Interview | Dr. Pankaj Chaturvedi Mumbai

‘War on tobacco: think ahead of industry’

The head and neck cancer surgeon says e-cigarette ban was needed, but more has to be done

Dr. Pankaj Chaturvedi, a head and neck cancer surgeon from Mumbai’s Tata Memorial Hospital has been a vociferous critic of tobacco use. The surgeon played a crucial role in Maharashtra’s gutkha ban and pushing the Centre to print gory pictorial warnings on cigarette packets. Dr. Chaturvedi talks to The Hindu about why the Centre’s move to ban Electronic Nicotine Delivery Devices (ENDS) was essential, and his concerns about the government’s failure to curb tobacco usage through smoking and chewing. Edited excerpts:

Activists like you have lauded the government’s decision to ban e-cigarettes but the popular perception is that they were a lesser evil than regular cigarettes. How is the government’s decision fair?

This “perception” was based on heavy lobbying of its use as a cessation device by tobacco companies. With many industry-sponsored studies reporting its conflicting safety and efficacy, the government constituted an independent expert committee to report the current evidence and potential impact of various forms of ‘nicotine delivery systems’. They unequivocally concluded that e-cigarettes contain nicotine and the use of nicotine (and its compounds), hazardous through any device and fatal to humans. In the interest of public health, the government’s research wing, Indian Council of Medical Research, came out with a white paper underscoring the dangers of using these products and how they become a gateway to other substance abuse. With all the mounting evidence along with the increase in deaths associated with e-cigarette use across the world, the government’s ban was justified. Having said that, the target of ENDS are not current smokers but former and future smokers. The ENDS industry would have jeopardised the government’s efforts to reduce smoking in India.

You have demanded a ban on all forms of tobacco and supari for long. Why has the government not acted on that?

One of the main arguments for the continuance of tobacco sales is that the government should not dictate what vices the public engages in. Another argument is a dent in tax collection and employment to farmers and workers. What we fail to realise is the loss in productivity and the exorbitant direct medical costs among tobacco users are far greater than the taxes and employment they generate. In case of ENDS, since India does not manufacture it, the ban will be successful. The tobacco industry is raising a hue and cry when the government has banned a new product used by 0.02% of Indians. Imagine what they would do when a product used by 26% of Indians is banned. Still, India has shown a steep decline (17% relative decrease) in tobacco consumption in the past decade.

Have the gory pictorial warnings on tobacco products helped?

Yes, they have helped immensely. Pictorial warnings have become an integral part of the World Health Organization framework for tobacco control measures the world over. A lot of research has gone into how humans act in response to their emotions and once a negative emotion is felt, like fear or disgust, they often avoid its source. The latest results from the largest tobacco-related population survey in India, GATS-2, shows that 46% to 62% of smoked and smokeless tobacco users thought of quitting because of warning labels on the packet.

But the incidence of head and neck cancers has gone up drastically, as has the use of tobacco among the youth. What can be done to bring about behavioural change?

There is the conundrum: tobacco use has no benefit, yet its use and risk of head neck cancer are going up, and it can’t be outlawed just yet. As a society, and as healthcare professionals, we need to first acknowledge that we are not doing enough. A simple intervention such as reminding users among our families, friends and patients about the ill effects of tobacco use is an effective tool. Of course, active cessation clinics should be set up and users should be encouraged to visit these. The government can implement laws to stop the sale of loose cigarette sticks, vendor licensing and enforcement of the Cigarettes and Other Tobacco Products Act.

What else can be done to push the government?

We need to keep motivating the government to bring in better laws and implement the existing ones better. For a decisive war on tobacco, we have to think ahead of industry. A ban on e-cigarettes has made the future of the cigarette industry bleak.

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Printable version | Aug 4, 2020 11:17:19 PM | https://www.thehindu.com/news/cities/mumbai/war-on-tobacco-think-ahead-of-industry/article29753419.ece

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