The movie “NO”, or why fear is a poor incentive for people to change habits

Tonight I watched for the second time the movie “NO” with Gael Garcia Bernal, which I highly recommend anyone that takes freedom for granted to watch:

But the lessons from the movie, where an ad executive helps create a controversial media campaign opposing military dictator Augusto Pinochet during the referendum on his presidency in 1988, go well beyond lessons that Venezuela should adopt in an effort to rid Venezuela of the impoverishing politics that have plagued it since Chavez and Chavez-influenced governments have been in power.

This week, I watched a new PSA created by the International Diabetes Federation (IDF), titled “Diabetes Kills“. I am not embedding the video in this post because it portrays a message that I refuse to support, one that is disempowering and seeks to get people to pay attention by making them feel afraid. In response to this PSA, I shared the following comment with IDF and with a fellow diabetes advocacy blog that told me they were considering writing a piece about the PSA in question:

At the Diabetes Hands Foundation we have always seen IDF as a beacon that we’ve aligned our views and goals with, being as they are, a representative of people touched by diabetes worldwide. However, when I first saw this video I felt profoundly disappointed, as a patient and as a diabetes advocate. While I understand that they want to appeal to the general public and governments about the urgency of the diabetes epidemic, not only does the message in the video fail to do this (it is not directly targeted at those two targets -it is living in YouTube and propagating via social media): it conveys a very disempowering message, a message devoid of any kind of hope.

Diabetes does not kill: let’s please stop using this language! Complications from uncontrolled diabetes do (this is not my idea, but me amplifying what amounts to the gospel by Dr. Bill Polonsky). I invite our friends at IDF to reconsider this approach, thinking how people around the world feel when they are fist diagnosed with this condition: what if the message you first hear about it is that diabetes kills? Is that the first thing they want people to hear? Our anger about government inaction needs to be driven differently: painting diabetes rosey is far from what we are talking about, but fear-driving tactics don’t work either and can ultimately alienate a very important support platform IDF has built up over the years.

I hope IDF will listen to the voices of a number of advocates that have no raised their voices and asked them to reconsider this message: not only because it can been seen by people with diabetes, as well as the general public and governments that IDF is attempting to influence…

… but because it’s not true:

8 thoughts on “The movie “NO”, or why fear is a poor incentive for people to change habits

  1. I agree, Manny. I can tell you first hand that when I was growing up, all of the diabetes scare tactics didn’t inspire me to take better care of myself. In fact, I grew up believing that diabetes would kill me for sure, so it didn’t matter if I tried to take care of myself or not. And so, I didn’t. I’m so lucky to still be here, 33+ years later, and to be healthy. But I wish I had been given a better message when I was a teenager, so I could have believed I had a wonderful future ahead.

  2. Totally agree, Manny. I think the IDF PSA is confused in itself, aside from the message it gives. I wrote a post on this and it’s running Tuesday. Like you, I hope the IDF listens to this and responds accordingly. Thanks, too, for posting a note about that movie; I’ve not seen it, but will add to my watch-list! Thanks for writing this and bringing more attention to this.

  3. I am amazed at horrible pictures that this piece paints. I have been T1 for 18 years now and had a fantastic life. I think that the people like Manny and his team are far and few in this word. To put out message of doom and gloom is so abhorrent, I must ask why ? What was the purpose of this message ? We are all constraint on giving advice about how to help people (quiet correctly), yet it seems that scaremongering is perfectly acceptable ! Would somebody explain ?

  4. I understand the instant distaste about fear messages. One of the reasons that fear tactics are used so often in PSAs is that there’s quite a body of research that shows that for short-term, preventive actions (such as getting a mammogram screening for possible breast cancer) playing on people’s fears is more effective than “soft sell” messages. This is, in short, because such messages need to convince people that not taking action is far more likely to hurt them, that they are capable of taking the required action (schedule and show up for the breast scan) and that the action (screening) will do great good in preventing or helping them to avoid the dreaded event (breast cancer). Where this starts to get murky is in caring for chronic conditions, which require daily perseverance without much positive or immediate feedback and a rather slow progression of complications. Do fear messages work in such situations (such as living with diabetes)? As my professors in my Master in Public Health program say: We need more research.

    • This is a great perspective, Kelly! Thanks for contrasting the acute vs. chronic care differences, amiga.

    • This is a really great point, Kelly. It reminds me of when I was a teenager, and got all scare-tactic’d (?) by my pediatric endo at the time – “you will die, you will get complications.” That scared the hell out of me, and I did change my behavior – but it was only short-term. Eventually, I did fall off that D-management wagon again and the fear tactics used initially didn’t stick. And then the next time? Yeah, they didn’t work again. Interesting aspect of looking at chronic care vs. preventative… Thanks for sharing this.

  5. I agree that fear is a poor incentive but I wonder about reality. There are people in my life who have diabetes and, to put it kindly, ignore it. Their doctors don’t tell them how serious it is and don’t give them the information or tools to help. If you trust your doctor and he doesn’t seem to care, why should you? What if the video helps someone take their condition seriously and make the changes they need?

  6. I would say this messaging is inappropriate for IDF as well as for companies that hope to cash in on the growth in people with diabetes. The other evening, I was watching television, and Pfizer featured a TV ad for its small-molecule drug Lyrica (pregabalin) whose primary label indication is fibromyalgia (chronic pain). The company has managed to get a label extension for diabetic managing nerve pain associated with diabetic neuropathy (whose incidence has declined in recent years thanks to improved glycemic control among patients), and makes the unfathomable claim that “its know that diabetes causes nerve damage …”. Hello, there is not a single study published in a medical or scientific journal proving diabetes, by itself, causes neuropathy (indeed, some studies have show certain kinds of neuropathy to have an autoimmune etiology), so the claim is baseless and misleading. As you quote Dr. Polonsky, poorly-controlled diabetes might cause diabetic nerve pain, but Pfizer, who failed abysmally with Exubera, doesn’t know the first thing about diabetes and its marketing people are idiots. The message is that people with diabetes need to stay on top of these organizations; if IDF wants our help, they need to work with us on the messaging or their campaign will not get the traction they’d like it to.

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