The looney fringe has done it again. They started with fantasies of stem cell therapy, plastic surgery, automobiles and space travel in ancient India. This was followed by a ban on beef, causing an estimated loss of Rs 1000 crores to the exchequer. Thereafter came claims of privilege and bravado in being able to carry match-boxes on board an aircraft. However it is when they transgress on areas where they actually endanger the lives of fellow Indians in their absurd and ignorant declarations on the use of tobacco, that it offends core professional values. Worse still, these outrageous declarations blatantly point to a prostitution of sound medical evidence on the altar of commercial expediency by vested interests bowing to the dictates of the tobacco lobby.
India passed the “Control of Tobacco and Other Products Act” (COTPA) in 2003,which came into force in 2004; one full year before it signed the WHO “Framework on Convention on Tobacco Control” (FCTC) treaty. One of the key areas of COTPA is: Specified Health Warnings on all Tobacco Products
This section of COTPA mandates “Pictorial warnings on the packaging of all tobacco products”. The warning must cover 40% of the cover with specified text “Smoking Kills” or “Tobacco Kills” and “Tobacco causes cancer”. This was a climb down from the 50% recommended by the FCTC. The language (maximum two) and text (legible and prominent) are specified.
Subsequent to the Act being passed in 2003, and coming into force in 2004, the authorities went into a stupor on the subject. No rules were framed, rendering the act impotent. It took a PIL in the Himachal High Court in December 2004, to direct the government to frame rules immediately. The government obliged, but conveniently forgot to notify the rules so that the end result remained the same; a totally useless law. A further PIL in the Shimla High Court was needed, followed by repeated directives to notify the rules. This was eventually done in July 2006. In short the implementation of any tobacco related legislation has a history of obstruction by the tobacco lobby.
Across the world the pictorial warnings have been confirmed to provide motivation to quit tobacco usage. Canada-58%, Brazil- 67%, Thailand- 44% and New Zealand- 67%; to name a few. Actual quit rates went up by 40% in Canada and U.K., 15% in Thailand and 10% in China. In short there is no doubt about the efficacy of the warnings. The UK has gone a step further by banning even the display of tobacco products, in supermarkets, since 2012 and in small stores and pubs on the 6th April 2015.
In October 2014 this country ruled that the pictorial warnings be increased in size to cover 85% of the packing. Against all available evidence, the parliamentary committee on subordinate legislation recommended that the Union health ministry set up a medical board to examine the health effects of tobacco on the Indian population before mandating that coverage by pictorial warnings be increased to 85%. The chairman of the committee BJP MP Dilip Gandhi has now declared that our current stance on tobacco is based on studies done in a foreign setting and that further studies are required in this country in an Indian population before concluding that tobacco actually causes cancer. Therefore the proposed increase in the size of the pictorial warnings should be put on hold.
Obviously Mr Gandhi has never heard of the numerous WHO publications and the evidence that around 900,000 people die of tobacco-related illnesses in India each year, the second highest number after China. And experts predict that could rise to 1.5 million by the end of the decade. He has ignored published studies like the 2008 report in the New England Journal of Medical research supported by none other than the Office of the Registrar General. His bias is amply demonstrated by the fact that his committee heard representations from the likes of the All India Beedi Industry Federation, and the Karnataka Virginia Tobacco Growers Association. No health expert, oncologist, or anti-tobacco activist of any description was invited to make a representation.
The pro-tobacco bias was unashamedly obvious and stands further exposed by recent media reports of politicians with interests in the tobacco industry. One cannot help wondering how this total contempt for human life, blatant corruption, and conflict of interest by the pro tobacco MLAs and MPs fits in with the PM’s “achhe din” and promises of good governance. Not that there is anything new in this. The current president of our country, during his political career was repeatedly re-elected from a constituency that had a thriving beedi industry.
There are cancer surgeons and oncologists all over India who have devoted their lives to dealing with the horrible aftermath of tobacco usage. They remain engaged in disfiguring surgery and following it up with crippling chemotherapy and radiotherapy. Many of these surgeons and oncologists are staunch BJP loyalists. It is disgraceful that there has not been a single word of protest from this otherwise extremely competent and well informed group against the absurd declarations of Mr Gandhi. He needs to be universally condemned by all rational individuals who are even remotely concerned about the welfare of their fellow countrymen in relation to tobacco addiction.
Sunita Tomar died last week in the Manipuri village in MP at the age of 28 years. She was the face of the government’s anti-tobacco campaign. Disfigured by surgery for cancer of the cheek and jaw, caused by the use of tobacco since the age of 22, her face appeared in advertisements and banners warning against the use of tobacco. She even wrote to the PM urging him to overrule Gandhi’s remarks because there were thousands like her who she had met in the course of her own treatment at the Tata hospital’s OPD. Sunita felt strongly that not only should the size of the pictorial warnings be increased, but there should be massive awareness campaigns against the use of tobacco. She died two years after her surgery, debilitating follow-up treatment, and an expenditure of over Rs 3 lakhs. She died at her request, in her own home, in her village, in the company of her devoted husband and two young children.
May be if our MLAs and MPs had sent her bottles of cows urine to treat her cancer, she would have fared better?
(Dr Gladstone D’Costa is the Chairman, Accreditation Committee and member, Executive Committee, Goa Medical Council.)
