The fear factor in health fundraising.

The boy in the poster gasps for air, his face barely above the surface of water. The tagline reads: “Cystic fibrosis is like drowning on the inside.” Another ad from the Canadian Cystic Fibrosis Foundation says that breathing with cystic fibrosis (CF) is like breathing through a straw. “No wonder so many people with CF stop breathing in their early 30s,” the poster states. Advocacy groups that raise money to combat illnesses often struggle to capture the public’s attention. There are many worthy causes out there, some higher profile than others, and getting people to notice a particular cause is hard enough — getting them to care about it harder still. Using an alarming image or message in an advertising campaign can be an effective means of making people pay attention. A picture of a drowning child is unlikely to go unnoticed. But startling ads to raise awareness about diseases can have quite a different effect on people suffering from those diseases. For them, such ads can be distressing, reminders of a future that is anything but certain. Some critics claim ads that depict worst-case scenarios border on fear-mongering and, in some cases, don’t even accurately portray those worst-case scenarios. “The ads for CF have been like this for years,” says Dr. Annie Janvier, a neonatologist and clinical ethicist at Sainte-Justine Hospital in Montreal, Quebec. “Every year, they have very vivid and shocking ads with kids in them that actually hurt families and the kids themselves.” Janvier says she has encountered parents of children with cystic fibrosis who became very scared after seeing the “drowning on the inside” ads. She says that children with the disease who see the ads may accuse their parents, who focus on giving them the best quality of life, of lying to them about their conditions. Even doctors who treat people with cystic fibrosis tend to dislike the ads, says Janvier, though they don’t criticize the Canadian Cystic Fibrosis Foundation because the group raises money to help their patients. The ads are not only scary but also misleading, says Janvier (CMAJ 2010; DOI:10.1503/cmaj.110-2082). Cystic fibrosis, a fatal genetic disease that affects about one in 1600 people, causes mucus to accumulate in the lungs, affecting breathing. But according to Janvier, people receiving proper medical care would at no time, not even when dying, feel as if they were drowning or breathing through straws. “It’s like saying someone is going to choke you at home. It’s shocking people with misinformation,” says Janvier. “Even the worst-case scenario is not like that. You don’t die as if you are drowning. If you die in pain, you have bad medical care. If someone feels like they are breathing through a straw, you have bad medical care.” But according to June Pierotti, the director of communications for the Canadian Cystic Fibrosis Foundation, the ads are not intended to mislead, scare or hurt anybody.