ACS defends controversial ad campaign

ATLANTA—The dramatic announcement by the American Cancer Society that it would devote its entire $15 million advertising budget to the consequences of inadequate healthcare coverage on cancer patients took many in the oncology community by surprise and drew some criticism in the media. But according to the Society's executives, the move was necessary to meet its goal of reducing cancer mortality by 50% by 2015. In an interview with Oncology NEWS International, Richard C. Wender, MD, ACS national volunteer president, and John R. Seffrin, PhD, the Society's CEO, explain the Society's reasoning and suggest that the ACS will widen its role in promoting universal access to healthcare.

ONI: What drove the Society's decision to devote its advertising budget to the issue of access to healthcare?

DR. WENDER: We decided to devote our paid advertising dollars to promote political awareness, which is really the goal of these ads, because we determined that it's imperative for our leaders to recognize the critical role that universal healthcare access plays in America's cancer fight. I realize some people think we're making an audacious decision. We think of it as a very clear decision. Frankly, unless we solve the access to care issue, we won't achieve our goal of reducing the incidence and mortality of cancer.

DR. SEFFRIN: We think of this as a mission-critical decision. Never before has a voluntary health organization done a paid media campaign to point out the broken healthcare system by showing the faces of real people with cancer fighting for their life, as well as having to fight for the care that we think they deserve.

In the early 1990s, ACS set goals to reduce cancer mortality by 50% by 2015. We've had 15 successive years of decreasing age-standardized mortality rates. However, our studies showed we were on a trajectory to fall far short of our goal.

The Board of Directors said, "Well, Mr. CEO, tell us what we have to do to make those goals." So we did a very thorough analysis and found that the only thing that could keep us from ever reaching our 2015 goals was the broken healthcare system itself. That's what informed our decision to take a more global approach to fighting cancer.

ONI: Are there studies to support your decision?

DR. WENDER: Yes. We recently began a series of publications looking at stage of diagnosis for cancer. We found that individuals who are uninsured are more than twice as likely to present with late-stage disease (Cancer, July 15, 2007).

ONI: Some would argue that spending ad dollars on prevention initiatives would yield better results. Any comment?

DR. WENDER: Although $15 million is a substantial investment, it's only a fraction of our cancer control budget. ACS is maintaining its commitment to proven interventions such as our fight against tobacco and our breast, cervical, and colorectal cancer screening programs. But there is no escaping the fact that our prevention programs are not broad enough to make up for a failing healthcare system that leaves too many Americans with inadequate access to cancer care.

ONI: Do you have any recommendations to the government on how to increase access to healthcare?

DR. SEFFRIN: We've developed a system to evaluate the proposals that we think have the best chance of working and getting passed in Congress. However, we believe that the American people charge their elected officials with the responsibility of hammering out the blueprint and the necessary legislation.

Our goal at ACS is to raise awareness and motivate our policy makers into direct action. If we don't intervene, cancer will ultimately become the leading cause of death in the United States, needlessly.

DR. WENDER: Look, we're not naïve about the complexity of delivering healthcare in the United States. But we believe that the system can be changed so that all of our cancer patients are cared for.

There are states taking very serious cracks at the problem. Massachusetts is certainly one of the leaders, but they're not alone. Others are designing interesting approaches to solving the healthcare access problem. Our global program includes partnering at the state as well as the federal level to galvanize a consensus and plan of action around this issue.

ONI: In a time of soaring costs, how can we afford universal healthcare?

DR. SEFFRIN: In a nation that spends nearly twice as much per capita on healthcare as the next highest spender worldwide, the issue of universal access should not be detoured over the worry that we can't afford it.

It's not the money; it's mustering the political will to ensure that all cancer patients get access to care, which in the end will create better overall outcomes and a more cost-effective delivery system.

ONI: Does this shift signal more political activism than we've seen before?

DR. SEFFRIN: Rather than a shift, it's an indication of our organization's maturity and growth. Remember, we added the word "advocacy" in our mission statement 15 years ago. We're talking about eliminating cancer as a major public health problem in this new century.

We're not a bunch of wild-eyed ideologues. The ultimate conquest of cancer is as much a public policy issue as it is a medical and scientific challenge. And to be true to our mission, we have to plant both feet strongly in the advocacy arena.

DR. WENDER: The ACS has always recognized the important role that advocacy plays in cancer control, and we're not going to be shy about mobilizing our grassroots coalitions to impact policy change. I cannot think of a decision that was made with more sense of unanimity and enthusiasm than this one. People are tired of nibbling around the edges of this issue. The time has come to find a more permanent and lasting solution. So, within the leadership ranks of ACS, there was a profound sense of conviction that this does need to happen.

ONI: The decision has taken some hits in mainstream media. How's the reaction been from the cancer community?

DR. SEFFRIN: I don't ever remember receiving more favorable communiqués from our sister organizations and colleagues in the cancer control community. We partner with many of the major health organizations on a variety of issues and the reaction to our decision has been overwhelmingly positive. Sure, we've had some negative press, like the Cato Institute op-ed piece in the September 10th New York Post [Tanner MD: Cancer society's deadly medicine, www.cato.org], which was just shoddy and erroneous journalism, insinuating that the ACS is calling for socialized medicine. But that's just a small minority from the fringe. The encouraging reaction from the cancer community is what counts.

DR. WENDER: I've also had very positive feedback. Seeing the real human impact of lack of access to cancer care is something that not everybody across the country is aware of. The faces and voices of unnecessary suffering tell a powerful story that touches everyone. To that end, in order to relieve the devastating effects of cancer, we believe that universal access to healthcare needs to be recognized as a national effort.

ONI: Any closing thoughts?

DR. WENDER: On a personal level, I'm proud to be in a leadership position with the ACS at a time when we made the decision to grapple with the central barrier to the delivery of quality cancer care, from prevention, to early detection, through therapy and, where necessary, through end-of-life care. We're very determined, and I speak for the entire Board, to stay the course with the access-to-care issue until solutions that benefit everyone in the country have been reached.

DR. SEFFRIN: This campaign will raise awareness not only about the uninsured but also about the underinsured. One-third of all people diagnosed with cancer last year were financially distressed; 100,000 went bankrupt. There's something fundamentally wrong with a healthcare system that allows that to happen. Cancer patients have to fight for their life; they should not have to fight for their care.