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- W2060745921 abstract "Cause-related marketing (CRM) is a relatively new concept in which non-profit and for-profit organizations enter into a cooperative financial agreement that is considered to be mutually beneficial. The CRM model is thought to have originated during the American Express-sponsored Statue of Liberty restoration in 1983 and has gone on to become a billion dollar business. Why do charitable organizations and for-profit companies engage in CRM agreements? In general, it all comes down to dollars and cents. For the non-profit organizations, it allows them to obtain financial resources to promote a topic or issue of importance to the organization. For the business entities, CRMs are thought to result in the company being viewed in a more positive light by consumers while increasing their revenue stream. In theory, this is the perfect marriage between non-profit altruism and for-profit corporate goals. Unfortunately, this is not always true. In particular, the non-profit runs the risk of being perceived as straying from their core missions and values at the expense of obtaining additional sources of revenue. For example, in 1997 the American Medical Association (AMA) and the Sunbeam Corporation entered into a CRM agreement in which the AMA agreed to endorse certain home health care products such as thermometers and blood pressure monitors. In return, the company agreed to pay the AMA royalties based on increased sales of these particular products. These royalties were to help fund the AMA’s research and education programs. Needless to say, this agreement created a huge uproar that ultimately resulted in the “resignation” of five of the AMA’s top executives, including its Executive Vice President. The reasons for the outcry were many, including the concern that the general public would see the AMA name associated with specific products and conclude that the AMA was endorsing these products over others. This was an unfortunate and telling example of how CRMs can go astray.Recently, the American Dental Association (ADA) announced the initiation of a 3-year, $9.5 million nationwide public service campaign that is underwritten by OralCDx Laboratories. This is a laudable campaign and I am extremely happy that the ADA is at the forefront in spotlighting what is often called the “forgotten cancer.” However, I am deeply concerned with two issues related to the ADA/OralCDx Oral Cancer Campaign. First of all, the content of the message is misleading. Rather than being an oral cancer awareness campaign that specifically attempts to achieve the stated goals of “boosting the awareness of oral cancer and spotlight the dentist’s role in helping stop this disease before it can even start,” the “awareness” campaign seems closer to an advertisement for a specific product complete with the ADA’s endorsement. While I certainly appreciate the disclaimer’s carefully crafted fine print, will the general public, who are the target audience of this campaign, appreciate this subtlety? While brush cytology is one option for aiding the dentist in their evaluation of oral mucosal lesions, it is certainly not the only one. Therefore, rather than stating that your dentist can use several potential techniques to aid in the detection of oral cancer, the advertisement singles out a single product suggesting that this is the “only or preferred” technique available to dentists and their patients. Furthermore, the top of the advertisement says: “Important Message About Oral Cancer From the ADA.” Additionally, it displays the ADA logo as well as the ADA web site address in two locations. Conversely, the bottom of the advertisement also contains a disclaimer statement (in the smallest font on the page) that the ADA does not endorse any product. Regardless of what the disclaimer may state, the content of the advertisement (information regarding a single product), along with the prominent references to the ADA, imply to any reasonable individual that the ADA is sponsoring this product. In short, this endeavor crossed the line when it diverged from the stated ADA mission of being an oral cancer awareness campaign. At the end of the day, one cannot have it both ways. You cannot develop an awareness campaign that focusses on a specific product and at the same time claim that you are not endorsing a product. Education is the goal of an awareness campaign. Providing information about oral cancer and the many potential methods to aid in its diagnosis should be the sole purpose of the campaign.My second and perhaps greater concern is that the advertisement contains several statements that are factually incorrect. For example, it cites the National Cancer Institute as the source of sensitivity and specificity data for brush cytology. To imply that this data was obtained from the National Cancer Institute is simply misleading. In truth, this data was derived from a manuscript by Scheifele et al.1Scheifele C. Schmidt-Westhausen A.M. Dietrich T. et al.The sensitivity and specificity of the OralCDx technique: Evaluation of 103 cases.Oral Oncol. 2004; 40: 824-828Google Scholar Aside from the issue of falsely representing the source of the data, there is an important weakness with respect to how these numbers were calculated. Specifically, based on the clinical diagnoses that were included in the study (including squamous cell carcinoma), the cohort of patients included in the study consisted of a mixture of both Class I (clinically suspicious) and Class II (clinically innocuous) lesions. Because brush cytology is only intended for Class II lesions,2Frist S. The oral brush biopsy: Separating fact from fiction.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96: 654-655Google Scholar, 3Eisen D. Brush biopsy ‘saves lives’.J Am Dent Assoc. 2002; 133: 688-689Google Scholar, 4Eisen D. Frist S. The relevance of the high positive predictive value of the oral brush biopsy.Oral Oncol. 2005; 41: 753-755Google Scholar the inclusion of Class I lesions would obviously have a profound effect on the reported sensitivities, specificities, and positive predictive values of this study.In addition, the advertisement says “Ask your dentist about a routine test that is as powerful as a Pap smear and colonoscopy.” While I appreciate that the challenge of writing a headline for the lay community that is both eye-catching and scientifically accurate is a daunting proposition, drawing analogies between these two tests and brush cytology is inaccurate. During a colonoscopy, if there is clinical evidence of some type of pathology, the patient receives a definitive diagnosis because the lesion(s) is surgically biopsied and histologically diagnosed. Oral brush cytology never results in a definitive diagnosis. Furthermore, while the analogy between oral brush cytology and cervical brush cytology is often made, it conveniently ignores a very important fact. The Pap smear is a blinded collection of epithelial cells that can be used to identify the presence of epithelial atypia on the cervix. Conversely, oral brush cytology is a directed collection of cells. Thus, while the technology used is essentially the same, the manner and rationale for using them is entirely different.Finally, the advertisement states: “However, over (my italics) 25% of oral cancer occurs in people who don’t smoke and have no other risk factors.” This statement is not consistent with the currently accepted demographic data related to oral cancer. The current consensus is that approximately 95% of oral cancers are associated with smoking and high-risk Human Papilloma Virus (HPV) infection. Therefore, current data suggests that less than 5% of oral cancer patients have no known risk factors, a number at considerable variance with the advertisement’s claim of “over 25%.”The ADA should be applauded for their initiation of an oral cancer awareness campaign, which is a fantastic concept. Until recently, surveys have always shown that the dental profession and the lay community have a limited appreciation of various aspects of oral cancer, including early diagnosis.5Yellowitz J. Horowitz A.M. Goodman H.S. et al.Knowledge, Opinions and practices of general dentists regarding oral cancer: A pilot survey.J Am Dent Assoc. 1998; 129: 579-583Google Scholar, 6Yellowitz J.A. Horowitz A.M. Drury T.F. et al.Survey of U.S. dentists’ knowledge and opinions about oral pharyngeal cancer.J Am Dent Assoc. 2000; 131: 653-661Google Scholar, 7Horowitz A.M. Drury T.F. Goodman H.S. et al.Oral pharyngeal cancer prevention and early detection Dentists’ opinions and practices.J Am Dent Assoc. 2000; 131: 453-462Google Scholar, 8Burzynski N.J. Rankin K.V. Silverman Jr, S. et al.Graduating dental students’ perceptions of oral cancer education: results of an exit survey of seven dental schools.J Cancer Educ. 2002; 17: 83-84Google Scholar, 9Horowitz A.M. Canto M.T. Child W.L. Maryland adults’ perspectives on oral cancer prevention and early detection.J Am Dent Assoc. 2002; 133: 1058-1063Google Scholar Evidence supports the concept that intensive and well-designed awareness campaigns may increase awareness.10Stahl S. Meskin L.H. Brown L.J. The American Dental Association’s oral cancer campaign: The impact on consumers and dentists.J Am Dent Assoc. 2004; 135: 1261-1267Google Scholar Therefore, we certainly must continue to have oral cancer awareness campaigns for both practicing dentists and the lay community. I am also realistic enough to appreciate the fact that such campaigns do not occur in a vacuum without some type of financial support (short of raising our ADA dues!). However, there is a fine line between a CRM that supports an oral cancer campaign and an advertisement that endorses a particular product. While one might argue that the fine print disclaimer is a reasonable demonstration that no endorsement is offered, it is highly unlikely that this subtle distinction will be appreciated by the general public and our dental colleges. I would therefore encourage the ADA leadership to strongly reconsider both the format and the content of the campaign as it goes forward into the second and third years. Specifically, any media using the ADA’s name should be carefully scrutinized for any inaccurate or misleading statements. Cause-related marketing (CRM) is a relatively new concept in which non-profit and for-profit organizations enter into a cooperative financial agreement that is considered to be mutually beneficial. The CRM model is thought to have originated during the American Express-sponsored Statue of Liberty restoration in 1983 and has gone on to become a billion dollar business. Why do charitable organizations and for-profit companies engage in CRM agreements? In general, it all comes down to dollars and cents. For the non-profit organizations, it allows them to obtain financial resources to promote a topic or issue of importance to the organization. For the business entities, CRMs are thought to result in the company being viewed in a more positive light by consumers while increasing their revenue stream. In theory, this is the perfect marriage between non-profit altruism and for-profit corporate goals. Unfortunately, this is not always true. In particular, the non-profit runs the risk of being perceived as straying from their core missions and values at the expense of obtaining additional sources of revenue. For example, in 1997 the American Medical Association (AMA) and the Sunbeam Corporation entered into a CRM agreement in which the AMA agreed to endorse certain home health care products such as thermometers and blood pressure monitors. In return, the company agreed to pay the AMA royalties based on increased sales of these particular products. These royalties were to help fund the AMA’s research and education programs. Needless to say, this agreement created a huge uproar that ultimately resulted in the “resignation” of five of the AMA’s top executives, including its Executive Vice President. The reasons for the outcry were many, including the concern that the general public would see the AMA name associated with specific products and conclude that the AMA was endorsing these products over others. This was an unfortunate and telling example of how CRMs can go astray. Recently, the American Dental Association (ADA) announced the initiation of a 3-year, $9.5 million nationwide public service campaign that is underwritten by OralCDx Laboratories. This is a laudable campaign and I am extremely happy that the ADA is at the forefront in spotlighting what is often called the “forgotten cancer.” However, I am deeply concerned with two issues related to the ADA/OralCDx Oral Cancer Campaign. First of all, the content of the message is misleading. Rather than being an oral cancer awareness campaign that specifically attempts to achieve the stated goals of “boosting the awareness of oral cancer and spotlight the dentist’s role in helping stop this disease before it can even start,” the “awareness” campaign seems closer to an advertisement for a specific product complete with the ADA’s endorsement. While I certainly appreciate the disclaimer’s carefully crafted fine print, will the general public, who are the target audience of this campaign, appreciate this subtlety? While brush cytology is one option for aiding the dentist in their evaluation of oral mucosal lesions, it is certainly not the only one. Therefore, rather than stating that your dentist can use several potential techniques to aid in the detection of oral cancer, the advertisement singles out a single product suggesting that this is the “only or preferred” technique available to dentists and their patients. Furthermore, the top of the advertisement says: “Important Message About Oral Cancer From the ADA.” Additionally, it displays the ADA logo as well as the ADA web site address in two locations. Conversely, the bottom of the advertisement also contains a disclaimer statement (in the smallest font on the page) that the ADA does not endorse any product. Regardless of what the disclaimer may state, the content of the advertisement (information regarding a single product), along with the prominent references to the ADA, imply to any reasonable individual that the ADA is sponsoring this product. In short, this endeavor crossed the line when it diverged from the stated ADA mission of being an oral cancer awareness campaign. At the end of the day, one cannot have it both ways. You cannot develop an awareness campaign that focusses on a specific product and at the same time claim that you are not endorsing a product. Education is the goal of an awareness campaign. Providing information about oral cancer and the many potential methods to aid in its diagnosis should be the sole purpose of the campaign. My second and perhaps greater concern is that the advertisement contains several statements that are factually incorrect. For example, it cites the National Cancer Institute as the source of sensitivity and specificity data for brush cytology. To imply that this data was obtained from the National Cancer Institute is simply misleading. In truth, this data was derived from a manuscript by Scheifele et al.1Scheifele C. Schmidt-Westhausen A.M. Dietrich T. et al.The sensitivity and specificity of the OralCDx technique: Evaluation of 103 cases.Oral Oncol. 2004; 40: 824-828Google Scholar Aside from the issue of falsely representing the source of the data, there is an important weakness with respect to how these numbers were calculated. Specifically, based on the clinical diagnoses that were included in the study (including squamous cell carcinoma), the cohort of patients included in the study consisted of a mixture of both Class I (clinically suspicious) and Class II (clinically innocuous) lesions. Because brush cytology is only intended for Class II lesions,2Frist S. The oral brush biopsy: Separating fact from fiction.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 96: 654-655Google Scholar, 3Eisen D. Brush biopsy ‘saves lives’.J Am Dent Assoc. 2002; 133: 688-689Google Scholar, 4Eisen D. Frist S. The relevance of the high positive predictive value of the oral brush biopsy.Oral Oncol. 2005; 41: 753-755Google Scholar the inclusion of Class I lesions would obviously have a profound effect on the reported sensitivities, specificities, and positive predictive values of this study. In addition, the advertisement says “Ask your dentist about a routine test that is as powerful as a Pap smear and colonoscopy.” While I appreciate that the challenge of writing a headline for the lay community that is both eye-catching and scientifically accurate is a daunting proposition, drawing analogies between these two tests and brush cytology is inaccurate. During a colonoscopy, if there is clinical evidence of some type of pathology, the patient receives a definitive diagnosis because the lesion(s) is surgically biopsied and histologically diagnosed. Oral brush cytology never results in a definitive diagnosis. Furthermore, while the analogy between oral brush cytology and cervical brush cytology is often made, it conveniently ignores a very important fact. The Pap smear is a blinded collection of epithelial cells that can be used to identify the presence of epithelial atypia on the cervix. Conversely, oral brush cytology is a directed collection of cells. Thus, while the technology used is essentially the same, the manner and rationale for using them is entirely different. Finally, the advertisement states: “However, over (my italics) 25% of oral cancer occurs in people who don’t smoke and have no other risk factors.” This statement is not consistent with the currently accepted demographic data related to oral cancer. The current consensus is that approximately 95% of oral cancers are associated with smoking and high-risk Human Papilloma Virus (HPV) infection. Therefore, current data suggests that less than 5% of oral cancer patients have no known risk factors, a number at considerable variance with the advertisement’s claim of “over 25%.” The ADA should be applauded for their initiation of an oral cancer awareness campaign, which is a fantastic concept. Until recently, surveys have always shown that the dental profession and the lay community have a limited appreciation of various aspects of oral cancer, including early diagnosis.5Yellowitz J. Horowitz A.M. Goodman H.S. et al.Knowledge, Opinions and practices of general dentists regarding oral cancer: A pilot survey.J Am Dent Assoc. 1998; 129: 579-583Google Scholar, 6Yellowitz J.A. Horowitz A.M. Drury T.F. et al.Survey of U.S. dentists’ knowledge and opinions about oral pharyngeal cancer.J Am Dent Assoc. 2000; 131: 653-661Google Scholar, 7Horowitz A.M. Drury T.F. Goodman H.S. et al.Oral pharyngeal cancer prevention and early detection Dentists’ opinions and practices.J Am Dent Assoc. 2000; 131: 453-462Google Scholar, 8Burzynski N.J. Rankin K.V. Silverman Jr, S. et al.Graduating dental students’ perceptions of oral cancer education: results of an exit survey of seven dental schools.J Cancer Educ. 2002; 17: 83-84Google Scholar, 9Horowitz A.M. Canto M.T. Child W.L. Maryland adults’ perspectives on oral cancer prevention and early detection.J Am Dent Assoc. 2002; 133: 1058-1063Google Scholar Evidence supports the concept that intensive and well-designed awareness campaigns may increase awareness.10Stahl S. Meskin L.H. Brown L.J. The American Dental Association’s oral cancer campaign: The impact on consumers and dentists.J Am Dent Assoc. 2004; 135: 1261-1267Google Scholar Therefore, we certainly must continue to have oral cancer awareness campaigns for both practicing dentists and the lay community. I am also realistic enough to appreciate the fact that such campaigns do not occur in a vacuum without some type of financial support (short of raising our ADA dues!). However, there is a fine line between a CRM that supports an oral cancer campaign and an advertisement that endorses a particular product. While one might argue that the fine print disclaimer is a reasonable demonstration that no endorsement is offered, it is highly unlikely that this subtle distinction will be appreciated by the general public and our dental colleges. I would therefore encourage the ADA leadership to strongly reconsider both the format and the content of the campaign as it goes forward into the second and third years. Specifically, any media using the ADA’s name should be carefully scrutinized for any inaccurate or misleading statements. Response to Dr. Lingen's Editorial on the ADA's Oral Cancer Awareness CampaignOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and EndodonticsVol. 106Issue 1PreviewI want to respond to some of the statements made by Mark Lingen, DDS, in the editorial, “Cause-related marketing: the uneasy alliance between altruism and corporate greed,” [2008;105:407-9] which is critical of the oral cancer awareness campaign that the American Dental Association (ADA) helped launch. Full-Text PDF" @default.
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