ARLINGTON, Tex. — THE Dallas Cowboys just got “pinked.”
And not just the Cowboys. The entire Cowboys Stadium here. Pink is everywhere: around the goalposts, in the crowd, on the players’ cleats, towels and wristbands.
In case you haven’t noticed, October is National Breast Cancer Awareness Month, when the entire nation gets painted pink. This is also when “pink” becomes more than a color: It becomes, for better or worse, a verb.
In marketing circles, “to pink” means to link a brand or a product or even the entire National Football League to one of the most successful charity campaigns of all time. Like it or not — and some people don’t like it at all — the pinking of America has become a multibillion-dollar business, a marketing, merchandising and fund-raising opportunity that is almost unrivaled in scope. There are pink-ribbon car tires, pink-ribbon clogs, pink eyelash curlers — the list goes on.
Down on the 50-yard line on this early October day is Nancy G. Brinker, the chief executive who has done more than any other to create what might be called Pink Inc. With a C.E.O.’s eye, Ms. Brinker has turned her foundation, Susan G. Komen for the Cure, into a juggernaut. She has tied this nonprofit to hundreds of for-profit brands and spread its message far and wide with “Race for the Cure” foot races. She has, in effect, invested to maximize returns. Over the years, Komen has raised many billions of dollars to urge women to get mammograms, as well as for treatment and research.
“It’s a democratization of a disease,” Ms. Brinker, who is the Cowboys’ honorary captain for the day, says just before the coin toss. “It’s drilling down into the deepest pockets of America.”
The story of Komen is, as much as anything, a story of savvy marketing. Ms. Brinker has rebranded an entire disease by putting an upbeat spin on fighting it. Her foundation generated about $420 million in the 2010 fiscal year alone. Perhaps more than any other nonprofit organization, Komen shapes the national conversation about breast cancer.
If you’re feeling hopeful about the strides being made against this disease, rather than frustrated by the lack of progress, that may well reflect Komen’s handiwork. If you think women should be concerned about developing breast cancer, that’s often Komen’s message, too. And if you think mammography is the best answer at the moment, that, again, is the Komen mantra.
Like Big Oil, Big Food and Big Pharma, Big Pink has its share of critics. Some patient advocates complain that Komen and other pink-ribbon charities sugarcoat breast cancer, which kills about 40,000 American women and 450 men annually. Others complain that pink marketing, despite the many millions it raises for charities, is just another way to move merchandise and that it exploits cancer by turning it into an excuse to go shopping. And some pink-theme products have no relationship with any charities at all. (Consumers should check before buying.)
In any case, these critics say, all of those pink ribbons and pink products create more good will for charities and corporations than game-changing medical advances for patients.
Executives at Breast Cancer Action, a San Francisco advocacy group, have questioned the value of pink October for 20 years. They say some charities spend millions more on promoting the medical status quo — annual mammography screening, that is — than they do on financing research into the causes and prevention of the disease. (Mammography has significantly reduced the death rate from breast cancer, particularly for women in their 50s and 60s. But health experts disagree on whether women in their 40s need routine screening, or whether they should decide individually, in consultation with their doctors, based on risk factors like their family history.)
“The pink ribbons have become a distraction,” says Karuna Jaggar, the group’s executive director.
Ms. Brinker has heard such complaints before. She says Komen has good reason to promote screening and to ensure that people have access to follow-up care, all the while financing research to advance cancer treatment.
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“Do you take care of people today?” asks Ms. Brinker, who served as ambassador to Hungary under President George W. Bush. “Or do you put everything into prevention research?”
Komen spent about $141 million in fiscal 2010 on public health education, including awareness campaigns. It also spent about $75 million to finance medical research and about $67 million to pay for breast cancer screening and treatment. All that, Ms. Brinker says, requires Komen to generate revenue from individual donors and corporate sponsors. And if that means promoting pink KitchenAid blenders, Nascar vehicles or Scotch tape dispensers, so be it.
“America is built on consumerism,” Ms. Brinker says. “To say we shouldn’t use it to solve the social ills that confront us doesn’t make sense to me.”
Heart disease and lung cancer each kill more women in the United States than breast cancer. But the fight against breast cancer attracts more corporate sponsors, in part because of Ms. Brinker.
New Balance, for instance, has “Lace Up for the Cure,” a promotion that donates 5 percent of retail sales of certain pink sneakers to Komen, with a minimum annual donation of $500,000. Yoplait, as part of its “Save Lids to Save Lives,” donates 10 cents per pink yogurt lid to Komen; since 1999, it has given more than $22 million. And this month, even Eggland’s Best eggs come stamped with Komen pink-ribbon logos on their shells.
Of course, Komen does not have a monopoly on pink-ribbon marketing. While the Cowboys have a separate relationship with Komen, there is also an overall N.F.L. pink partnership with the American Cancer Society. And for almost every product, including a beer pong table available on Amazon, there is someone marketing a pink version.
It wasn’t always this way.
Until 1974, when Betty Ford, then the first lady, disclosed she had had a mastectomy, breast cancer was a taboo subject for many. After she went public, the number of women seeking mammograms spiked, in what epidemiologists would call “the Betty Ford effect.”
Several years later, Ms. Brinker’s sister, Susan G. Komen, a mother of two in Peoria, Ill., learned that she had breast cancer. But she didn’t receive aggressive treatment immediately. Later, even intensive chemotherapy could not save her.
In her memoir, “Promise Me,” Ms. Brinker tells how she promised her dying sister she would work to find a cure.
“She didn’t ask me to do something small,” Ms. Brinker says. “She asked me to eliminate death from this disease.”
In Ms. Brinker’s early career as a sales trainee at Neiman Marcus, she learned some marketing principles — like “never stop selling” — from Stanley Marcus, the legendary Texas retailer. When she started Komen in 1982, she applied those techniques. She was determined to shift people’s focus to hope and survival from the grim reality that this disease can kill.
“We were going to have to do things to attract people that didn’t scare them,” she says.
But Ms. Brinker quickly understood that her group needed a grass-roots movement. So, in 1983, Komen held its first race in Dallas to raise money. About 800 runners took part.
“They were bonding, sharing their experiences,” she recalls. The runners provided reassuring images. “For the first time,” she says, “you could see what survivors looked like.”
From her husband, Norman Brinker, a restaurant entrepreneur who started chains like Bennigan’s and later took Chili’s public, Ms. Brinker learned other business lessons, like how to replicate a concept in one city after another.
Komen now has 121 affiliates, mostly in the United States, which stage a “Race for the Cure.” The series of 147 races was attended by about 1.7 million people and generated about $120 million in fiscal 2010. It is Komen’s single biggest revenue engine.
“We recognize that we are not a business,” Ms. Brinker says. “But we run ourselves like a business.”
The Dallas Cowboys cheerleaders, in pink frills, are performing an upbeat halftime number with pink pompoms. Beside them, 300 breast cancer survivors unfurl two pink ribbons that run the width of the field. The women wear pink T-shirts, available this month at Old Navy, which read: “Hope! Fight! Cure!”
For Charlotte Jones Anderson, the Cowboys’ executive vice president for brand management and the daughter of the team owner, Jerry Jones, the Cowboys’ partnership with Komen is an example of synergistic co-branding.
“We felt we could do our part in loaning our visibility to increase their visibility to a scale that was even larger,” Ms. Anderson says, perched on a stool in the owner’s suite.
Associating with Komen, she says, sends a message to Cowboys fans, nearly half of them women, that the team cares about issues that touch their families and friends. The partnership also enhances the Cowboys’ stature as a manufacturer of fashionable sports gear. Ms. Anderson designed the pink T-shirts and approached Old Navy to be the team’s retail partner.
This month, the line of pink T-shirts for women, men and children is on sale at all 1,000 of the chain’s stores nationwide. Five percent of the purchase price goes to Komen. In the first week of sales, the three top-selling items at Old Navy were pink Komen logo T-shirts, says Tom Wyatt, the Old Navy president. The items won’t generate big revenue for the company, he says, but they should generate good will for it — and several million dollars for Komen.
This year, Komen has 216 such corporate partnerships and expects about $50 million in revenue from them.
Some of the partnerships have been controversial.
Last year, Komen worked with KFC on a promotion called “Buckets for the Cure.” Critics lambasted Komen for teaming with a fast-food chain even as the foundation advises women that obesity can be a risk factor for breast cancer.
But for Komen, the KFC program was a way to reach places where it did not have a strong presence, says Mark E. Nadolny, Komen’s chief financial officer. The promotion involved grilled chicken, not fried, he says, and KFC franchisees agreed to donate a portion of sales to Komen, raising more than $4 million in six weeks.
Both sides decided not to repeat the effort this year.
The giant video screens at Cowboys Stadium are delivering an upbeat ad.
“So, I promise I won’t bring the team over for lunch again without telling you,” Mr. Jones, the team owner, says in the spot, speaking to his wife off-camera. “I’ll go to the spa with you,” he says, “if you’ll get a mammogram.”
Then Bradie James, a linebacker, appears. “Because with early detection,” he says, “your chance of survival is 98 percent.”
Komen is an expert at packaging complicated medical information into emotionally appealing sound bites. Its glass-half-full approach can risk oversimplification.
Now Komen is introducing a new mammography campaign, called “Less Talk, More Action.” An ad in magazines like Prevention reads: “Get screened now. Early detection saves lives.”
Elizabeth Thompson, Komen’s president, says the campaign uses psychology to move women from awareness to action. “If you give people the option to do something else, they almost always will,” she says. “If you give them an imperative, they often respond.”
But some patient advocates say women might want more balanced information. The Cowboys’ video, for example, seems to suggest that screening will prevent 98 percent of breast cancer deaths. But the correct statistic is that when breast cancer is caught early, 98 to 99 percent of women will be alive five years after the diagnosis — but that screening itself may not extend everyone’s life. (Komen executives said the script they provided to the football players contained incorrect language and they planned to reshoot the segment.)
The Komen print ad, meanwhile, presents statistics in a simplified way that seems to overpromote the benefits of screening, some cancer experts say.
“It changes the focus of what we should be looking at to some advertising, marketing slogan,” says Dr. Otis W. Brawley, chief medical officer of the American Cancer Society. He says advocacy groups, including his own, should be more cautious in explaining that mammography has limitations even as they promote screening as an important tool.
Ms. Thompson, Komen’s president, says the group acknowledges that screening has limitations — it provides more detail on benefits and drawbacks on its Web site. Even so, she says, Komen is “happy to review our advertising if people are unhappy with it.”
This kind of mammography marketing by a variety of nonprofits frustrates patient advocates like Frances Visco, who says it lulls the public into thinking that breast cancer is a manageable chronic disease, while tens of thousands of women are dying from it. Routine screening does identify many breast cancers at early stages, when they are most treatable. It also ends up increasing the numbers of people with precancers and slow-growing tumors who may get unneeded invasive treatment, she says, while doctors still don’t know how to prevent many of the most aggressive breast cancers from spreading.
“If we continue to pretend that it is making a huge difference, we are not going to do the real work and figure out how we can save tens of thousands of lives every year,” says Ms. Visco, president of the National Breast Cancer Coalition, a network of hundreds of patient and professional organizations.
The public emphasis on pink merchandising and cancer awareness may camouflage the breadth and depth of Komen’s activities. Its community health division, for example, is currently focused on addressing health disparities and improving access to care.
“We could prevent countless deaths if everyone got the same level of care as upper-class white women in Boston or New York,” says Dr. Eric P. Winer, director of the breast cancer program at the Dana-Farber Cancer Institute in Boston and chief scientific adviser for Komen.
Komen, Dr. Winer adds, is also now focused on financing research that could reduce the number of deaths from breast cancer or the number of people who develop it. In 2008, Komen started backing longer, larger scientific projects with the idea of translating laboratory ideas more quickly into clinical trials for patients. Komen has financed 17 such grants for about $84 million.
“Because we generate all of our own money, we are extremely careful about how we deploy our assets,” Ms. Brinker says. “You might say we are an equity fund with an investment in each area, except we operate these things.”
Secret Service agents are pacing the porch of a house on University Boulevard, the home of the president of Southern Methodist University. Laura Bush is about to arrive. The occasion is a small cocktail party to celebrate Ms. Brinker’s donation of her foundation’s early records to the university’s library.
It’s a coup for S.M.U. to acquire the Komen archive — 25 linear feet of documents, scrapbooks and event packets, as well as one terabyte of digital material — says R. Gerald Turner, the university’s president.
“Seeing the Dallas Cowboys in pink shoes, towels and wrist bands really showcases how this crusade has taken off and is really part of the culture of the United States,” he says to the guests, including Mrs. Bush, who started the tradition of turning the White House pink for an October evening.
But Ms. Brinker, who serves as the good-will ambassador for cancer control at the World Health Organization, has bigger ambitions for Komen. Last month, the State Department announced a “Pink Ribbon Red Ribbon” initiative to expand cervical cancer screening and treatment in Africa — by using clinics that already screen people for H.I.V. Komen is one of the partners in the project, along with the George W. Bush Institute.
The program could save many lives. It also helps position Komen to be the leading global brand in women’s health.
Ms. Brinker says she is acutely aware of her critics. But, she says, Komen is following the model of AIDS activists who adopted a red ribbon as their symbol and promoted awareness until antiretroviral medicines became widely available.
“Until we make more progress on the treatment side, on the understanding of what’s causing breast cancer,” Ms. Brinker says, “what would people like us to do, stop talking about it?”
This article, “ ” first appeared in The New York Times.