IActivities of the Youth Smoking Prevention Foundation

F I V E Y E A R S

OF ACTIONFOR A SMOKE-FREE COUNTRY

CONTENTS

Preface

Aims

To rid society of tobacco

Facts

200 new smokers every day

Tools

Two lung specialists against the tobacco industry

Self-help book for a smoke-free existence

A successful policlinic for stopping smoking

Prize-winners

Youth Smoking Prevention Foundation

Manifesto on Tobacco Prevention

Media appearances

TabakNee unmasks the lobby

Reactions to TabakNee

Smoke Alarm mobilizes children and parents

Five popular short films

Laying the blame where it belongs

Next

The battle against the killer industry continues

Campaign aimed at politics

The State on trial

Board of Youth Smoking Prevention Foundation

Committee of Recommendation

1

3

6

9

11

13

17

22

24

27

30

30

1

PREFACE

As doctors, we want to treat our patients as best we can. We do

all in our power to offer them every chance of surviving, but for

most of our patients there is unfortunately no cure. What we can

do, however, is make the quality of their remaining life as good as

possible.

And that involves trying to convince patients, with increasing

urgency, to quit smoking. Already diseased because of tobacco,

our patients find quitting so difficult that it underlines the

importance of preventing others from starting to smoke. We must

encourage smokers to stop and, more importantly, ensure that

children don’t start smoking.

That is why we try to make as many people as possible aware —

through the Youth Smoking Prevention Foundation, the TabakNee

website and the Smoke Alarm campaign — of the damage caused

by tobacco and of the vile methods that the industry employs to

get people hooked and keep them hooked.

We do not do this alone, but with a team of scientists,

journalists, researchers and lawyers, and with our

secretary Frits van Dam as the driving force. This

book offers an overview of the work accomplished

over the past five years and our plans for the near

future. We hope that you will support us financially

so that we can continue our work. Help us to make

tobacco a thing of the past.

Pauline Dekker

Lung specialist, Red Cross Hospital, Beverwijk

Wanda de Kanter

Lung specialist, Antoni van Leeuwenhoek Hospital,

Amsterdam

2

one main aim

RID SOCIETY

OF TOBACCO

3

Given all that we now know, would tobacco be allowed on

the market today if it weren’t already there? Of course it

wouldn’t. A highly addictive and poisonous substance that,

if used as intended, is ultimately lethal, wouldn’t stand a

chance of being allowed onto the shop shelves.

But tobacco is already on sale in shops, and its legal status

is the most important argument made by manufacturers and

some politicians to keep tobacco on sale. For the government

too, 19,000 deaths a year from smoking are apparently no

reason to ban tobacco, or at the very least impose greater

restrictions on it than are currently in place.

The Youth Smoking Prevention Foundation has one clear

aim: to rid society of tobacco and make smoking a thing of

the past. The only way to achieve this aim is to ensure that

nobody starts smoking. The foundation is therefore urging

the government to adopt a number of measures to create an

effective prevention policy:

• substantial increase in sales tax to put tobacco out of

the reach of children

A packet of cigarettes should cost at least 10 euros so that most

children cannot afford to buy them.

• tobacco-free school playgrounds

Smoking in and around schools should no longer be allowed.

AIM

4

• effective enforcement of the age restriction for buying

tobacco

It should effectively be impossible for persons under 18 to buy tobacco.

• reduction in the number of points of sale

With some 60,000 points of sale, tobacco is far too easily available, and

enforcing compliance with the age restriction is impractical. Tobacco

should be removed from supermarkets, chemist’s shops and bookshops,

and should only be sold from special licensed tobacco outlets.

• tobacco products should not be visible to customers

at points of sale

A wall filled with packets of cigarettes is a tobacco advertisement.

Tobacco advertising is illegal, and tobacco products should therefore no

longer be visible in shops.

OTHER COUNTRIES HAVE SHOWN THE WAY

More and more countries are proving that these measures

are not uncommon. Countries such as Australia, New

Zealand, Norway, Finland and Ireland have implemented

strict anti-smoking policies.

Cigarette vending machines are illegal in England, and since

April 2012 cigarettes are no longer allowed to be displayed in

ordinary shops. The same is true in Finland.

Anybody found to have sold cigarettes to a person under the

age of 18 in Finland can receive a half-year prison sentence.

Australia, New Zealand and Iceland are considering the

introduction of a total ban on cigarette sales.

Ireland aims to be smoke-free by 2025.

In the interests of our children’s future, the Netherlands

should join this list as soon as possible.

5

200 NEW SMOKERS A DAY

Some 200 children under 18 start smoking in the

Netherlands every day. 126 of them will start

smoking daily, 70 will remain smokers for the rest

of their lives, and 35 of them will die from its

effects.

200

70

35

6

Some 19,000 people die each year of diseases caused

by smoking. Half of those people are younger than 65.

Half of all people who smoke throughout their life die from

the effects of tobacco, on average 10 to 15 years before

the age at which they would otherwise have died.

87% of all new cases of lung cancer are caused by

smoking. The figure for COPD (chronic obstructive pulmonary

disease) is 85%, for acute heart attacks 31%, and for strokes

20%.

In 2013 the percentage of smokers among Dutch people

aged 15 and older was 25%

(26% men, 25% women, rounded).

In 2013, 30% of Dutch youths aged from 15 to 19 had

smoked within the past four weeks.

Some 200 children under 18 start smoking in the

Netherlands every day. 126 of them will start smoking daily,

70 will remain smokers for the rest of their lives, and 35 of

them will die from its effects.

FACTS

7

In 2013, 65% of smokers aged 15 and older in the

Netherlands admitted they had made a serious attempt to

stop smoking. If they could live life all over again, almost

90% of smokers would not start smoking.

4 to 10% of smokers aged 15 and older in the Netherlands

who tried to stop smoking in 2011 had not smoked a single

factory-made or hand-rolled cigarette one year (in 2012)

after stopping.

Each year the Dutch state collects 2,4 billion euros

in tax on tobacco sales.

In 2012 Dutch people bought a total of 12.2 billion cigarettes,

which cost them 3,3 billion euros.

Sources:

National Public Health Compass; Continu Onderzoek Rookgewoonten;

Roken Jeugd Monitor; International Tobacco Control Netherlands Survey;

AC Nielsen; Ministry of Finance.

8

Two lung specialists

against the tobacco

industry

9

In 2007 Pauline Dekker and Wanda de Kanter have had

enough. The two lung specialists at the Red Cross Hospital in

Beverwijk see that almost everybody in their waiting rooms

sit there as a result of smoking. And the diseases in question,

mainly lung cancer and COPD, are incurable.

When Dekker and De Kanter realize that there’s no substance

more addictive than nicotine, they no longer want to stand by

and watch. Instead, they decide to take action. So together

the two doctors write the book Nederland Stopt! Met roken

(‘The Netherlands Stops Smoking!’), which they present in

May 2008. The presentation coincides with the centenary

of NVALT, the Dutch society of lung specialists, and the

introduction on June 1 of the smoking ban in cafes and

restaurants in the Netherlands.

The timing can’t be better, and thanks in part to the

unflinching efforts of both doctors, the book receives plenty

of media attention. Ever since, Dekker and De Kanter succeed

in reaching the media whenever tobacco is in the news.

SELF-HELP BOOK FOR LIFE WITHOUT TOBACCO

Nederland stopt! Met roken is a practical and

effective manual for stopping smoking. The

book reveals and explains many issues related

to smoking and what makes quitting so difficult.

It discusses the myth of addiction, the tactics

employed by the tobacco industry, the health

advantages for those who stop, and the dangers

for those who don’t.

Featuring a ‘step-by-step guide to stopping’,

the book helps readers to prepare properly for

TOOLS

10

stopping, which is essential for maximising the

chances of success. In addition, the book discusses

the various methods for stopping smoking: cold

turkey, with and without supervision, with and

without nicotine substitutes or medicine.

Moreover, medical specialists tell of the effects

of smoking in their area of expertise. The book

also translates the latest scientific insights into

everyday life.

That makes Nederland stopt! Met roken a

comprehensive manual for a smoke-free existence.

Scores of readers express how helpful the book

was to them. Here are some of their comments:

‘The step-by-step guide to stopping shows you

just how bad your situation is. The book is not the

slightest bit aggressive in tone, but written so you

can see the facts for yourself.’

‘For me as a social worker the book has become a

real bible!’

‘The good thing about this book was that I was

prepared for difficult moments, especially those

moments when I didn’t want to stop.’

‘I am now a non-smoker thanks to your book.

I really have been rescued. MY DEEPEST

GRATITUDE TO YOU!’

‘The book includes a letter from a woman who

was diagnosed with lung cancer within one week.

Her lung specialist asked her to write a letter to

11

her children. While reading the letter I stood up,

cut my remaining cigarettes in two, and I haven’t

touched a cigarette ever since.’

But the lung specialists also continue to highlight the

disastrous effects of smoking in the news. In Beverwijk they

open a Stop Smoking Policlinic, which proves extremely

successful within a few years. According to a survey it

conducts, half of the participants hadn’t smoked one year

after treatment. That high percentage is in part the result

of a method adopted from England called ‘motivational

interviewing’ (MI) and, allied to that, a strict selection of

motivated participants. Asking the right questions makes

patients feel they are taken seriously, but they also have

to face up to the peculiar reasoning they follow to justify

their unhealthy habit. In 2010 Dekker and De Kanter write

a second book devoted to this method entitled Motiveren

kun je leren (‘Motivation can be learned’), specially intended

for people working in health care. The book helps medical

professionals to discuss healthier behaviour with patients in

a more effective manner.

Both books are successful, with print-runs of 40,000 and

10,000 copies respectively. A tear-off calendar and an

audio-book based on Nederland stopt! also prove popular.

On top of all that, Dekker and De Kanter set off on a lecture

tour in which they explain to 10,000 doctors, dentists and

pharmacists in the Netherlands why it is so important to

advise patients to stop smoking and how they should do that.

A SUCCESSFUL POLICLINIC FOR STOPPING SMOKING

12

PRIZE-WINNERS

Thanks to all their activities and success, in 2012

the Dutch Foundation on Smoking and Health

(Stivoro) proclaims Dekker and De Kanter as the

best practitioners treating tobacco addiction in the

Netherlands, and the news makes the front page

of De Telegraaf newspaper. In the same year they

receive the 38th Professor Muntendam Prize from

the Dutch Cancer Society ‘for their innovative

approach to the treatment of tobacco addiction

and their tireless battle for a no-smoking country’.

On May 31, 2013, the lung specialists earn another

accolade when, within the framework of World

No Smoking Day, they receive the Gerbera Award

2013 from Stivoro on behalf of the Dutch Cancer

Society, the Dutch Heart Foundation and the Lung

Foundation.

According to the jury report: ‘The lung specialists

Wanda de Kanter and Pauline Dekker deserve all

support and admiration for their tireless efforts

to put the problem of smoking on the political and

social agenda. They are motivated in those efforts

by their concern for the health damage caused by

tobacco that they see in their daily work.

And like few other people they have the courage to

take on the tobacco lobby in their crusade. Pauline

and Wanda are part of a long tradition of doctors

with the courage to highlight social issues with the

aim of creating a healthier society. A doctor on the

barricades fighting for a cause: that’s something

the sector should be extremely proud of!’

In late October 2013, both lung specialists receive

distinctions abroad, this time the Roy Castle

13

Lung Cancer Foundation Prize for their TEDx

performance entitled ‘Replacement smokers’. The

prize of 500 pounds is awarded during the 15th

World Conference on Lung Cancer in Sydney.

In their contribution to TEDxNijmegen in

April 2013, Dekker and De Kanter gave their

presentation the form of a biting role play in which

they denounce the involuntary nature of tobacco

addiction, the shame felt by patients for their

‘self-inflicted’ disease, and the shameless greed for

profit in the tobacco industry.

As Dekker and De Kanter immerse themselves more deeply

into the subject, they realize that all efforts to help people

stop smoking are ultimately futile as long as new smokers

continue to join the ranks of those already smoking. All the

information that reaches them from the literature and from

their international network teaches them to see through the

devious methods employed by the tobacco industry to recruit

new smokers among young people. So to offer resistance,

they set up the Youth Smoking Prevention Foundation

in 2009. The aim of the foundation can be summarized

succinctly: to make smoking a thing of the past.

That aim can be achieved through a number of related

measures:

• heavy increase in sales tax to put tobacco out of the

reach of children

• creation of tobacco-free school playgrounds

• increase in the minimum age for buying tobacco in

combination with an effective age control

• drastic reduction in the number of sales points

• concealment of cigarettes from view at points of sale

YOUTH SMOKING PREVENTION FOUNDATION

14

The foundation’s advisory council is made up of leading

figures from the medical and academic worlds and other

prominent figures. Foreign members of the council are:

Robert N. Proctor, professor of the History of Science

at Stanford University and author of Golden Holocaust;

Professor Robert West, University College London, Smoking

Cessation Institute; and Dr Jeffrey Wigand PhD, whistle-

blower from the tobacco industry and founder of Smoke-Free

Kids,

Dekker and De Kanter express their views at every possible

opportunity, and the Dutch Clean Air Foundation (CAN)

proclaims them to be the 2009 Non-Smokers of the Year.

Soon afterwards, the foundation’s ranks are strengthened

with radiation therapist Lukas Stalpers, secretary of the

Dutch Oncology Society, and Frits van Dam, Emeritus

Professor of Psychology and former researcher at the Dutch

Cancer Institute. Van Dam is appointed foundation secretary

and Stalpers becomes a member of the Committee of

Recommendation. Around the same time, the Dutch Cancer

Society decides to support the foundation financially.

That support is vital, because the political climate takes

a turn for the worse in the autumn of 2010 when Edith

Schippers is appointed as the new Minister for Health,

Welfare and Sport. Very quickly she reverses a number of

measures in the area of tobacco policy. She lifts the ban on

smoking in small cafés, halts information campaigns, and

takes remuneration for stopping smoking out of basic health

insurance policy.

Dekker and De Kanter decide to respond and draw up a

Manifesto on Smoke Prevention in which they call on the

minister ‘to do all in her power to make tobacco addiction

a thing of the past for future generations and to limit its

damage to current generations’. Some 1000 physicians,

15

MANIFESTO

Based on their knowledge of and responsibility

for sustainable public health, the undersigned

call on the new Minister for Health to do what is

necessary to make tobacco addition a thing of the

past for future generations and to limit its damage

on present-day smokers. Specifically:

1 To greatly increase the cost of tobacco

products (a doubling of the price)

2 To remove tobacco products from view at

points of sale (‘wall of fame’ in supermarkets)

and reduce the number of points of sale

3 To ban smoking in or near schools (smoking is

contagious)

4 To raise the age at which people can buy

tobacco to 18

5 To enforce the ban on smoking in cafes and

pubs and to balance the legislation from the

viewpoint of prevention for youths

16

academics and prominent figures sign the manifesto. After

much perseverance Dekker and De Kanter are allowed to

present their manifesto to the minister on 19 January 2011.

In her reply, Schippers asserts that she too wants to prevent

children from taking up smoking, but has decided to use

other means to achieve that aim.

Even so, the media devote plenty of coverage to the

appeal by the doctors to the minister. The current affairs

TV programme EenVandaag reports on the presentation

made to the minister and gives Dekker and De Kanter amply

opportunity to explain what should be done.

Later that year, in October 2011, the investigative TV

programme Zembla, with help from the Youth Smoking

Prevention Foundation, convincingly shows how short

the lines are between Minister Schippers and the tobacco

industry. No wonder that she is rightly known as the ‘Minister

for Tobacco’. The programme does not go unnoticed. The

authoritative medical periodical The Lancet devotes an

editorial to the subject entitled Can the Dutch Government

really be abandoning smokers to their fate? (Volume

379, issue 9811, p. 121) and the programme is screened at

international congresses with English subtitles.

Questions raised in parliament after the programme prompt

the decision to relieve Schippers of responsibility for tobacco

policy and put it in the hands of state secretary Martin

van Rijn.

Door een onzer redacteuren

Amsterdam. Twee longartsen

van het Rode Kruis Ziekenhuis in

Beverwijk hebben een website

opgezet waarop zij mensen ver-

oordelen voor banden met de ta-

baksindustrie. Zij noemen onder

meer oud-senator en oud-minis-

ter van Defensie Hans Hillen

(CDA), die betaald advies gaf aan

sigarettenfabrikant British Ame-

rican Tobacco en emeritus hoog-

leraar Irene Asscher, moeder van

de vicepremier en commissaris

bij sigarettenfabrikant Philip

Morris. Minister Schippers

(Volksgezondheid, VVD) wordt

wegens veronderstelde contac-

ten met de tabaksindustrie neer-

gezet als ‘minister van Tabak’.

De longartsen, Wanda de Kan-

ter en Pauline Dekker, voeren al

jaren actie tegen roken. Vo l g e n s

hen overlijden jaarlijks 23.000

mensen aan de gevolgen. Hun

voornaamste doel is te voorko-

men dat jongeren ermee begin-

nen. Voor het naming and shamingop hun website ‘Tabak Nee’ base-

ren ze zich deels op het werk van

onderzoeksjournalisten.

Volgens een woordvoerder van

Schippers zijn de aantijgingen op

de website „nergens op geba-

seerd”. Als minister in het kabi-

net-Rutte I verhoogde zij juist

het budget voor antirookvoor-

lichting aan jongeren, stelt hij.

Wel beëindigde Schippers de du-

re televisiecampagnes via Post-

bus 51, omdat voorlichting via de

sociale media effectiever zou zijn.

Inmiddels valt het ontmoedi-

gingsbeleid voor roken onder

staatssecretaris Martin van Rijn.

Longartsen hekelen ‘minister van tabak’

17

MEDIA APPEARANCE

Pauline Dekker and Wanda de Kanter appear

frequently in the media after the release of

their book Nederland stopt! They give scores

of interviews and contribute to all national and

regional newspapers, consumer magazines from

J/M to Opzij, and professional journals such as the

Nederlands Tijdschrift voor Geneeskunde, Medisch

Contact and Arts en Auto. In addition, they appear

regularly on popular radio and TV programmes

such as De Wereld Draait Door and Nieuwsuur.

The Youth Smoking Prevention Foundation also

actively campaigns through social media. Since

2008 the www.nederlandstopt.nu weblog is

updated weekly with all activities from the past

week. More than 10,000 contacts receive daily

news and updates via Facebook, Twitter (@

Wdekanter) and LinkedIn about matters relating to

tobacco and the fight against tobacco.

De Zembla documentary shows just how far the tentacles

of the tobacco industry extend into society and politics

and teaches us the effect of exposing that. The foundation

therefore decides to continue its investigative journalism and

to unmask the tactics and tools employed by the tobacco

industry on a separate website. The TabakNee site publishes

profiles of current and former politicians and other public

figures who, directly or indirectly, work for the tobacco

industry.

TABAKNEE UNMASKS THE LOBBY

18

When the TabakNee website goes online on March 11, 2013, it

provokes an unprecedented media explosion. All newspapers,

radio stations and TV programmes highlight this unusual

form of ‘naming and shaming’ by a website. Politicians and

others linked to the tobacco industry by the website are

furious and the press rubs its hands with glee.

In its first year TabakNee makes numerous revelations about

the lobby of ‘the tobacco industry & its cronies’. In addition

to its own publications, the team behind the website works in

various ways with established media channels. For example,

two of those who work for TabakNee, Stella Braam and Ivo

van Woerden, make a series of four stories for the weekly

Vrij Nederland magazine about the lobby and the network

of the tobacco industry. The first story, about the powerful

support from the Confederation of Netherlands Industry and

Employers (VNO/NCW) for the tobacco industry, appears

in July 2013 and comes as a bombshell. Many other media

report on the subject and the revelations lead directly to

questions in parliament.

Articles on the website itself highlight a PR advisor who

works for both the tobacco industry and the health care

sector, so-called independent research that turns out to be

funded by the tobacco industry, the powerful lobbying by

the VNO/NCW on behalf of the tobacco industry, the work of

small tobacconists and café owners on behalf of the tobacco

lobby, academics who dance to the tune of the tobacco

industry, the heavy lobby in the European Parliament, and

the interweaving of the tobacco lobby in the political arena.

Many articles result in questions in parliament. On at least

five occasions, members of parliament put questions to

responsible ministers as a result of information from the

TabakNee website, which operates with its own editorial

charter and independent editorial office, and posts more than

250 articles in less than a year. Visitor numbers grow steadily

19

20

and increase even more rapidly after the launch of a two-

weekly newsletter.

In late 2013 TabakNee receives internal documents from

Philip Morris concerning the tobacco manufacturer’s

lobbying in Brussels. The documents disclose in detail how

Philip Morris tries to influence members of the European

Parliament who have to decide about revisions to the

European Tobacco Product Directive. These internal

documents form the basis for a series of stories on TabakNee

published after December 2, 2013. In late February 2014,

current affairs programme EenVandaag airs a TV report

based on the same documents and on additional research.

That collaboration illustrates once again the added value of

TabakNee. The investigative journalism of TabakNee forms a

welcome addition for editors of current affairs programmes

such as EenVandaag. In this way, TabakNee works beyond

its own website to disseminate information about the tactics

employed by the tobacco industry and to make people

understand that implementing measures against smoking is

essential.

REACTIONS TO TABAKNEE

Immediately after the launch of TabakNee,

politicians and other figures in positions of

authority are asked to respond. They have two

choices: they are either for or against the website.

The Dutch Labour Party (PvdA) and Socialist

Party (SP) issue statements in which they express

support for TabakNee. Myrthe Hilkens (PvdA) tells

NOS news: “The tobacco industry sells outdated

nonsense and this is about public health. We

should be concerned about the health of young

people, and smoking is always bad. If people work

with the tobacco industry, it is good we are aware

of that.”

21

NRC Handelsblad newspaper observes that this

comment increases tensions between the parties

in the coalition cabinet, the PvdA and the Liberal

Party (VVD).

Former minister for health Els Borst (D66) is also

pleased with the site. “It is the only thing that

the tobacco industry listens to. People who sit on

the board of directors of a tobacco manufacturer

should ask themselves if they would be better

off spending their time doing something more

useful,” she tells the AD newspaper.

There is less enthusiasm from the VVD and CDA

parties. VVD member of parliament Arno Rutte

is angry about his own profile on the site. “We

should conduct the discussion on the basis of

serious arguments. For me that means showing

the arguments for and against. And if I take

tobacco manufacturers seriously, surely that

doesn’t immediately mean I’m a lobbyist? The

VVD is also concerned about the increase

in the number of smokers,” he says in de

Volkskrant newspaper.

In an editorial article NRC Handelsblad

newspaper writes: “Luxury goods

industries should be able to handle some

rough treatment. After all, they know

exactly what they’re doing when it comes

to making tobacco and alcohol appeal

to children and inventing an effective ‘lifestyle’

to go with it. [...]The doctors who have to clean

up the mess are the whistle-blowers. Take them

seriously.”

Trouw newspaper describes the efforts of

Dekker and De Kanter outside their surgeries

Een aantal artsen heeft het wel

gehad: zij radicaliseren. Kin-

derarts Nico van der Lely, al jaren

in touw tegen alcoholmisbruik on-

der minderjarigen, zei zondag in

Brandpunt dat het „nu klaar is”. Op

zijn polikliniek worden twaalfjari-

ge kinderen met een Jägermeister-

vergiftiging binnengedragen. De

gemiddelde alcoholcomalengte bij

kinderen is nu drie uur. Dat was

negentig minuten. Als hij denkt

aan de mannen „met stropdassen

in hoge gebouwen die hieraan ver-

dienen, word ik een pitbull”.

Twee Beverwijkse longartsen

openden maandag met de website

Tabak Nee frontaal de aanval op

politici, bestuurders en andere me-

deplichtigen aan de nicotineversla-

vingsindustrie. Deze artsen willen

de schuld- en schaamtegevoelens

van hun kankerpatiënten op hun

spreekuur niet meer incasseren.

Hun lieve stichting Rookpreventie

Jeugd (‘Zoek je een spreekbeurt?’)

is nu met www.TabakNee.nl grof

in de aanval. Dat gaat met stevige

retoriek en ad hominem. Wier zoon

minister is maar zelf toch voor de

tabaksindustrie blijft werken of

wie privé ervaring met kanker

heeft maar weigert tabaktegen-

stander te worden, krijgt onderuit

de zak. Dat is niet steeds gepast of

Tabak en alcohol: 18 plusCOM M ENTAAR

even smaakvol, maar begrip kan er

wel voor worden opgebracht. De

rauwe realiteit uit de kliniek van

de longarts of alcoholdokter mag

in het debat gevoeld worden. De

genotmiddelenindustrie moet te-

gen een stootje kunnen. Zij weet

immers precies wat ze doet: hoe ze

tabak en alcohol op smaak voor

kinderen brengt en er een effectie-

ve ‘lifestyle’ bij verzint. Heineken

is cool, althans denkt dat te zijn.

Verslaving doet de rest. Het indivi-

du leeft er korter door.

Ernst en omvang van alcoholin-

cidenten bij kinderen nemen in-

tussen toe. Het aantal jonge rokers

groeit eveneens. Ieder kabinet ont-

werpt opnieuw grootschalige pre-

ventieplannen waarin ouders, be-

drijfsleven en overheid er ‘samen’

uit moeten komen. Dat artsen daar

verveeld mee raken, valt te begrij-

pen. Zij helpen immers jaarlijks

tienduizend burgers met longkan-

ker hun levenseinde zo lang moge-

lijk uitstellen. Dat gaat tegenstaan.

De rokers hebben het uiteinde-

lijk zichzelf aangedaan – het was

hún individuele keuze. Aangemoe-

digd, uitgelokt door uitgekiende

marketing, dat zeker. En niemand

is nog ongeïnformeerd over de risi-

co’s of onwetend over de gevolgen.

Tegelijk behoort dat individu

ook beschermd te worden, zeker

de minderjarigen. Een rookverbod

op scholen, een rookleeftijdsgrens

van 18, een verder terugdringen

van rookgelegenheid – het ligt al-

lemaal in de rede. Net als een ver-

dere verscherping van alcoholma-

tiging voor de jeugd. De artsen die

de rommel opruimen, zijn de klok-

kenluiders. Neem ze serieus.

De een z’n brood is

de ander z’n dood,

jaagt artsen op stang

22

as exemplary. “Against their better judgement,

manufacturers have for years denied that smoking

causes cancer. Now they finally acknowledge the

risk, but they still do everything they can to get

young people everywhere on earth smoking. That

is not only in bad taste and offensive but also life

threatening.”

Columnists from everywhere join in the discussion.

“Everybody support TabakNee!” writes Max

Pam in de Volkskrant. Frits Abrahams in NRC

Handelsblad writes: “I wish the campaigners

lots of success. Their mission deserves it.” His

colleague Bas Heine comments: “The website

by the two lung specialists is therefore justified,

because it rationally exposes an accepted form of

hypocrisy.” And Youp van ’t Hek puts it succinctly

the following Saturday: “Keep it up, ladies! Full

speed ahead.”

In the meantime, the foundation works to reach parents

through their children in the battle against tobacco. In

collaboration with ad agency Pool, it launches the Smoke

Alarm campaign to fan the flames of indignation among

parents concerning the tactics of enticement employed by

the tobacco industry and the lazy attitude adopted by the

government in response.

At the core of the Smoke Alarm campaign are a number

of short films in which primary school children gradually

expose the power field around tobacco. The films are shared

on social media platforms like Hyves – later continued on

SMOKE ALARM MOBILIZES CHILDREN AND PARENTS

23

Facebook – and Smoke Alarm attracts 40,000 followers.

The films then form the raw material for a new documentary

aimed at adults entitled ‘The Replacers’, which appears in

2014. The aim of the film is to motivate parents to make their

opinions known to people in politics.

FIVE POPULAR FILMS

The riddle of group 8

from 3 April 2013 – 66,796 views

One thing that all children in group 8 know for

certain: they are never going to smoke. But

five years later a third of them do, because in

puberty they forget everything they now consider

important. This video shows how that happens.

The proposal from group 8

from 30 May 2013 – 40,714 views

All cigarette manufacturers say they don’t want

children to start smoking. Even so, they design

pretty packaging and add flavours to cigarettes

that children find appealing. Because of this,

Group 8 tries to help manufacturers to find an

alternative.

Get it at AH

from 5 September 2013 – 31,876 views

Why do supermarkets sell cigarettes? They

should not do that because many children enter

supermarkets. That is why over half the children

in the final year of primary school know about

cigarettes largely from supermarkets. In this

film the children ask Albert Heijn to stop selling

tobacco.

24

AH has it all

from 11 September 2013 – 291,108 views

Albert Heijn supermarket puts cigarettes on

display so that many children know exactly what’s

for sale. A serious pastiche on the AH commercials

on TV.

Group 8 in The Hague

from 30 May 2014 - 26,052 views

Laws are made in The Hague. Pupils in their final

year of primary school visit politicians and ask

them to take action. If not, the pupils plan to go to

court.

2837 petitions signed

Figures per 3 June 2014

In early 2014 a DVD is released containing nine interviews

with lung cancer patients and/or surviving relatives. Made

by film and television maker Frans Bromet and entitled

‘You have to die of something’, the films are produced with

money that Dekker and De Kanter receive for the Muntendam

Prize. The films are also circulated through the Dutch Cancer

Society website and on YouTube.

‘With these films we want to let patients have their say,’

says Wanda de Kanter, who now works as a lung specialist

at the Antoni van Leeuwenhoek Hospital. ‘Mostly we don’t

hear them in the discussion, because their disease usually

develops rapidly and they die quickly. Even so, we want to

make these patients more visible and give them a voice.

LAYING THE BLAME WHERE IT BELONGS

25

These portraits are about empowering patients. At the same

time, they are intended to lift the sense of guilt that patients

feel about their smoking behaviour. After all, that guilt lies

squarely with the tobacco industry, which makes people

addicted to a product that kills if used as intended.’

The series of portraits prompts the Nieuwsuur TV

programme to air a report on 31 January 2014 entitled ‘The

invisible cancer’. It asserts, among other things, that the

relative invisibility of lung cancer is the reason why so little

money is allocated to research into this disease.

An article in De Correspondent also covers this subject under

a headline that reads: ‘The deadliest form of cancer has a

major marketing problem’. The article quotes Paul Baas, lung

specialist at the Antoni van Leeuwenhoek Hospital:

‘There is a form of cancer, says lung specialist Paul

Baas, that claims so many victims and that could

be tackled easily through focused government

intervention. After all, the tax on tobacco could be

channelled directly into research. “A new incentive

fund, an extra euro charged on each packet of

cigarettes, intended solely for research,” says

Baas. ‘But maybe the government itself is just as

addicted to the tax collected from cigarette sales

as the smokers are to smoking. This year it is

allocating 5 million euros to tobacco prevention,

while some 2.5 billion euros are collected annually

through tax on tobacco sales. “That’s why I had

such mixed feelings when I saw the Minister for

Health Edith Schippers appear on the Stand Up

Against Cancer programme,” says Baas.’

The films are screened by the Dutch Cancer Society on

February 4, 2014, World Cancer Day, in the presence of those

featured and who, it must unfortunately be stated, are still

alive.

26

The battle against the

killing industry continues

27

The Youth Smoking Prevention Foundation has achieved

much in five years, especially in terms of raising awareness.

With the support of the Dutch Cancer Society, the foundation

succeeded in distributing a lot of information through its

own publications, and certainly through the press, about the

harmful effects of smoking, the powerful influence of the

tobacco industry, and the measures that will actively help to

protect the youngest in society from becoming addicted to

smoking.

One of the aims of the foundation has even been achieved

already: tobacco may not be sold to anybody under the

age of 18. That has prompted many schools to ban smoking

around their buildings. Nonetheless, progress has been

limited here, since enforcing the age restriction is a farce at

the moment, and a law to turn school playgrounds into no-

smoking zones is a very long way away.

In general, it should be stated that the battle is far from over.

There is hardly any movement in the halls of power in The

Hague. Politicians are not prepared to implement real change

in the area of tobacco prevention. The tobacco industry is

leading the VVD by the nose, and the PvdA is keeping quiet

on the matter so as not to disturb the peace. Parties that feel

a responsibility to do something about the almost 20,000

tobacco-related deaths each year can make no headway.

NEXT

28

CAMPAIGN AIMED AT POLITICS

That is why the Youth Smoking Prevention Foundation

is going to concentrate even greater efforts on exerting

influence in the political arena. Politicians and public

officials must dispense with the notion that smoking is a

free choice for people who don’t need overprotection. The

truth is, however, that free will is eliminated when it comes

to addiction to nicotine, the most addictive substance on

earth. Almost nobody thinks of the compulsory safety belt

and motorbike helmet as forms of overprotection. So why is

that the case for protective measures against tobacco? The

absence of measures amounts to neglect of citizens.

The only person with a choice is the child who can

decide to start smoking or not. But it is precisely

the brain of adolescents that does not bother with

bans or sensible decisions. And the tobacco industry,

which owing to the harm inflicted by its own

product has no choice but to constantly find new

customers, skilfully exploits that brain weakness. It

deliberately makes its product lethally addictive, or

‘deadly by design’ as the historian Robert Proctor puts

it. That is what politicians must realize and what they should

protect the population from. That is not overprotecting but

simply protecting people.

Once upon a time politicians took a stand against the legal

practice of slavery. They decided that the practice was no

longer acceptable and decided to end it. Now is the time

to decide that the cigarette, a stealthy but skilled killer, no

longer belongs in our world.

The Youth Smoking Prevention Foundation will battle

tirelessly to achieve that goal.

29

THE STATE ON TRIAL

One of the means to that end is the legal action that

the foundation is preparing against the Kingdom of

the Netherlands. These legal proceedings will test the

interpretation of the Framework Convention on Tobacco

Control (FCTC) from the World Health Organization.

More specifically, it will examine the provisions of Article 5.3,

which states that in determining its policies for preventing

and reducing tobacco consumption, the government shall

act to protect these policies from all vested interests of the

tobacco industry. It has been demonstrated, thanks in part

to the editorial staff of TabakNee, that Dutch officials at the

Ministry of Health, Welfare and Sport, and at the Ministry of

Finance, have totally ignored precisely this provision. Since

the responsible cabinet ministers claim again and again that

their ministries cannot be blamed for anything, it is time to

hear the verdict of the judge.

30

Committee of ReCommendation

BoaRd of Youth Smoking PRevention foundation

Wanda de kanter, lung specialist, Antoni van Leeuwenhoek Hospital, author of Nederland stopt! Met roken (chairwoman)

emeritus Professor frits van dam, psychologist, University of Amsterdam, former staff member of Antoni van Leeuwenhoek Hospital (secretary)

Rob giebels, econometrician, former advisor financial affairs and risk management for the City of Amsterdam (treasurer)

Professor René Bernards, molecular biologist, Utrecht University, Antoni van Leeuwenhoek Hospital, member of Royal Netherlands Academy of Arts and Sciences (KNAW)

Barbara van den Broeke, child and youth psychologist/psychotherapist

geertje Creijghton LL m, administrative lawyer, Baarn

Pauline dekker, lung specialist, Red Cross Hospital, author of Nederland stopt! Met roken

Professor Jacques Wallage, former state secretary for Education and Social Services, former mayor of Groningen

Rob Barnasconi mSc, dentist, chairman Netherlands Association of Dentists and Dental Specialists

dr Renee Bittoun, adjunct associate professor of Medicine, head of Smoking Cessation Institute, University of Sydney

emeritus Professor Piet Borst, former Scientific Director of Netherlands Cancer Institute

Professor Paul Brand, child lung specialist Isala Clinics Zwolle

31

COMMITTEE OF RECOMMENDATION

Ireen van Ditshuyzen, documentary maker

Gert van Dijk, medical ethicist KNMG

Marjolein Drent, Professor of Interstitial Lung Diseases, Maastricht University

Benedicte Ficq LL M, criminal lawyer

Bas van Goor, former volleyball player, Director Bas van Goor Foundation

Pauline Haasbroek, stop smoking coach

Dr. Miriam de Kleijn, general practitioner-epidemiologist

Emeritus Professor Caro Koning, radio therapist

Emeritus Professor Bob Pinedo, oncologist, VU University Amsterdam

Professor Dirkje Postma, Professor in Pulmonology, University of Groningen

Robert N. Proctor, Professor of the History of Science, University of Stanford

Dr. Lukas Stalpers, radio therapist Academic Medical Center

Dr Jeffrey Wigand, tobacco industry whistle-blower, founder of Smoke-Free Kids Inc.

Professor Robert West, health psychologist, Director of Tobacco Studies, University College London

Dr Nout Wellink, former president De Nederlandsche Bank

Professor Michiel Westenberg, developmental psychologist, Leiden University

Professor Rudi Westendorp, geriatrician, Leiden University

Professor Reinout Wiers, developmental psychopathologist, University of Amsterdam

32

The members of the board of the Youth Smoking Prevention

Foundation receive no remuneration for their work for

the foundation. A number of professionals do receive

remuneration for various activities of the foundation.

The funding for that remuneration comes from a limited

number of financial supporters, among them the Dutch

Cancer Society. We ask for your support to give the Youth

Smoking Prevention Foundation a more solid basis and to

ensure that it can continue its work.

Make a donation to us, big or small, so that we can continue

to expose the tobacco industry and make smoking a thing of

the past.

You can support us by sending your donation to the Youth

Smoking Prevention Foundation in Amsterdam, bank account

number NL11 TRIO 0390 186 511.

The Dutch Tax and Customs Administration recognizes the

Youth Smoking Prevention Foundation as an Institution

for Public Benefit. This means that private donations to

the foundation are tax deductible at a rate of 125% of the

donated sum.

For more information, please contact Frits van Dam,

+31 6 20 61 67 43

SUPPORT THE YOUTH SMOKING PREVENTION FOUNDATION

CREDITS

TabakNee

Final editing: Frits van Dam

Journalists: Stella Braam, Bas van Lier, Broer Scholtens

Design: Wiebe de Wolf

Logo design: Nathalie Soetens

www.tabaknee.nl

Smoke Alarm

Campaign: Pool ad agency, Amsterdam

www.rookalarm.nl

'You have to die of something'

Bromet & dochters

www.bromet.nl

COLOFON

© 2014 Youth Smoking Prevention Foundation, Amsterdam

Text: Bas van Lier, Amsterdam

Translation: Billy Nolan, Amsterdam

Design: Philip de Josselin de Jong, Haarlem

Printing: Kapsenberg van Waesberge, Rotterdam

www.stichtingrookpreventiejeugd.nl