Promoted by a slick and
many-tentacled advertising campaign, gutka, an indigenous form
of smokeless tobacco, has become a fixture in the mouths of
millions of Indians over the last two decades. It has spread
through the subcontinent, and even to South Asians in
England.
But what has prompted particular concern here
is the way that in the last 10 years, gutka - as portable as
chewing gum and sometimes as sweet as candy — has found its
way into the mouths of Indian children.
Young people
have become gutka consumers in large numbers, and they have
become an alarming avant-garde in what doctors say is an oral
cancer epidemic.
That, among other factors, has
prompted the state of Maharashtra, which includes Bombay, to
take an unusual step. It enacted a five-year ban, the longest
permitted by law, on the production, sale, transport and
possession of gutka, a $30 million business in the state,
effective Aug. 1.
Several other states have undertaken
similar bans, although some have been stayed by the
courts.
It is easy, on the streets of Bombay, to find
young men like Raga Vendra, now 19, a railway worker who began
taking gutka at age 11. It is also easy to find gutka sellers,
like Ahmed Maqsood, who say they have had customers as young
as 6.
Dr. Surendra Shastri, the head of preventive
oncology at Tata Memorial Hospital, noticed about five years
ago that his patients were getting younger, by about eight to
10 years. "High school and college students were coming in
with precancerous lesions," he said. "Usage was starting much
earlier."
India has 75,000 to 80,000 new cases of oral
cancers a year — the world's highest incidence, and about
2,000 deaths a day are tobacco related.
A 1998 survey
of 1,800 boys ages 13 to 15 from a wide range of socioeconomic
groups found that up to 20 percent were already using three to
five packets of gutka daily. The price is low: sometimes less
than two cents a packet. The contents, a mixture of
ingredients including tobacco, are usually placed in the cheek
lining, savored, then expelled.
Gutka was the product
of a packaging revolution that made an Indian tradition
portable and cheap. Many Indians have long chewed paan, a
betel leaf wrapped around a mixture of lime paste, spices,
areca nut and often tobacco. But obtaining paan required a
visit to a paanwallah — it was too messy to be
transported.
All of that changed with gutka, a dried
version of the concoction, but without the betel leaf,
preserved and perfumed with chemicals and sealed in a plastic
or foil pack.
Gutka could be used at will, at work or
at home or at school, and it was used, in very large
quantities. Sales of gutka and its tobaccoless counterpart,
paan masala, are now more than $1 billion a year, having
quintupled during the 1990's.
"What caused this boom of
oral cancers was this packaging of tobacco," said Dr. A. K.
D'Cruz, the lead head-and-neck surgeon at Tata Memorial
Hospital. "Convenience got them hooked."
Many consumers
say they welcome the ban, because they see no other way to
curb their addiction. Even some vendors like Mr. Maqsood have
embraced it, saying they felt they were trading in toxins.
"The chemicals used in gutka were poisonous," he said. "I have
seen some customers who can't open their mouth."
The
ban's critics, gutka manufacturers among them, argue that
countless other tobacco products remain on the market. While
vendors, fearing large fines, are largely observing the ban
for now, gutka can easily be bought just a state
away.
Gutka manufacturers contend that the ban stemmed
less from concern about children than from a desire to protect
cigarette makers, who are fighting for market share. The gutka
makers have begun running an ad that argues that if gutka is
banned, cigarettes should be as well.
"No government in
the world has been able to stop cigarettes," Dr. Shastri
countered. The gutka ban, he noted, is possible only because
of a law allowing the state to ban harmful foodstuffs.
"The gutka makers say the ban will have spurious
effects," he continued. "I don't care — 70 to 80 percent of
children won't have access to the black market, or to
smugglers. We will prevent children from taking it
up."
Gutka is seen by doctors as particularly insidious
because it contains many unhealthful additives, like magnesium
carbonate, and is cheap.
For children and teenagers,
smoking cigarettes remains taboo. Gutka has no social stigma
among peers, and it is easy to hide from
parents.
Padmini Samini, who started an antitobacco
advocacy group after her father got oral cancer, said she had
found cases in which gutka makers had given free samples to
children after school. Some of it was sweetened so much to
mask the harsh tobacco taste, she said, that children
considered it candy.
Gutka manufacturers managed to
erase whatever stigma was tied to using tobacco with paan by
marketing campaigns that made gutka use glamorous and socially
acceptable.
For about a decade India's version of the
Oscars has been sponsored by Manikchand, one of the
top-selling brands. Gutka manufacturers have sponsored
religious festivals, distributing free samples. In television
commercials, gutka gives actors the power to perform
superhuman feats.
That may be why Abinash Parab, an
ordinary laborer, thought he needed gutka to do his heavy
lifting job.
Until two weeks ago he was using 20 to 25
packets of Manikchand a day. "There was a sense of
intoxication" from gutka, he said.
What stopped him was
not the ban; it was the wards he passed through at Tata
Memorial Hospital when he went to get ulcers in his mouth
checked out. Tumors bulge from cheeks and jaws. There are
holes where larynxes used to be.
About 30 percent of
the cancers in India are in the head and neck, compared with
4.5 percent in the West. Furthermore, Dr. D'Cruz added, "most
of our cancers come a decade earlier than the West." They come
in the cheek and jaw, often preceded by submucosal fibrosis, a
hardening of the palate that can make it almost impossible to
open the mouth.
Rasiklal Manikchand Dhariwal, the
founder of Manikchand and the country's king of gutka, says he
has no such health problems, despite being a user himself. The
fruits of gutka's popularity are visible at his
14,000-square-foot home in Pune, where he lives behind guarded
gates in immodest opulence.
He exports gutka to 22
countries, and calls his product a health promoter and job
producer, noting that hundreds of thousands of Indians farm
tobacco for their livelihood.
Manikchand, he said, is
made with the highest level of quality control. He compared
its scent to a "French perfume." As long as the brand is of
high quality, he said, it is fine for children, although his
product is now marked "not for minors."
He disparaged
his competitors for making shoddy, possibly injurious
products. He also blamed consumers for overdoing it. "If you
take anything in excess it will also harm, no?" he said. "Even
milk." |
