Pink Ribbon Blues by Gayle A. Sulik: Book Review

Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health. Gayle A. Sulik. OxfordUniversity Press. 2011. 402 pp.

The forward for Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health authored by Bonnnie Spanier PhD, as a microbiologist and molecular geneticist, frames Gayle Sulik’s book as providing “an authoritative, evidence-based approach to distinguishing well-grounded hope from misleading hype,” (pg. viii).  The Pink culture is described as ubiquitous, this statement does not overreach today’s pink climate, the headlines on the internet contain a pink ribbon, your kitchen appliances now come in the appropriate shade of pink, steering wheel covers sport the ribbon, logos pertaining to pink cover collegiate bodies walking to class…. It is everywhere, and for breast cancer ‘survivors’ like my mother this is overwhelming and unwanted external stimulus. Sulik uncovers the optimistic face of breast cancer and the statistical manipulation required to sustain the ‘pink’ optimism.  Mortality rates for women have not changed in fifty years despite the not so ‘new’ progress in treatment and detection while genomics and protemics confuse and obscure twistable data towards the ‘tyranny of cheerfulness” while examining the morality of corporation participation in further embodiment of human medicalization, discourages analyzing the voices that are missing or silenced by this pinked culture. Sulik herself puts it this way; “Lives are at stake. The plausibility of reaching that goal (or ‘cure) has been diminished not through lack of effort, investment, visibility, or will but through misdirection and distraction,” (pg. xiv). Sulik explores the misdirection and distractions and allows those silenced to speak and the missing to be found in an accepting space that does not require a ‘tyranny of cheerfulness.’ Through research and encouragement of co-writers she confronts a challenge of moving outside of the pink box to analyze health information that can empower and or pressure patients into utilizing treatments that may not improve quality or quantity of life.  It is the ‘quality’ that Sulik focuses on as the goal for any sustainable life.

Sulik’s first chapter frames the question; ‘What is Pink Ribbon Culture?’ Her use of visually loaded descriptors is eloquent in her articulation of a doctor’s office maintaining an ambiance of an ‘ultra-feminine pink kitsch’ referencing the ability of pink ushering women backwards into an infantile innocence where it is acceptable to sell grown women ‘pinked’ stuffed animals while men with prostate cancer are not given Mattel toy cars with blue ribbons on them.  This infantilizing bleeds over into every aspect of breast cancer treatment’s promotional consumeristic aura.  The kitsch is an appropriate descriptor of this phenomenon; the direct to consumer advertising has potentiated this kitsch aesthetic. Suvivorship becomes a rite of passage to return these women back to adulthood after the regression to innocent childhood through the transformative powers of disease and its ability to transcend their previous existence into an enlightenment of survivorship.  The transformative qualities of disease create a level of pride earned by successful completion of this ‘rite of passage.’ Sulik places research agendas, promoting profitable systems of screening, pharma and consumerism as counterproductive and in no way reflective of the breast cancer ‘survivor’ experience. Advocacy does not erase the ugly reality it only silences it through maintaining a stigma against ‘bad’ attitudes that undermine the ‘tyranny of cheerfulness. “Sober accounts that reveal realism, cynicism, ongoing struggle, or death often fall on the margins,” (pg. 14).

Breast cancer is not a unitary ‘pinked’ experience nor is the movement unitary yet the facade creates a ‘pinked’ unitary norm.  Gender roles designated at birth by the traditional painting of a little girls room pink creates the ideal of pink enhanced through cultural norms of innocence, nurturance, sensitivity, support and an awareness that expands and reinforces societal gendered expectation through a simple recognition of the color pink.  “Since breast cancer places the social integrity of a woman’s body in jeopardy, restoring the feminine body (or at least normalizing its appearance) is a sign of victory in the war on breast cancer,” (pg. 15). The dichotomy of protecting ‘pink’ values is championed by the war analogy.  Historically women and children are collateral damage outnumbering the deaths of actual acknowledged war related deaths; it is an irony here that breast cancer that kills more women than men is used to sustain a ‘pink’ war attitude.  Feminine and masculine aesthetics merge to create the survivor.  ‘Pinked’ gender norms expand to include strength, courage, and aggressiveness forged through a battle returning victorious, revitalized and ultimately transcended.  Women are better for having had breast cancer. Tragedy can, has and will be utilized to create opportunities for profit through the vehicles sympathy and empathy. Narrowing the expectations of breast cancer through pinking creates specific values and ideas about normalization creating an invisible disease.  Audre Lorde’s army of one breasted or no breasted women does not rise up to defend these women, they are hidden behind and under the wigs and prosthetics erasing the evidence of any war.

The history of breast cancer is developed in; Chapter 2 The Development of Pink Ribbon Culture.  Breast cancer began as socially stigmatized deviation that the ‘victim’ bore some level of responsibility for.  This assumed deviant behavior responsibility is not an expired notion.  Women still carry a personal form of doubt about what causes breast cancer.  Science has not found the silver bullet explanation and the community of breast cancer has difficulty seeing cause in pyramidal effects. “In addition to high mortality and a corresponding fear that breast cancer was synonymous with a death sentence, the taboo surrounding breast cancer intensified medical and social mores that promoted women’s dependence on paternalistic medicine,” (pg 27).  Outreach communities and bodies of support for breast cancer patients with forums of information and funding raising abilities for a deviant disease was unthinkable. The Breast Cancer Movement created an atmosphere reversing these preconceived notions.  The 1970’s were the decade of empowerment following a decade of uprising demanding empowerment.  Medical knowledge began its public debut through information sharing and informed patient doctor relationships.  Following in the war analogy the Department of Defense Peer-Reviewed Breast Cancer Research Program of 1993 began active participation in ‘defeating’ breast cancer and the growing community of a known breast cancer population, this growing acknowledged population began an erosion of the stigma surrounding the disease.  An optimistic ‘culture of survivorship’ takes root and flourishes through the birth of the pink ribbon that merged advocacy and industry. Medical Consumerism fosters the informed patient consent though Sulik continues to question the validity of the information allowed to be dispersed to the reality of censoring information to steer or manipulate the desired decisions. The 1970’s maintained radical mastectomies that are questioned today as possibly inappropriate health care, “the results were debilitating and produced no real health benefit,” (pg. 33).

Aesthetics and normalization had its foundation in Victorian etiquette.  “Breast cancer was characterized to be a malady of the weaker sex, just another female problem that resulted from women’s reproductive malfunctioning, negligence, sexual impropriety, or some other undisciplined behavior,” (pg. 36).  This was the basis for stigmatization and created a space of assumed accountability and punishment. A multitude of programs were developed from the 70’s that propagated information in censored ways.  “Reach to Recovery even forbade volunteers from discussing medical information to avoid contradicting doctors,” (pg. 38). Focus remained appropriate to Victorian standards a white, heterosexual, and upper class discouraging access here to multitudes of women, just as first wave feminism did. Breast cancer ‘survivors’ were expected to normalize and appear ‘happy, whole, restored, and better than ever.’

Sulik presents three key factors to what is getting in the way of the eradication of breast cancer.  “The known risk factors account for only thirty percent of breast cancer cases,” Secondly “Pink ribbon culture omits, marginalizes, or downplays environmental factors, even though individual breast cancer advocates an grassroots breast cancer organizations have increasingly focused on the environmental links to breast cancer,” Thirdly “Big Pharma uses advertising to exaggerate the benefits of their products, conceal risks, and expand their market base, even though the benefits of chemotherapy are often fewer than we think,” Resulting in a booming cancer industry that performs ‘proper’ citizenship with profits “with the goal of dominating the market, pink ribbon culture provides the organizational structure and cultural resources necessary to gain consumer loyalty and public trust while taking advantage of the good will and intentions of individuals who would like to do something about breast cancer,” (pg 62-63).

The dichotomy created by the pink ribbon is discussed in; Chapter 3 Mixed Metaphors: War, Gender, and the Mass Circulation of Cancer Culture. “Forcing sides in the war enabled the emergent cancer culture to blame women who did not engage properly in battle, castigating women who did not follow the commands of medical authorities,” (pg. 74). Ambiguity is met with the fear of uncertainty creating unmanageable issues that were unacceptable to the ‘pink’ culture, adhering to the business rule of ‘know the answer before you ask the question.’ Culture values are higher for the healthy, normal and pure, while no one fits these categories, all of us only being able to find unity under a title of ‘mutant’ where the abnormal, unhealthy and polluted reside as a population thinking that we are normal even though we acknowledge personal variants that move us away from normal.  Lance Armstrong is brought into play here by Sulik to demonstrate the male ethos of the American Cancer Culture in contrast to Gilda Radner’s female appropriate ethos exemplifying generosity, inspiration and hope as pink femininity is maintained. Sulik uses the term ‘pink femininity’ to describe an assumed softness, innocence, dependence, and virtue of girlhood and true womanhood as they are posed and defined by female deviant traits of opposition to independence, cunning and manipulative seduction. “Pink ribbon culture reminds women that the problem of breast cancer can be solved if women know their place and do what they’re told,” (pg. 99). The She-ro becomes Sulik’s ultimate ‘survivor’ who knows her place and does exactly what she is told exemplifying the perfectly pink role model.

Sulik begins Chapter 4 Consuming Pink: Mass Media and the Conscientious Consumer with “In modern capitalist society, everything has its price,” (pg. 111).  Samantha King’s Pink Ribbons, Inc. is cited throughout Sulik’s writing coming to focus in this chapter.  Women magazines reinforce the ‘pink’ attitude awareness and support for the ‘cure.’  Early attitudes toward health allowed doctors to decide what their patients should or should not be told.  Magazines printed disclaimer statements following guides to self breast examination such as “intended to help you know more about your breast, but not to help you make judgments about your health.  Leave that to your doctor,” (pg. 117). Women’s actions limited to established medical ideals about the feminine body that did not allow for any questioning establishing dependence on men, doctors and husbands. Two events that are credited for expanding and creating ‘The Breast Cancer Audience’ are the 1985 National Breast Cancer Awareness Month and the 1992 branding of breast cancer with the pink ribbon. “Cultural representations (including advertisements, promotional material, and mass media) are a dimension of social reality in which people learn what should frighten them, offer them hope, and make them feel good about themselves and their situations,” (pg. 125).  In 2007 Komen redesigned the pink ribbon into a form that they could patent along with a ‘cure’ logo.  Corporation competition demanded ribbon availability at the price of a donation and Komen desired to distinguish themselves from generic donation.  The ribbon propagates, sustains and expands appropriate ‘pink’ attitudes and actions.

“The absolute risk of dying from breast cancer as decreased about 0.05 percent from 1990 to 2005.  Yet a woman diagnosed with invasive breast cancer gets more treatment spends more money, and has about the same chances of dying from the disease as she did 50 years ago.  Why aren’t we winning the war?” (pg. 1  59).  Sulik asks this question in Chapter 5 Consuming Medicine, Selling Survivorship, after already providing the answer.  The ‘cure’ would collapse and multibillion dollar business, why would they want a ‘cure.’ “The force of profitability of breast cancer detection and treatment cannot be ignored as a key element of society’s failure to eradicate breast cancer,” (pg. 160).  Prevention is rarely advocated in these circles although society is applying pressure to reverse this standard.   Mammography exposes women to 5 years of radiation if the protocol of one every two years starting at the age of 40 is followed.  The Institute of Medicine reports that 75% of ‘positive’ mammographies are false positive, and that they miss on average 25-40% of cancerous tumors,” (pg. 181). These errors lead to over diagnosis, under diagnosis and overtreatment. The cost benefit analysis leads one to believe that screening may not be ‘worth’ it. General Electric’s revenues from mammography increased from $3 billion in 1997 to $9 billion in 2007.  Pharma statistics paint a similar picture only exchanged billions for trillions.  The amount of money produced through the ‘disease’ of breast cancer with minimal change in mortality rates is a sobering reality supported by Sulik’s data.

Chapter 6 Under the Pink: Optimism Selfishness, Guilt and Chapter 7 The Balancing Act, are emotional personal stories of women that either adhered to the ‘pink’ rules or were deviant, supporting Sulik’s previous 5 chapters with analyzed testimony. Sulik develops the Feeling Rules.  Feeling the Rule I: Optimism (Incorporation of the She-ro and Rejecting the She-ro) advocates normalizing, avoiding complaints and empowerment; Feeling Rule II: Selfishness (She-roic Selfishness (i.e., Rational Coping Strategy) and Selfishness as Confessional) promoting sisterhood, symbolic activities and transformation supporting mental health and Feeling Rule III:  Guilt (The Inadequate She-ro, Embodied Social Stigma and Family Disruption) failed she-ro attempts, embodied social stigma and being a burden.  These rules access how a woman should or should not feel or act, and the consequences of following or deviating.

“Today’s breast cancer culture dictates the terms of women’s shared experience in ways that marginalize those who do not passionately participate and cheerfully comply with the culture’s rules of survivorship.  There is no room for lackluster support, contemplation of scientific controversies, inquiry into conflicts of interest between cancer advocacy and the cancer industry, alternative ways of coping that do not involve pink consumption, or public health strategies that do not rely on the mass proliferation of screening programs,” (pg. 274).

Truth is sought out and defined in; Chapter 8 Shades of Pink.  The truth presented by Pink Ribbon Blues is the silenced and marginalized section of women that are left out of the perky pink parade.  War remembers the victors and conquerors not the fallen or the unpopular, or as the old radio talk show celebrity Paul Harvey used to say “and now we know the rest of the story” that Sulik is unveiling.  The rest of the story for breast cancer exists underneath of and pushed out to the margins waiting for their time and their voices to be heard.  The women whose experiences are exhibited here speak of the inaccuracy of being a survivor, they won’t feel that they have survived unless their death is caused by something else and they do not wish to survive, they wish to live.  These sentiments echo the message that Audre Lorde gave voice to in the 1980’s.  She feared that normalization and the dogma of appropriate cause and effect relationship between women and breast cancer would be exploited for profitability.  Sulik confirms Lorde’s fears.

The ideology that being against pink ribbons translates to being against women with breast cancer is resituated in; Chapter 9 Rethinking Pink Ribbon Culture.  We can think of the yellow ribbon here as well. Just because you are against the war does not default to a reality that you’re against the solider.  Anti-war sentiment can and have been taken as a personal assault towards the soldier and the soldier’s family, this may not be accurate, as the soldier is ‘victim’ in the machinery just as the breast cancer war ‘victim’ is.  Presenting an anti-war against those in charge of said war could present a new avenue that is needed to change the tide in favor of those ‘victims’. “The worst thing a person can ask about any war is whether those who died, died in vain,” (Sulik, pg. 363).

Sulik’s arguments are well placed and grounded.  She utilizes a variety of sources and experts to evaluate the breast cancer culture that has grown and continues to grow at amazing rates.  The book is stimulating and readable for most who are interested in ‘the rest of the story’. This book is a productive addition to any woman’s library.

For more of January

Pink Ribbons Inc, book review

King, Samantha. Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy. University of Minnesota Press 2006.

Samantha King’s primary goal in writing Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy is stated as; “I have sought to offer a genealogy account and critique of the place of organized giving under neoliberalism.” (pg117) King’s book is written in an easily read style and length creating access to an entire population surrounding breast cancer from the men and women who experience it, their family, friends and any interested in the culture surrounding breast cancer for multiple motivations through the sharing of issues that could and do affect over a quarter million new patients yearly and their extended networks. She brings a complex and controversial subject into the management of common sense through the exposure of finances, taking a culturally acceptable and societal fashionable cause to an intended dichotomy between philanthropy and capitalism. Critiquing industrial profit from increased exposure of a stigmatized disease transitioned to a popular charity and the industry that has grown up around it and because of it. King is an associate professor of physical and health education and women’s studies at Queen’s University in Kingston, Ontario. She received grants and awards supporting this writing from Illinois University, Arizona University and Queen’s University.

The book begins with a strong foundation for the rest of the book in the: Introduction: Breast Cancer and the Culture of Giving. Her first three pages visually demand attention utilizing photographs from cover of The New York Times Magazine. The first photo is from 1996 of a common model persona type, from any popular magazine cover, draping her left arm over her apparently healthy breasts and body representing the accepted ideology of beauty through embodiment mediated by commercialization. She conforms to cultural expectations of beauty and femininity answering the subtitle ‘How Breast Cancer Became This Year’s Hot Charity’. The next visual on the opposing page is from the same magazine three years earlier. The photography artist Matuscha’s self portrait is raw and exposing, it is not sexy, answering it’s subtitle ‘You Can’t Look Away Anymore,’ it is arresting and the subtitle is provocative and accurate. Matuscha’s mastectomy scar is front, center and provocative to a society with a breast fetish focus. Dichototic photos provoke emotions of pain and suffering and the mirage of feminine ideals shattered by breast cancer. King utilizes these dichotic photos to focus her point of illusional ideology versus the harsh reality that surrounds a ‘disease’ that kills. King’s point is direct and compelling, she has few visuals interlaced in her type, none of them are superficial each has a unique voice strengthening King’s goals. King frequently speaks of a ‘tyranny of cheerfulness’ that covers up the culturally perceived ugliness of Matuscha naked and exposed scar where a breast should be. King’s marks her audience with her unspoken message of how things have changed in just three years. King does not use negative or derogatory statements towards any involved in this transition yet she subtly successfully. She acknowledges the difficulty of going against the grain of popular ideals with financial backing yet she logically proceeds convincing you along the way. The path takes you from a stigmatized disease to neglected epidemic that results in an enriching and affirming process that leads to the ‘tyranny of cheerfulness’ silencing the unpleasant deaths of over 40,000 women and over 400 men yearly.

She theorizes that the greatest strength of the causes for breast cancer has also become its weakness. This is explored in; Chapter 1: A Dream Cause: Breast Cancer, Corporate Philanthropy, and the Market for Generosity. “In the practice of corporate philanthropy and marketing over the past two decades, a broad cultural preoccupation with philanthropic solutions to social problems, the discourse of efficiency and cost-cutting in business practice, changing psychological conceptions of the consumer, and invigorated consumer demands for a more ethical form of capitalism have converged to produce the transformation of corporate philanthropy from a relatively random, eclectic, and unscientific activity to a highly calculated and measured strategy that is integral to a business’s profit-making function.” (pg. 2)  The NFL and Avon are examples of this. The NFL utilizing ‘pinking’ as a means to absorb innocence from the breast cancer culture defusing rowdy and occasionally incarcerated players through association. Surmising that someone who supports the ‘cure’ for breast cancer cannot be capable of criminal activities thus sanitizing public opinion of rich playboys gone wrong to players that women will root for. It brings to mind the Sears commercial campaign “The Softer Side of Sears” that targeted the growing consumer population of women to expand their business. Big burly men wearing pink ribbons create champions for ‘survivors.’ Women wearing their favorite player’s jersey in pink represented a new avenue of consumer productivity and participation. “Consumers are yearning to connect to people and things that will give meaning to their lives.” (pg. 11)  Generosity is advocated here by finding the ‘cure’ through pink purchase participation. King balances this overwhelming generosity by presenting actual amounts donated being capped by corporations upfront regardless of profits incurred by corporations. Corporations are also charged with supporting breast cancer while ‘causing’ or contributing to it, attaching the pink ribbon to products that are carcinogenic or emit carcinogens, using the cosmetic industry and later the automotive industry as proven examples of this strategy.

Volunteerism is the focus in; Chapter 2: Doing Good by Running Well: The Race for the Cure and the Politics of Civic Fitness. Irony is exhibited here by the financial gain of cosmetic corporations sponsoring multiple day walk-a-‘thons’, highlighting exercise and the production of proper citizenship through activity, action and association. You are expected to feel ‘good” about volunteering your time and money and as an additional bonus you can feel ‘good” about an exercise program facilitated by participating in helping the ‘cause.’ Nationalism is satisfied here by inhabiting ‘good’ citizenship space. This absolves you of any selfish purpose in fitness through altruist conduits. Altruism hazes the financial motives presented for multiple corporations presented by King. The Komen foundations participation is described as “committed to the state as a crucial vehicle in the ‘elusive search for a cure,’ and for creating and maintaining the conditions in which free enterprise and the market for breast cancer can flourish.” (pg. 46)    Komen’s assets were tripled from $109.3 million in 2003 to $316.9 million in 2007.

King describes the lack of knowledge and assumptive nature of pink advocacy as an act of doing ‘good” can also be interpreted as, “to be innocent is also to refuse to know.” (pg. 43)  The ‘thons’ advocate early detection thus opening another opportunity for financial gain for corporation supporters. Companies producing ‘detection’ devices are noted in sponsorship commercialization mutually inhabiting the altruistic haze. ‘Thons’ become a space of physical, moral and civic participation producing ‘proper’ citizens nationalizing a feminine ideal.

The ‘cause’ not only produces proper citizens but proper bipartisan politics. Utilizing the power of pink properly and creating the very first ever postal stamp to provide proceeds for any ‘cause’ is analyzed in; Chapter 3: Stamping Out Breast Cancer: The Neoliberal State and the Volunteer Citizen. Congress excited by an issue that could rally bipartisan support  “claimed it was an effective way to enlist grassroots participation in the fight against breast cancer and a means by which to inject consumption with ethical value and meaning, it is an ideal vehicle through which the state could enable the public to demonstrate their spirit of volunteerism and generosity, and it was a vital tool in preservation of the nation’s mothers and, by extension, nuclear families.” (pg. 71)  Breast Cancer now encompasses proper patients, citizens and government. Hillary Clinton is even observed by King to experience a chameleon like change through breast cancer akin to the NFL player’s ugly caterpillar transformation to beautiful butterfly. Hillary’s masculine, domineering and independent persona is pinked into ‘good” mother, sympathetic wife and compassionate mother, (pg. 76)

Breast Cancer ‘Cause’ goes global in; Chapter 4: Imperial Charity: Women’s Health, Cause-Related Marketing, and Global Capitalism. Pharmaceutical corporation participation is noted here by their promotion and production expansion of Breast Cancer Awareness Month to a global market by sponsoring chapters in Germany, Greece and Italy in 2000. European skepticism has kept the pinking from reaching epidemic proportions in the ‘global’ breast cancer world as it has been targeted for scrutiny through the fact that other diseases are real epidemics in other countries and breast cancer does not have the numbers or social presence to surpass other global issues growing from poverty. “The greatest risk factor facing women living in third world poor countries [is] living in third world countries.” (pg. 96) Breasts are not a focus globally; the ‘American’ fetish has not spread far enough to pink the world. The altruist haze is penetrated by the fact that early detection is not in the global budget. The marketing ploy of philanthropy, ‘early detection’, has not been able to gain ‘proper’ citizen cooperation abroad. “Businesses that are seeking to produce and sell goods in an ever-expanding number of locations, has increasingly deployed philanthropy not merely to further some social ‘good’, but as a technique for market penetration and retention.” (pg. 98)

Audre Lorde is a voice utilized by King to sound discord in; Chapter 5: The Culture of Survivorship and the Tyranny of Cheerfulness. Lorde is used throughout the book but her arguments are poignant in this chapter. “Lorde’s warning that to look on the bright side of things is to obscure realities that might prove threatening to the dominant order is more relevant now than ever before.” (pg. 102) King’s central argument is stated here, “breast cancer became a philanthropic because of an informal alliance of large corporations (particularly pharmaceutical companies, mammography equipment manufacturers, and cosmetics producers), major cancer charities, the state, and the media that emerged around the same time and was able to capitalize on growing public interest in the disease.” (pg. 111)  The veil of ‘awareness’, volunteerism and goodness protects the ‘pink’ from logical analytical discourse by involving and heightening over-emotional response. ‘Pink’ critics are not popular, they are stigmatized, ironic isn’t it. “The culture of breast cancer survivorship does not, in other words, embrace patient-empowerment as a way to mobilize critical engagement with biomedical research, anger at governmental inaction, or resistance to social discrimination and inequality, even if its history is bound up with attempts to do just this.” (pg. 105) The survivor discourse has eliminated the patient just as it eliminated the victim creating a health illusion for only the tyranny of cheerful survivors to remain. This tyranny has no tolerance for criticism.

The reality of breast cancer is reached in the; Conclusion: Beyond Pink Ribbons. “The fact remains that women diagnosed with breast cancer today face essentially the same treatment options; surgery, radiation and chemotherapy that were offered when the War on Cancer was first declared thirty years ago. And when it comes to prevention, the only options we are given are powerful pills with dangerous side effects, and surgery more drastic than that often prescribed for women with the disease.” (pg. 119)  While this conclusion is grim King does follow up with: “[Needed is] a coordinated, adequately funded approach to breast cancer research, with the ultimate goals of understanding the causes of breast cancer and the reasons for different incidence and mortality rates among different racial and ethnic groups, and discovering more effective, less toxic treatments. Outcome-driven research, in which the researchers look for answers to these types of questions of most concern to the affected community, is necessary to achieve our goals. As a new approach to the standard scientific model, outcome-driven research frames the hypothesis to get the answers we need to important public health questions.” (pg. 119)

King hypothesizes and proves a darker side to the tyranny of cheerfulness. Yet King has missed a movement towards alternative medicine that is gaining momentum and a record of ‘successful’ cancer treatments that have existed in the United States possibly as early as the 1930’s. Options are available and are being used. Alternative medicine is gaining ground as demonstrated by the Pills, Potions and Poison seminar held at the University of Wyoming this fall. Attendance to the seminar was higher than expected and subject matter ranged from lobbying against the FDA to a speaker from the FDA.

The goals stated by King are met however. She sketches a landscape and history of a pink ribbon culture and how even the best intentions of philanthropy can be corrupted and manipulated for profit. King is cited in peer type research and in books along similar research lines like Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health by Gayle A. Sulik. King’s analysis is practical, convincing and moving. She is passionate about her subject and kind to her ‘adversaries.’