By Jonathan Purtle

There we stood in front of the bulletin board at the Old City coffee shop Fork:etc  — perplexed, trying to decipher the meaning of the ad. Hipsters Deserve to Die, it said, over a picture of a young African American man wearing glasses and a scarf. My girlfriend works in marketing, I work in public health, and together we couldn’t quite figure out the intention of the Lung Cancer Alliance's most recent social marketing campaign. The supplementary text — “lung cancer doesn’t discriminate, neither should you” — wasn’t particularly instructive. A visit to the organization's website provided some clarity.

The purpose of the No One Deserves to Die campaign is to “defeat the stigma and blame associated with lung cancer.” The site makes that point that many people believe individuals with lung cancer did something (i.e., smoked cigarettes) to deserve their fate despite findings that a significant minority of people with lung cancer (the 2006 National Health Interview Survey puts it at 18 percent) have never smoked. An alliance fact sheet notes that lung cancer was the leading cause of cancer mortality in 2009 — responsible for 158,158 deaths, more than those caused by breast, prostate, and colon cancer combined. In terms of cancer incidence, or new cases, lung cancer was second to prostate cancer among men and second to breast cancer among women in 2008. Despite this, lung cancer is the focus of substantially less federal research than other cancers.

According to the alliance, $231 million was spent on lung cancer research compared to $354 million for colon, $378 million for prostate, and over $1 billion for breast cancer in fiscal year 2012. While not overt, the subtext in these materials is that the funding disparities are the result of lung cancer being perceived as a self-inflicted cancer, and that those who develop it are not considered worthy of federal research dollars.

Founded in 1995, the Lung Cancer Alliance is dedicated to providing support and advocacy for people living with, or at risk for, lung cancer. Based on its website, increasing early detection and improving treatment for lung cancer are the organization’s top priorities. While the alliance has centralized some smoking cessation resources, preventing lung cancer appears to be of secondary concern. The organization's annual report indicates that it collected over $5.5 million in revenue in 2011. Among its major donors are GlaxoSmithKlineLilly USA, OSI, and Pfizer —all of which market drugs to treat lung cancer.

The series of No One Deserves to Die ads — among them are a middle-aged woman stating that “Cat Lovers Deserve to Die” and a tough-looking man stating “The Tattooed Deserve to Die” — started popping up in cities across the United States in early July. The campaign was developed by the ad agency Laughlin Constable with the intention of striking a visceral chord with viewers and invoking the response that, indeed, no one deserves to die — particularly people with lung cancer.

If prompting an emotive response is a metric of success, the campaign appears to be a hit—some media coverage includes reports of the ads being angrily torn down. While the ads are shocking, however, are they likely to produce benefits for public health?

The campaign’s explicit purpose of “defeat[ing] the stigma and blame associated with lung cancer” is a worthy and laudable goal. Stigma is an enemy of public health, regardless of the condition. Stigma discourages people from seeking care, negatively impacts the quality of health care provided, and can cause psychological distress that adversely affects disease trajectories. A recent systematic review of research on stigma and lung cancer provides empirical evidence for the alliance's claims that people with lung cancer are judged for their disease. Numerous studies in the review found that health care workers held negative perceptions of lung cancer patients and that these perceptions translated into poorer quality of life and greater psychological distress among patients. I believe there is a disconnect, however, between the campaign’s aim of reducing stigma and the takeaway message from the “Deserves to Die” ads.

The campaign includes no facts or figures about the pervasiveness of stigma, discrimination, or perceptions that people with lung cancer “deserve to die.” Even if most people truly do discriminate against those with lung cancer, I doubt that they’re conscious enough of this bias to make sense of the ads. The message is novel and complex, and, as the trade publication Ad Week notes, the campaign may struggle to convey this message with such cryptic images and minimal text.

The fact that nearly one in five people who develop lung cancer have never smoked, perhaps the campaign's most compelling fact, is not even a prominent feature. It is not stated on any of the ads I've seen on walls or the web, and is available only to the über curious individual (i.e., a public health blogger) through a fact sheet online.

How about the alliance's suggestion that lung cancer research is underfunded because people with the disease are not perceived as being worthy of precious research dollars? Perhaps. History has shown that politics, advocacy, and ideology, not data, often shape funding decisions. Still, we know more about what raises the risk for lung cancer (smoking) than probably any other cancer. So it makes sense that funding would be directed toward research on the causes of other common cancers about which we know less.

To be sure, people with lung cancer do not deserve to die, be stigmatized, or treated with any less empathy than those with another condition. Nevertheless, I believe that the No One Deserves to Die campaign misses the mark. The ads are unclear, unpersuasive, and insensitive to the cat lovers, tattooed people, and other archetypes that are used to deliver the message. There is already too much hatred in America, without posters proclaiming that people "deserve to die" plastered all over public spaces.

That said, the campaign had enough shock value to get me to write about it — and to promote its message as a result. Is that a good thing?

Read more about The Public's Health.