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  World No Tobacco Day  
  An Open Letter to Oommen Chandy  

AS you know, today (May 31) is the World No Tobacco Day. I write this open letter in my capacity as an Oncologist and Cancer Surgeon, who had super-specialty training from India's premier cancer institute, Tata Memorial Cancer Centre, Mumbai, and Memorial Sloan Kettering Cancer Center, New York, as well as MD Anderson Cancer Center, Texas, USA. This is to express my deep sense of gratitude and praise for you and your esteemed Cabinet colleagues for the landmark decision you have taken to ban the sale of pan masala, gudka and all sorts of smokeless tobacco in Kerala. This is a gift to our fellow human beings, children, young adults and the unborn new generation.

Tobacco is an industry which produces a consumable product. But it is the only product which has the ability to kill 60 per cent of its consumers and patrons. Millions die across the globe due to the ill-effects of tobacco, including cancer, heart attacks, angina, high blood pressure, cerbrovascular accidents, cerebral arteriosclerosis and chronic respiratory diseases, gastric abnormalities and hyper acidity.

It causes absorption problems and syndromes, various skin allergies, vessel-narrowing syndromes like Berger's Disease. It has also the capacity to produce impotence in males. Consumption of tobacco can lead to lack of sperm counts, infertility in females and still births in pregnant mothers. The over 40,000 toxins in it are the only agents which can penetrate the placental barriers and damage the brain of unborn children leading to mentally retarded children.

Withdrawal Symptoms lead to mental confusion/violence. The picture is more alarming than we can imagine. Tobacco kills 10-15 lakh persons annually in India (more than TB, HIV/AIDS, malaria combined), i.e., 2500 deaths daily. It causes 50 per cent of cancers in men and 25 per cent in women. India has got the highest incidence of oral cancer and other head and neck cancers in the world. Tobacco advertisements and peer pressure initiate about 10,000 youths into tobacco use every day. Almost 40 per cent of TB-related deaths among men are associated with smoking.

A statistical survey by a Government of India Agency has quoted total economic cost of treating 3 major diseases due to tobacco use in India at Rs. 30,833 crore in 2002-03. Economic costs related to treatment of tobacco-related ailments are 16 per cent higher than the annual tax generated from tobacco. A recent paper on the "Economic Cost of Tobacco Use in India, 2004" reveals that the "direct medical costs of treating tobacco related diseases in India amounted to Rs. 4125 crore for smoked tobacco and Rs. 1296 crore for smokeless tobacco. The indirect morbidity costs of tobacco use, which includes the cost of caregivers and value of work loss due to illness mounted to Rs. 1810 crore for smoked tobacco and Rs. 473 crore for smokeless tobacco. The total economic cost of tobacco use amounted to Rs 7731 crore."

If you take this into consideration your decision to ban smokeless tobacco is a boon to our state. The Director General of the World Health Organisation has quoted that "the tobacco industry has subverted science, economics and political process to market lethal and inherently defective products that impose a massive burden of disease and death on the countries. Tobacco killed one person every eight seconds. That made it 4 million preventable deaths".

If this is the gravity of the issue, dear Chief Minister, what prevents you from taking bolder steps for the benefit your own people? If one product is banned, it indirectly promotes another product with similar contents. That is human tendency. Pan masla and gudka are penetrants from northern states, thanks to the migration of workforce. But why not ban the sale of the old Kerala-style pan (Murukkan) the usage of which is rampant among the low socio-economic strata in our state since time immemorial as well? The laws are made to break, especially so with tobacco. They are flouted every day. There is not enough of enthusiasm to implement these laws or, in other words, there is lack of attitude in the premises where the laws are supposed to be enforced. This should change.

You are a progressive Chief Minister, progressive in implementing projects for the well-being of the people of this state. Though Kerala is the 2nd state (after MP) to have implemented this law, we don't feel you are second to any other chief minister. I would rate you much above Mr. Narendra Modi, Mr. Nithish kumar and Mr. Naveen Patnaik. I do not know what prevents us from getting the benefit of a cigarette smoke-free environment? Pan/gudka kills only the consumer but cigarette destroys the innocent people around as well. Looking at the quantum of diseases cigarettes can induce as mentioned earlier, why do we target only pan and gudka? It is the right of non-smokers and unborn children in the womb of mothers to enjoy fresh air. Why should we not take action or help to reduce that menace also?

There is a Regulation and law regarding explicit display of smoking scenes in cinemas and serials (COTPA-2003). But as we look around, we can see it is grossly violated by film makers. When superstars perform any vices, the fans and children will try to emulate them. You could see such huge hoardings across Kerala of several movie stars of Malayalam filmdom with burning cigarettes on their lip. (I don't deny that you see Bollywood superstars with burning cigarettes in IPL matches, commercial ads for pan, gudka in between sports events and similar hHoardings across India.

Can you not give stricter instructions to the Censor Board not to sanction release of such movies? Will it not save thousands of youngsters from giving lame excuses if they are asked to quit? Please ban surrogate general advertising and large hoarding all over Kerala, advertising smoking as a virile masculine character with a hint of sex.

Once again I congratulate you for banning tobacco products around school premises. I have direct knowledge from the community survey conducted in Ernakulam district that school-going children are lured into pan chewing by peers and elders. Majority of brands even add ganja and glass pieces to get the "kick" faster and to adhere to one brand as marketing strategy. Sir, will this ban have 100 per cent effect, unless we educate our children? You are an ardent supporter of education for all children born in this state. Hence why not educate children on the ill-effects of tobacco through curriculum? If properly taught and if the teachers do not show double standard (tobacco usage among teachers will have negative impact).Will it not add more credibility to the banning?

Please give instruction to the education department to set aside one page in the textbook of science from Class V onwards. There should be an increase of knowledge on the subject of tobacco in successive classes up to the 12th standard. There must be compulsory questions from the topic on final examination as well. Will this knowledge not change the society in the years to come?

It will not cause a paisa to the government to add this subject to the curriculum. As Chief Minister, you are in a position to set an example to other states, CBSE and ICSE boards? The statistics brought out in a recent survey that covered school students in the 13-15 age-group are an eye-opener:

Among such children 14.6 per cent use tobacco (boys 19 per cent, girls, 8.3 per cent; 4.4 per cent smoke (boys 5.8 per cent, girls 2.4 per cent; 21.9 per cent live in the homes where other smoke in their presence.

Medical students are no exception! Among the third-year medical students, 13.4 per cent smoke cigarettes (men, 16.5, women, 7 per cent; 11.6 per cent use tobacco other than cigarettes, (men, 13.7 per cent, women 7.5 per cent).
Four among five smokers indicated that they want to quit; 29.1 per cent received formal training in smoking cessation.

Among third-year dental students, 6.5 per cent smoke cigarettes (men, 17.5 per cent, women, 1.5 per cent; 8.6 per cent use tobacco other than cigarettes (men 18.8 per cent, women 3.7 per cent)

About 62 per cent of current smokers wanted to stop smoking; 54.8 per cent received formal training in smoking cessation during dental school.

Among the teachers in the teaching Institutions, 23.4 per cent use tobacco (mostly teachers; 10.3 per cent smoke cigarettes (mostly teachers; 10.1 per cent teachers had received training on youth tobacco use prevention; 86.6 per cent think teacher tobacco use influences youth tobacco use.

What does all this show? If you want to translate the benefits of the ban on pan masala and gutka, law alone cannot be the answer. You need to educate the masses. That should not be a one-day affair but year-long.

Will you be kind enough to pass a Cabinet resolution in the best interest of the public that every TV channel in Kerala should air anti-tobacco advertisements in prime time? Every radio station, whether FM or state-run, should send messages about the ill-effects of tobacco at definite intervals? At least your request to the public could be recorded and aired? Why not ask the cell phone providers to send SMS to all its customers to quit tobacco? Why not a small section in every Malayalam and English dailies be set aside against tobacco use? All these will not cost the government even one paisa. But it may change the life of smokers. It may prevent thousands of youths from falling prey to the menace. It will save thousands of unborn babies in the womb of mothers from the ill effects of tobacco.

Why can't we raise taxes in such a way that buying cigarettes become impossible to the middle and lower class? I even suggest that there should be a special license to sell tobacco products and that be granted only to very selected merchants if they can give government huge deposits as security. There is a wonderful regulation currently in vogue in Great Britain where by display of tobacco products within the shops and supermarkets are even banned. This will avoid the visual attraction and temptation to buy cigarettes. As you are aware tobacco is an addiction. There is dependence in tobacco users. Hence this will help many. Implementation of the same in our state also is possible.

There is a strong consumer protection law in this state. Every tobacco user is a consumer. If the product is killing more than 60 per cent of its consumers over a period of time, then why can't the consumer go for compensation? The issue is more grave because, as per rule, every product on sale to public should contain a literature describing its benefits and ill-effects to the consumer. Without such details and the right of the consumer to know about the details of the consumable item, how can you allow its sales?

As a cancer surgeon, with over 25 years of experience in treating tobacco-related cancers and as Chairman of Rotary Cancer Project of Dist 3201 and president of Kerala Cancer society, I would say that your decision to ban pan/gudka sales in Kerala is the most vibrant and people-friendly decision that you have offered to the citizens of this state. This is the greatest gift that you have given to the citizens of Kerala on this World No Tobacco day. I would request you to consider the points I have raised in this letter and implement them, for it will cost the government not a single paisa.

Yours etc

The writer can be reached at
  By  Thomas Varughese  
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