Another round of jeopardy

CMAJ 2000;162:1113

But patients cannot pick another category, and life isn't a game show, as the Heart and Stroke Foundation recently discovered when they launched an ad campaign to draw attention to the burden of heart disease among women. The ad showed a woman's naked torso with her hands cupping her breasts. It read, "Quick, what's the number one killer of women? Here's a hint. It's not what you think."¹ The foundation was inundated with calls from women across Canada who felt that the ad trivialized breast cancer. For women of all ages, 38% of deaths are due to cardiovascular disease;² however, at least as many women under age 60 die from breast cancer as from cardiovascular disease.^2,3 By pitting the risk of heart disease and stroke against that of breast cancer and by failing to measure mortality in terms of potential years of life lost, the ad campaign inadvertently diminished the tragedy of breast cancer. The women who objected to the ad voiced the need to work cooperatively, rather than in competition, to educate women about health risks.

The Heart and Stroke Foundation, an important national resource for heart health information, was surprised by the reaction from the public. The ad had apparently tested favourably in focus groups before the launch of the campaign. To its credit, the foundation promptly withdrew the ad and is reconsidering the campaign.

What are the lessons to be learned? Clearly, marketing strategies that delineate and package diseases like brand-name products are unpalatable and do not reflect the complexities of illness or of life. And quiz show banter, very much in vogue these days, is an inappropriately glib way to communicate mortality rates, for these are not trivial pursuits. Although focus group testing can be used to estimate how a population might respond to an ad, it is as vulnerable to issues of validity, bias and interpretation as any other methodology.

The recent death from cancer of Canadian Olympic curler Sandra Schmirler, a 36-year-old wife and mother, should remind us that the burden of disease can not be reduced to sheer numbers. Heart disease and cancer have put many women's lives in jeopardy. They and their families need to know that medical research is continuing to defy the awful randomness of nature and that small gains and insights are being made every day. Headless torsos belong in museums — not in advertisements or, for that matter, hospital gowns. — CMAJ

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1. Askew K. Heart agency ad trivialized cancer, groups protest. Ottawa Citizen 2000 Mar 11: Sect A:7.
2. Heart and Stroke Foundation of Canada. The changing face of heart disease and stroke in Canada 2000. Ottawa: The Foundation; 1999. p. 68-9. Available: www.hc-sc.gc.ca/hpb/lcdc/bcrdd/hdsc2000/index.html (accessed 2000 Mar 21).
3. In 1997 there were 1176 deaths from cardiovascular disease in Canadian women aged less than 55,² whereas in 1999 there were an estimated 8655 cases of and 1680 deaths from breast cancer in Canadian women aged less than 60 (see www.cancer.ca/stats2000/tables/tab11e.htm).

© 2000 Canadian Medical Association or its licensors