Thursday, 9 April 2015

Tobacco indeed causes cancer: Kerala medical community

Amid widespread shock and anguish over misinformed statements on tobacco’s association with cancer, Kerala’s medical community have rebuffed these and have stated that tobacco use indeed causes cancer. Public pronouncements mooted by self-contained interests cannot dispel years of revalidated study and research by scientific and medical community, they say.

Kerala’s medical community have also congratulated the Hon’ble Prime Minister for his timely intervention in keeping up to the commitment of the 15 October 2014 notification requiring tobacco companies to devote 85 per cent of all tobacco product packs including bidis, cigarettes and smokeless to pictorial warnings.  

Dr Paul Sebastian, well-known surgical oncologist and Director of Regional Cancer Centre here said, “No less than the World Health Organisation has categorically said that tobacco causes cancer. Independent research conducted by Indian organisations has only strengthened this.”

He points out to the cohort study in Karunagappally taluk started in the late 1980s to study the potential health effects of high background radiation. 

“The study that covered 65,829 men aged 30–84 however showed an elevated lung cancer incidence among bidi smokers, strengthening the association of lung cancer risk with bidi smoking,”

“Karunagappally is known for high background radiation from thorium-containing monazite sand and the study set out to explore the lung and other cancer risks increased by exposure to high-level natural radiation, and the synergistic effect between radiation and other factors including bidi smoking. However, our cohort study showed that the relatively high lung cancer incidence in this area is unlikely to be due to high-level natural radiation,” 
Dr Sebastian added.

Eminent oncologist and Founder Director of Regional Cancer Centre Padma Shri Dr M Krishnan Nair said, “The Prime Minister’s assurance that the Government will go ahead with 85 per cent pictorial warnings is reassuring. It sends out a clear message that tobacco is indeed to harmful to health and it speaks volumes of the Government’s commitment to reducing tobacco consumption.” Dr Nair also remembered the Prime Minister’s tweet on World No Tobacco Day 2014 about working to “reduce tobacco consumption in India.”

“Baseless statements that tobacco does not cause cancer cannot take away from established facts of science, and collective efforts of the scientific and medical fraternity. Reports of the National Cancer Registry Programme (NCRP) have a dedicated chapter on tobacco related cancers. The 2011 Report shows 45.4 per cent tobacco related cancers among males and 16.8 per cent among females in India,” Dr Nair added.

The Indian Council of Medical Research with a network of cancer registries commenced the NCRP across the country in December 1981 to generate reliable data on the magnitude and patterns of cancer.

Dr. VP Gangadharan, pioneer medical oncologist and HoD of Medical and Paediatric Oncology, Lakeshore Hospital, Kochi said, “Tobacco use is the leading preventable cause of death and disease and strategies such as large pictorial warnings can save one million precious Indian lives every year. Tobacco snatches away the best years of a user’s life, hampering productivity and social well-being. Pictorial warnings of 85 per cent can go a long way in preventing youngsters, migrants, and illiterates from getting addicted to tobacco products.”

Citing a 2014 report of the Union Ministry of Health & Family Welfare and the World Health Organisation on the economic burden of tobacco use, he added, “Tobacco use not only impairs health of individuals; it also badly affects the health of the economy. The economic burden for four specific diseases including cardiovascular diseases, cancer, tuberculosis, and respiratory disease in Kerala for the year 2011 was Rs 545 crores.”

Twenty-eight-year-old tobacco control crusader Ms Sunita Tomar, who made a public appeal for large pack warnings through the online campaign #LivesBachaoSizeBadhao, succumbed to oral cancer on April 1 – the same day when large-sized pack warnings were to be implemented in India. Sunita has made a dying request to the Prime Minister for 85 per cent pack warnings.

As many as 38,735 persons including doctors, tobacco victims, bidi workers unions, international and national public health experts and youth across the country had appealed to the Union Health Minister to implement 85 per cent pack warnings. 

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Saturday, 4 April 2015

History of pictorial warnings on tobacco products in India

The issue of pictorial warnings on tobacco packets is not one which is troubling a government at the centre for the first time.

The latest controversy is following BJP MP Dilip Gandhi's comments that there were no Indian studies to substantiate the claim that usage of tobacco could cause cancer. Gandhi, heads a Parliamentary panel subordinate legislation examining the provisions of Cigarettes and Other Tobacco Products Act, which has asked the government to keep plans of increasing pictorial warnings on tobacco products to 85% in abeyance.

It was in 2006 that India’s health warnings policy was first drafted. But there was no consensus on how severe the warnings should be, and after two sets of revisions in 2006 and 2007, the first set of health warnings were approved by a Group of Ministers led by Pranab Mukherjee in 2008.




The warnings shown below, was approved initially, then toned down dramatically in 2008.

In spite of toning down the warnings, they were not implemented for months. After postponing the implementation of warnings seven times, it was finally done on May 31, 2009.

And after years of discussion and debate, one would have expected that the warnings would be worth it, but one of the three pictorial warnings was the picture of a scorpion, though it was meant to be a crab.



(Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors. In Greek, these words refer to a crab, most likely applied to the disease because the finger-like spreading projections from a cancer called to mind the shape of a crab. The Roman physician, Celsus (28-50 BC), later translated the Greek term into cancer, the Latin word for crab.) Source- Cancer.org. 

Two other pictorial warnings from that period on cigarette packets show corroded lungs in one and an x-ray image of damaged lungs in a picture which lacked in clarity.



The Congress in 2009 had defended its stand of toning down the warnings. A CNN IBN article quotes Congress leader Oscar Fernandes, "If we’re talking about making the pictures harsher, we may as well shut down the industry. There are several districts in West Bengal where poor bidi workers earn their livelihood from this.”

It had also been reported then that as Pranab Mukhejee won from the Jangipur constituency, that has a sizable population of bidi workers, this was one of the reasons why the government was not keen on harsh warnings.

The tobacco packets between 2011 and 2013 though contained graphic images of people ridden by oral cancer which were visible distinctly.

The warning on cigarette packets during the same phase were controversial for another reason altogether. They carried a doctored picture of the then English football captain John Terry with corroded lungs. After Terry found out and threatened to sue the government at the start of 2012, another picture, with just his head taken off, was used for another year.


Between 2013 and 2015 again, the warning on cigarette packets concentrated on the lungs again, not looking to focus on oral cancers or those of the throat. Packets of tobacco did not change during this period either though.

The images that were proposed to be put on tobacco packets from April 1, 2015 were these



Courtesy: Newsminute
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Tuesday, 24 March 2015

Smoking rates down among Indian men, up among women

The fifth edition of Tobacco Atlas has revealed that smoking rates have marginally gone down among Indian men between 2009-10—as per Global Adult Tobacco Survey figures—and 2013, but there has been an almost proportionate increase in the number of women smokers.

The Atlas, which was unveiled on sidelines of the 16th World Conference on Tobacco or Health, details the scale of what it calls “tobacco epidemic”, track its harmful effects on health, poverty, social justice and environment, the progress being made on tobacco control and machinations of the industry to counter those measures. It has been brought out by World Lung Foundation and American Cancer Society.

Using 2013 figures, the Atlas estimates that about 23.2 per cent of adult males in India smoke.

The Global Adult Tobacco Survey (GATS) fact sheet for India for 2009-10 estimated 24.3 per cent of Indian males smoked. The female smoking rates as estimated by the Tobacco Atlas is 3.2 per cent, marginally higher than the GATS figure of 2.9 per cent. The Atlas estimated that 25.9 per cent of Indian adults— roughly one in every four— use smokeless tobacco.

India’s tobacco control initiatives and the move to ban gutkha have been praised, but the Atlas, by admission of its authors, does not make an accurate estimate of the smokeless tobacco problem in the country because of lack of authentic data.

The trend of increase in female smoking rates, meanwhile, is a global one with some rare exceptions like Japan where rates have stayed constant over the years. The Atlas estimates that lung cancer is now killing more women than breast cancer and smoking rates are particularly increasing among young girls in many countries.

The Atlas said that according to the WHO, with $5 per person per year, India will be able to pay for the four best buys in tobacco control policy—raising tobacco excise taxes, enforcing a comprehensive national smoke-free law, a ban on tobacco advertising and promotion and mandating large graphic warning labels appear on tobacco product packaging. “This small investment will reap enormous dividends in health and prosperity,” it said.

To download India fact sheet, click here

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Wednesday, 18 March 2015

Exposure to ads & smoking in films led to increase in smoking among adolescents: Union Health Minister

Various studies conducted over the past decade on advertising, marketing and depiction in Bollywood films has had a significant effect on adolescents taking to use of tobacco.

Hon'ble Health Minister JP Nadda cited various studies in Parliament that show increase of tobacco use among adolescents aged between 12 to 16 years not only because of Bollywood films, but also because of advertisements of tobacco products on cricket grounds during important series between India and other countries.

A study done between 2009 and 2012 showed that 59 movies contained 412 tobacco use occurrences. The prevalence of ever tobacco use among adolescents was 5.3 per cent. Compared with low-exposure adolescents, the adjusted odds of ever tobacco use among high-exposure adolescents and being receptive to tobacco promotions was also associated with higher adjusted odds of ever tobacco use.

A cross-sectional sample of 3956 adolescents (eighth and ninth grades, ages 12–16 years) from 12 randomly selected New Delhi schools were taken for the survey, assessing tobacco use status, receptivity to tobacco promotions (based on owning or being willing to wear tobacco-branded merchandise) and exposure to tobacco use in movies.

A 10-city survey of over 9,000 students between the ages of 13 and 17 showed that after seeing the Wills World cup Cricket Series, 13 per cent felt a desire to smoke. The survey also showed that 72 per cent thought that there was at least one smoker on the Indian cricket team, which played in the 1996 World Cup.

A previous study published in the British Medical Journal, showed similar results. It concluded that cigarette company sponsorship of the India-New Zealand cricket series in 1995 had a significant impact on kids, who watched it on television. The advertising created the impression among the 1,948 children aged 13-16 years, who participated in the survey, that “smoking gives more strength, improves batting and fielding and ultimately increases the chance of winning.”

There are independent studies that have been conducted to determine the impact of advertising and promotion of tobacco products on the consumption of these products by Indians, the Minister said. Evidence suggests that exposure to promotional activities for tobacco leads to initiation and progression of tobacco use. Research also corroborates that exposure to tobacco advertisements and receptivity to tobacco marketing are significantly related to increased tobacco use among students.

Shri Nadda also quoted other studies related to advertising of tobacco products and said that according to the Report of the Tobacco Control in India (2004), tobacco advertising, in direct or indirect form, boosts consumption.

Section 5 of the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA, 2003), prohibits all direct and indirect advertisements of the tobacco products. The prohibition also extends to any activity that promotes the use or consumption of cigarettes or any other tobacco products.

The advertisement of Pan Masala is regulated by Section 30 of the Food Safety and Standards (Packaging and Labelling) Regulations, 2011, issued under the Food Safety and Standards Act, 2006, which states that every package of Pan Masala and advertisement relating thereto, shall carry the warning, “Chewing of Pan Masala is injurious to health.” 

Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations 2011 issued under the Food Safety and Standards Act 2006 by the Food Safety & Standards Authority of India (FSSAI), lays down that tobacco and nicotine shall not be used as ingredients in any food products. Therefore, Gutkha is a prohibited product under the Food Safety and Standards (Prohibition and Restrictions on Sales) Regulations 2011 under the Food Safety and Standards Act, 2006, and hence its advertisement is also prohibited.

Image courtesy: NewsHimachal

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Friday, 13 March 2015

Music composer M Jayachandran launches #LivesBachaoSizeBadhao

Close on the heels of ace cricketer Rahul Dravid coming in favour of larger graphic health warning on tobacco products, Kerala’s well-known music composer, singer, and musician M Jayachandran has also publicly endorsed this cause. 

The musician behind many a hits launched the online petition campaign #LivesBachaoSizeBadhao in Kerala on ‘No Smoking Day’ today and signed it live before the media and tobacco control advocates, signalling the need for mass public support. 

The online petition appeals to the Hon’ble Union Minister for Health & Family Welfare Shri JP Nadda on behalf of 27-year-old tobacco-induced oral cancer victim Sunita to implement larger picture warnings on tobacco products. The campaign mounted on change.org is available at http://chn.ge/1Dy6Q

Likening tobacco control efforts to music of goodness and health, Shri Jayachandran, in his post-launch interaction said, “The increased use of cigarettes and tobacco products among youth is worrying. Starting with cigarettes and tobacco, youngsters are soon lured into use of drugs. The society has an obligation to protect younger generation from the use of tobacco products.” 

Shri Jayachandran also expressed solidarity and strong support to the movement for a tobacco-free Kerala. 

Dr Paul Sebastian, Director, Regional Cancer Centre and Vice Chairman of Tobacco Free Kerala, which is driving this campaign in the state said, “The online campaign is an extension of on-the-ground campaign in which over 900 signatures were amassed from a cross-section of society across all 14 districts in just two weeks. Pictorial warnings are a cost-effective means to communicate the harms of tobacco use. It has been demonstrated that picture health warnings are more effective than text-only warnings; it effectiveness increases with the size of pictorial warnings.”

Dr Sebastian also acknowledged and thanked the support of medical community and management of Regional Cancer Centre here; Malabar Cancer Centre, Kannur and Baby Memorial Hospital, Kozhikode, officers and staff of HLL Lifecare Limited, Trivandrum besides teachers, students, media representatives and the public for wholeheartedly participating in the campaign to bring down tobacco use in our state and country.

Dr PG Balagopal, Addl. Professor, RCC said, “Nearly a quarter of Kerala’s adult population use tobacco in any form, potentially increasing their risk to life-threatening diseases including cancers, heart attacks, and stroke. Large pictorial warning on tobacco product packs will inform and prevent prospective customers – children and youth – from initiating and getting addicted to tobacco use.”

Sharing his travails, tobacco-induced oral cancer victim Retd. Circle Inspector Shri M Hussain Kunju said, “I started cigarette smoking at the 17. By the time I was 35, I was afflicted with tongue cancer for which I have been under protracted treatment at Regional Cancer Centre.” He also appealed all to keep away from this dangerous habit and participate in the online campaign to register their support for larger pack warnings.

On 15 October 2014, the Government of India brought a notification requiring tobacco-manufacturing companies to devote at least 85 per cent of the surface areas of all tobacco products packages on both sides for text and picture depiction of the statutory warning, ‘Tobacco Kills’ and ‘Smoking Kills’. 

Cricketer Rahul Dravid has applauded the Government of India for mandating 85% pictorial health warnings on tobacco product packages. This has elevated India from 136th position in the Global Cigarette Package Health Warnings Ranking to second place. 

Shri S Jayaraj, State Coordinator, Tobacco Free Kerala also spoke. 

To sign the petition, click here
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Sunday, 8 March 2015

Tobacco Free Kerala condoles demise of Speaker


Tobacco Free Kerala condoles the passing away of Hon'ble Speaker of the Kerala Legislative Assembly Shri G Karthikeyan. 


A tobacco control enthusiast, the Speaker had taken pains to understand and share the grief of tobacco-induced cancer victims during an interaction with them on 20 May 2014. 


He had called for more proactive interventions to bring down tobacco use in the state and assured all support for bringing down the disease burden due to tobacco use in Kerala.

Shri Karthikeyan, 66, died on 7 March in a hospital in Bangalore, where he was undergoing treatment for liver cancer. 


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Tuesday, 24 February 2015

Tobacco kills two in three smokers: Australian Study

A large Australian study of more than 200,000 people has provided independent confirmation that up to two in every three smokers will die from their habit if they continue to smoke.

The research, published today in the international journal BMC Medicine, is the first evidence from a broad cross-section of the population to show the smoking-related death toll is as high as two thirds.

“We knew smoking was bad but we now have direct independent evidence that confirms the disturbing findings that have been emerging internationally, said lead author Professor Emily Banks, Scientific Director of the Sax Institute’s 45 and Up Study and a researcher at the Australian National University.

“Even with the very low rates of smoking that we have in Australia we found that smokers have around three-fold the risk of premature death of those who have never smoked. We also found smokers will die an estimated 10 years earlier than non-smokers.”

Until relatively recently it was thought that about half of smokers would die of a smoking-related illness, but newer studies in UK women, British doctors and Amercian Cancer Society volunteers have put the figure much higher, at up to 67%.

“We have been able to show exactly the same result in a very large population-wide sample,” Professor Banks said.

The research is the result of a four-year analysis of health outcomes from more than 200,000 men and women participating in the Sax Institute’s 45 and Up Study ? the largest longitudinal study of healthy ageing in the Southern Hemisphere.

Australia has one of the lowest smoking rates in the world – at 13% of the population and is an international leader on plain cigarette packaging. “But our findings are an important reminder that the war on tobacco is not yet won, and tobacco control efforts must go on,” Professor Banks said.

The research was supported by the National Heart Foundation of Australia in collaboration with major 45 and Up Study partner Cancer Council NSW and was conducted by a national and international team. It also found that compared with non-smokers, smoking just 10 cigarettes a day doubles the risk of dying and smoking a pack a day increases the risk four- to five-fold.

The NSW Heart Foundation’s CEO, Kerry Doyle, said the Australian Government was on the right path in driving down smoking rates through initiatives like tax increases and plain packaging.

“Higher tobacco prices have been shown to be the most effective intervention available to governments to reduce demand for tobacco. With smoking being a major cause of cardiovascular disease, including heart attack, stroke and peripheral vascular disease the more deterrents people have between them and smoking, the better,” Ms Doyle said.

Scott Walsberger, Tobacco Control Manager at Cancer Council NSW, said the research results highlighted an important message for smokers: “It’s never too late to quit ? no matter what your age, or how much you smoke.”

Source: ScienceBlog
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Saturday, 21 February 2015

Smokefree workplaces linked to smokefree homes in India

Adults in India are substantially more likely to abstain from smoking at home if they are prohibited from smoking at work, according to a study published in Tobacco Control - an international peer-reviewed journal for health professionals and others in tobacco control.

The percentage of respondents employed indoors (outside the home) working in smoke-free environments who lived in a smoke-free home was 64.0% compared with 41.7% of those who worked where smoking occurred. Indian states with higher proportions of smoke-free workplaces had higher proportions of smoke-free homes. In the individual-level analysis, working in a smoke-free workplace was associated with a significantly higher likelihood of living in a smoke-free home.

The authors of the study, from Imperial College London and the Public Health Foundation of India (PHFI), say the findings suggest that the implementation of smokefree legislation in India may have resulted in substantial health benefits for the population, particularly for women and children.

“This study suggests that, in India, there is good evidence that smokefree laws in workplaces are associated with a reduction in second-hand smoke at home,” said Dr John Tayu Lee, from the School of Public Health at Imperial College London, who led the study.

“The results support the idea of ‘norm spreading’, whereby restrictions on smoking in public places make it seem less acceptable to expose others to second-hand smoke more generally, including at home,” said Dr Christopher Millett, from the School of Public Health at Imperial. “They highlight the importance of accelerating the implementation of smokefree legislation more widely in India.” Dr Millett is also a Visiting Senior Research Fellow at PHFI.

"Achieving sustained and equitable reductions in SHS exposure is a high public health priority for India. Our findings highlight the importance of accelerating the implementation of existing national tobacco control legislation on smoke-free public places (Section 4 of the Cigarettes and Other Tobacco Products Act 2003) building on earlier successes in achieving smoke-free environments," the study notes. 

The study can be downloaded here
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Tuesday, 10 February 2015

Call for bigger health warnings on tobacco product packs

Concerned over the growing tobacco menace in India, health organisations from across the world have asked the Indian Government to oversee new warning labels on tobacco packets.

Tobacco products like cigarettes and gutkas will have more prominent health risk warnings from April 1 this year. 

“Similar health warnings were first proposed in 2006 and they were vigorously opposed in and out of courts by the tobacco industry.

"The Government of India persevered until announcing the new measures last year. The tobacco industry will certainly object to the warnings, just as it does in other countries. 

"We recommend that the tobacco industry simply be ignored and that priority be given to the health of the Indian population,” wrote Laurent Huber, director of Framework Convention Alliance (FCA), Switzerland. 

“If countries such as Nepal, Thailand, Australia and Uruguay can implement similar size warnings (80-90 per cent), there is no reason why India cannot. 

"The FCA also notes that in India, the new warnings will apply to tobacco products generally and not just cigarettes. This is essential, given the diversity of tobacco products in Indian market,” he added. 

Various international public health organisations working on tobacco control and cancer have individually written letters to Prime Minister Narendra Modi and Union Health Minister J.P. Nadda on the new tobacco package issue. 

“The large and improved warnings on tobacco packs serve as a no-cost and proven mass education tool that can protect the health of our people... The best evidence of their efficacy lies in the tobacco industry’s opposition to the warnings. 

"The Government needs to prioritise the nation’s health over narrow commercial interests,” said Shoba John, Health Bridge programme director. 

Former Union Health Minister Dr Harsh Vardhan had on October 15, 2014, issued a notification requiring tobacco manufacturing firms to devote at least 85 per cent of the surface areas of all tobacco products on both sides to graphically and literally represent the statutory warning. 

“Awareness has increased gradually regarding the harmful effects of tobacco. This decision will further help,” said Dr Jagdish Kaur, Chief Medical Officer at the Union health ministry, adding: “Industries have been given enough time to prepare new stocks.” 

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