Everyone wants breast cancer. Hard to believe, but it's true. It's natural that AstraZeneca has a stake in cancer; the pharmaceutical company manufactures tamoxifen, a leading treatment drug. And Kodak and DuPont are both makers of mammography screening equipment. But why would Avon or Estée Lauder want anything to do with tissue tumors? What does breast cancer mean to Yoplait, American Airlines, the Republic of Tea, the NFL? What about the disease would inspire 1.4 million Americans in 2005 to go for a brisk 5K jog?
In recent years, Samantha King, an associate professor at Queen's University in Ontario, has attempted to unravel the strange web of philanthropy, marketing, and public policy that enshrouds the issue of breast cancer in America. The title of King's new book, Pink Ribbon Inc., is a pretty fair summary of her conclusions. King argues that the pink ribbon is primarily a branding tool for big business, and that it has contributed surprisingly little to the cause of preventing breast cancer. While the book (on University of Minnesota Press) occasionally indulges in academese—throwing in phrases like "heteronormative" and citing, yes, Foucault—it also delivers a damning and eye-opening analysis of "cause marketing." She points out, for instance, that there are now so many companies mounting pink ribbon campaigns that one of the first, Avon, actually felt obliged to look for ways to take back "ownership" of the issue.
King spoke about the business of breast cancer by email last week, on the eve of a book-release party in Kingston, Ontario. (She reads twice in Minneapolis next week—Monday, October 9 at the University of Minnesota and Tuesday, October 10 at Amazon Bookstore.) "I had noticed the increasing popularity of shopping as a way to express support for a cause," King explains, "and it soon became clear that breast cancer was at the front and center of this trend."
Put another way: When it comes to putting a friendly face on its public image, corporate America has found that breast really is best.
City Pages: Was the pink ribbon ever a grassroots movement?
Samantha King: The pink ribbon was created by Estée Lauder, so, no. However, a peach ribbon, the predecessor of the pink ribbon, was. In the early 1990s, Charlotte Haley, a 68-year-old with a history of breast cancer in her family, began making peach-colored ribbons in her dining room at home. Each set of five came with a card with the words: "The National Cancer Institute annual budget is $1.8 billion, only 5 percent goes for cancer prevention. Help us wake up our legislators and America by wearing this ribbon."
A few months later, Self magazine, which was planning its second annual Breast Cancer Awareness Month issue—with Evelyn Lauder, senior corporate vice president at Estée Lauder, as guest editor—decided to create a ribbon that would be distributed at the company's cosmetics counters across the country. At first, the magazine approached Haley asking her if she would work with them on the plan and, as part of the deal, relinquish the concept of the ribbon. Haley refused, claiming (correctly as it turns out) that she feared the commercialization of her approach, and so Self, in consultation with their lawyers, settled on a different color: pink.
CP: Who have been the greatest industry sponsors of the pink ribbon?
King: Cosmetics manufacturers like Estée Lauder, Revlon, and Avon have led the way. But car companies like Ford and BMW have also been prominent players in the pink ribbon industry. Interestingly, all these companies produce products that are linked to breast cancer incidence: parabens and phthalates in the case of the cosmetics, and polycyclic aromatic hydrocarbons in the case of cars.
CP: You write about the vast range of companies that support the Komen Foundation. What do Boston Market fried chicken, Lee Jeans, Breeder's Choice pet food, and the Dirt Devil have to do with "breast cancer awareness"?
King: There is no obvious connection between these companies and breast cancer. That's part of what's so interesting to me. One of the key principles of cause-related marketing is that the cause must fit the product, but the interest in breast cancer has undermined that entirely. This points to the emotional appeal of breast cancer and the way that has been exploited by marketing campaigns.
CP: Who are some of the most absurd sponsors of the pink ribbon that you've come across in your research?
King: Wipe for the cure—a pink toilet paper promotion. This year I've also seen fishing tackle, frozen dinners, and snow shoes.
CP: What is breast cancer "awareness"?
King: When people learn of the concerns highlighted in my book, their response is often to point to the good work that breast cancer campaigns perform in raising "awareness." But what exactly are we being asked to gain awareness of? Research shows us that people are quite aware of the existence of breast cancer and that in fact women overestimate their risk of getting the disease.
For those campaigns that venture into specifics, awareness usually means preaching the benefits of early detection through mammograms. Although this approach might prompt people to discover if they already have breast cancer, this selective brand of awareness asks individuals to take personal responsibility for fending off the disease, while ignoring tougher questions related to what might be done to prevent it in the first place.
CP: Do you have any reckoning of how much money the pink ribbons have brought in?
King: It's in the millions of dollars, but I don't have an exact estimate.
While some campaigns actually raise very small amounts of money despite the big promises often made, the overall amounts are quite considerable. Yoplait and its parent company, General Mills, alone, claim to have given a total of $15.5 million.
Information about exactly how much money is raised and how it is spent is very hard to find, however. This is one of the reasons Breast Cancer Action in San Francisco launched their Follow the Money Campaign to track the dollars flooding into the breast cancer cause.
CP: What epidemiological results can the pink ribbon movement point to as a result of its fundraising and "awareness" campaigns? Is there less breast cancer in the American population than there was 20 years ago? Are survival rates higher?
King: Breast cancer incidence has actually increased over the period since the pink ribbon movement emerged. Women had a 1 in 14 lifetime risk of getting breast cancer in 1980 and they have a 1 in 7 lifetime risk now. Mortality rates have improved slightly in recent years among all women, but have worsened among American Indian women. According to the latest statistics, black women are less likely than white women to survive five years after a breast cancer diagnosis: 77.3 percent versus 89.7 percent respectively.
CP: In the book, you write about the way that major pharmaceutical companies and medical imaging companies have lined up behind the pink ribbon campaigns. How does that kind of targeted giving program fit with our general idea of "philanthropy"?
King: I think we tend to think of philanthropy as purely altruistic, or if not purely altruistic at least as something that does more good than harm. But I'm not sure we can say that about breast cancer marketing on the part of pharmaceutical companies. Are we ever going to be able to prevent breast cancer, when companies that profit from treating it are driving the research fundraising agenda?
CP: Do other countries share our predilection toward these public-private health movements? How do you explain their huge cultural currency in the U.S.?
King: They're certainly a growing phenomena in other countries, Canada and Great Britain in particular. They're much more prevalent in the U.S. because of the historical importance of the private or volunteer sector in providing for the common good. In other social systems, people expect to help provide good health for all through paying taxes, but this has never been the case in the United States where private solutions are deemed preferable.
CP: When do you think you'll see your last Livestrong bracelet out in public?
King: That's a good question! January 1, 2007.
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