Indian research on smokeless tobacco, bidi, pan masala

An Indian man prpares chewing tobacco, ghutka. File photo

An Indian man prpares chewing tobacco, ghutka. File photo  

The recent controversy about Committee on Subordinate Legislation on Rules on the Cigarettes and Other Tobacco Products Act 2003.

The recent controversy about several members of the Parliamentary Committee on Subordinate Legislation on Rules on the Cigarettes and Other Tobacco Products Act 2003 highlighted how financial interests of the members flouted ethical principles. These gentlemen should have resigned from the committee. They did not, and the Prime Minister’s office had to take corrective action.

And they took liberties with truth, which are now published both in the official government website and in the press and media. The chairman said: “Bidis are natural products (sic) and are very small as compared to cigarettes. As such, bidis should not be compared with cigarettes as far as rules are concerned”. Well, are cigarettes made from natural products too? Another said: “there is very little tobacco in each bidi, hence the harmful effects are nil as compared to cigarettes and chewing tobacco” A third said: “what people find in Abu Dhabi does not apply to India. There is no work done in India to show that bidi and smokeless tobacco (meaning ghutka etc) cause cancer”. A fourth one knows some people who smoke 60 cigarettes a day and are yet cancer-free.

Clearly, each one of these statements is disingenuous. I refer the reader to the comprehensive special section on tobacco control, published in the Indian journal Current Science, Vol.96, no.10, 25 May 2009 available free on the net. The article there by Drs . C. Ray and P. C. Gupta (pp.1324-1334) cites as many as 37 studies done by Indians in India (out of a total of 65 references). So, to say that there are no Indian studies on bidi and smokeless tobacco use and their health effects and cancer connection is plain nonsense. The above review further points out the bidi smoke contains many of the same cancer causing chemicals as cigarette smoke, and that bidi smoking generates similar or slightly higher nicotine levels in the blood compared to conventional cigarette smoking.

These data have been published in the report “Bidi Smoking and Public Health”, edited by P.C. Gupta and S. Asma, submitted to the Ministry of Health and Family Welfare, India in 2008 (ref. 21 and 22 in the above paper), and are freely accessible to all, including the Subordinate Committee members, if only they had tried. It is clear that the Committee had members whose business interests have made them cancer-deniers (similar to the climate change deniers of the U.S.).

Even as we concentrate on tobacco smoking, let us not forget smokeless tobacco and pan masala, which too are consumed by many as 45 per cent of Indians, namely, almost every second Indian. These are in the form of snuff, chewing tobacco, tobacco leaf, gutkha, mawa, and the like. Gutkha is basically a flavoured and sweetened dry mixture of areca nut ( supari), catechu ( kattha), slaked lime and tobacco. The same without the tobacco is termed pan masala. Here again there is plenty of Indian research done in India (and in neighbouring Sri Lanka) to link their continual use with what is referred to as oral submucosal fibrosis or OSF.Even pan masala and areca nut use is worrisome. Drs. Kalpagam Polasa, B. Sesikeran, P.C.Gupta, Ranju Ralhan, A. Mukherjee, B. J. Dave, Sabakhan, R. A. Bhisey are just some researchers (I am missing out on many other equally distinguished researchers, and apologise for the lapse), and they have produced a volume of literature on the constant use of Pan masala, and supari (areca nut) and OSF. It starts as intolerance to spicy food, rigidity of lip and tongue, hardening of the submucosal fibres, and whitening of the area (leukoplasia). Two detailed reviews on the connection between the continuous use of pan masala and OSF appear in (a) the journal Mutagenesis, 2004 by Urmila Nair and others, and (b) in Oral Oncology, 2006 by W.M. Tilakaratne and others, both free on the net. The most recent Indian work on areca nut chewing and OSF comes from R. Anand and others in J. Cancer Res. Ther. 2014. Thus we need to worry when a pan masala king joins any panel involved in restricting the use of supari and gutkha.

That areca nut, used for centuries in India and the East, both as a “health practice” and as social courtesy can have ill effects would worry many readers. Sadly it is true, and as an occasional use or as a social grace it should be limited. The saving grace is in the practice of offering or even consuming it with betel leaf.

This is because the betel leaf contains many compounds that tend to be not only beneficial but also some molecules that are chemopreventive (work by Drs S.V. Bhide and Colleagues at the Cancer Res. Inst, Parel, Mumbai) and antioxidants (by Shetty and others as the NITTE University, Mangalore) and others. We had covered it in an earlier column in this newspaper (issue of November 4, 2010), and the most recent review on this issue comes from Drs R. Toprani and D. Patel of the HCG Cancer Centre, Ahmedabad, titled: “Betel Leaf: Revisiting the benefits of an ancient herb”, in the South Asian J. Cancer. p. 140-141, 2013. Next time when someone offers you Tambulam, think about these.

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Printable version | Jun 4, 2020 4:27:18 PM |

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