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Archive for the ‘Cause Marketing’ Category

Recent news and commentary of note on US and global issues related to health and well-being:

Medicare Part D Ups Patient Compliance, Reduces Hospital Costs

Why do 70 dead in Norway rank higher than tens of thousands in Somalia?

For-Profit Hospices Keep Patients Longer, Push Costs Up

Where’s the Advocacy, Komen?

Divided Appeals Court Rules That Companies May Patent Breast Cancer Genes, but Invalidates Patents on Comparing the Genes

Big Pharma wants to ‘friend’ you

Drug prices to plummet in wave of expiring patents

Two Steps Forward, One Step Back on Hospital Transparency

The most and least expensive cities for health care

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The article Efforts to Undermine Public Health:  Health Advocacy Organizations and the Pharmaceutical Industry: An Analysis of Disclosure Practices in the Jan.13 issue of  American Journal of Public Health focuses some much-needed attention on a serious and growing problem , which directly impacts the creation of rational health policy.  It’s also good to see the wide media attention being given to the study, which has been flagged by venues across the spectrum, including  healthcare sector analysis and investigative reporting blogs to mainstream  business media and news reports.

It’s been interesting too,but not surprising to see, that a number of people are also sending identical comments to multiple venues  which covered the story, some to decry the findings of the study, or  to make  off-topic remarks. The comments from the National Health Council , for example emphasized that it has a policy of requiring member groups to have internal disclosure policies regarding industry support received. The NHC itself  has a listing of funding received in 2009 from its  many “Corporate Partners.”   However, just like with payments to physicians, merely acknowledging industry funding doesn’t mean that it does not influence the actions of the recipient, nor not create conflicts of interest.  Unlike the significant body of research on the topic of influences on the prescribing practices of doctors (which have found that while many  state that they themselves are not influenced by pharma gifts and perks, they believe that their colleagues are) , much less attention has been paid in the US to the phenomenon of  industry support of HAGs and its impact on public policy.

Based on personal observations both as  patient and a healthcare professional , I believe that the “don’t bite the hand that feeds you”  phenomenon  relating to HAGs, contributes to  the present inaction on getting states and federal government to do something about the exorbitant and escalating price of medicines as a public health measure. Until the electorate actively protests what is going on, the lobbying power of the biopharma industry  on Congress will remain in effect. While it is becoming more common to find  media pieces highlighting  complaints by provider and  disease groups  about the price of Rx drugs, along with the unaffordable co-pays for those insured, almost never do we hear patient advocacy groups demand that something be done about the situation.  The only logical conclusions that seemingly can be made about the scenario is either that the public is incredibility naive about how the pharmaceutical  and insurance  industries  function, or else HAGs have been so influenced by their pharma benefactors that recipients actually believe that the prices are justified by R & D costs, and that patient assistance programs ( PAPs) are a genuine access solution.  Likely it’s some combination of factors.  More about this later.

Since a requirement that  HAGs disclose industry funding was dropped from Sunshine Act provisions incorporated in the ACA, it’s time start to address the problem by pressing the IRS to require that all 501(c)3 charities disclose their funders and amounts received from each. At the same time, much more public education  is needed about  “the ties that bind”, to paraphrase the title of a 1999  report on the topic  by Health Action International.

In the meantime, those interested in starting to research  industry links to patient and disease groups will find the following resources of independent organizations helpful:

Essential Action
Pharmafiles database: Patient and Health Groups and Their Corporate Funders
Patients, Patents and the Pharmaceutical Industry

Knowledge Ecology International
Medical professional and patient group funding by drug and medical device companies

Healthy Skepticism


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No surprise to me read to read the WSJ report Charity Brawl: Nonprofits Aren’t So Generous When a Name’s at Stake, detailing how the Susan G. Komen Foundation is aggressively going after small disease charities who use the phrase “for the cure” and/or the color pink in their fundraising efforts and programming.  The article includes details on other big box charities who engage in the same snarky practices, as  this kind of uncharitable behavior is increasingly the norm.  Here’s hoping that a dose of sunshine will not only lead to reform but  serve to wake up the public to the realities of what’s really going on with the increasingly corporatized nonprofit sector.

Hat tip to Gary Schwitzer  for his HealthNewsRevieew post  Who owns pink ideas or cure slogans? Welcome to the Charity Brawl.

 

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These news items have as yet not received much attention, but highlight health issues of concern:

Asda to sell cancer drugs at cost price

Asda is to sell cancer drugs on a not-for-profit basis while thousands of NHS patients continue to be denied medicines that are deemed too expensive.

The supermarket giant called on other pharmacists to follow its lead and lower the price of all cancer drugs that are prescribed privately, to give patients access to drugs that are not always available on the NHS.

The move could save cancer patients thousands of pounds on the cost of treatments that may extend their lives by weeks, months or years, but which have been judged to be too expensive to be routinely available for free from the health service.

The move comes as the Government restated a pledge to make more expensive treatments available to NHS patients from April next year, with a £200million fund to pay for cancer drugs………..

What is not mentioned in the article is urgent need for price controls on medicines.  If the NHS  is going to be successful in implementing the new cancer drugs fund, it’s going to need to negotiate prices with the biopharmas.  No health system public or private, nor any insurer, employer, or individual has endless resources, although the drug companies typically act like purchasers do.  And for the most part , advocacy campaigns by patient and disease groups, no matter their location, seem to focus only on demands for drugs, not that  genuinely useful drugs be made available by being affordable.  With so many patient groups receiving industry funding, this is no surprise, but it certainly is not a sustainable position for resolving the access problems.  While the conflict-of-interest issue may have often garnered more attention in the UK than in the US,  it’s a growing, worldwide phenomenon.  And even in the UK, most ordinary folks simply cannot afford to pay out of pocket for drugs with 5- and 6- figure annual costs, nor can the NHS if it is to continue to fulfill its mission.

Asda is a large UK supermarket chain, part of the Walmart group.  Earlier this year, Asda pharmacies started selling specialty prescription drugs needed for IVF treatments, which likewise were not being covered by the NHS.

Also relevant to cancer treatment is a news item from the US:

Altamonte Springs stem cell company scheduled for sale at debtors auction

A judge has ordered Cryobanks International, an Altamonte Springs company that stores stem cells in super-cold freezers, to either repay a California businessman the $3.5 million he loaned it or be sold at a courthouse auction in two weeks.

Company President John R. Edwards, M.D., would not predict Wednesday what would happen to the company or who would wind up owning it.

Of the auction, he said, “I don’t know if anything can be done to stop it.”

But he stressed that the company’s stem cells would remain safe. From 5,000 to 10,000 units are currently housed in liquid-nitrogen freezers at the company’s Altamonte Springs office…………

The type of stem cells referred to are those from the umbilical cord blood of newborns, which now can be used  in the same way as bone marrow and peripheral blood stem cells, for transplantation  to replace the malfunctioning immune systems of patients with blood cancers and other diseases.  Most of the customers of Cryobanks International are private individuals who have paid to store the cord blood of their newborns as supposed “biological insurance” against many  future ills, often wooed by emotional marketing of an industry that is still unregulated in the US. Most medical groups worldwide, including the American Academy of Pediatrics, recommend against private cord blood banking, and stress the tremendous unmet need for donation to public banking programs to serve today’s patients. Because of the small volume of blood from the umbilical cord, most such transplants are done for children.

And therein lies the public health concern about the future of Cryobanks International.   In addition to its private clients, since late 2005 the company has been a network member of  BeThe Match (formerly called the National Marrow Donor Program or NMDP) , the federal contractee which operates the US national public cord blood registry. Currently it’s possible to donate cord blood only in a handful of states, and Cryobanks International is listed as offering a unique “mail-in” option for interested expectant parents living everywhere else. Information does not seem to be readily available about the federal subcontract, nor on how many cord blood units have been collected by Cryobanks International for the NMDP. (It’s also not clear why an exact count of  stored CBUs held by Cryobanks did not seem to be available for the news story.)  CI states it has a division in India as well, with an India-specific website listing multiple sites nationwide.

This is not the first time that questions and controversy  have swirled around  Cryobanks International. In 2003, CI was identified as the supplier of cord blood to an Atlanta regenerative medicine clinic raided and shut down by the FDA. Run by an osteopath named Mitchell  Ghen, the clinic offered unapproved treatments  to desperate patients with diseases like ALS. Ghen offered expensive therapies using cord blood stem cells, but it is not clear if these were actual blood stem cell transplants.  CI cut off supplies of cord blood units (CBUs) to Ghen, who then relocated his clinic to Belize ,offering the same treatments– source of the CBUs unknown–and generating the same concerns.

Subsequently, media outlets including the New York Times reported on other business  activities involving CI.  In 2005, CI stated it was negotiating a merger with a new cord blood company named Biostem, which previously ran parking lots, provided Internet services, and operated a small mining company in Washington state. According to the Times, Biostem was being promoted to potential investors through dubious advertising pitches for so-called penny stocks. According to SEC records, the merger was abandoned in 2007.

I’ll be writing more soon about the complex field of blood and marrow transplantation and other key policy issues.  In the meantime, the public needs solid information about what’s going on with Cryobanks International and the Be the Match program.  Stay tuned as I endeavor to learn more.

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Didn’t think that fast food cures cancer?  Well think again, as now there are pink buckets for the cure.

Last week another linkage between the promotion of unhealthy food for a big box health charity made headlines and generated buzz in the blogsphere.  This time it was KFC which launched its ” Buckets for the Cure”  promotion,  a fundraiser for Susan G. Komen Breast Cancer Foundation. The main company website now sports a hot pink background, and on the Buckets site, the Colonel is now pink, and there is an image of the  pink  serving bucket  The buckets feature photos of real life breast cancer survivors. Here’s  how the promo works :

Participating KFC franchise locations will be selling specially designed pink buckets of grilled and Original Recipe chicken. KFC has pledged 50 cents to Komen for every pink bucket ordered by its restaurant operators during the promotion period, with a minimum donation of $1 million and a goal to raise more than $8 million.

KFC Pink Bucket

Fine print at the bottom of the company website further explains that the funds to be donated to Komen come directly from the purchases of pink buckets  by KFC franchise owners,  who buy them for their stores,  between  April 5-May 9, 2010, and that “Customer purchases of KFC buckets during the promotion will not directly increase the total contribution.” The KFC  Pink Buckets website urges viewers to ” Help Make the Largest Single Donation to End Breast Cancer Forever “, and links to a Komen online donation form, which sports the pink Colonel Saunders logo. In other words, just buying a pink bucket of KFC chicken does not generate a donation to Komen, although consumers may think it does.

KFC materials do not explain exactly how the corporate donation to Komen will end breast cancer, merely  talks about need to raise awareness, and links out to the Komen site. Commentary about the promotion around the web ranges from  praise for a new way to help “the cause,” to  increasingly, critical analysis of why  promoting consumption of high fat, high sodium, high calorie food is problematic for health in  general, and for cancer prevention in particular, including breast cancer.

One of the most cogent deconstructions of what’s wrong with the campaign from both health and cause marketing viewpoints was an article by Scott Henderson entitled Cause Dissonance: KFC and Komen Buckets for the Cure, on his Rally the Cause blog. Using easy-to obtain data, Scott  explained a few facts:

Here’s what I learned from KFC.com (which currently features the Double Down wrapped in pink):

  • KFC lists its nutrition facts based on individual pieces of chicken, not the bucket.
  • Buckets come in 8, 12, and 15 pieces. You can choose between original recipe, extra crispy, spicy, or grilled. And you get wings, thighs,drumsticks, and breasts.
  • Assuming you like original recipe and buy a standard 8 piece bucket for your pink bucket, you’ll bring home 1,600 calories and 90 grams of fat. If extra crispy is more your style, say hello to 2,380 calories and 160 grams of fat.
  • If four people split the bucket, you’ll average 400 calories and 22.5 grams of fat (original recipe) or 595 calories and 40 grams of fat (extra crispy).
  • Calories from fat in the pink bucket is 49% (original recipe) and 60% (extra crispy).

Then I searched for daily nutrition guides and found this from the American Heart Association:

  • Without any sides or beverages, two pieces of chicken total 22-33% of the recommended caloric intake for women age 31-50.
  • For optimal health, total calories from fat should be 25-30% of your diet. Now compare that to the 49% and 60% that your pink bucket gives you.

As word of the pink bucket hype spreads, it’s encouraging to see that there is increasing awareness of  how inappropriate this campaign is, and that it’s not just about KFC finding a  new way to promote unhealthy food or improving its corporate image,  but that Komen is equally to blame for choosing this alliance.   Hopefully the critical reviews mean that the work of  groups like  Breast Cancer Action , one of the first to sound the alarm about  problematic pink cause marketing , is bearing fruit. BCA  has held its Think Before You Pink campaign each October ( Breast Cancer Awareness  Month)  since 2002, to educate the public about what’s really going on.  BCA is notable as one of only a handful of independent disease organizations–it accepts no industry funding– which also addresses social and environmental issues about the illness, plus offers patient  services. Visitors to the BCA website can now add their signatures to a letter  to Tell KFC and Komen to stop the pinkwashing!

This pinkwashing is especially egregious because KFC, like most fast food chains, is overwhelmingly present in communities that have poor health outcomes.  Susan G. Komen for the Cure knows that social inequities affect breast cancer mortality rates. Given this disconnect, we are especially disturbed by this partnership. It’s preposterous, and we have to tell them to stop.

Hat tip  for alerting me to this  new campaign goes to fellow Seattleite Jeanne Sather,  The Assertive Cancer Patient,  who  has been writing about the pink promotions for some time, and has held  “How LOW Will Komen Go” contests  for the past  3 years on her blog. Readers submitted entries with illustrating the most offensive pink products being hyped each October.  You can read the mind-boggling entries, many complete with photos,  for 2007, 2008, and 2009 plus extensive reader commentary.   While not all the products now on the market are tied to Komen campaigns, the organization is now synonymous with pink ribbon cause marketing, which itself has a controversial history.

And why my mention of emesis basins?  As a cancer survivor, the first thing that came to my mind when I heard about the pink buckets, was the image of those hospital puke pans ( taking a little liberty on the shape) which I’d used so often. And their large-sized cousins, the wash basins often needed for their greater volume, are frequently pink.  The pink buckets promotion made me feel sick to my stomach.

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More recent heartening news — literally and figuratively– was the March 31 launch of the “Retire Ronald” campaign by Corporate Accountability International.  CAI began work  in the late ’70s as INFACT ( Infant Formula Action Coalition) , to create global awareness  and action to curb the inappropriate marketing of baby formula in poor countries which caused devastating health and economic effects.  Today the organization campaigns to change harmful corporate practices in many fields. Health continues as a major focus, so mounting concern about the now-global problem of childhood obesity prompted its new Retire Ronald campaign. Fast food, today an international industry, is part of the problem;  McDonald’s business success its emblematic of its pervasive and detrimental reach.   Since its start almost 50 years ago, McDonald’s has utilized an array of multimedia marketing pitches, both overt and subtle, specifically targeting children.  The ubiquitous ads and events, in all their forms,  often feature Ronald in likeness or in person.  Detailed information about the Retire Ronald campaign, including  deconstruction of ads and  backgrounders on promotional  techniques used by McDonald’s , and a 28-page  report Clowning with Kids’ Health: The Case for Ronald McDonald’s Retirement, can be found the CAI website and the group’s Facebook page.  Readers also have the opportunity to sign an online retirement card to convey their messages to McD’s corporate office.

Companies the size of McDonald’s are able to utilize multiple venues and a range of techniques to disseminate their messages to potential customers of all ages: children,  youth, and adults. Of McDonald’s several websites, for example, its corporate site features a special section for students, which touts the many facets of its corporate social responsibility plus information on job and scholarship opportunities. In the FAQ section along with facts on company  operations,  item #14 in the Q & A  presents distorted information about nutrition :

Isn’t it healthier for me to make lunch for my kids rather than buy it at McDonald’s?

Actually, a 4-piece Chicken McNuggets with Apple Dippers and milk contains fewer calories and fat than a homemade grilled cheese sandwich, cup of tomato soup and glass of lemonade.

Not only is the question not answered (and seems to address parents, not students) only a single type of McDonald’s fare is compared to single type of homemade meal, hardly a valid analysis!  Parsing out comparisons between numerous McD items in contrast with a full array of possible home-prepared lunches could be the basis for an excellent lesson plan in independent living classes, for example.

Ronald McDonald has his own website directed at children with interactive online games, and messages informing parents that the activities help kids develop their fine motor skills . The main company site features products, nutrition information and special promotions along with “multicultural marketing” pages targeting at young African-AmericanAsian American ( with sections in Chinese and Korean) and Latino customers, the latter version in Spanish.

Through my own work that spans involvement with Healthy Skepticism ( an NGO which aims to  promote health by countering misleading promotion of medicines) and my background as a nutrition educator and a mom of  children now grown , I was glad to learn of the Retire Ronald campaign.  My interest was further piqued because in the advocacy world too, I’ve been hearing other concerns related to Ronald, that make one wonder just how family-friendly he really is.

For starters, beyond just  problematic promotions,  is the fact that there are McDonald’s restaurants located in hospitals ,including in at least 30 in childrens hospitals around the country.  According to a 2006 study published in Pediatrics, some 30% of  all US hospitals had fast food restaurants located on their premises.  The researchers also found that:

…the presence of a McDonald’s restaurant in a children’s hospital was associated with (1) increased fast food purchasing by parents, (2) the belief that McDonald’s Corporation was a hospital benefactor, and (3) more positive perceptions of the healthiness of McDonald’s food.

And when hospitals try to put words into action with their own health messages to patients and families, by eliminating  fast food , they have faced corporate pushback.  This was the experience of a new CEO at the Cleveland Clinic ,which specializes  in cardiac care, when he tried to break a 10-year lease with McDonald’s.

The company’s clown mascot is further  known around the world through his namesake Ronald McDonald House Charities . RMHC sponsors Ronald McDonald Houses, which meet the vital lodging needs of  families of seriously ill children being treated at hospitals outside of their home communities. Reviews of  company history have revealed that McDonald’s got involved with charitable work not purely out of altruism as is commonly believed, but to enhance its own image and thus its bottom line,  through branding opportunities . According to research cited by CAI ( see pages 5 and 27 of the full report)  Fred Turner, former McD’s CEO and Chairman once told an interviewer:

We got into it [ charitable work] for very selfish reasons,  It was an inexpensive, imaginative way of getting your name before the public and building a reputation to offset the image of selling fifteen cent hamburgers. It was probably ninety-nine percent commercial.

RMH facilities are lodge-style  homes-away-from-home , usually situated adjacent to hospitals, in cities around the globe. The Houses in the US typically charge $10-$25 per night and RMHC Global has a universal access policy as part of its mission, stating that:

…..families either stay at no cost or are asked to make a donation up to $25 per day, depending on the house. The RMHC Global Policy is that families are never turned away; if its not possible to pay, the fee is waived.

There is a great need for this service, as in addition to the medical expenses, families also face enormous uncovered non-medical costs just at the time when income is decreased due to the sick child’s hospitalization and care needs.  With  hospital stays typically lasting  from weeks to many months, even paying for  subsidized temporary lodging ,while also paying rent or a mortgage back home, may be impossible.  As illustration of the  great demand  for lodging support are the facts that many RMHs keep waiting lists, and that many like the RMH in San Diego, report having had to turn away hundreds of families each year due to lack of space.

RMHC is  a 501(c)3, tax-exempt US charitable organization, separate from the McDonald’s Corporation, it’s principal corporate sponsor.  The RM Houses are run by local chapters of the  RMHC, and each chapter is incorporated as an independent  charitable organization in its home state, and conducts local fundraising, including at McDonald’s stores . For more about the links between McDonald’s and RMHC, see Our Relationship with McDonald’s.

There is the irony  of course that this essential healthcare support service is so heavily supported by the sales and promotion of unhealthy food.  But there are other issues too about the conditional welcome, or even exclusion, that some families may encounter at individual RMHC  facilities, and how RMH employees may be treated.

There seems to be some variability in the universal access policy, although the vast majority of the RMHC chapter websites that I reviewed– including  Springfield, MOPhiladelphia, Minneapolis, SeattleAustin, TXClevelandLos Angeles, just to name a few– explicitly state that no one is ever turned away because of inability to pay.  In New York City however, this does not seem to be the case, as their RMH website says only that There is a $35.00 fee per night, per room to stay at Ronald McDonald House of New York, and offers no information on flexibilities.

While Salt Lake City  RMH too has the open financial policy, published on its website is the stipulation that “For those who do not speak English an interpreter will need to accompany them on their first visit“. I’ve heard anecdotally that telephonic interpreting is not acceptable , although this service is commonly utilized by hospitals to complement live interpreter services.   Especially for families arriving after business hours, this requirement can be impossible to meet;  it resonates as mean-spirited and  exclusionary.  The Birmingham AL  RMH  website states that families can bring a friend or family member who can translate…..if you do not speak English.  (FYI,  interpretation refers to spoken or signed language, while translation is exclusively of written work; these terms are frequently confused). While I’m not an attorney, I do know that  these are the kind of policies which need to be reviewed for compliance with civil rights laws pertaining to  public accommodations.

The  validity of the warm, fuzzy, caring  attitude associated with Ronald in all his manifestations has at times been the subject of headlines regarding issues that have arisen at individual  RMHs  including:

  • a 2005 case in Baltimore, where a family of a child about to undergo heart surgery, was initially turned away by the facility because the patient’s blind mother was accompanied by a guide dog, in supposed violation of a RMH  “no pets” rule .
  • a 2007 case in Houston, where the mother of an infant who had just undergone surgery for a brain tumor, was admonished for nursing him  in a common area of the RMH, with implications made that if family wished to continue their stay , breastfeeding should be done only in the family bedroom.
  • a 2009 case in Miami, where the former assistant manager of RMH of South Florida has filed a lawsuit alleging violation of labor laws as she was often required to work off the clock, and did not receive  $20,000 in overtime  pay for  her customary 70-hour work weeks.

It’s important to know too that sponsorships by major corporations, which come product promotion ties, are not the only way to meet the housing needs of sick kids and their families. All around the country (and the world too) there are grassroots endeavors, by both organizations and individuals,  providing patient lodging. To learn more , visit the website of the National Association of Hospitality Houses.

Retiring Ronald could be a positive step to improving the health and well-being of our children, one meal at a time.

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