Concerns about the campaign are sloughed off as the niggling residue of corporate sponsorship. The potential health benefits of a well-funded marketing scheme can justify a great deal.

"It's better than nothing, that at least it becomes an issue," says Dr. Seymour Rettinger, a member of the ADA for the past 41 years. "We all understand that very few campaigns have people who are middle-aged."

The arrangement was negotiated by the ADA according to its well-defined partnerships policy, and despite the fact that OralCDx is the only biopsy or screening product to earn the ADA "seal of acceptance," no explicit mention of it is made in the most visible promotional material. But even the implied conflict of interest is enough to worry bioethicists.

"These ads are a classic example of what professional societies should not do," says Glenn McGee, the editor-in-chief of the American Journal of Bioethics. "No matter how well-intentioned, corporate sponsored campaigns on the part of the most important association in dentistry send the message that the organization is bought."

That message may be secondary if the campaign saves lives. In theory, the ads could reduce mortality by promoting screening, and thereby increasing the number of oral cancers that are detected at an early, more easily treatable stage. But the question of whether oral cancer screening does in fact reduce mortality rates remains unresolved, according to the National Cancer Institute; its answer would require further large-scale clinical study.

If it might save lives, it stands to reason, why not do it? This is the same argument that has been made in favor of continuing mammography in the face of controversial clinical data. But the same counter-arguments apply: Opponents of mammography point out that false positives are four to five times more likely than correct identifications, and potentially lead to hundreds of thousands of unnecessary and anxiety-provoking biopsies per year. According to the ADA's statistics, 10 percent of the population has questionable sores that might merit a biopsy, but less than .02 percent of the population gets oral cancer. In other words, 500 oral cancer biopsies are likely to turn up negative for every positive result.

"Clearly there's a tremendous amount of literature associated with false positives," says Dr. Lisa Lehmann of the Division of Medical Ethics at Harvard Medical School. "We tend to neglect the very serious psychological sequelae of taking the test."

To claim that the willful misrepresentation of risk is inconsequential compared to an increased awareness of oral cancer suggests a dangerous reinterpretation of "awareness" as an end in itself. The real value of awareness ought to be defined in terms of the social decision-making that emerges from it, and not from its marketability. The success of the ADA-CDx campaign -- that is, the degree to which it raises awareness -- depends on the number of people who get screened, whether or not those people are at risk.

More distressing is the possibility that a corporate-funded campaign of this kind gobbles up a finite resource by invading the public space. As consciousness-raising begins to rely on commercial strategies to underscore its message, it becomes more and more apparent that "awareness" is a commodity -- and a legitimate marketing target in its own right. By partnering with a professional society, a company like CDx can seize market share with concrete value and measurable returns.

Private funding can provide a conduit for important public health messages that would not otherwise be heard. But the professional and health organizations that validate these campaigns have a responsibility to guide the resources toward the areas of greatest need. The oral cancer campaign could have emphasized prevention over detection, and it could have targeted the people at the greatest risk for the disease. Neither of these strategies precludes corporate funding; Zila Pharmaceuticals is financing just such a campaign in the coming months. Obviously it would be foolish to restrict corporations to bald profiteering; as long as necessity directs their public service efforts, "awareness" can be invested responsibly and to the greatest benefit.

Recent Stories