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Four perspectives on smoking and the tobacco lobby

Doctors are entering the fray, court cases are being filed and smokers are becoming more of a pariah. From lobby expert to medical biologist: four Leiden researchers give their perspective on smoking, the tobacco industry and smoking policy

‘The balance is shifting to a general smoking ban’

Although it’ll take more like ten years than two, we are coming ever closer to a smoking ban in the Netherlands, says Professor by Special Appointment of Public Affairs and lobby expert Arco Timmermans. He predicts that the mythic proportions of the tobacco lobby will lose the battle against other forces, which are currently gaining strength.

‘The front against smoking is getting wider. The Smoke-Free Netherlands Alliance is gaining more partners: doctors, businesses and, tentatively, the hospitality industry. If it becomes even more of a social taboo, a formal taboo will be the next step. A ban, in other words.’

It’s not just opposing forces that are causing the tobacco lobby’s losses, says Timmermans. ‘It’s also because the tobacco lobby often doesn’t stick to the rules. For instance, many more tobacco lobbyists proved to be active in Brussels than the number that had signed up dutifully to the European transparency register. Public outrage increases with these kinds of revelations.’ This makes it increasingly difficult for politicians and civil servants to justify entering into talks with the tobacco industry, says Timmermans: ‘They are beginning to watch their step.’

We have known for ages how bad smoking is. Why hasn’t it been banned already? ‘Soft instruments such as public information campaigns don’t work. The difficulty with tobacco is that, like alcohol and betting, it isn’t event sensitive. There isn’t one big accident that convinces people in one fell swoop of the need for a ban, as was the case with the Stint accident this spring. Those vehicles were taken off the road immediately.’

‘We doctors were lulled to sleep’

Paediatric pulmonologist Noor Rikkers from the LUMC was one of the doctors who sat in the public gallery of the Dutch House of Representatives on 3 September, when the National Prevention Agreement was discussedShe is vehemently against smoking, but the last thing that she wants is to send smokers to purgatory. ‘The first thing people are asked when they are diagnosed with lung cancer is whether they have ever smoked. People think that if you smoke, it’s your own fault if you get lung cancer. Wrong. It’s not the smoker’s fault: they’re addicted. It’s the tobacco industry’s fault.’

Rikkers is livid with the tobacco industry. ‘They add vanilla, sugar and cocoa to make cigarettes taste better to children. Expectorant to stop you coughing straight away. Ammonia to make sure the nicotine reaches your brain in seven seconds. This makes you associate the pleasure of nicotine with what you’re doing: smoking. Within a month children are addicted.’ She takes a breath before adding: ‘Smoking is just as addictive as heroin and cocaine. Every year, 60 babies in the Netherlands die at birth because their mothers smoked during pregnancy. Two-thirds of persistent smokers die from the effects of smoking.’

You could say: doctors know how bad smoking is, pulmonologists more than any. But that wasn’t the case for a long time. Rikkers: ‘We doctors also accepted it for way too long. Smoking was so normal in the past. We were lulled to sleep. Many a doctor smoked too. I only woke up when I began to investigate in 2014. It was a massive shock. I discovered that a hundred Dutch children started smoking every day. That was my motivation to fight for a smoke-free generation.’

‘Appreciate that people have needs that have to be met’

He started smoking cheap roll-ups when he was around the age of 12. Sometimes Bernhard Hommel, now a Professor of Psychology who specialises in topics such as action control, didn’t smoke for whole periods of time. ‘Later on, I bought cigarettes. When I wanted to give up, it was a tough six months.’

Hommel says there are four smoking triggers, and people’s sensitivity to each trigger differs. ‘The physical and the psychological addiction: you want something and a cigarette gives you that. Third: smoking gives you something to do if you are alone somewhere and feel unsure of yourself. Smartphones are now assuming that role.’ Last, there is the social role: ‘It’s “we sociable smokers” against the anti-social non-smokers. Particularly if they are forced to stand on balconies or terraces.

‘In the past smoking was cool too. That determines whether people start smoking. That is on the decline now. Although I have noticed more stars smoking again in films.’ Could the tobacco industry be circumventing the advertising ban?

How do you reduce smoking as a society? ‘Saying that it’s bad and not allowed doesn’t work with a lot of people. Something must come in its place. You have to appreciate that people have needs that have to be met. This must be something that people think is fun to do and that is cool. Playing sport with others, for instance, or games.’ But that does take more of an effort than lighting a cigarette. ‘Definitely. I certainly wouldn’t say it’s easy.’ Hommel managed in the end: he hasn’t smoked again since that tough six months, a long time ago now.

‘Smoking makes you more susceptible to infections’

At the Department of Pulmonology at the LUMC, it’s as if smoking never went out of fashion. In a special smoking room, Anne van der Does has equipment that exposes cultured lung cells to cigarette smoke. She wants to research how exactly the smoke affects these cells. And then if this damage can be repaired afterwards.

The cultured cells come from patients with COPD: chronic bronchitis or emphysema, usually caused by smoking. Van der Does cultures the cells until she has a good living imitation of the surface of your airways that the cigarette smoke passes. ‘In the lung epithelium there are, for instance, cells with cilia and cells that secrete mucus. These are really important for removing dirt from your lungs.  Sometimes you cough to help the process.’

If the cultured cells are exposed to smoke for a quarter of an hour, Van der Does can see an inflammatory response. ‘If we do this for a certain period of time every day, you see lasting effects. The cilia cells become impaired or die, which means they can no longer sweep away dirt. Cells that make immune molecules against bacteria, our own antibiotics, also become impaired. Wounds that we make don’t heal as well. In short: you become more susceptible to infection.’

Although lung cancer is not her specialism, Van der Does knows that smoking causes DNA damage, which leads to lung cancer. ‘As the cells can no longer repair this damage, the cells are able to divide uncontrollably and thus form a tumour.’

Text: Rianne Lindhout
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