In the early ’90s, a Simi Valley, Calif., woman named Charlotte Haley, appalled at the minuscule amount of money going to cancer research, created the first breast cancer ribbon. It was an orangey-pink — salmon-colored, really — and made of fabric. Haley, who was not only a breast cancer survivor but also had seen numerous friends and family members suffer from the disease, began attaching her ribbon to cards she sent out with the words “Breast Cancer Awareness Ribbon. . . . Join this grassroots movement. Help us to wake up our Legislators and America by wearing this ribbon.”

Soon after she introduced her creation to the world, big business came calling — specifically, representatives of Conde Nast’s Self magazine and international cosmetics company Estee Lauder, who wanted to make Haley’s ribbon the official symbol of the disease. Haley, concerned about the commercialization of her creation, turned them down. Undeterred, Self and Estee Lauder consulted their attorneys, changed the ribbon’s color to pure pink — all-female focus groups said it was the most nonthreatening, reassuring and feminine color — and went on their merry way.

The pink ribbon is now everywhere, but as the contretemps over the Susan G. Komen foundation’s hastily retracted decision to defund breast cancer screenings for Planned Parenthood proves, a spoonful of sugar may make the medicine go down, but there’s no promise it’ll stay there. These feelings of disappointment and betrayal inform writer/director Lea Pool’s critical documentary, “Pink Ribbons, Inc.,” which was released a week ago in Canada.

Of course, the outrage isn’t just about Planned Parenthood, or even Komen, arguably the most high-profile of American breast cancer charities. Like Haley, what the chorus of critics is pushing back against is broader in scope: an emphasis on optics over integrity, crass commercialism and the infantilization of the female experience into something fashionable, cheerful or sexy. As a number of pundits and commentators put it, the events of last week make it clear that for more and more American women, “pink stinks.”

‘Breast cancer culture’

“Pink Ribbons, Inc.,” which will premiere locally at the Washington, D.C., International Film Festival in April, has impeccable timing and a subject ripe for exploration — namely, the normalizing of an agonizing, widespread and often deadly disease and its repackaging as a lifestyle, what critics call “breast cancer culture.” (Emphasis on the “cult.”) The film is also an indictment of the industries that both align themselves against and profit from the disease, which is to say, the pharmaceutical, chemical and consumer-goods companies that manufacture products containing cancer-causing toxins at the same time that they market treatments, palliatives and charity goods in service of finding a “cure.”

Critics of breast cancer culture, including “Pink Ribbons, Inc.” producer Ravida Din, call such hypocrisies “pinkwashing.” Din was inspired to tackle the subject seven years ago, after she was diagnosed with breast cancer. Her sister had forwarded along Barbara Ehrenreich’s prescient November 2001 Harper’s magazine essay, “Welcome to Cancerland,” in which the cultural critic detailed her growing disgust with the commercial and medical establishment that she encountered after her diagnosis. (Ehrenreich’s essay was incorporated in her 2009 book “Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America.”)

“Reading Barbara’s essay was a real aha moment for me,” says Din, whose film is strongly informed and named after Canadian academic Samantha King’s 2008 book, which explicates the changing contours of the public presentation of the disease. (Both Ehrenreich and King appear multiple times in “Pink Ribbons, Inc.”) “I had just come out of treatment, and I felt that Barbara gave me the language to start to understand how we have all become complicit in creating this breast cancer culture.”

“That pink ribbon cult becomes, for many women, the idea of what the women’s health movement is: wearing pink and going to races and things like that,” Ehrenreich said Thursday. “This kerfuffle with the Komen foundation really showed they don’t represent a women’s health movement. You can’t depoliticize women’s health issues. You can’t just make a nice philanthropy around it. I think that particular delusion or illusion, that Komen really represented women in some comprehensive way, is gone.”

As Din and others point out, critics of breast cancer culture are not opposed to fundraising on behalf of breast cancer research or the research itself. The stated missions of organizations such as Komen — to help underwrite medical studies, offer support and help end the stigma against the disease — are not in question, nor are the motivations of the millions of women and men who have donated their time, money and energy to such causes.

What critics such Ehrenreich and breast cancer activist Barbara A. Brenner chafe at, however, is the evolution of much of breast cancer activism from a scientifically curious and explicitly feminist grass-roots movement with an interest in causes and prevention to the highly marketed, watered-down and corporatized iteration of today, focused mainly on treatments and “cures.” They also question where most of the money raised is going.

“We are not doing enough with looking at the disease origins,” Din says. “Why do we get cancer in the first place? The fact is that most of the money raised focuses on awareness and lifestyle changes and not on primary prevention.”

Or, as Janet Collins, an activist who organized the first world conference on breast cancer in 1997 tells “Pink Ribbons, Inc.’s” filmmakers: “If you ask people . . . if you raise the issue of prevention, they’ll say, ‘Well, we can’t prevent when we don’t know what causes it.’ Well how the hell can you cure what you don’t know?”

Going mainstream

You can’t. But you can make money trying. Although the mainstreaming of breast cancer activism and awareness is a triumph of marketing and outreach, its ubiquity has come at a cost — or depending on your point of a view, a profit — in the form of hundreds if not thousands of new or retooled consumer products. Cars, makeup, vacuum cleaners, stuffed animals, NFL and MLB apparel . . . all these and more have, at one point or another over the past few decades, been slapped with a fresh coat of (pink) paint and the imprimatur of any number of breast cancer charities, including Komen and the other behemoth in the breast cancer space, the Avon Foundation.

Twenty years after Haley refused the request to market her salmon-colored ribbon, pink ribbons, pink ribboned-consumer goods and associated runs, walks and jumps “for the cure” have become so commonplace and therefore benign that we hardly notice them; we’re anesthetized to this major killer of women to the point that it’s almost accepted as a rite of passage, not a profoundly painful experience. The color has been promoted as fashionable, a shorthand for a sort of optimism and positivity — what King calls the “tyranny of cheerfulness” — that threatens to obscure much of the justifiable grief, frustration and fear that accompany the epidemic, not to mention the hypocrisies of the companies who benefit from it.

“I think if people actually knew what was happening, they would be really pissed off,” Brenner tells “Pink Ribbons, Inc.’s” filmmakers, noting that many of the companies that donate to breast cancer charities — Revlon, AstraZeneca, Ford, Yoplait — have manufactured goods that contain or expel known carcinogens, estrogenics and endocrine disruptors. Komen founder and chief executive Nancy Brinker counters that coming from a place of anger does not “include or incent people to be part of a mission.”

Politicization

Tell that to “Linda in Las Vegas.” The breast cancer patient and former Komen supporter uploaded a video to YouTube on Feb. 2 titled “What Breast Cancer Is, And Is Not!,” in which she rails against the politicization behind the Komen foundation’s defund­-ing of Planned Parenthood. (Komen backed down, somewhat, on Feb. 3. On Tuesday, Karen Handel, a Komen senior vice president and reportedly the brains behind the group’s contro­-versial decision, resigned.) About two-thirds of the way through the video, which has garnered more than a quarter of a million hits in less than a week, Linda opens her bathrobe to reveal scars from her recent bilateral mastectomy. There is nothing pink, cheerful or fashionable about her, and that’s precisely where her power comes from.

“Do you see politics on my chest?” she asks. “Do you see religion on my chest? Do you see moral values or what you believe to be moral values? No, that’s not cancer at all. It’s not on my chest and that’s not it.”

She smiles. “The foundation? You showed your ass. Now you can kiss mine. Thank you.”

To read Anna Holmes’s previous columns, go to wapo.st/anna-holmes .