For much of her professional life, Wanda was a strange contradiction: a lung doctor who smoked.

‍

“If we went out to dinner, I always told myself that I wouldn’t smoke around other people”, she says. “But after a few glasses of wine, I’d always light one up again. At a certain point, I got used to being a pariah – that crazy lung doctor who smokes.”

‍

When Wanda first started smoking, it felt very different. “I had been smoking since I was 12,” she says.  “But I never saw any association between that and my chosen profession. Lots of students smoked when I was at medical school (1977-1984). During my first internship, we even smoked in A&E!”

‍

The cultural customs surrounding smoking evolved over time. More and more often, people gave Wanda pushback when she lit a cigarette: “But aren’t you a lung doctor?” And that’s how she ended up in the uncomfortable dichotomy where, research shows, the vast majority of smokers find themselves: they want to stop smoking, but can’t because they are simply too addicted to give it up. To avoid being judged by the people around her, Wanda increasingly started sneaking cigarettes in secret.

‍

Until that fateful moment on 3 August 2007. “One night my 14-year-old daughter caught me,” Wanda says. “She was so sad and upset. ‘Don’t you want to be my mother anymore?’, she asked me, because she equated smoking with death. That’s when I decided it was really time to quit for good.”

‍

A product where nothing has been left to chance

As a lung doctor, Wanda knew all the potential consequences of smoking: lung cancer, COPD, cardiovascular disease, lung failure, joint inflammation and other rheumatic disorders, depression, dementia, preterm birth, and blindness. 19,000 people die from their smoking addiction every year in the Netherlands. Worldwide, we’re talking about as many as 18 million deaths annually.

‍

As a smoker, Wanda had grown accustomed to viewing the habit in terms of her own personal responsibility. After all, it’s your own choice whether you smoke or not, isn’t it?

‍

The clear and unambiguous answer is: no. Smoking is not a regular choice that we make freely. It was only after Wanda had actually quit smoking that she was able to see the problem from a bigger perspective, and understand that her addiction – and the addictions of millions of others – had been caused by an industry that was unequivocally malicious. The tobacco industry has spent decades investing billions in making cigarettes more and more addictive. Year after year, the industry has made a fortune on what historian Robert N. Proctor has even referred to as “the deadliest artefact in the history of human civilization”.

‍

“The cigarette is a product where nothing has been left to chance,” Wanda explains. “Designed to have a much faster effects than substances like alcohol, which has to travel all the way to your liver before you feel anything. The tobacco is burned and ammonia is added, all in order to ensure the nicotine hits your brain within seven seconds. That short time frame is incredibly important: it goes straight to your dopamine receptors and conditions you extremely fast, making you addicted.”

‍

Wanda also quickly disposes of the claim that smoking is supposedly a free choice and the tobacco industry is an ordinary retailer:

‍

“We know from their own secret documents that they refer to our children as replacement smokers. They know how many customers die every year, and have to be replaced. They also know that 80% of smokers started before the age of 18. That’s the point when they want to reach people: when children are still young and their brains are enormously susceptible to nicotine.”

“The worst part is when people blame themselves,” Wanda continues. “They get lung cancer when they’re just 40 and think that it’s a consequence of their own actions. I’ve heard that so often in my appointments, and it’s completely unjustified. These people were made sick.”

‍

“We just did our work as usual, and on the side we also made an effort to help people stop smoking. But that was very strange for most lung specialists.”

From pneumologist to activist

Wanda’s first step? Writing a book for everyone who wants to stop smoking, co-authored by her colleague and friend Pauline Dekker.

‍

Wanda: “At that point, we thought: ‘Now everyone has a good book, problem solved... Right?”

‍

But Wanda and Pauline quickly concluded that it would take a lot more than that. As Wanda explains it, her passion for the topic grew very organically from that moment on. She and Pauline started talking to patients more and more, and established the country’s biggest outpatient clinic to help people stop smoking.

‍

Back then, she wasn’t an activist yet, Wanda says herself: “We were just lung doctors doing our work as usual, and on the side we also made an effort to help people stop smoking. But that was very strange for most lung specialists.”

‍

At a certain point, it became clear that if she really wanted to do something about smoking, Wanda would have to dig down to the root of the problem:

‍

“As lung doctors, we were working to help as many people as possible to stop smoking, but in the meantime there were political parties supporting the tobacco industry, and the former Minister of Health became a lobbyist for none other than Philip Morris.”

‍

In 2013, Wanda and her colleagues launched TabakNee: a journalistic website under the umbrella of the Stichting Rookpreventie Jeugd (a Dutch foundation to prevent young people from smoking, established in 2009), from which they set out to go on the offensive against pro-tobacco lobbying. Naming and shaming, from politicians who held paid positions at tobacco companies, to supermarket chains that opened tobacco shops to circumvent the ban on selling tobacco products in supermarkets.

‍

“Many people felt that doctors should not be exposing people,” Wanda says. “They believe that it isn’t part of our role as doctors. But when you see that former government ministers and ministry spokespersons accept jobs in the tobacco industry, then our approach is more than warranted. And we have never had to retract any of our statements. Everything that we and our fantastic journalists have published is solid fact.”

‍

Starting small

It came as no surprise to lung doctors that cigarettes left devastation in their wake. Even so, it was far from usual in Wanda’s profession to speak out openly against the tobacco industry.

‍

It’s very strange when you think about it, in Wanda’s opinion. “It’s one of the seven medical competences,” she explains. “When you see a major societal phenomenon that causes an illness, then you have to take action.”

‍

Wanda sees her activism as an extension of her work as a physician. “As a doctor, you always have to be lobbying on behalf of your patient,” she explains. “If there’s a new medicine that isn't covered by insurance yet, for example. You always make an effort to arrange what’s best for your patients.”

‍

Many doctors already make an above-average contribution to society simply by virtue of their profession. But Wanda was uncomfortable with focusing solely on the individual patient right in front of her, when she had a chance to do something about a bigger problem. That doesn’t mean that every doctor should become a full-time activist, but it does show that you can look around you to identify small steps to start with.

‍

“You could start small, for instance by writing a good protocol in your own hospital,” she says. “In the RKZ hospital, I wrote the DNR/DNI protocol (for not resuscitating or intubating against patient wishes), so we made agreements with every patient who came in based on the medical facts and on what the patient wanted. That means you’re actually doing something positive for the whole hospital, because you’re not moving people to the ICU if they really don’t want that, or if it doesn’t extend their quality of life at all.”

‍

“You can do that when you’re young,” Wanda continues. “Just start. If you see that everyone wastes a half-hour sitting in the waiting room for no reason, do something about it. That’s how small it starts.”

‍

“Tobacco is really going to be eradicated. It’s such a senseless and destructive product – someday we’ll be rid of it.”

A sacred obligation

Wanda knows that there’s still a long, long way to go before the tobacco industry finally goes broke. But the conviction that she is on the right side of history encourages her.

‍

“It’s not going to happen in my lifetime, but it is a problem that will be solved,” she explains. “Tobacco is really going to be eradicated. It’s such a senseless and destructive product – someday we’ll be rid of it.”

‍

Meanwhile, she continues to be motivated by the injustice she sees. “It’s a sacred obligation,” Wanda explains. “This is so deeply unfair, I want everyone to see it. That’s when we have been successful: when people finally understand that they are being manipulated by the vast interests of the industry and we are on our way to a smoke-free generation.”

‍

• • •

‍

Translation by Joy Phillips

‍

About Wanda:

• Wanda de Kanter
• Born in 1959 in The Hague (NL)
• Grew up in Borneo and The Hague
• Went to medical school in Leiden 1977-1984 and did internships at Groene Hart Hospital in Gouda (1984) and VU Medical Centre in Amsterdam (1987)
• Worked as a lung doctor in the RKZ regional hospital in Beverwijk (1993-2013) and the Antoni van Leeuwenhoek oncology clinic in Amsterdam (2013-2021
• Established Stichting Rookpreventie Jeugd in 2009 and launched the TabakNee website in 2013
• Became a fulltime activist fighting the tobacco industry in 2021

‍

Wanda's exploration tips:

‍

📚 The Golden Holocaust (2012), by Robert N. Proctor

‍

🎥 The Insider (1999), by Michael Mann

‍

🎧 Zomergasten with Wanda de Kanter (2019)

‍

‍

‍