The frustration was growing steadily in the Washington offices of the National Osteoporosis Foundation.
Since it was founded in 1986, the nonprofit, largely volunteer group had been trying to get information about the severe bone disorder to U.S. women, half of whom are at risk for the disease.
But a 1993 survey of 1,000 women showed 61% had little knowledge of osteoporosis.
“We were at our wits’ end trying to find ways to educate people,” says Sandra Raymond, executive director of the foundation.
So when the pharmaceutical giant SmithKline Beecham called one day last year and invited the foundation to help create a 30-minute television program on osteoporosis--at no expense to the foundation--Raymond was delighted.
The fact that SmithKline was interested in sponsoring the “infomercial” to help launch Tums 500--a calcium supplement that helps prevent osteoporosis--gave her only a moment’s pause. Sure, SmithKline was touting its new product, but the message was good: prevent osteoporosis.
“I would have a problem linking up with business when the information presented isn’t medically sound and when it isn’t a balanced message,” Raymond says. But SmithKline “bent over backward to offer a balanced message.”
Still, the arrangement isn’t all that innocent, a growing number of critics say. They charge that some of the nation’s nonprofit consumer health groups are perhaps going too far in their attempts--however sincere--to get their messages heard.
Increasingly, groups such as the NOF, Arthritis Foundation, National Safe Kids Campaign, the American Cancer Society and dozens of others have gratefully accepted corporate funding to help them promote their causes. (For example, the osteoporosis infomercial cost $400,000, something the NOF never could have afforded on its own.)
Other health groups--notably, the National Breast Cancer Coalition--have been criticized for aligning themselves with questionable allies in an attempt to generate publicity.
This spring, regional editions of Playboy carried an ad from the National Breast Cancer Coalition to raise awareness of the disease. But the ad, which pictures a baby breast-feeding, is topped with the rather provocative headline: “You’ve probably been a breast man since day one.” The ad space, worth $167,000, was donated by Playboy, and the ad will run in all editions in July because it’s such a big hit.
Are these groups, critics wonder, selling their souls? Just how far are they willing to go to cure cancer, stop the pain of arthritis, put a halt to smoking or keep children safe and healthy?
Pretty far, say people uneasy with the trend.
“There are a lot of people making a lot of money brokering these deals,” says Michael Jacobson, co-founder of the Center for the Study of Commercialism in Washington. “In hard times, it’s hard to be too much of a purist. But over the long run, the nonprofit sector is being jeopardized.”
Nonprofit health groups today are savvy enough to know that the traditional boring pamphlets, telethons and 20-second public service announcements don’t cut it, Jacobson says. Moreover, charitable giving has dropped since the 1980s, making the organizations needier, according to the Society for Nonprofit Organizations in Madison, Wis.
“They had trouble getting their messages out in the past. So industry says, ‘We’ll fund them.’ I think maybe now (the health groups) are getting a little greedy,” Jacobson says.
It takes a little shock value to be heard nowadays, health experts say. Witness the success of the AIDS advocacy group Act Up, which does everything from heckling politicians to staging sit-ins, to get its messages heard. Breast cancer groups have followed suit.
“It’s almost like diseases have become crusades,” says Jim Petersen, a senior staff writer at Playboy who helped coordinate the breast cancer ad. “This is about getting Washington to respond. It’s sad that that is what it takes.”
Desperation is what drove the NOF to join SmithKline in the osteoporosis infomercial, Raymond says. And it’s what motivated the National Breast Cancer Coalition.
The Playboy ad idea arose last summer when breast cancer advocates were working furiously to collect 2.6 million signatures to deliver to President Clinton, pressing for government action. A coalition member approached Playboy about placing an ad in the magazine.
“Playboy loved the idea . . . and agreed to put it in when they had a blank page in various regional editions, says Christine Brunswick, a coalition member.
“It was a bold move. I think there was some concern that people might be offended by it. But I think the bottom line is it may anger some people, but we are very angry about the disease. And we are willing to do whatever it takes to get the message out there.”
Brunswick says the ad has generated a few sizable donations from Playboy readers and very little criticism. (Ms. magazine staffers lambasted the NBCC during several radio talk shows.)
And Brunswick denies that the organization has gone too far.
“What is ‘too far’? We are in no way compromising our mission, our goals. What we believe is that women have been too polite and too silent for way too long. The headline catches your attention--which is what we wanted.”
Indeed, forming partnerships with for-profit businesses is increasingly seen as the best way for health groups to be effective, says Jay Winsten, director of the Center for Health Communications at the Harvard School of Public Health, who has studied health-related public service announcements.
“It’s win, win, win for everyone,” he says, noting that health groups get exposure while the sponsor gets to either promote a product or polish its image.
In a 1990 study, Winsten--an early advocate of health education supported by advertising--criticized the effectiveness of the traditional public service announcement.
According to his research, PSAs depend on donated air time, which is usually in the wee hours. And while PSAs help boost awareness, they rarely prompt viewers to take action.
“Public service announcements don’t achieve much,” he says. “Organizations get upset that their messages don’t get on the air, but their messages wouldn’t be very effective anyway.”
But with a fat corporate bankroll, organizations can produce television specials or more sophisticated PSAs and educational materials.The American Medical Assn., for example, recently joined forces with a media company and the health-food store chain, General Nutrition Center, to produce a smoking cessation program. The program is sold only at GNC.
Although some purists might be bothered by a joint commercial-public health program, AMA Vice President Steve Seekins says: “It’s the only way you can develop (programs) that will get into the mass market.”
And few health organizations with corporate sponsors appear to be hanging their heads in shame.
At the Massachusetts Division of the American Cancer Society, a program providing free mammograms in a van that toured low-income neighborhoods was running out of money when the organization joined forces with a local TV station and CVS Pharmacy.
The cancer society received 15 free PSAs, two hourlong prime-time TV specials and sponsorship for the mammography van in the deal. The television station and pharmacy chain got their names printed on the van and boosted their images.
The real winner was the fight against breast cancer, says Karen Rouse, vice president for marketing and communications of the ACS, Massachusetts Division. Calls for breast cancer information rose 60% after the campaign began.
“Forming these types of partnerships is the way of the future,” Rouse says. “We can no longer count on PSAs to get the kind of airing that they need to get people to take action on their health. We consider our sponsors to be gold.”
But Rouse also acknowledges the debate surrounding this trend and the possibility of a downside.
“I think it’s up to the members of the partnership to make sure the line isn’t crossed in terms of conflict of interest,” she says. “It wouldn’t help an organization like ours to cross that line. But we didn’t see a conflict in this case. We saw it as a plum of a deal.”
Nonprofit groups have always been reluctant to accept money from sponsors who might, ultimately, try to influence their work or opinions, says Daniel Callahan, director of the Hastings Center, a nonprofit ethics think tank in New York. But the trickle of corporate money--and the potential for meddling--is turning into a gusher.
“One of the problems these days is that corporations are doing much more targeting of organizations than they used to do,” he says. “They used to just give in general. Now they say, ‘We are interested in children’ or ‘We are interested in arthritis.’ ”
But Jacobson, of the Society for Nonprofit Organizations, says health groups that accept corporate money, free ad space or other services risk losing their independence and their public image.
“As soon as a nonprofit organization takes money from a company, they have sold off a bit of their independence,” he says.
Nonprofit health groups should not sacrifice their ability to speak freely, agrees Cindy Pearson of the nonprofit National Women’s Health Network in Washington.
Businesses are constantly offering them money. But, she says: “We’ve made it simple for ourselves. We take no money from drug or device makers. So it’s easy to weigh in with our opinions on what drugs should or shouldn’t be used.”
For example, many women’s health groups are being asked whether the Pill should be sold over-the-counter. One nonprofit health group that plans to testify before the Food and Drug Administration on the issue routinely accepts operating money from makers of the Pill. That, says Pearson, is wrong.
“I feel they have lost the ability to give their opinion that is free from business interests,” she says.
A more difficult decision is whether to accept money or services from a business that probably can’t or won’t attempt to influence the organization, Pearson says--such as the Playboy-NBCC pairing.
“Playboy is sexist. It exploits women’s bodies. It exploits women’s breasts. But (accepting the free ad) is different, I think, from taking money from organizations that make a profit from the health issue,” she says.
“The downside would be if there is a conflict of interest; if (the sponsorship) interferes with the credibility of the message,”
Another factor is whether the corporate giver remains in the background.
In one case, McNeil Consumer Products, the makers of Tylenol, issued a $500,000 grant to the Arthritis Foundation in 1992 to produce consumer education programs. In one commercial for the foundation, the Tylenol spokeswoman, actress Susan Sullivan, praises the partnership of Tylenol and the foundation. Tylenol is often used for arthritis pain.
“If the corporation has a legitimate service or product, I think that allows for a very supportive partnership between the two groups,” says Katie Burnham, executive director of the Society for Nonprofit Organizations. “I see nothing wrong with that.” But Jacobson says any group that blurs its image loses credibility.
“A nonprofit (group) is normally thought of as being objective, unbiased, independent. Companies want to buy some of that credibility. That is what they are buying: innocence by association,” he says.
“But it diminishes (the health organizations’) credibility. If one or two nonprofits out of thousands do it, it’s not a problem. But if large segments of the nonprofit groups are compromised by associations with industry, then I think we’re jeopardizing a large portion of our society. And that is the direction things are going.”