Replacement smokers: Pauline Dekker and Wanda de Kanter at TEDxNijmegen 2013
The speaker, a pulmonologist, argues that patients with lung cancer and COPD are ignored because they are ashamed, drawing parallels between addiction and "freedom of choice." A patient's testimony highlights the devastating effect of smoking, while a tobacco industry representative presents a new, "girly lipstick like cigarette" marketed to young people, emphasizing the need to "create doubt." ## Speakers & Context - **Pulmonologist:** Treats patients with lung cancer and COPD. - **Lung Cancer Patient (Testimonial):** Initially thought she had the flu, received a cancer diagnosis (bone metastasis), and felt immense shame, guilt, and loneliness regarding smoking. - **Tobacco Lobbyist/Representative (Unnamed):** Speaks at a shareholders meeting of "big tobacco" to discuss marketing strategies. ## Theses & Positions - Lung cancer patients and COPD sufferers are "seen nor heard" despite lung cancer being the most common type of cancer in males and females, and COPD being the third most common cause of death. - The reason patients are marginalized is not just due to early death (for cancer) but because they feel guilty and ashamed, believing they "invited the cancer in themselves by smoking." - The idea that addiction is a personal failing is reinforced by politicians who frame tobacco use as a "Freedom of Choice." - The tobacco industry aims to continually recruit new smokers, especially the young, by marketing products as a fundamental freedom. - The industry strategy involves "creating doubt" by questioning the direct link between smoking and cancer. ## Concepts & Definitions - **COPD (Chronic Obstructive Pulmonary Disease):** Described as a condition where patients suffer for years, with their world "slowly narrowing down to the confinement of their own home." - **Bone Metastasis:** Presence of cancer spots in the bones, noted as "all these black spots." - **Addiction:** Described as a habit that is not solely a personal choice, especially in puberty. - **Glamour:** A product described as a "very girly lipstick like cigarette" filled with "honey Shar and spice." ## Mechanisms & Processes - **Marketing for Youth:** The industry's strategy involves targeting the young by designing aesthetically pleasing, attractive cigarette products like "glamour." - **Marketing in Restricted Areas:** When marketing is restricted, the company becomes "very creative," using "excellent ties with liberal parties" to argue it is a "freedom thing to choose to start to smoke when you're young." - **Creating Doubt:** A documented technique used by the tobacco industry involves spreading information that suggests smoking is not inherently linked to disease (e.g., citing a grandfather who smoked heavily but died young, or someone who never smoked but got cancer). - **Medical Progression:** The patient's journey involved symptoms leading to diagnosis, followed by "CT scan broncoscopy pet scanner" treatments, culminating in bone metastasis, and finally epilepsy, leading to death two weeks after her 50th birthday. ## Named Entities - **American Lung Association / Pink Ribbon Ladies:** Group mentioned as an example of organizing/advocacy groups, which the speaker notes that cancer patients cannot be like. - **Big Tobacco:** The organization holding the annual shareholders meeting. ## Numbers & Data - Lung cancer: The "most common type of cancer" in males and females. - COPD: The "third most common cause of death." - Smoking age onset: The patient started smoking when she was **13**. - Disease-related mortality: **6 million people** die annually due to Tobacco related diseases. - Smoking fatality rate: **One in four smokers** die due to smoking before the age of **65**. - Tumor metastasis: Mention of "all these black spots" visible everywhere. ## Examples & Cases - **The Patient's Life Arc:** Loved her life, experienced symptoms, had cancer diagnosis (noting metastasis), realizing she wouldn't see her son graduate, making a vow to quit smoking, attempting quitting through "sensation clinics" and reading "alen Carr," but ultimately failing due to addiction, and dying shortly after her 50th birthday. - **The Industry Marketing Example:** Showcasing the "glamour" cigarette, marketed to Indonesian boys and used to convince liberal parties of its freedom. - **The Medical Scans:** Process included "CT scan broncoscopy pet scanner" following diagnosis. ## Tools, Tech & Products - **CT scan** - **Broncoscopy** - **PET scanner** - **Glamour:** The "girly lipstick like cigarette" product. - **Sensation clinics:** Mentioned as places the patient went to quit smoking. ## Counterarguments & Caveats - The industry argues that the problem is a personal choice, framing tobacco use as a "freedom thing to choose." - The patient notes that medical treatments were ultimately "all in vain." ## Conclusions & Recommendations - The primary recommendation/call to action is to "tell the world your story and the story of other people killed by tobacco." - The speaker promises to "challenge the tobacco industry the tobacco lobbyists and the politicians that listen to them." - The final plea is to prevent avoidable deaths, stating, "let's prevent the avoidable." ## Implications & Consequences - The systematic failure of public health awareness and political will to treat addiction as a public health crisis rather than a personal moral failing. - The economic success of the tobacco industry is predicated on maintaining the narrative of individual choice and doubt. ## Verbatim Moments - *"The COPD patients on the other hand suffer for years on end their world slowly narrowing down to the confinement of their own home."* - *"It's because my patients they're ashamed and they feel guilty they're told they invited the cancer in themselves by smoking."* - *"in a world where addiction is called Freedom of Choice by politicians"* - *"what did you expect you are a smoker"* - *"The only moment there really is freedom of choice is when you start to smoke your first few cigarettes and that choice is usually made in puberty"* - *"I have lung cancer and every time again they said were you smoker"* - *"I will tell the world your story and the story of other people killed by tobacco"* - *"I can guarantee you your money is safe with us and our Roi is under the double digits and stock prices are soaring Sky High"* - *"we designed a very girly lipstick like cigarette called glamour"* - *"we tell them it's a freedom thing to choose to start to smoke when you're young"* - *"what do you think there's growth Market out there wouldn't be lovely"* - *"this has all got to stop right now every year 6 million people die due to Tobacco related diseases one in four smokers die due to smoking before the age of 65"*