Pink Ribbons, Inc.

Breast cancer as commodity

21 mins read

Take a ride down any city street, walk down the dry goods aisle of your local supermarket or women’s clothing department, peruse cosmetics counters or flip through any number of magazines. You’ll see pink ribbons bedecking buildings, toilet paper or car bumpers—not to mention lapels, where they’re sometimes jewel-encrusted. You’ve probably been solicited for donations and have likely given to the cause. Maybe you’ve even taken part in a gruelling two-day walk or bike ride, often through polluted city streets. And quite possibly, you personally know someone who has been diagnosed with breast cancer.

Small folded ribbons seem innocuous enough. They mark our commitment to AIDS awareness (red) and to ending violence against women (white). So what is there about innocent pink versions of these talismans to deserve a National Film Board feature documentary, directed by one of Quebec’s pre-eminent filmmakers, Léa Pool?

NFB executive producer Ravida Din, who became interested in the subject during her own experience with breast cancer, initiated Pink Ribbons, Inc. “I had just finished treatment and was reading Barbara Ehrenreich’s Harper’s essay “Welcome to Cancerland,” which initially opened me up to the wider issues. Soon afterwards, I received Samantha King’s book Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy. I was just coming into my new position at the Board and was considering what kind of projects I wanted to see happen. I saw this as a way of furthering the NFB mandate of pursuing important social debates.”

The project was researched, developed and co-written by feminist filmmaker Patricia Kearns, who was originally slated to direct it, and Nancy Guerin, who eventually became associate producer. When the final treatment was presented to the national programming committee in Toronto, a decision was made to bring in a high-profile director who would boost the film’s visibility. Pool was clearly someone with the breadth of experience necessary to tackle such a complex and unwieldy subject.

Born in Switzerland, Pool has lived in Quebec since 1975, when she studied in the University of Québec’s then-nascent communications program. She is best known for her feature films, a dozen since her debut in 1984 with La femme de l’hôtel (A Woman in Transit). She is an internationally recognized and multiple-award-winning filmmaker.

Pool has made a documentary per decade during that time and loves the way the form challenges her. She says it’s an “outside in” process, very different from her fictions, for which she does very little research and whose stories spring, Diana-like, from her head and perhaps some personal experience that surfaces from her subconscious.

For Pink Ribbons, Inc., Pool tackled the 2,000 pages of research, trying to focus it into a cinematic oeuvre. It was exhaustive, covering the history of the feminist movement and of breast cancer, as well as including several major additional dossiers. She saw an important, virtually unexplored—almost taboo—subject, an apparently noble cause that no one really wanted to touch or explore.

Pool was also attracted by the possibility of making something different in her career, neither fiction nor the more personal docs she has made to date, but instead a subject-driven, interview-based exploration requiring foremost the construction of a coherent and intelligent argument.

“In documentary, you begin with very little knowledge of the subject. So you inform yourself, and you write a script based on what people tell you. You cut and paste. You imagine images without really knowing what you’ll find out there; you create a canvas, you internalize ideas and the result is similar to what you have at the beginning of a work of fiction,” she says.

This film marks a shift in Pool’s work, a movement toward more social concerns, and yet on a continuum with her previous films, which have overwhelmingly been with and about women. While it lacks the intimacy of her auteur films, treading a delicate line between investigative journalism and humanistic narrative, it is an important film whose message goes beyond the single issue of breast cancer.

The semiotics and symbolism of breast cancer—the potent combination of nurturing and destructiveness—makes compelling matter for films, both fiction and documentary. Since 2001, when Newfoundland director Gerry Rogers made er ground-breaking documentary, My Left Breast, a small industry of films has been produced about the disease.

Toronto’s Breast Fest, now in its fourth year, may be the only event of its kind, but others are sure to follow. The fest features documentary and fiction films, as well as conferences, variety shows and musical performances. Founded and administered by the ReThink Foundation, which specifically addresses the concerns of young women with breast cancer, the festival is deemed primarily an outreach and education tool. Its steadily growing audience bespeaks its success but also suggests a darker reality of the growing incidence of breast cancer among women in their twenties.

What emerged in the case of Pink Ribbons, Inc. was the need to focus on what was most obviously “attack-able” in the whole story: the “inc” in pink and the shameless harnessing of that most elemental fear of all, mortality and death, for mercantile interests. The film’s elegant studio interviews, set against shifting luminous backgrounds, are artfully enriched with cutout animation sequences, archival clips and live footage.

Multiple pink ribbon campaigns have become the defining feature of public knowledge about breast cancer. Not only can you run, walk, jump out of an airplane, ride, shop, wear denim, and even invest “for the cure”, you can also buy a dizzying array of pink ribbon–inflected products, from cuddly teddy bears to KFC. The vast range of props offered to women inspired Barbara Ehrenreich to write of an existential space that “bears a striking resemblance to a mall.” Corporate-sponsored drives make a cure seem as simple as a range of consumer choices.

Pink Ribbons, Inc. and the roster of feminists, breast cancer activists, doctors and writers it gives voice to (almost all of them women) argues that these campaigns have prettified the disease and, in the process, de-politicized it. The film suggests that those who advocate for a change of priorities—from cure to cause, from individual to public responsibility—or who argue that, for example, the role of environmental toxins in the growth of cancers needs to be examined, find themselves marginalized by a massive onslaught of positivist, cheerleading campaigns, financed and administered by a wide array of corporations.

It’s not difficult to see why, given the sums in question. The Susan G. Komen for the Cure foundation, headed up by Nancy Brinker, a George W. Bush appointee to several high ranking positions, has raised over $1.9 billion since its inception in 1982, making it the largest breast cancer charity in the world. If approximately 35 percent of that goes to administration, how can smaller independent organizations such as the Breast Cancer Action Network, that rely on donations from individuals and refuse corporate links, compete?

Samantha King writes about the appropriation of pink ribbons as part of a larger phenomenon of corporate philanthropy, or “cause marketing,” and dates it to the Reagan presidency with its attacks on “excessive government spending, taxation and regulation.” In an address to the National Business Alliance, Reagan talked about the need to tap into America’s “deep spirit of generosity,” volunteer activities and philanthropy, without forgetting “a buck for business.” Thirty years later, breast cancer has become the unchallenged poster child of this phenomenon.

Pool filmed several pink ribbon events and they punctuate the film, acting as a kind of narrative motif. We begin in an empty fairground environment as people begin to gather, and then follow them through various stages of the events. While we feel empathy and solidarity with the participants, the sheer level of crass commercialism stands out: it’s all a bit of a circus with hawkers and fire breathers and amateur cheerleading groups and, of course, lots of merchandise. By the end of the film, we feel we have walked and run for the cause and engaged in a cathartic group therapy.

A handful of the most important organizations are featured: Komen’s Race for the Cure in Washington, D.C., Avon’s San Francisco–based Walk for Breast Cancer, Revlon’s Run/Walk for Women in New York, and Pharmaprix’ Weekend to End Women’s Cancers in Montreal. According to Pool, it wasn’t about balance but showing who the big players are, those that are shaping this whole culture and setting the agenda.

The film makes good use of archival material, with PSAs taking us back to the early days of breast cancer awareness campaigns. In the 1940s they were defined by a militaristic jargon, as women were enlisted in the “war on cancer.” A 1959 clip shows Alfred Hitchcock directing William Shatner as he plays doctor to a tearful woman contemplating disfigurement.

Contemporary campaigns sometimes defy belief and the standards of good taste—not to mention ethics. The Komen-sponsored Kentucky Fried Chicken’s “Buckets for the Cure” is the biggest stretch, showing KFC employees in hokey choreographed dances. Even more offensive is the Ford “12 Warriors” campaign, an elaborate construction aimed at selling Mustangs.

Ironically, the pink ribbon was the invention of Charlotte Haley, a woman with no affiliations and a lot of cancer in her family, who discovered that less than five percent of research monies at the National Cancer Institute (NCI) was going to prevention. She sent salmon-coloured cloth ribbons to people, urging them to write to the NCI. Her grassroots movement took a different turn after Estée Lauder appropriated the idea, hiring lawyers, convening focus groups and ultimately creating a “comforting” pink ribbon. The rest, as they say, is history.

Even now, very little money is spent on prevention or the search for causes of breast cancer. A cure remains elusive and the death rate has changed very little since the 1930s, when mastectomy was the only treatment available. Cancer in general is on the rise, most notably and tragically among children.

Dr. Olufunmilayo Olopade, director of the Cancer Risk Clinic at the University of Chicago’s medical center, informs viewers of Pool’s film that, unlike heart disease, we simply haven’t done the fundamental research that will tell us how to prevent breast cancer. And Dr. Susan Love, one of the world’s foremost experts on breast cancer, is highly critical of what she calls the “slash, burn and poison” approach to treatment, which she says hasn’t changed in 20 years and is a crude response to something that is poorly understood.

The film’s argument inexorably shifts towards what has been glaringly obvious from the start—that cosmetics-based companies whose chemical constituents may themselves be implicated in breast cancer fund most of the campaigns. But very little is spent on researching the link between cancer and environmental toxins.

The question of where the billions raised by pink ribbon events go is the great unanswered heart of this film. Transparency and public accountability are not the defining characteristics of the foundations and their corporate sponsors. Websites admonish visitors to make “positive changes in your life to reduce breast cancer risk,” to exercise and eat healthy foods, to shop for the cure, offering generalizations and obfuscatory statistics.

The Canadian Breast Cancer Foundation, parent to the CIBC Run for the Cure, actually features a section on its website—albeit somewhat difficult to find—on the dangers linked to common household products, cosmetics and plastics. Otherwise, little in the way of advocacy by large foundations touches on environmental pollution. The focus is on wider access to screening (read: mammograms, upon whose efficacy many studies have cast doubt), treatments and care.

Contradictions abound and put the whole “pink” edifice on rather shaky ground: money goes to cosmetic giants like Revlon and Avon, whose campaigns belie the known carcinogens in their products; or to dairy producers like Yoplait whose products contain Recombinant Growth Bovine Hormone (RGBH), which has been linked to breast cancer.

Particularly shocking is the story of Astra Zeneca, a pharmaceutical giant that inaugurated October as Breast Cancer Awareness month back in the ’80s. Zeneca manufactures tamoxifen, an anti-estrogenic drug used in some breast cancer treatments, as well as Atrazine, a widely used pesticide that is estrogenic (and whose use has been banned in Europe).

Sometimes, the contradictions are more ridiculous than diabolical. Barbara Brenner of Breast Cancer Action in San Francisco talks about a Yoplait campaign requiring consumers to remove the lids of their individual-sized yogurts, wash them, put them in an envelope and mail them back to Yoplait, which donates 10 cents for each lid to the cause. She calculates, if you eat three yogurts a day for the four months of the campaign, you will have raised $34. Her response: just write a cheque.

In the film, we return periodically to a “stage 4” support group from Texas (The IV League), their testimonies offering a stark contrast to the exuberant, honking atmosphere of the fundraising drives. While Pool was determined not to diminish women’s involvement in campaigns or the need to be proactive in the face of cancer, she also wanted to pay homage to women for whom a cure is no longer an option—whose cancer has metastasized and for whom mainstream medicine no longer offers anything.

The focus on “survivorship” suggests that if your cancer returns, it’s probably because you just didn’t try hard enough, were not optimistic enough, and didn’t partake of what Samantha King calls the “tyranny of cheerfulness.” Not only do these women feel excluded from the pink ribbon culture—like bulls in a china shop, says one woman—they are also written off medically, as very little research addresses why breast cancer recurs and metastasizes.

Pink Ribbons, Inc. challenges us to ask harder questions, to be skeptical, rather than just say what’s the harm in raising money for breast cancer research? Lots, shows Pool’s film, if the millions spent on pink ribbon campaigns eclipses the work that has been done on the ground, over decades, by activists advocating for a coordinated, less competitive and more broadly focused research agenda.

Pink ribbons have drained the politics out of breast cancer action, substituting a kind of desperate upbeat joy for the anger that motivates many long-term activists. Barbara Brenner remarks that if women knew what was going on, they would be really pissed off. Against Nancy Brinker’s view that anger will not incite people to participate, Samantha King notes that activism has always combined anger with pride and optimism. Susan Love says it clearly: women need to repoliticize the movement, not just hand over the money.

As the film concludes, these questions are crucial as they assume greater importance worldwide. The pink ribbon movement is exported to countries where breast cancer isn’t an important health issue and has been used as a tool of diplomacy, or more accurately, yet another instance in a long tradition of cultural imperialism.

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