The Blood Money Obstructing the Prevention of Oral Cancer
If actors and cricketers refuse to endorse pan masala, it will go a long way in reducing the consumption of gutka and the incidence of oral cancer in India.
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Bhavin Jankharia
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Bhavin Jankharia
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As I have said before, there are two aspects to preventive medicine. The first is detecting a problem early (high blood pressure, diabetes, some cancers) and treating it in the hope that early detection and timely treatment will eventually allow us to live long, healthy. The second and more important preventive method, which does not get a lot of press because there is no money to be made (tests, treatment) is preventing the problem from occurring in the first place.
Let’s take oral cancer (cancer of the mouth). It is the 2nd commonest cancer in India in both sexes combined after breast cancer and the commonest cause in men, with an incidence equal to lung and esophageal cancers combined [1] with dismal 5-years survival rates. It however does not get as much press as lung or breast cancer, mainly because it is not a cancer of the Western world and it is not a “sexy” cancer that gets influencers and evangelists a lot of press and publicity.
Most oral cancers can be prevented because unlike many cancers that don’t have a direct cause, oral cancer does. Gutka (tobacco, areca nut) is responsible for the majority of oral cancer cases. If gutka and supari are banned and people do not have access to these, the cases of oral cancer will plummet significantly, just as slowly but surely, smoking bans are helping to reduce the incidence of lung cancer [2].
While regular check-ups of the mouth may help in picking up oral cancer early, these are difficult to implement at a population level and given the poor follow-up, there has been no significant impact of screening camps on the incidence of oral cancer [3].
It is much, much more important therefore to try and prevent people from chewing gutka and supari, in the first place as compared to spending money on camps to find oral cancer in people who chew gutka.
Gutka bans have been in place in some form or the other since 2002. However, these bans are easily circumvented. As Keyur Adhikari and his colleagues wrote in 2020 [4], they were able to purchase gutka easily in 5 Mumbai Metropolitan areas, in 3 forms, 1. Marked “export” only. 2. Sold in twin packs (tobacco and pan masala sold separately to be mixed by the individual), and 3. Packaging that does not use the word gutka. Clearly, a lot needs to be done to implement legislation to prevent people from accessing gutka.
Legislation however can only help when firmly implemented, the way smoking bans have been implemented in public spaces, which are also just a halfway measure until the production and sale of cigarettes are totally banned. Nevertheless, there is a clear reduction in the incidence and prevalence of smoking, especially in the younger generation, because of a combination of these bans, better understanding of the ill-effects of smoking, warning labels on cigarette smoking and also likely, peer pressure [5].
The same is unfortunately not true of gutka. The irony is that cigarettes are easily available, but have no surrogate advertising, while gutka production and sales are banned in most states in India, but surrogate advertising is used to push gutka sales by having famous actors and cricketers endorse pan masala as a cool thing to consume.
Mr. Amitabh Bachchan, Mr. Ranveer Singh, Mr. Shahrukh Khan, Mr. Ajay Devgan, Mr. Akshay Kumar, Mr. Kapil Dev, Mr. Sunil Gavaskar, Mr. Virendra Sehwag have a lot to answer for the blood money they have earned through surrogate gutka or pan masala advertising. If even one individual gets hooked onto gutka because of the ads in which these individuals have endorsed pan masala, and that person develops oral cancer because of that gutka use, that’s blood on their hands. This is direct cause and effect, where these film stars and cricketers are directly pushing a dangerous substance that causes oral cancer and accelerates deaths.
There is no excuse. Is it the money? Or have they been stupid in not understanding the consequences? And why the hypocrisy? For example, Mr. Akshay Kumar is seen in one sanitary pad ad castigating a man for smoking, when he could have used that cigarette money to buy a pad to alleviate his wife’s suffering…the same actor pushes pan masala? Seriously? And Mr. Bachchan, who is seen in all kinds of social awareness ads, pushes pan masala?
The excuse often used is that gutka use is a personal, individual choice. This is bullshit. When smoking is shown in films as part of a character’s profile, the audience intuitively understands that this is the character, not the actor, smoking (no character seems to use gutka as a cool character trait in a movie). When the actor participates in an advertisement, they are specifically endorsing the use of that substance, whether they themselves consume it or not, with the idea of influencing people to use that product.
What is wrong with them? It is as if their credibility is on sale to the highest bidder. We should therefore acknowledge people like Mr. Sachin Tendulkar and Mr. Gautam Gambhir who have gone on record saying they will refuse to endorse pan masala, as well as others who may have also refused to do such ads, but without us being aware of their decisions.
Oral cancer is rare in countries where gutka and supari are not common [6]. This tells us clearly that if we can reduce the consumption of gutka, the incidence of oral cancer will fall significantly. Gutka bans will have effect over a period of time, if there is no one pushing it and if perhaps the same influencers and actors and cricketers go on record saying that gutka and pan masala are harmful and should not be used.
Blood money is blood money. It has pushed back oral cancer prevention by a generation and it will take much more time now for gutka bans to make a difference through a combination of better policing and bans on surrogate advertising in all forms.
Until then, in our atmasvasth quest to live long, healthy, we need to not use gutka, and if we see or know anyone consuming it, we should try and counsel them to stop. Period. And stop believing anything that these so-called celebrities spout outside of their profession.
I use ChatGPT4 as a search engine these days. For those interested in going through the Q & A related to this topic, here is the link.
Footnotes:
1.https://gco.iarc.who.int/media/globocan/factsheets/populations/356-india-fact-sheet.pdf
2. Hahn EJ et al. Lung cancer incidence and the strength of municipal smoke-free ordinances. Cancer. 2018 Jan 15;124(2):374-380. doi: 10.1002/cncr.31142.
3. Sharma P et al. Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention. Fam Med Community Health. 2023 Dec 17;11(Suppl 1):e002397. doi: 10.1136/fmch-2023-002397.
4. Adhikari K, et al. Observed Circumvention of the Gutka Smokeless Tobacco Ban in Mumbai, India. Tob Regul Sci. 2020 Sep;6(5):331-335. doi: 10.18001/trs.6.5.3.
5. Lahoti S, Dixit P. Declining trend of smoking and smokeless tobacco in India: A decomposition analysis. PLoS One. 2021 Feb 25;16(2):e0247226. doi: 10.1371/journal.pone.0247226.
6.https://gco.iarc.who.int/media/globocan/factsheets/populations/36-australia-fact-sheet.pdf
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