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) :
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.
Table of Contents
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:
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!
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.
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
- Consultation on the proposed Tobacco Products Regulations (Plain and Standardized Appearance) – Health Canada
- CDC alters anti-smoking ads after complaint from ostomy association – The Washington Post
- Health Labels for Cigarettes and Little Cigars – Health Canada
- Graphic Canadian Cigarette Warning Labels and Adverse Outcomes: Evidence from Canadian Smokers – WHO
- Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial
Evans AT, Peters E, Strasser AA, Emery LF, Sheerin KM, et al. (2015) Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial. PLOS ONE 10(12): e0142879. https://doi.org/10.1371/journal.pone.0142879 - Brewer NT, Hall MG, Noar SM, et al. Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial. JAMA internal medicine. 2016;176(7):905-912. doi:10.1001/jamainternmed.2016.2621.
- Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The Impact of Strengthening Cigarette Pack Warnings: Systematic Review of Longitudinal Observational Studies. Social science & medicine (1982). 2016;164:118-129. doi:10.1016/j.socscimed.2016.06.011.
- Our Response & Action to the CDC’s Ostomy Ads – Fight Colorectal Cancer
- Cigarette packs with graphic images, blunt warnings are more effective: focus groups – Toronto Star
While I support any campaign to show the effects of smoking, it does not excuse using an ostomy bag for shock effect. I took a search online to see if any country in Europe had done or planned to do the same. I am glad to say I found none 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. even then the people responsible tried to deny it was the families loved one!! While the reasons behind these ads may be good very little thought is going into the unnecessary hurt caused by using an ostomy bag which we use to live a normal life. I am not ashamed of my bag and am not even bothered if it is visible when at the beach but cannot accept my illness used this way. the above post also shows the hurt caused to family members as well.
Like Jattzl, I found the ad offensive but after reading Eric’s opinion, didn’t have to look far to figure out why. I have had my colostomy for over 5 years and am still struggling to accept it. I have not had a easy time of it, so I know that’s part of it. I also, like many others, have ongoing physical (and emotional) effects of cancer and cancer treatment to deal with on a daily basis. It doesn’t help that I have gotten a very negative response from someone-whom I thought was a “safe" person to share my story with; she responded with disgust and that response has stayed with me. Anyway, I still find the ad offensive but I also know that I cannot look at it objectively.
I’m a little late to the discussion but just got my weekly email with the link from @VeganOstomy. I am a non-smoker and for many reasons, supportive of the anti-tobacco “shock value" as an effective ad campaign. I understand it. Even though there is no directly offensive wording (this is debatable) regarding ostomies, it was used for shock value – I believe that is exactly the intention with this ad. It hurt to have such a painful struggle in my life used for that shock value. I realize Eric’s quote “Are we hurt by how other people may perceive our ostomy or are we hurt by how we feel about living with an ostomy?" pertains to my reaction due to my own struggle with self image as an ostomate. There is a healthy process of acceptance most of us must work through. I agree with his point that our reactions needed to be contemplated.
Ostomies have a negative repulsion aspect that is too often used in media. I have seen it used on standard TV episodes to add that OMG gasp. It hurts every time. None of us would choose this. It is always an end result of a serious life threatening health event or condition. And along with it comes a good amount of adjustment, self reflection and priority evaluation. So, I have to view this ad with empathy and from the view point of a newly diagnosed person or people who have just endured the trauma, pain and struggle of the surgery and those of us who are just trying to make the most of life and what it has given to us. It is too deep to be used for shock value.
Is the main cause of an ostomy from smoking? No. Why not use a lung cancer victim instead. Do they have to put a picture of a full pouch with a fat man’s stomach? No. If the Government wants to deter people from smoking, stop taking lobby money/donations and taxes from tobacco companies. If the government did not get tax money from tobacco companies, perhaps they would let them go out of business.
Hi Joy,
These warning labels have a long history (several decades) and there are several dozen of them in rotation – they cover many smoking-related illnesses and tend to show the after-effects of developing cancer, lung disease, heart disease, oral disease, etc. These new label proposals cover another 39 health warnings, so the ostomy was just one of them.
Unfortunately, the health care costs attributed to smoking far outweigh any revenue the government receives – more than double from what I’ve read. The smoking public are the ones who need to decide to end the industry, and these warning labels (which are of very little cost to implement) has been helping them to quit.
Perhaps in Canada, and socialist countries where people expect to live off the government, aka working people. Any individualist would be smart enough to quit on their own. If people are going to pay 10 bucks for a pack of cigs, the picture is not going to help them. If you eat too much processed food, it could do the same to your health as cigs. You going to put pictures on processed food too?
I disagree that it’s meant to educate. You’d have to live under a rock to not know the dangers or smoking cigarettes. Graphic images are used to “arouse strong negative emotions". This is why I oppose using an ostomy in an anti-smoking campaign. My son has Hircshsprung’s Disease and has an ostomy for reasons that have nothing to do with lifestyle choices. I do feel that to mount a campaign that provokes negative emotions around ostomies, is hurtful to my son and others like him.
Hi Sara,
I would disagree that most people are aware of the dangers of smoking, and studies have shown that adolescences knowledge of tobacco-related risk varies greatly: https://pubmed.ncbi.nlm.nih.gov/27107909/
The same lack of knowledge is seen across diet/food choices too.
The warnings on cigarette packages are designed to target young smokers, so arousing “strong negative emotions" has been shown to be the most effective way of doing that.
But I disagree that the negative emotions are targeting ostomies – they are targetting smoking (the action) and cancer (the result). The ostomy is there to show what colorectal cancer entails. I don’t think most people have a clue what life with cancer is like. This is an opportunity to show it.
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
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, such as my son, who should not be held accountable for the choices of smokers, simply because he has an ostomy (unrelated to smoking). He is a young teen, who will have to navigate the waters of bullying without any added stigma from a photo campaign that portrays ostomies in a negative light.
The photo of the ostomy is meant to arouse strong negative emotions, which will be associated with all ostomies. It’s not likely people will develop different views of ostomies for people with cancer than for those without. The negative association with ostomies will apply to the community in general.