India

Ban All Forms of Chewing Tobacco & Betel Nut Products

Krishnaraj Rao for BeyondHeadlines

Mumbai: Several state branches of Indian Dental Association (IDA) have addressed a letter earlier this month to Prime Minister Manmohan Singh pointing out the while banning gutka was good, it was not good enough. The letter said: “We the dentists who are responsible for oral health, are extremely worried about rising trends of mouth cancer especially amongst the youth. This epidemic is the result of rampant use of Tobacco and Areca nut in different forms. As per Global Adult tobacco Survey, 2010 released by Ministry of Health, 22 crore Indians are chewing this deadly concoction. We would like to thank the government for banning Gutka in several states under the Food Safety act.

“However, Gutka chewing accounted for only 10 % of all smokeless tobacco consumption. Regional consumption of smokeless tobacco product is diverse and smokeless tobacco product is been flavored and packaged in different pouches and sachets. The major chewing is in the form of Jarda, Surti, Khaini, Mava, Kharra,Panetc apart from Pan Masala (supari/betel nut) with or without tobacco. Supari (betel nut or areca nut) is a confirmed cancer causing substancesa nd leads to many other diseases.D espite plethora of knowledge against it, Supari is being sold as mouth freshener under brand name of Pan Masala or Supari Mix.

Ban All Forms of Chewing Tobacco & Betelnut Products

“The epidemic of mouth cancer cannot be curtailed without a comprehensive prohibition of selling these lethal products freely as packaged mouth fresheners. We sincerely hope that you will use your good offices to prevent premature deaths in our country by strict implementation of section 2.3.4of Food safety and standards (prohibition and restrictions on sales) regulation 2011 to ban all flavored and packaged smokeless tobacco product across country. Please prohibit the packaged and misleading areca nut preparation in the form of pan Masala, Supari Mix etc.”

Read the full text of IDA’s letter to PM.

“I request the PM to urge the remaining 8 states to ban Gutka for effective implementation of the ban across the country to save millions of lives, especially, youth from this killer product”, said Dr Ashok Dhoble, General secretary, IDA Head Office.

20 states and two Union Territories have banned gutka in the past 10 months, after Madhya Pradesh set the juggernaut rolling on 1st April 2012. (See tally of states here: http://tinyurl.com/Tobacco-ban-tally )

A few more states have been ordered by their respective high courts to implement the ban.

While the tobacco bans passed by states earlier in 2012 were strictly restricted to gutka and pan masala containing tobacco, some of the later ones have been tending towards taking on other forms of chewing tobacco also. For instance, see Mizoram’s ban order, which says, “complete ban on sale of gutka/pan masala/zarda or other chewable products containing tobacco or nicotine with immediate effect and until further order.” This is also one step ahead of most other states, which have put a one-year tenure on their ban orders.

This shift towards a wider and more sweeping ban has been mandated by the Union Health Ministry, which issued a fresh letter to chief secretaries of all states in  November 2012. The order cites an order of Allahabad High Court, taking the clear stand that tobacco is a food article, and therefore all tobacco articles such as zarda are liable to be banned as per Central Govt’s Food Safety and Standards Act (FSSAI) and Rules.

Ban orders, tallies etc are available for download here: http://tinyurl.com/Tobacco-ban-orders-states

The death knell for the chewable tobacco industry first sounded on August 1, 2011, when a new rule was notified under Central Government’s Food Safety and Standards Act (FSSAI). It said: “tobacco and nicotine shall not be used as ingredients in any food product”. Soon afterwards, 20 states banned gutka, namely: Madhya Pradesh, Kerala, Bihar, Maharashtra, Himachal Pradesh, Rajasthan, Haryana, Jharkhand, Chattisgarh, Gujarat, Punjab, Uttarkhand, Mizoram, Delhi, Sikkim, Andhra Pradesh, Odisha, Nagaland Uttar Pradesh, Jammu & Kashmir and four Union Territories  – Chandigarh, Daman & Diu, Dadra and Nagar-Haveli and Andaman-Nicobar.

The Supreme Court issued notice on 13 December, 2012 to the Government of India on a plea for ban on manufacture, distribution, sale, export, import and consumption of chewing tobacco, gutka and pan masala in all their forms. Justice G.S. Singhvi and Justice S.J. Mukhopadhaya issued notice after the counsel Prashant Bhushan told the court that 14 states had banned gutka but the restriction was not effective as the product was still being manufactured in other states.

The Chief Ministers of these states were prompted into action when approached by doctors and victims of oral cancers. All the Chief Ministers assured the victims of their commitment by signing a pledge calling for a ban on gutka and khaini products. The pledge states that “I will raise my voice against this issue and support all initiatives to rid India of this menace of gutka and khaini and help save millions of Indian lives”.

In the letter, MoHFW requested all the state Government (Chief Secretaries) to examine the issue and pass necessary orders in view of the order of the Hon’ble Allahabad High Court which had held that Chewing Tobacco products like zarda, khaini are all food articles and hence are governed by FSSAI 2.3.4 notification and so can be banned like gutka.

Supreme Court in Godawat Pan Masala Products I.P. Ltd. & Another Vs Union of India & Others, (2004 7 SCC 68), after discussing in detail the provisions of COTPA, 2003, and the PFA, Act, held that pan masala, gutka or supari are food product, and the power of banning an article of food or an article used as ingredient of food, on the ground that it is injurious to health, belongs to the Central Government.

The gutkha/pan masala industry had filed writ petitions in the High Courts of Maharashtra, Rajasthan, Madhya Pradesh, Bihar and Kerala asking for a stay on the ban, but all the High Courts have upheld the ban declaring it constitutionally valid. In a landmark decision, the High Courts have recently ordered the State Govt’s of Jammu & Kashmir, West Bengal and Assam to implement the FSSAI notification & to ban gutka, pan masala and other chewing tobacco products.

Even pan masala brands marketed as “tobacco-free” contain high levels of nicotine, as revealed by a study commissioned by the Ministry of Health & Family Welfare. While gutkha, zarda and khaini are known to contain some tobacco and are sold as such (their manufacturers don’t claim zero-tobacco content), pan masala makers promote and advertise their products as “100 per cent tobacco-less”, as they are subject to review under the 1955 rules of the Prevention of Food Adulteration (PFA) Act. But the laboratory analysis of randomly picked pan masala brand samples by the Central Tobacco Research Institute (CTRI), Rajahmundry, Andhra Pradesh has revealed that Rajnigandha pan masala contains 2.26 gm of nicotine per 100 gm of pan masala. This was actually more than Goa 1000 Gutkha brand, which was found to have 2.04 gm of nicotine per 100 gm of the product. Manikchand’s Gutkha RMD contained 1.88 gm nicotine. Chaini Khaini contained 0.58 gm of nicotine while Raja Khaini had 1.02 gm of nicotine per 100 gm of the smokeless product.

A parallel study by the Food Research and Standardisation Lab, Ghaziabad (U.P) under the Food Safety and Standards Authority of India (FSSAI) showed that Rajnigandha pan masala contained exceptionally high nicotine levels. In all the tested samples, pH levels were found to be carefully fine-tuned to facilitate rapid absorption of nicotine into the blood, delivering to the consumer the desired kick. The intention is clearly to make pan masalas highly addictive to one-time users and repeat-users alike. The ban order by Maharashtra Food and Drugs Administration dated 19 July 2012 highlights the risk posed by Magnesium Carbonate present in pan masala, which leads to hyper magnesia, and sometimes cardiac arrest.

“While Gutka will soon be history, we must understand that it constitutes only 10% of the smokeless tobacco consumption. The leading killer continues to be zarda, khaini, mawa, kharra etc. It is sad that industry continues to sell this deadly product with flavorings and perfumery to mislead kids and youth. It is well known that supari, the major ingredient of Pan Masala, is highly addictive and carcinogenic. Despite a hard hitting report from NIHFW as per direction from Supreme Court, Government of India has turned a blind eye to massive Pan Masala advertising. We must get ban on all Pan Masala and all industrial preparations of smokeless tobacco”, said Dr. Pankaj Chaturvedi, Professor, Head and Neck Surgeon Tata Memorial Hospital, Mumbai.

The Government of India was pushed to act on this issue by the civil society that has been pressing for a ban on smokeless tobacco products. The Directors of 14 Regional Cancer Centers in India, including the Indian Dental Association & Tata Memorial Centre (TMC), have wrote letters individually to the Honorable Prime Minister Shri Manmohan Singh & Honorable Health Minister Shri Ghulab Nabi Azad for implementing nationwide ban on the sale of gutka/pan masala products in the country.

In the words of Dr Rajendra Badwe, director, Tata Memorial Hospital, “Tobacco is the single most important cause of preventable death amongst youth. It is time for the government to consider serious steps to eventually ban on all tobacco products. The food act is wonderful opportunity to ban all smokeless tobacco and pan masala. It is sad that tax revenue is the only reason for this industry-driven holocaust.”

Directors of 23 Regional Cancer Centers are the opinion leaders in the country and most respected cancer specialists. Most of them have spent several decades in the field of oncology before they became Directors.  In the letter addressed to the Hon’ble Prime Minister and to the Health Minister, they have raised serious concerns over the growing Gutka/Pan Masala menace and urged the Government of India to take urgent action to completely stop the sale of smokeless tobacco products (specifically Gutka and Pan Masala) throughout the country. QUOTABLE QUOTES & OTHER DETAILS ARE DOWNLOADABLE HERE.

According to Global Adult Tobacco Survey (GATS) India, the estimated number of tobacco users in India is 274.9 million of which 25.9% are users of smokeless tobacco while 5.7% are cigarette smokers and 9.2% smoke bidi.  This reveals that 75% of Indian tobacco users use smokeless forms of tobacco that includes pan, gutka, pan masala, khaini and mawa.  Slowly and gradually the use of chewing tobacco is reaching at dangerously endemic levels in the country with 8% of all adults in the country chewing gutka.

India has the highest prevalence of oral cancer globally, with about 80,000 new cases of oral cancers in a year. Smokeless tobacco, which contains 3095 chemicals, out of which 28 are cancer-causing and these products are consumed by a large and growing number of Indians making India the cancer capital of the world. According to a health report submitted by the Ministry of Health & Family Welfare in consultation with National Institute of Health and Family Welfare on the ill-effects of chewing tobacco revealed that the number of oral cancer cases in India alone is 86 per cent of the oral cancer figures across the world. What is more shocking is that chewing tobacco and gutka contribute to 90 per cent of oral cancer cases in the country.

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