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Monday, Nov 9, 2009
The American Dental Association's oral cancer awareness campaign targets young white people -- but that's not who's most likely to get oral cancer.
Mar 26, 2002 | An attractive young woman glances to one side and touches her tongue to her upper lip. She looks as though she's just heard a dirty joke. An arrow points to an almost imperceptible white speck on her tongue, and there is text beside it: "It's tiny now. Don't let it grow up to be oral cancer."
Five hundred of these public service announcements have been plastered up in New York City subway and commuter rail stations since the American Dental Association's 11-city campaign began here on Nov. 1. A second image shows a close-up of a lipsticked mouth projecting a photogenic tongue. There is another white speck, or is it a bit of glare? "See your dentist. Testing is now painless."
Never mind that one of these images is a stock photo, and that the white specks are added in post-production. That is of as little concern to the campaign designers as the fact that 90 percent of those diagnosed with oral cancer are over 45 years old, that most are men, that almost all either smoke or drink heavily and that African-Americans are at highest risk.
"You can argue that a 65-year-old, heavy smoker and drinker who looks down and out might more accurately have represented the target audience," said an ADA representative who chose to remain anonymous. "But would anyone have paid attention to that?"
It's possible that 65-year-olds would have paid a bit more attention. But they make up a small percentage of the people who will be viewing the ads. Everyone with a modicum of business sense knows that the best way to get a message out is to market to the middle. "The woman is young and attractive," continues the same ADA representative, "and we believe that's increased the campaign's visibility."
Exposure is the bottom line. "The overarching goal of the campaign is to get more people aware of oral cancer," explains Sandra Stahl, vice president of marketing for CDx Laboratories -- the corporation that funded the campaign with a public service grant. "Every effort was made to communicate as broadly as possible." In the linguistics of advertising, the young, attractive white woman on the poster is Esperanto.
Despite her mass appeal, the lip-smacking poster girl is not the target audience. Caucasian women already see their dentists 2.4 times per year, according to the Centers for Disease Control -- more often than any other group. And they're 30 percent more likely to have the insurance to pay for those visits than people of other races. Even if they've never heard of oral cancer -- and this is a crucial point for a public awareness campaign -- as regular dental patients they are probably being tested for the disease already. Dr. Lawrence H. Meskin, former editor of the Journal of the American Dental Association, has written on the many screenings that are performed unannounced in the course of regular check-ups.
It is no surprise that those who are at greatest risk for developing oral cancer -- older patients and African-Americans -- have the least access to a widespread (although covert) screening program that is already in place. The ADA has signed off on a campaign whose primary goal should be to rein in these outliers dying at the highest rate, but whose strategy rests on the familiar marketing logic of maximum visibility and targeting the center.
Why should we expect otherwise? No one involved in the campaign apologizes for the intertwining of private and public interests at its roots: The source of funding for the ads is also the developer and sole manufacturer of OralCDx, the noninvasive brush biopsy alluded to in the campaign slogan "testing is now painless." For every patient who undergoes an OralCDx biopsy, CDx Laboratories earns a $65 fee to process the results. And for every person who sees the ad and rushes to get screened, a private dentist charges a fee of about $95 for the checkup. In terms of revenue, it makes perfect sense to raise awareness among the people who are most likely to schedule an appointment. Again, these people are the least likely to die of oral cancer.
