Will the ban on gutka curb tobacco use?


Sagarika Ghose,CNN-IBN
Jul 26, 2012 at 11:00am IST

In a major breakthrough in the battle against tobacco, six states have banned gutka and other tobacco foods.

Here is the full transcript of CNN-IBN's Deputy Editor Sagarika Ghose's chat with experts over the issue:

Sagarika Ghose: Hi there. Good evening. We are focusing tonight on the tobacco product gutka. Now anti-gutka campaigners say gutka is extremely injurious to health and leads to oral cancer. India is the capital of oral cancer, 8000 new cases of oral cancer are recorded every year. In what is being called a breakthrough in the battle against tobacco, six states have banned gutka, but will the ban work. And now that gutka is banned should other tobacco products like even cigarettes be banned?

The statistics are scary, 65 million Indians use gutka, 8000 new cases of oral cancer every year. It is an epidemic, but will the ban work?

Joining us tonight Amal Pushp, Director of the National Tobacco Control Programme of the ministry health. We also have joining us Mr Sanjay Bechan, he is Executive Director of Smokeless Tobacco Federation Of India, he is someone who is anti-gutka ban. We have Dr Srinath Reddy, President of the Public Health Foundation of India. We also have Mr Naveen Khanna, you are in fact an oral cancer victim and you have contracted oral cancer thought eating gutka. And we also have Ashwini Kumar, Madhya Pradesh Food Commissioner. Remember Madhya Pradesh was the first state to ban gutka.

Let’s kick off our discussion by asking Mr Amal Pushp, can a ban work because the experience is when you ban something the product goes into the black market. The other experience is it comes back under different brand. And the other experience is if it is banned only in few states and not banned in other states, then if you want to consume it you will simply go to other state and procure it from there.

Amal Pushp: My opinion in this point is that ban is going to work. But for that ban to effectively work we have to ensure that it is enforced. Not only a theoretical ban but a practical ban will work. And the other point which I want to make is the ban will also work if it is banned across India. The problems you pointed out they will happen if the ban is not total, if it is partial.

Sagarika Ghose: But are you not worried about the black market because if there will be a demand there will be supply. And the supply will be provided by black market.

Amal Pushp: Yes I am worried about that but I’m also happy about the fact that the people who are more vulnerable in the society, like small children or young people or women, they will have less access to these products. Probably in the black market they will not access these products. The black market will not have access these people, so I am happy for that.

Sagarika Ghose: So the vulnerable sections that are consuming gutka will not be able to access the black market. Dr Srinath Reddy, let me put to you the point - is it clear from the medical evidence that gutka is causing these 8000 new cases of oral cancer? Could it not be cigarettes, could it not be kahani, could it not be other tobacco products? Is gutka the main culprit of oral cancer?

Srinath Reddy: In studies conducted in India and else where in the world, where oral tobacco is consumed, the research actually separates out the influence of different oral cancer causing agents.

Sanjay Bechan: I’m sorry Dr Reddy I have lot information collected from regional cancer centers.

Sagarika Ghose: Let Dr Reddy respond, I will get to you to respond.

Srinath Reddy: I would like to mention to you that apart from the international agency for research on cancer, which is a division of WHO, which has stated categorically that oral cancer is caused by smokeless tobacco. We have had studies conducted in India, in southern India and central India, and the number of studies which have now been collated and analysed by the national institute of health and family welfare through an expert committee established by the ministry of health in prurience to the directive by the Supreme Court which states that there is strong evidence of oral cancer caused by it.

Sagarika Ghose: So when it comes to oral cancer it is smokeless tobacco. Smoking could cause lung cancer?

Srinath Reddy: No, smoking can also cause oral cancer, but there are people who only consume oral tobacco in chewed form, there are those who only smoke, there are those who do both, then you have a gradient of risk. We know that smoking also causes oral cancer but those who do not smoke and only chew tobacco have oral cancer. Then you can’t incriminate smoking there.

Sagarika Ghose: You can’t incriminate smoking there but on the other hand you can incriminate smoking in lung cancer. So the question we can ask, will ask you later in the programme, Ban cigarettes, if we can ban gutka. But let me come to you Mr Sanjay Bechan, you wanted to respond to both Mr Pushp and Dr Reddy.

Sanjay Bechan: See what he is saying is a total lie. I have accessed information from all regional cancer centers which says very categorically that it is impossible to distinguish which cancer is caused by smoking and which cancer is caused by smokeless tobacco. I challenge Mr Reddy whether these regional centers are providing false information.

Sagarika Ghose: In the cases of oral cancer it is impossible to that gutka is the culprit.

Sanjay Bechan: And director Tata Memorial says ‘existing cancer data in India was mainly about the dieses, incidents that was drawn up from 24 cancer registries located in cities. The accuracy of mortality and deaths due to cancer wasn’t clear.’ And I’m quoting Dr Reddy, this book is written by you Dr Reddy.

Srinath Reddy: Edited by me I was one of the contributors.

Sanjay Bechan: It says, “If all oral products are banned completely, a sizable amount of tobacco consumption in India will be removed. Even half of the oral tobacco consumers switch to smoking cigarettes.

Sagarika Ghose: The accusation is that you (Dr Reddy) is speaking on behalf of cigarette lobby. You are saying that Dr Reddy and Mr Pushp are speaking on behalf of cigarette lobby?

Sanjay Bechan: Yes. Please hear me out. The Book says, “Even half of the oral tobacco consumers switch to smoking cigarettes to satisfy their carving for nicotine such a ban is likely to have a major impact on women, children and vulnerable class.

Sagarika Ghose: Respond to this important charge that they will switch to smoking, the harm reduction will be very limited.

Srinath Reddy: Well let me emphasise on the word ‘even if’, we are talking about the worst case scenario. First let me deal with the scientific proof. I think the volume of your voice, sir, does not add weight to your argument. There are n-number of studies which have been compiled and analysed by a very competent committee of the National Institute of Health and Family Welfare, submitted to the Supreme Court of India through the agency of the health ministry. There is a major international study called 'Interheart' which again has look at multiple diseases caused, specially heart attacks caused by tobacco and the risk factors. They have also incriminated smokeless tobacco in heart attacks. So it is not only cancer we are taking about, there are multiple disorders caused by smokeless tobacco.

Sanjay Bechan: What Dr Reddy is saying (in his book), "Overall smoking currently causes about 7 lakh deaths per year." Why government of India is leaving cigarette.

Sagarika Ghose: We will come to that. But let's complete the scientific theory. Then we will ask whether gutka is unfairly targeted?

Srinath Reddy: See let me make it clear, every single tobacco product is harmful to health. The reason I think gutka is being picked up first, is because it is to most frequently consumed product currently. 26 per cent of the people above the age of 15 years is now consuming oral tobacco as compared to 14 per cent smoke. It is accessible and women and children are increasingly targeted. If you look at women 18 per cent of the women consume oral tobacco as compared to 2 per cent smoking. If you look at children again the fastest growing consumption of tobacco is oral tobacco. And now that you have an opportunity under the FSSAI act to ban gutka, it will be the first one to go.

Sagarika Ghose: It will be the first one to go because preciously it is easily accessible, it is cheap, and as our health correspondent also pointed out to me earlier in the day that there is no social restriction. It is not like lighting up a cigarette where people will look at you.

Srinath Reddy: One wicket at a time. Every tobacco product has to go.

Sagarika Ghose: Let me come to you Mr Naveen Khanna, you are a victim of oral cancer - is it because you consumed gutka? Did you get cancer because you consumed gutka?

Naveen Khanna: Tobacco and gutka. With in three years I got oral cancer.

Sagarika Ghose: With in three year. And were you able to come out of your addiction. Did you find it highly addictive?

Naveen Khanna: No I was eating it in a less quantity. Two or three pouches in a day. But it is similar to an example, when you pass a road if you die you die, but if you don’t, you don’t.

Sagarika Ghose: And do you agree that gutka should be banned?

Naveen Khanna: It should be banned.

Sanjay Bechan: Sagarika, I will tell you one more interesting figure…

Naveen Khanna: You (Sanjay Bechan) said if gutka is banned people will switch to cigarette smoking. But cigarette is usually not smoked in front of everyone but when it comes to gutka children eat it in public.

Sanjay Bechan: I will tell you this is Dr Reddy saying (in his book), “The relative risk due to tobacco, tested from rural India, it says 40 to 80 per cent higher for any type of tobacco use. But it is saying 50 to 60 per cent higher than smoking. But government of India is much interested in banning gutka, which is less harmful.

Sagarika Ghose: Let me get Mr Ashwini Kumar, who is also joining us, because he has been listening silently. Mr Ashwini Kumar you are the Madhya Pradesh food commissioner, Madhya Pradesh was the first state to ban gutka. Do you believe that by banning gutka you have actually made a breakthrough in the battle against tobacco? Or is cigarette or use of other forms of tobacco much more dangerous, if not equally dangerous as gutka?

Ashwini Kumar: Certainly Sagarika, I think, we have made a good beginning and the battle won’t stop till the time we have covered all the tobacco products.

Sagarika Ghose: But isn’t this partial ban a little shot sighted because it is banned in Madhya Pradesh, but if you don’t get it in Madhya Pradesh you can go the neighbouring state and pick it up from there. So are in favour of an all India ban?

Ashwini Kumar: Unfortunately, let me make this point very clear, this ban is an all India ban, the food safety act is applicable to entire country. But what really is lacking at the moment is that the vigorous enforcement which is required is not taking place all across the country. I am happy the other states are joining now; we have state after state coming and declaring that they are interested in curbing sales of gutka in their states. And I’m sure this will happen in remaining states as well.

Sagarika Ghose: Mr Bechan let me come to you. There are so many powerful arguments saying that because of gutka there is a rise in cancer. Nobody is saying that gutka is not the only reason of cancer but we are pointing to the other causes, like it is easily accessible, there is no social taboo, it’s very cheap, children are using it. So therefore is it important for you to realise that this is a highly poisonous substance which as I have here contain 3000 harmful chemicals.

Sanjay Bechan: See making gutka is very easy, it is made by a (*) and some tobacco. I don’t know how come you came to this conclusion because CTRI, which is the…

Sagarika Ghose: Children as young as 10 to 12 years are getting addicted increasingly to gutka.

Sanjay Bechan: It is all false allegations. See government is duty bound. There is a cigarette act…

Sagarika Ghose: COTPA, let’s bring up COTPA, cigarette and other tobacco products act. By this act the tobacco products are to be regulated and not banned.

Sanjay Bechan: If a states is failing their duty, they are not preventing, they are not enforcing COTPA, how can you blame gutka that it is easily available.

Sagarika Ghose: Let me put that to you, how can you ban gutka as a food, he (Sanjay Bechan) is saying that it is not a food, it is a tobacco product which must have the same rules as per COTPA

Srinath Reddy: There are number of tobacco products which will all be regulated under COTPA. What happens with gutka, tobacco is one of the cancer causing agents (*) which is there is also a cancer causing agent, there are other constituent which are also harmful to health. So the whole combination is actually chewed and partially consumed orally. Therefore it comes under the category of a food product. And because of the current legislation which is of 2006 very clearly states that tobacco and nicotine should not be part of any food product. Then the regulation is in the nature of a food product and the law becomes applicable to this category. Where as the others will be continued to be regulated under COTPA. And we hope one time they also will be banned. But at the moment the legislation which is available in the country enables atleast this number one killer to be tackled.

Sagarika Ghose: So let’s start with this. It is a number one killer, we should start with this.

Sanjay Bechan: Sagarika, I’m sorry but it is not number one killer. Number one killer Dr Reddy says (in his book) is cigarette. And you are saying that gutka is not food, I have received information from FSSI which very clearly says…

Sagarika Ghose: Well hang on, the FSSI clarified on record to CNN-IBN as long as gutka is eaten it is food and any food containing tobacco and nicotine is banned. This is a food safety law last August which bans all tobacco and nicotine content in food.

Sanjay Bechan: Sagarika this is also from FSSI please read this…

Sagarika Ghose: Mr Bechan have got your point. Is gutka a food or a tobacco product?

Amal Pushp: If you see the food safety standards act, food there is defined as any substance whether processed, partially processed or unprocessed which is indented for human consumption. So this definition is quite wide and it includes gutka, pan masala and other items also. Further even the honourable Supreme Court has held in various higher judgments that pan masala, gutka… since pan masala, gutka are eaten for taste and nourishment they are all food.

Sanjay Bechan: Read that judgment in totality. This is Ghodawat you are talking about.

Amal Pushp: There are various other cases also

Sagarika Ghose: The debate here Mr Bechan is whether gutka is a food product. Ministry of health says it is a food. But let me bring in Mr Ashwini Kumar here, who had a point, Mr Ashwini Kumar do you want to respond to the charge that Mr Bechan is making that in fact all those who are campaigning against gutka are the spokes person of the tobacco lobby. And because you know if you stop eating gutka they will all switch cigarettes.

Ashwini Kumar: Let me make it very clear, we are not pro-tobacco lobby and not anti-gutka here. We are not in favour of both actually. Let me comment on two points which are made there today. Whether gutka is a food or not? That issue was settled why back in 2004 when in Ghodawat case Supreme Court pronounced that gutka is a food item.

Sagarika Ghose: Right we are completely out of time. But I just want to get from you, do you believe…

Ashwini Kumar: Can I just come in on COTPA point. Somehow the interpretation given to COTPA is that this is something which basically legitimises the tobacco business. That is no so, if you go back in history and see this act is a subsequent act of 75. We had an act in 1975 which controlled the advisement of tobacco product. In 2003 we have an act which even prohibits in certain cases; sale of tobacco products for says people below 18 years of age. So in a way we are gradually moving towards curbing the use of tobacco. In 2006 ad 2007 we got the 44J rule of PFA. So it is a very wrong argument, this point has already been decided by Bombay High Court.

Sagarika Ghose: Mr Kumar we are completely out of time. I’m very quickly going to ask the doctor his last word, if any one who finds himself addicted to gutka then is it time he stop right now?

Srinath Reddy: Absolutely because it can cause cancer, it can cause heart attack, it can cause stroke. It can cause a number of health conditions which are avoidable.

Sagarika Ghose: And very quickly Mr Bechan you believe that gutka has been unfairly targeted?

Sanjay Bechan: Definitely, see FSSI says no such notification has sent which mentions tobacco as food product. Gutka is a tobacco product and ready Ghodawat in its totality.

Sagarika Ghose: We do not have the time. This has been a very enlightening debate. The ban on gutka, Mr Bechan speaking for gutka and saying why you unfairly targeting gutka. The other panellist maintaining that gutka is number one killer and cause of oral cancer. Thank you very much, Dr Srinath Reddy, Mr Amal Pushp, Sanjay Bechan, Naveen Khanna and Ashwini Kumar. Thank you very much for joining us.

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