ray turned out to be a cancer tumor. I couldn't believe the doctor when I received my diagnosis, hey, non-smokers can't get lung cancer, remember? It's a smokers' disease - but it's not. Lung cancer - it's not just for smokers anymore!
Environmental agents can lead to lung cancer. We have all heard of how friable asbestos can lead to lung cancer (asbestosis/mesothelioma). Other factors that have been highlighted are: lead dust, coal dust, radon, mercury and lead levels in drinking water, and food additives. Something besides smoking lead to my cancer, who's to say that something besides smoking has lead to cancer in those who happen to use tobacco?
Time for more research, and smoking SHOULD be taken out of the picture. Once a patient checks that "smoker/former smoker" box, no other cause is investigated. If smoking were the only cause of lung cancer, only smokers would be diagnosed. If non-smokers get lung cancer, there are other avenues to explore. Research is what's needed, stigma and blame are not.
Richard Barg (May 11, 2005)
The ACSH critique of the NYT/Lung Cancer Alliance ad badly misses the mark.
One of the principal justifications advanced by those lukewarm to lung cancer research is that such an approach is inefficient. In their view, the best return on investment is simply getting people to quit. Under this Jurassic Park scenario, lung cancer would, like the dinosaurs, eventually become extinct. And all that research would have been for naught. Many prominent cancer non-profits and foundations are reputed to have implicitly ratified this notion through lackluster funding of lung cancer research.
But what if quitting en masse (even from an addiction as intractable as heroin) turned out to be an ineffective solution? Recent evidence suggests that even for those who have managed to quit, the die has largely been cast. Thus, Dr. Claudia Henschke of IELCAP reported in late 2004, “It takes at least 20 years for the risk to decrease. Up until 19 years after smokers quit the risk stays steady, and then it drops by half at 20 years.” http://my.webmd.com/content/article/97/104279.htm
The NYT/Lung Cancer Alliance ad was very catchy, triggering a “double take”, “scratch your head” response from the reader - a woman, Karen Parles, appearing much like your next door neighbor in suburbia, fighting lung cancer without ever having smoked. Imagine that!
Based on ACS projections, 17,000 of such cases (lung cancer in non-smokers) will be dx in 2005, exceeding the total of many other individual cancers. A number this large puts the lie to the idea that lung cancer is self-inflicted, even assuming one bought into the highly dubious notion that smokers, current and former, at the inception of their habit, were mature persons who knowingly and voluntarily did so with full knowledge of the risks.
Even if every smoker in the world suddenly quit today, hundreds of millions would remain at risk for developing lung cancer. As the NYT/Lung Cancer Alliance ad points out, over half of lung cancers today in the U.S. (I have seen the number pegged as high as sixty percent) are diagnosed in former smokers and non-smokers. For this population, only a massive research initiative to race ahead of the disease process will put a dent in this massive public health problem over the next half century. Such research will also benefit current smokers, and that’s fine because as human beings, smokers are every bit as deserving of effective medical care for their disease.
Richard N. Barg, J.D., M.B.A.
Director of Strategic Planning
Thoracic Oncology Program
University of California, San Francisco
Bo Bennett (May 12, 2005)
This whole argument lately about what the cause of under funding of lung cancer is, is misleading. The argument that lung cancer is seriously under funded, is a fact. All the articles of late is just about the spin on which is the best way to better promote lung cancer funding and all the spin stems from and to the smoking issue. Most of the spin seems to come from those who feel smoking is unfairly persecuted as a reason for no support. Many agree that smoking is unfairly persecuted, many feel its justified but let it be known to all those who want funding. If you ask someone that has practiced discipline in their life for their health, to help someone who didn’t, chances are they will first ask “are they helping themselves now“. If they say “no” The expected response is a given. If the argument is then turned around to skirt the real issue, smart people, those with money and those who practice a healthy lifestyle, figure it out very quickly and refuse to be had and or donate.
Lung Cancer is under funded, not merely because we mistakenly aided in our disease, but because we won’t accept the responsibility and many of us want to continue what is destroying our lungs while fighting a lung disease. Specifically smoking cigarettes.
This issue must be separated if it is to be successfully argued and funding is to happen. Those who got L.C. and didn’t smoke might as well have, because this issue is aimed directly at them. Take the argument to where it belongs and that isn’t necessarily the former smokers.
Bo Bennett
Michael Siegel (May 12, 2005)
I think many may be missing the point of Rivka Weiser's excellent post.
First, the advertisement was misleading, plain and simple. By emphasizing that half of lung cancer cases occur in patients who do not smoke, the ad obscures the strong, established link between smoking and lung cancer. The ad could easily produce damage in terms of the public's perception of the risks of smoking. People are likely to misinterpret the fact that the bulk of lung cancer occurs in people who don't smoke as meaning that there is less of a connection between smoking and lung cancer. The misleading nature of the ad does a service to no one.
Second, by making an implicit assumption that lung cancer funding is more justified because it does not only affect people who currently smoke, the ad actually does damage to the cause. It increases, rather than decreases the stigma attached to smoking and reinforces, rather than breaks down, the idea that medical research funding should be tied to whether the victim is to blame or not.
Katie Brown (May 12, 2005)
No, I get her point very clearly.
The problem is that people are wasting time on articles such as this one, debating the ill effects of this advertisment to some who over analyze or those that smoke- when another lung cancer patient has just died.
The patient ran out treatment options due to limited funding, very few clinical trials and even less understanding from the public at large because they think this patient "asked" for lung cancer.
Yes, make the masses aware that you DON'T ever have to have had one single puff of a cigarette to get the deadliest cancer out there. Yes, let them know if they get it, there are very few options out there for them to survive. And Yes, let them know WHY there are so few options out there.
I personally won't waste a single second on the smoking stigma or issue or the fact that LCA's ad may mislead smokers into thinking they aren't as much at risk.....bologna!
As long as there are anti-smoking ads in every magazine and ads on TV and health classes at school, multitudes of online support for smokers and in-your-face anti smoking/dangers of smoking campaignes- (millions of dollars on prevention) it is common knowledge that smoking kills----
Very VERY few know that non smokers are at risk for lung cancer too.
Stop the blame game and advocate for those who are invisible.
K. H. Ginzel, M.D. (May 14, 2005)
I think your point is well made. You rightly expose what appears to be the ulterior motive of the ad: to suggest that, in order to boost research, the emphasis must be placed on lung cancer cases NOT caused by smoking (indeed, a most frustrating charge since about 90 percent are...). To get away with this, the ad tries to mislead the reader by stating that nonsmokers and former smokers, in this sequence, make up 50 percent of all newly diagnosed cases, thereby creating the erroneous impression that nonsmokers constitute the bulk of the latter rather than former smokers whose lung cancer risk is known to linger on for many years after quitting.
The fact that exposure to environmental tobacco smoke also contributes to nonsmokers' lung cancer, as now generally recognized by leading authorities in the field including the International Agency for Research on Cancer, IARC, of the World Health Organization, WHO, is simply ignored.
Inadvertently the ad perpetuates, on the one hand, the often heard view of nonsmokers that smokers' lung cancer is self-inflicted and therefore less worthy of attention, while it stresses, on the other, the urgent need for more research in support of cases purportedly not related to smoking.
What is entirely missing from this line of reasoning is the fact that smoking is a powerful addiction unleashed and fostered by more than half a century of aggressive tobacco industry marketing. Since the overwhelming majority of adult smokers started and became addicted to nicotine as children, the "ground zero" of the cigarette pushers, the charge of conscious choice, the industry's favorable buzzword, has a hollow sound indeed. Witnessing the unprecedented tragedy of almost half a million annual smoking-related deaths in this country alone, more than 160,000 of which are due to lung cancer, we must realize that this inexcusable epidemic is not the consequence of careless self-indulgence and self-mutilation that smokers have unthinkingly brought upon themselves. Almost 40 years ago, in the subtitle of her pioneering book "The Smoking Gun", Elizabeth Whelan hit the mark in her plain statement: "How the Tobacco Industry Gets Away with Murder".
The lung cancer patient, smoker or not, deserves from each of us sympathy and compassion, and from the nation the mobilization of expanded research into new and improved treatment options and, most importantly, the commitment to preventive action that does not shy away from tough socioeconomic choices.
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