Wrap your worthy cause in a corporate image.

1256 HOSPICE AND PALLIATIVE CARE CLINICIANS are terminally nice people. We root for the underdog, care for the vulnerable, and the marginalized. But most of all, we are self-appointed patient champions fighting the health care system with a passionate commitment to improving care at the end of life. Indeed, our activism has been amazingly successful as evidenced by the recent subspecialty recognition of the field of Hospice and Palliative Medicine (HPM) in the United States in a mere two decades (a bare nanosecond in terms of historical timelines). An important and necessary consequence of this success is the integration of of HPM into mainstream biomedicine. While the long anticipated mainstreaming1 of HPM is the next natural step in the growth of the field, it cannot be denied that this new change is fraught with some uncertainity and a certain amount of cognitive dissonance. We are now being absorbed into the health care system that we have agitated against for so long . . . the very same system that has roused our “fright and fight” instincts over the past couple of decades. Thus this next phase of growth of HPM clearly needs a new modus operandi. We have to learn to play the “inside game” and accrue “health system currency,” even as we continue to passionately champion the cause of palliative care patients and their families. In fact, the field of HPM has to do reverse cause marketing, in order for the subspecialty to successfully integrate into the health care system while preserving our core mission. The discovery of cause marketing2 is attributed to American Express, Inc.,3 which has strategically adopted giving back and being a “good citizen” as a hallmark of the brand. In 1983, American Express launched the first-ever cause marketing campaign, the Statue of Liberty Restoration Project, as an effort to enhance the community where they lived and worked. According to this campaign, for each purchase made with the American Express card, the company contributed 1 penny to the renovation of the statue for the centennial celebration in 1986. This effort was a stroke of genius and generated $1.7 million for the restoration of the statue while concurrently serving as a marketing tool for the American Express card. Most importantly, it firmly established American Express as a corporate good citizen in the minds of the American public. Since then numerous corporates have launched cause marketing campaigns2 that support locally based charitable causes in ways that also promote their business including Avon Inc’s campaign against breast cancer and the more recent Product Red4 against global infectious diseases. Interestingly, the field of HPM needs to do reverse cause marketing, i.e., we are currently seen as “dogooders” fighting for a worthy cause but we have a nebulous corporate image. In order to effecively integrate within the system, we need to retain our worthy cause good citizen image while concurrently developing a robust corporate image that will make us invaluable to the local health care system. This winning combination will assure the local administrative leaders that our palliative care programmatic goals are aligned with and congruent to their corporate goals. The day-to-day reality is that as HPM clinicians we may find ourselves at odds with the fast-paced health care system that is typically not sensitive to the needs of the frail patient population we serve. But we have to desist from playing too much of an “outside game.” Instead we have to work the system “from the inside” as Dr. Billings demonstrates so beautifully by tracing his career path in his pioneer essay.5 Fortunately, HPM programs can easily strike natural synergy with the local health care corporate world in terms of promoting quality improvement measures, patient-centered care, health professional education, and also helping with many other performance mea-