Monday, January 16, 2012

For The Cure, Or Not?

The following print advertisement appeared in the January/February 2012 issue of the Brown University Alumni magazine.  Beneath the title, which read "Every 74 seconds a woman dies of breast cancer", was the following text:


The first item that struck me, in the above advertisement, was the logo.  Where's their famous strap line, "for the Cure"?  Compare to the logo at left that currently appears on Komen's website.

Does the dropping of the strap line represent yet another rebranding effort for the Komen organization?  Are they seeking to take the emphasis off being for the cure, in order to lower the public's expectations and avoid the criticism by the likes of the "Grumblers" with respect to Komen's spending priorities, specifically the relatively low amount allocated to research?

If this omission of the strap line does indeed represent a rebranded logo, then I have to wonder where the last thirty years and over $2 billion of funds raised actually went?  Is Komen finally admitting that funding research will never be their top priority, and that a reach-for-the-stars strap line is simply not delivering the kind of success metrics donors and the public alike might be starting to look for?

As I said I don't know if this a rebranding exercise.  Or whether Komen just picks and chooses which logos to use depending on the publication, but I'm keeping my ear to the ground on this one.


Next I looked at the text of this advertisement, which, as usual,  is full of decontextualized factoids and sound bites.

"Last year alone we funded more than 700,000 breast screenings"

To this factoid I say, so what?  Is the number of breast screenings the metric which Komen uses to define its success in early detection? Wouldn't a better metric be the number of deaths that were prevented as a direct result of screening and so-called early detection?  Trouble is, this kind of metric could only really be proven if the person screened ultimately died of something other than breast cancer, and would require a long-term research study.  As we know, people who are diagnosed early can still go onto develop metastatic breast cancer.  In fact, I personally have met a number of women, originally diagnosed at Stage 0/I, for whom this happened.

So of the 700,000 screenings, it would be far more useful to know how many women were diagnosed with invasive cancers? How many of women went onto develop metastatic breast cancer?  How many lives were really saved out of the 700,000 screenings?   Only then can the donating public really understand whether the "700,000 screenings" indicates a level of success worth investing in.

Recent studies have suggested that breast cancer screenings can result in a 20-30% reduction in breast cancer mortality rates.  But as Gayle Sulik, author of Pink Ribbon Blues aptly points out;

If the reduction in mortality is only 30 percent or less depending upon the country, the context, the follow-up, the level of expertise of providers, and the individual profiles of the women (and this is a short-list of just a few caveats), then what are we doing for the remaining 70 percent? [Editor: Emphasis added]

For the world's largest breast cancer organization to crow about 700,000 screenings without providing relevant success metrics is simply not good enough.

"We helped 100,000 people financially through treatment" 

In 2010, Komen spent about $20 million or 5% of their budget on treatment.  For 100,000 people helped, this equates to about $200 per person.  Whilst any money is good money to those in need, realistically $200 would pay for about fifteen minutes of consultation time with an oncologist.  I've been in treatment since 2004.  My first year alone, I paid close to $10,000 in charges that my insurance didn't cover.  What if I didn't have insurance?  $200 would be nice, but it certainly wouldn't even scratch the surface in terms of financial help for treatment.

Given that poverty has been associated with higher cancer mortality, I would argue that treatment assistance should be much higher in Komen's spending priorities, not the lowest as it currently is now.

"We educated millions about breast cancer"

Yes, to the tune of $141 million in 2010.  $141 million or 37% of Komen's annual budget, and Komen's number one spending priority by far!


Compare Education spending to their other allocations.  Extraordinarily high.

"We invested $66 million in breast cancer research and related programs"


It's interesting that this is the only dollar amount mentioned in the ad copy.  And yes, $66 million is a lot of money, but when compared to Komen's total revenue of $389 million in 2010* , and the amount spent on education, it's clear that research comes up far short in terms of priorities.

And perhaps more so in the future if Komen is indeed no longer interested in being for the cure as the ad logo would suggest.

* Note that 2011 financial statements are not yet available.

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Given Komen's relentless pursuit of the almighty dollar, and its almost megalomaniacal status as the world's leading breast cancer organization, is it not time for Komen to be more transparent about where it's future priorities lie and how it evaluates it's success? 

Don't we, as the donating public, deserve better?   

Come on Komen, what's your plan for the next $2 billion, and if you are no longer for the cure, then what are you for?

30 comments:

  1. brilliant, rach. just brilliant.

    incisive, thoughtful... right on the point.

    i would love to have some answers to these excellent questions.

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    1. Thanks CB - if only Komen would give us some answers. I'd have so much more respect for them

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  2. Interesting observations you make here. I wonder if this is a re-branding of sorts or if it's merely an isolated case. Time will tell. As Anderson Cooper from CNN would say, you're "keeping them honest," or maybe more accurately you're "trying to get them to BE honest." And knowing that makes me feel better. It really does.

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    1. As you say Nancy only time will tell. But I do know that everything in an advertisement is done very deliberately.......

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  3. Rach..... Nice detective work and very nice job of picking apart the article for the brain challenged to understand....

    Am I to presume the lack of PINK was to pay homage to Brown by coloring the ribbon with their school colors rather than sticking with pink?

    You always make me stand up and cheer.... and fist pump and yell, YEAH! Go get 'em, Rach.. hell yeah!

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    1. Thanks AM - it would be so much easier if only Komen would provide the context! As for the ribbon color, actually it is pink in the magazine, but looks brown after scanning. Good eye!

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  4. As usual, Rach, you ask the questions that need to be asked. Pointedly. And I, too, will be very curious to see if this dropping of the tag line "for the cure" is permanent.

    Grumble on, my friend. I'm right there with ya.

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  5. Thanks Rachel, I will share this widely. AnneMarie, I noticed the ribbon too. Hmm.

    Katie

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    1. Ta Katie....see my response to AM re ribbon color.....it is pink

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  6. Excellent analysis. I think the local affiliates are different from headquarters. The Dallas folks are marketers first and foremost, completely set on a business model.

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    1. I suspect you are right on this Ann. Thanks for commenting.

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  7. I recently took a job with a non-profit (http://citrinehealth.org) that serves a 5 county area of low income women providing easier access to social service resources and breast and cervical health screenings and treatment. Komen provides funds for a large percentage of our screenings and for the following treatments these women receive. I have not been a fan of Komen in the past because of its branding among other things. But I had to shift my perspective as I work day in and day out with women who need access to health services they cannot afford and are receiving treatment because of Komen and government grants. No one is turned away once they find our system. No one is left behind. Maybe Komen spends too much money pushing their name, but I am beginning to see the soft heart of the beast. Maybe they don't want anyone to know they serve women who are forgotten - who society judges because of their inability to speak English, the fact they live in a shelter or can't afford their COBRA payments when they lose their jobs. But it isn't just the poorest who get served - it is ANY women who can't afford tests or treatment. I don't know why Komen choses to market themselves the way they do...it was with great surprise that I saw their funds making a real difference in real women's lives. Yes, a cure is needed, but so is daily quality of life assistance for the women fighting. Maybe that is where they are trying to go with this (apparently) new marketing technique. I am cautiously easing up on SOME of my previous judgments.

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    1. Robyn - thanks so much for your thoughtful comment. I absolutely agree with you that access to care and financial assistance through treatment is crucial for anybody in need and dealing with catastrophic illness. It's great to hear that Komen is providing help at your nfp in this regard. Still, as I pointed out in the post, treatment assistance is only 5% of Komen's budget, and screening only 12% for that matter.

      Nearly 40% of Komen's budget is spent on "Education" and I'd be very interested to hear your thoughts on this issue. Personally I think Komen could be doing a lot more with respect to treatment assistance spending, and not so much on the education/awareness aspect.

      Komen also has the financial heft to really make a difference on the research front, none more so than in the hugely underfunded metastatic breast cancer research, but for some reason does not consider this to be a priority. I agree that we must focus on helping women now, but research to affect future outcomes is important as well, particularly for those of us, myself included, who will die from metastatic cancer. They just have to do better on this front, especially since their namesake died from metastatic breast cancer.

      An honest evaluation of priorities and success metrics is what is needed, not another meaningless marketing campaign, designed to keep Komen in business for another 30 years. What they need to be planning on is closing their doors.

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  8. This is a very interesting development. There have been subtle changes in Komen's marketing strategies in the last year that seem to be in response to the ongoing critique of pink culture and industry.

    To the argument that there is enough awareness, marketing has shifted from "Breast Cancer Awareness Month" to "Breast Cancer ACTION Month"; To the ongoing concerns about screening mammography, marketing has shifted from "screening saves lives" to "screening HELPS save lives"; To the evidence that Breast Self Exam has not been found to find tumors early or reduce mortality, marketing is changing the phrase "Breast Self Exam" to "Breast Self-AWARENESS;" and in response to concerns about Komen's legal efforts against other NPOs over the phrase "For the Cure" AND charges against its research allocations, there is now a subtle back-step from using the phrase in every advertisement.

    Robyn and Ann make important points that Komen's marketing and communications are organized by the Komen national organization. Individually, some of the affiliates are not only filling much needed gaps in services in their communities, they also at times (some of them) fund research. Yet, they must continue to turn over 25% of the funds they raise from their races to Komen national, and they have little, if any, say in how Komen national does its business. The system needs an overhaul so that NPOs in communities across the country can do the much needed work to provide health care and support (logistical, financial, informational, and emotional) to all of those who need it.

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    1. Excellent comment here Gayle. It does feel like the marketing games have begun to supercede what's really at stake here. A strategy that will move the breast cancer movement forward and make a real difference for the women and men slated to die from this disease. Perhaps Komen national would do well to listen to their affiliates and make the necessary changes to the system, rather than play with words.

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  9. Lots to say here, about breast cancer in general and Komen in particular.

    1) Everyone -- including Komen - is waking up to the fact that there isn't a "cure." The term is outmoded and false. No one (least of all your oncologist) wants to state that any woman with ER+ disease is ever cured. We all know that late recurrences happen. They aren't common, but they happen. So we might speculate that in a slow evolutionary change we will see Komen ease off the "for the cure" phrase. I don't know. What I do know is that phrase "for the cure" suggests a promise that is false from the get go...as if there is a cure; as if every other organization, but default, ISN't for a cure. Right. There will ultimately be successful preventive strategies, disease management and genetic manipulation, but not cure (s).

    Does anyone say diabetes is "cured?" Or heart disease? I don't think so.

    2) Komen at the grass roots level: I agree with what Robyn said about seeing their work up close and personal. Last fall I sat in a funding meeting for grass roots organizations. A conference room was packed with nonprofit directors, coordinators and nurses who work on the community level. The poor are with us, in huge numbers, in Texas and all across the country right now. Health literacy is not the norm. The discussion of how to screen all women and when, is one issue. The other huge issue that not enough people are looking at is this: what do we do with the under and uninsured once they HAVE been diagnosed with breast cancer? THERE's the problem. And we need to be really, really, blunt here: white, educated, professional women know as much about breast cancer as many oncologists. But we are not the majority. The point I continue to grapple with is this: how can we obtain an accurate picture of what the educational expenditure truly represents and where do we place the stick in the sand?

    Rachel, as always you raise excellent questions. In many ways the issue is even bigger than Komen: it has to do with how we would envision research, screening, treatment and follow-up for every woman in this country. That's what you're talking about. That's where your questions lead me. I want to start talking -- beyond Komen. Let's go there, shall we?

    Thanks for charging up my mental batteries:)
    jms

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    1. Jody - I can't wait to have this discussion in person with you one day. I absolutely agree with you that the word "cure" is obsolete, however it concerns me that this backstep may also be a sign that Komen is going to ease off on the research spending as well. We need an investment in the future as well as for today.

      I also agree with you and Robyn on the racial disparities in care once diagnosed, which is why I pointed out that only 5% of Komen's budget is devoted to treatment assistance. It should be higher. I too would like to know exactly how the education expenditure is divvied up, but Komen is less forthcoming on how the financial information translates to actual programs. At $140M I think we should know what we're getting for our money.

      Lastly it would be great if I didn't feel the need to write about Komen so regularly, but unfortunately Komen IS the big picture as far as the public is concerned. They have set the rules of the game with their financial might and slick pink marketing. So one cannot talk about what the "perfect" world looks like without imagining Komen in it. And make no mistake, I want Komen there, but what I want now is to understand what Komen has in mind for the future. There is just too much money at stake to get it wrong and waste the public's goodwill.

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  10. Yes, the donating public deserves better. Rachel this is an outstanding posting, and it is interesting about the Komen logo change. Maybe the pressure of unhappy bloggers disgusted with Komen's practices is finally getting to Komen?

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    1. Thanks for your comment Beth. It's entirely possible we are being heard, so let's get some real answers rather than the usual rhetoric.

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  11. I love your no-nonsense style. Keep Blogging!
    Cancer Warrior
    www.perksofcancer.com

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  12. You make a very important point, Rachel. I'm sure the powers-that-be got together in a conference room and hashed out the best revised logo they could muster, given the current anti-Komen climate. Good for you for noticing this not-so-subtle change. Keep up the vigilance. We readers love it!
    Jan

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  13. Great questions and observations, thanks.
    And thanks to Chemobabe for linking me in.
    As a Canadian i'm only partly familiar with Komen though we have similar though smaller orgs. I was just on their site http://ww5.komen.org and note that "for the cure" remains. Perhaps it is just some of their promotional material that's changed or someone goofed?
    As i delve into breast cancer i'm astounded by the sheer numbers and prevalence of the disease. Increased screening and improved technology is catching many more women with very early stage to the point where treatment direction becomes very unclear. Some even suggest that these very early stage cancers may never manifest and should be left alone.
    Further to the above comments, I find the strategy of promoting increased screening to be brilliant for any fundraiser as it "feeds the breast cancer machine" and adds more early stage women which in turn reduces the death rate and/or increases the survival rate (a more positive twist) just by the simple math!
    Rach, i'm with you as you pose your questions (to quote you): "it would be far more useful to know how many women were diagnosed with invasive cancers? How many of women went onto develop metastatic breast cancer? How many lives were really saved out of the 700,000 screenings? "
    I’d like to see those numbers too.
    Keep up the good work.
    Mimi

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    1. Thanks for reading and your comment. I tend to think the "for the cure" was deliberately left off this ad - any copy for a full page ad such as this is the fruition of so many different decisions right down to the ink color etc. It's my prediction we're going to see the "for the cure" phrasing slowly banished over time and perhaps a redefinition of priorities. It remains to be seen whether this will be or for better or for worse, but you can be sure I'll be reporting it!

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  14. I'm sorry that I'm just finding your blog today, given the circumstances. But, for future readers, I pose this question: When Komen says "Education," is that genuine education? Or another word for "marketing?"

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  15. I have been doing some research myself over the past few days, as I too want to know where my money is going. All donations that go to the national organization of Komen go to research. In FY2011 (FY's run from April 1 to March 31), an extensive amount of research grants were funded. (List found here: http://ww5.komen.org/2011researchgrants.html). Affiliates are responsible more for the education, screening and treatment grants. Of the affiliates I looked at, it seems that 75% of net profits are going to grants in local communities and 25% of net profits are going to back to the national organization for research. The affiliates also had their grants listed on their website and most had phone numbers. I even found that Komen funds a tissue bank in Indy that partnered with the Super Bowl. They have audited financials and 990 forms at www.komen.org. I'm ok with where my money is going now that I know the facts and not the spin the media has put on everything. I will continue to donate to PP too, as both are worthwhile organizations.

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  16. This was such an excellent, well-needed post (and blog!) for everyone to consider. NPOs, especially larger ones with much more sophisticated fundraising drives and campaigns, have a responsibility to their donors to make sure that their dollars can withstand scrutiny.

    My mom was diagnosed and died due to complications of breast cancer almost 21 years ago (on June 1st) and while I will admit the overall culture of understanding seems far greater than it was when she was diagnosed, the level of research into treatment options seems to have plateaued.

    It is important to bring the focus back to the patients and their families, and the communities who need those resources to serve ... and organizations like Komen simply portray a need to grow funds for marketing purposes that might help some people, but nowhere near the number of people they could help were their focus back on those patients, those families, and the communities.

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