Tobacco Warning Labels: Offensive to Ostomates?

ostomies and tobacco warning labels header

Once in a while, the media or a government agency will say something that deeply offends ostomates.

UPDATE from Health Canada (July 23, 2018 @ 4:36pm) : 

You can view the original tweet here.

Such was the case when Canadian news articles began reporting on the testing of new cigarette warning labels, one of which featured an ostomate.

To say that my private messages and Twitter feed exploded was an understatement, and I’ve had numerous requests to let Health Canada know that I am outraged that they would stigmatize ostomies and offend my community.


A History Involving Ostomates

This isn’t the first time something like this has happened. Several years ago the CDC ran a similar campaign stating the risks of smoking and it features two ostomates (in two separate ads) who were sharing their negative experiences of living with an ostomy as a result of smoking.

A lot of pressure was put on the CDC to have the ads removed or revised, and they did end up modifying the message. In that case, I was in support of the revisions because I felt it put too much negative emphasis on having an ostomy, rather than why they had the ostomy to being in (smoking).

That said, these were patient testimonials, and nobody should have the right to undermine their experiences (I did publically reach out to one of the people featured to see if I could help by offering stoma care tips).


Health Canada’s Proposed Labels

But the new Health Canada warning label is different than the CDC ads and there is no testimonial.

For example:

You can view the original tweet here.

The proposed labeling is part of an open consultation (including open to the public) to, “get feedback on the proposed measures to standardize the appearance of tobacco packages and certain tobacco products.” according to Health Canada (SOURCE)


Why Put Warnings on Tobacco Products?

Warning labels on tobacco products sold in Canada are nothing new and they can be quite graphic (SOURCE). They’ve been around for decades, and their effectiveness in both raising public education about the dangers of smoking and their ability to influence people to quit has been studied for decades as well.

Some studies show that these warnings cause smokers to think of risks and can encourage them to stop (SOURCE, SOURCE, SOURCE), even across dozens of countries who use similar labeling strategies (SOURCE).

These new mock-up labels have also been tested in focus groups, and their impact on teens showed that they offer education and pause to think – especially when the message is to the point and realistic (i.e. like the ostomy one).

As the Toronto Star reported, “Youth participants, aged 15 to 19, noted learning new information in the focus groups, like the fact colorectal cancer could result in reliance on a colostomy bag.”. (SOURCE)

To me, this seems like a great idea that the public (and ostomates) should be supporting.


So Why the Outrage?

If these labels are meant to educate, and they’ve been shown to be effective at getting people to quit smoking, why all the outrage over the ostomy bag?

That was my first thought when I started getting tweets and private messages about it.

Surely, if so many people were upset there must be a good reason – right?

But as I looked at the specific warning label in question, I found nothing to be offended by.

Nothing I felt was stigmatizing to ostomates. Nothing that made me feel bad about living with an ostomy. Nothing exaggerated or made to seem different from what life might look like with an ostomy bag.

It simply shows a person with an ostomy bag – the image is similar to many I’ve seen on social media that get praised and shared around!

cigarette-health-warnings-ostomy
Proposed warning label being tested by Health Canada.

I’ve seen comments like these and have scratched my head for the last few days trying to understand why people are so upset:

“This enforces the already terrible stigma there are regarding bags and stomas! So annoying! The wording is very offensive…”

“…it makes a mockery of everything ostomates and advocates are achieving breaking the stigma attached to having a stoma bag. I find the wording insulting as well.”

“It’s the wrong way to promote quitting and offensive to Ostomates”

“This is disgraceful ….. [the] federal government needs to get their facts right about stoma bags before putting them on cigarette packages…”

“Disgraceful and out of order very upsetting for lots of ostomates”

As I read these comments and then look back at the warning label, it’s as though I’m looking at something totally different from what the comments refer to.

The label stated a fact: “Cigarettes cause colorectal cancer”.

It then stated a possible reality of having colorectal cancer: “You may need to use a bag as a toilet for the rest of your life.”

With the message, “You can quit. We can help.” that includes a phone number and website where someone can go to find resources to help them quit.

The image is that of an ostomate with an ostomy bag on their side. This person may or may not be an actual ostomate, but I will note that the ostomy appears to be on the right side of the person, which would indicate an ileostomy, rather than a colostomy.

It gets to the point (smoking causes colon cancer which may result in having an ostomy) without actually attacking ostomates in any way. And unlike with the CDC ads, this one doesn’t show an ostomate struggling or complaining about the smell or difficulties they’re having.

There is no hint that having an ostomy is “worse than death” or that it’s a “worse case scenario”, but it is being shown as something that could happen if you end up with colorectal cancer (which is still true).

Heck, the photo shown looks tame compared what my abdomen looked like after surgery!

If the warning had been misleading or intentionally made it seem like living with an ostomy is terrible, then I would have something to say about that. All of us would.

But I just don’t see it here.


What If You Are Offended by It?

Many people don’t agree with me, and I respect that. But I would like you to consider something if you feel offended by that warning label.

Are we hurt by how other people may perceive our ostomy or are we hurt by how we feel about living with an ostomy?

I think it’s important to ask ourselves why we feel offended by things like this. The label is targeting smokers and using the facts to help inform them.

I repeat: The goal of these labels is to inform people about the risks of smoking and provide them with an incentive to quit – saving lives in the process. It is not about shaming ostomates.

And I get it: We value our ostomy because it likely saved our lives, and it also allowed us to regain a quality of life we never imagined. Nobody is challenging that and the warning label does not elude to what actually living with an ostomy can be like (I don’t believe it ever intended to).

Promoting positivity when living with an ostomy is key to my own advocacy and I’m here to support anyone who has an ostomy. But for those who know me, it also means I don’t sugar coat the realities of life with an ostomy (including having blockages, leaks, and pouch odors).

And while we may see ostomy surgery as a treatment option for illnesses we had no control over; a life-saving option after an accident or emergency; a life-improving option for someone with cancer; we should do what we can to promote the avoidance of disease and surgery influenced by lifestyle choices – like informing smokers of their risks.

If you feel hurt or offended by these warning labels, you can certainly voice your opinion to Health Canada, and I encourage all Canadians to share their thoughts with Health Canada about these newly proposed labels.

But more importantly, I’d like you to think about why a warning label that is stating a fact causes such a negative reaction in you.


Thoughts from Other Ostomy Advocates

Many of my fellow ostomy advocates do not share my opinion (and that’s OK!), but I’m glad they are starting discussions around it.

The original tweet can be found here.
The original tweet can be found here.
The original post can be found here.
The original tweet can be found here.

I am glad to see that not everyone is outraged by these campaigns, including Fight Colorectal Cancer, a US advocacy group that works with many ostomates. They offered a rational and level-headed response to the CDC smoking ads which aired several years ago.


What Can We Do from Here?

Firstly, I encourage you to share your thoughts and feelings about these proposed labels.

We can’t move forward as advocates and patients living with an ostomy if we don’t understand the reasons behind our motivations or rationale.

I will be opening up a thread on the VeganOstomy Community Forums to give people an opportunity to openly discuss this topic. I hope that you’ll join in! You can also leave a comment below.

Secondly, I’d like you to stop and think. Knee-jerk reactions to things like this are often short-sighted and unplanned. Something we may take offense to one minute may actually be something we agree with after giving it some thought.

If there’s something specific about the label that rubs you the wrong way (the wording, the image, misinformation, etc.), please let Health Canada know.

If you have a more effective way to help educate people about the risks of smoking, please make those ideas known!

I want to be clear that I’m not trying to start an argument within the ostomy community, nor am I interested in debating over the rights someone might have to smoke. I would love for us all to have a collective voice that benefits everyone in meaningful ways, and that starts with open discussion.

Thank you for reading this.

If you need help to quit smoking, please click HERE.

Note: Already have an ostomy and are looking for some direction? I’ve got many helpful articles and videos available HERE!


References

62 thoughts on “Tobacco Warning Labels: Offensive to Ostomates?”

  1. In the UK just this week the Government has banned advertising of certain fast foods and foods aimed at kids near schools. I agree that its a blurred line on some foods being labelled as processed. The supermarkets target busy families with convenience ready meals which can be low quality and the art of home cooking is being lost. Just a fact the price of a packet of cigarettes here in the UK is £11.50 that’s $14.55 US $19.29 Canadian. Crazy!!

    Reply
  2. Posted by: Robert

    Joy I agree with you if people are gonna pay $10 a pack they probably aren’t gonna pay any attention to a warning no matter what it is .

    I would disagree for many reasons, but I don’t want to back and forth with it.

    I also agree that processed food is not good either and yes where are the warning pictures on that ? 

    Actually, there have been many petitions to get certain foods (i.e. processed meats) labeled with cancer warnings. In California, fast food restaurants have signs posted that their food causes cancer. 

    An unfortunate part about food labeling is that the industry often has their foot in the door when it comes to the direction these labels take. The salt, sugar, meat, dairy, and egg industries are constantly fighting science and regulations meant to protect consumers – fortunately, Big Tobacco has been losing that battle, but we have a long way before the food industry gives way. This is why consumer education about food, much like educating the public about the risks of tobacco products, should be consistent and aggressive. 

    But more realistically, you have to consider this: 

    Smoking, at any dose and at any frequency, is harmful. Even second and third-hand smoke is harmful. Warnings should be mandatory and upfront. 

    “Processed foods” is a loaded term – are we talking whole grain bread (a processed food) or cured meats? Are we talking deep-fried potatoes or frozen fruit (both are processed foods)? 

    Do these foods always cause harm? Do they provide any benefits (i.e. white bread is fortified with vitamins and minerals that certain people may not be consuming)? 

    Another thing you need to consider is how much of these harmful foods is someone consuming? Nobody smokes one cigarette a month, but I can find millions who might only drink one can of soda a month. 

    So the quantity matters as does the frequency, but also the content of these foods. 

    EDIT: It appears that warning labels on sweetened beverages can certainly influence parent’s buying decisions: http://pediatrics.aappublications.org/content/early/2016/01/13/peds.2015-3185   I, for one, would support greater efforts to label foods. 

    Reply
  3. Joy I agree with you if people are gonna pay $10 a pack they probably aren’t gonna pay any attention to a warning no matter what it is . I also agree that processed food is not good either and yes where are the warning pictures on that ? I think the commercials I see on TV about quitting smoking where someone has a hole in their throat is more effective of a warning to quit smoking than some body with a bag hanging off their belly .

    Reply
    • If they can read….  Then the government did their job.  I agree with Robert…….  yes, I payed 10 dollars +  tax for a pack of cig.  And kicked myself in the butt every time. 

      AND I CAN READ TOO !!!!!!!!!!!!!!!!  AND I QUIT TOO !!  Hurts the pocket book.. !! amen!

       

      I agree with Robert………….  If you can read and spend that kind of money?  Got to think more than once..  something is missing– like a nice dinner out,??  A new car payment?  Even Gas for the car!!!  This is how I though when I decided to stop–  I was loosing a lot.. 

      Reply
  4. Posted by: Sarah

    Perhaps that was an American survey? In Canada, as far back as 20 years ago, kids knew of the risks, and awareness has only been increasing over the years. “Statistics Canada’s 1996/97 National Population Health Survey found that 96% of Canadians older than 12 are aware of smoking-related health risks. Younger people are more likely to know about the risks — 98% of those aged 20-24 knew of them, versus 93% of those aged 75 or older.” http://www.cmaj.ca/content/cmaj/162/2/250.1.full.pdf

    Hi Sarah, 

    I apologize for the delayed reply. I really wanted to put together some information before I followed up.

    The stats you are referring to are from 1996 – a time when Canada’s population of immigrants was quite low. This is important to note because the risks of smoking are less known to people born outside of the country and anti-smoking campaigns were more visible back then (i.e. posters in doctor’s offices). 

    A more recent (2002), comprehensive study found a great lack of knowledge across different countries, including Canadians ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593062/ ).

    One example: “Over 20% and 40% did not believe smoking causes stroke and impotence, respectively.” 

    They also have misconceptions about nicotine: 

    “A sizeable minority in all countries (ranging from 41% in Canada to 49% in the UK) believed that nicotine causes most of the cancer. “

    I disagree with you that the photo of the ostomy is not targeting ostomies. It’s not targeting yellow teeth. An ostomy is not the flagship of cancer, as there are many people with ostomies…

    I may not have explained myself very well.

    When I mean “they aren’t targeting ostomies”  I mean what they are trying to prevent is cancer in smokers. The ostomy is being shown as a result of cancer (the most common surgery for someone with colorectal cancer), so that someone is made aware of what cancer might entail. 

    It would be the same as if they put a photo of pill bottles or hospital bills (associated with having cancer), because it helps people to visualize what life with cancer might be like (most people who have never experienced cancer in their life have no idea what it’s like).

    The negative association with ostomies will apply to the community in general.

    Perhaps that’s where we differ in our perspective. I don’t see the warning label or photo as a negative towards ostomies – I simply see it as a realistic look at life. It gives context to the label.

    Posted by: john68

    …but did come across a case here in the uk where a terminally ill cancer patient was pictured in his hospital bed and this was used on a similar ad to warn and shock. the horrible reality was the family was not asked permission and did not know until the pictures where made public. 

    That’s terrible. I would imagine the person responsible for using the photo without permission was reprimanded.

    On a side note, here’s what the labels look like in the UK (warning: they are very graphic):  http://www.tobaccolabels.ca/countries/united-kingdom/

    Posted by: Marann

    There are so many ramifications…..I know, I worked with these patients.  They are more the norm than you want to believe.  There is nothing better than visual aids to make your point. 

    Thank you for sharing your experience. I also believe (and research confirms) that visual has far more impact vs. text-only warnings. 

    Reply

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