Vivid Health Messages Can Run Afoul of Networks’ Sensibilities

As an entertainment attorney in Hollywood, Don Biederman has operated largely behind the scenes. Beginning this week, Biederman, 64, enters the public glare in a commercial about skin cancer, a disease that forced doctors to remove Biederman’s nose and left cheek.

Wearing a prosthetic nose that also hides his missing cheek, Biederman narrates the commercial, dwelling on the sunburns he received as a youth growing up near the beach in Long Island, N.Y. As the spot ends, Biederman turns sideways and removes the prosthetic device, exposing a dark cavity where his nose had been.

The commercial, sponsored by the American Academy of Dermatology, a physicians’ group, is an example of how nonprofit organizations are using those who have dealt with disease, smoking or drugs to persuade viewers to change attitudes and behavior. Their testimony has a strong impact, experts said, because they put a face on seemingly remote dangers and demonstrate the worst that can happen.

In using frightening images to jolt viewers, however, nonprofit organizations risk running afoul of networks sensitive about offending their shrinking audiences. KABC Channel 7 in Los Angeles required a warning on the Department of Health Services’ anti-smoking commercial that shows a cancer patient smoking a cigarette through her esophagus. ABC rejected the skin cancer commercial as too graphic to broadcast nationally; an official at ABC described it as the “rip your face off” ad.

Since the dermatologists are seeking free broadcast time for their commercial, it is unclear how many people will see it. Television stations typically relegate public service messages to time slots late at night, where they don’t crowd out paid advertising. Last year, two far less dramatic PSAs from the dermatologists received free broadcast time worth only $3.4 million--about the cost of airing five ads in a top-rated prime-time show.

Minneapolis-based Campbell Mithun Esty, the dermatologists’ advertising agency, said the commercial was inspired by a photograph in an issue of National Geographic that showed an Australian man who had lost his nose to cancer. After sending inquiries to dermatologists, the agency found Biederman, general counsel for Warner Chappell Inc., whose nose and cheek were removed in 1996 because of a malignant form of squamous cell cancer. His doctors believe years of overexposure to the sun triggered the disease.

Biederman, who has had more than 30 operations to root out the tumor, agreed to do the commercial despite apprehension from his wife and 30-year-old daughter.

“It is a tough choice to do this--make myself available as a public monster,” said Biederman, who has had eight prosthetics to fit the changing contours of his face where it is no longer supported by bone and muscle. “I am hoping more than anything that people will be sufficiently terrified to . . . stay out of unprotected sun.”

He has started the painstaking process of having his face surgically rebuilt.

The commercial uses clips from home movies shot on Super 8 film showing Biederman’s now 34-year-old son as a toddler playing on a beach, and Biederman’s father, now deceased, reclining shirtless on a lounge chair. The idyllic scenes are juxtaposed with close-ups of Biederman as he narrates his transformation from sun worshiper to cancer patient.

“All my friends used to say, ‘The first time you go to the beach, get a good burn. You’ll tan faster.’ . . . A tan was considered healthy,” he said in the commercial. “None of us knew the potential ramifications.”

Previous ads from the dermatologists group warning about skin cancer used visual analogies. A 1997 commercial showed a small child riding a bicycle in freeway traffic, comparing the danger to risks from sunburn.

“People are told in so many commercials, you’re gonna die, you’re gonna die. They stop responding to it,” said Bill Johnson, a creative director at Campbell Mithun Esty. “They are more shocked by a guy taking off his nose . . . it seems to scare us more.”

In Massachusetts, a decline in smoking among middle school students has been linked to documentary-style commercials, the most dramatic of which centers on a woman dying of emphysema. And in a recent study of anti-tobacco ads by the firm Teenage Research Unlimited, the three spots that tested best with teenagers featured victims, including the California ad with the woman smoking through the hole in her neck.

“I don’t know that there is one silver bullet. What we’ve found is that real people with real stories score high in getting people to stop and think about the issue,” said Lisa Unsworth, executive vice president at Boston-based Arnold Communications, which creates anti-smoking ads for the state of Massachusetts.

The skin cancer commercial tells viewers to avoid overexposure to the sun and to see their dermatologist if they notice a suspicious spot on their skin--advice that could benefit doctors financially. A representative of the American Academy of Dermatology said that is not the group’s motivation.

“We are trying to wake people up that skin cancer not only kills but can result in disfigurement,” said Dr. Roger Ceilley, a past president of the AAD. “Some people will be seen by their primary-care doctors and not request consultation . . . dermatologists have the expertise.” He said there are more than 1 million cases of non-melanoma skin cancer each year, many of them minor.

Campbell Mithun Esty said that NBC rejected the ad because the AAD did not meet its guidelines for pro bono advertising. The ad wasn’t submitted to CBS because its guidelines are similar to NBC’s, the agency said. It has been shipped to local broadcast stations around the country, and to cable networks.

Faye Bliese, an account executive at Campbell Mithun, said the agency worried that viewers frightened by Biederman’s appearance might avoid getting treatment. For that reason, the agency decided not to air a spot it prepared that shows a frontal view of Biederman’s face without his prosthesis, and another ad shot in the bathroom of Biederman’s home, where he is shown washing out his prosthetic nose.

“We are not trying to gross people out,” she said. “We are trying to change behavior and show, in the most tasteful way, what can happen.”