Dirty Secrets… The Smoke-Less Affair

Post written by Shalini

90% of oral cancer cases among Indian men are attributable to tobacco consumption, according to the World Health Organization.

Since 2010, India has been engaged in a major war against smokeless or oral tobacco products, including a ban on gutka. Gutka is a popular oral tobacco product that is a highly addictive concoction of more than 3000 chemicals, including heavy metals like lead and ingredients found in coal tar. Gutka was sold for as cheap as a rupee or two, making it by far the cheapest smokeless tobacco product available.

As a journalist, I had the opportunity to cover both sides of the story. The smokeless tobacco industry in India proved to be a rich lobby but one that ultimately lost the legal war.. Its most profitable product is now banned. But while that ban was struggling to make its way to each state in India, the industry endlessly debated the legality of the law. The Indian tobacco industry also argued that while restrictions were being tightened on the domestic industry, the multinationals that manufacture mostly cigarettes were facing no such restrictions on their deadly products. The industry argued against cancer surgeons, public health activists, the health ministry, even cancer victims. Perhaps unsurprisingly, the industry continues to circumvent the ban in many innovative ways.

But what interests me is one particular argument the industry made against the ban on gutka. The industry questioned the link between chewing tobacco and cancer. They have been quoted as saying that cancer can be caused by pollution, pesticide residues in the environment and even chillies! They questioned, how can a doctor or any public health activist or the government prove that cancer was caused by chewing tobacco? Oral cancer surgeons and cancer institutes across the country had already written to the Prime Minister, stating that cancer wards are burgeoning with victims of tobacco, especially oral tobacco and imploring the government to ban such products. But the industry wasn’t satisfied.

But I have now found some answers that will be satisfying, from the industry’s own internal documents.

Here’s an industry document (BATES number: 521034348-52103435) from the Tobacco Legacy Documents labelled as a ‘privileged’ and ‘internal correspondence’ from the year 1979 – a letter written to the Brown & Williamson Tobacco Corporation, detailing what was discussed at a meeting of the ‘Smokeless Tobacco Council’ on health research.

And here’s what it confesses. I quote:

“…the prevailing theory is that the best position for the STC (Smokeless Tobacco Council) is on the question of the effect on the human body of the whole product and to identify various constituents, many of which might be defined as tumorigenic in other contexts would weaken the industry’s position. In other words, it is “the other side’s” duty to produce allegations that certain constituents result from the use of smokeless tobacco and are harmful.”

It is important to note here that the (European) Smokeless Tobacco Council is a lobbying group that campaigns against the European Union’s ban on oral tobacco products. There’s a similar body in both the US, and in India  the SLTF or the Smokeless Tobacco Federation, which acts as the mouthpiece of the industry.

In this document, it is clear that the Smokeless Tobacco Council’s own health research had found back in 1979 that not one but many of the constituents in its products were cancer causing. And, that they knew it all along.

When it says it is “the other side’s” duty to produce allegations – it is cleverly putting the responsibility of proving the charges on whoever tries to challenge them. In this case, doctors, cancer surgeons, victims and governments – across the world. And they have been doing this for more than three decades.

While the smokeless tobacco industry in India is said to have ‘domestic’ roots, it is interesting to note that these companies sell their products in many other countries including the US. The Indian industry adopted the same argument, strategy and method of dealing with the allegations that smokeless products were causing a public health epidemic.

Another related internal document (Bates number: 521034371-521034372) shows that the cigarette company Brown & Williamson Corporation made a contribution of five thousand dollars to the Smokeless Tobacco Council, while choosing to not become a member. The cigarette companies took an interest in the smokeless products and knew how harmful they were, but decided to not let out the evidence. What has been typically happening in India is that each time the issue of health harms is raised, the smokeless tobacco companies and the cigarette companies turn to blame the other. They also come together at times that best suit them, for example when protesting against taxes or pictorial warnings. But once the pictorial warnings were issued, the smokeless industry fought with the government, saying the cigarette industry got away with watered down warnings. The cigarette industry was in on the smokeless industry’s secrets.

206 million Indians consume smokeless tobacco products and nearly 5 million Indian children are already addicted to them, according to the Global Adult Tobacco Survey (GATS) and Global Youth Tobacco Survey (GYTS). That’s more than the population of Brazil, or the population of Egypt, or Mexico. That’s as many lives at risk of painful and fatal cancers. That’s many little children whose lives are at stake. That’s an industry which makes money out of filling coffins. Of ruined lives.

That’s a dirty secret, indeed.

Shalini has worked as a television health journalist for 9 years, with CNN-IBN (Indian affiliate of CNN International) in India. She has covered disease outbreaks, medical breakthroughs, and has extensively reported on public health epidemics like tobacco control. At present, she is working with the Public Health Foundation of India.

  • Key to India’s 200 million smokeless users breaking free is understanding and respect for findings from lapse/relapse studies such as Brandon 1990 showing that the distinction isn’t necessary, as any taste of tobacco when quitting nearly always results in relapse. It’s called the Law of Addiction, that one equals all, that “Administration of a drug to an addict will cause re-establishment of chemical dependence upon the addictive substance,” that one dip, chew, puff or vape will be too many, while thousands won’t be enough.

  • Jon Fell

    It might be helpful to make a few points here on the differences between the situation in India and that in the US / Europe.
    1) As far as I am aware, the European Smokeless Tobacco Council (founded 1989) has nothing to do with the Indian Smokeless Tobacco Federation and shares none of the same industry members;
    2) The US Smokeless Tobacco Council merged with the Tobacco Institute and no longer exists; the Tobacco Institute was disbanded as part of the US 1998 Master Settlement Agreement. I do not recall it having any Indian company members.

    3) While some Indian companies may be involved in selling smokeless tobacco in the US, they account for a tiny fraction of share in the overall US smokeless tobacco market;

    4) Indian smokeless tobacco in its various forms is very different to the smokeless tobacco consumed in the US and in Scandinavia [1]. Almost certainly, the 1979 US tobacco industry documents referred to do not concern the kind of smokeless tobacco products widely available in India. No European or US tobacco companies are involved in selling traditional Indian smokeless tobacco products in India nor, to my knowledge, have they ever been; and

    5) Substantially all of the European Smokeless Tobacco Council’s efforts in lobbying the EU to lift the European Union’s ban on oral tobacco products (outside Sweden, where they are legal) relate to a type of Scandinavian oral tobacco known as ‘snus’. There is a very wide body of evidence, supported by many public health experts, suggesting that snus is a much less risky alternative to cigarettes – and also less dangerous than some other forms of smokeless tobacco.

    For instance, WHO’s Study Group on Tobacco Product Regulation wrote in a 2009 publication [2] that “risks [associated with smokeless tobacco] vary dramatically by geographic location and composition of the smokeless tobacco product used, with very high risks evident for products used in Africa and the Indian subcontinent and lower risks occurring in studies conducted in the US and Scandinavian countries, particularly in Sweden where low nitrosamine snuff has been in widespread use”.

    A more recent review of the relative harms of various tobacco products, including different forms of smokeless tobacco, was published by Nutt et al in 2014 [3]. That work suggests that the harm caused by snus is very much lower than that caused by cigarettes and that unrefined smokeless tobacco (the type of product typically available in India), while more hazardous than snus, is nonetheless also significantly less dangerous than cigarettes.

    There is a lot of literature available on snus and harm reduction – for further reading you might start with the May 2011 letter written to the EU Commission by various public health experts (available on the website run by Clive Bates, former director of Action on Smoking & Health in the UK) which links to various interesting references [4].

    Jonathan Fell

    Former tobacco equity analyst, now investor. I do not currently own any tobacco stocks but have done in the past and may do so in future.

    References
    [1] WHO. The Scientific Basis of Tobacco Product Regulation, 2009. See Table 1.1, pg 4. Available at http://www.who.int/tobacco/global_interaction/tobreg/publications/9789241209519.pdf
    [2] WHO. Study Group on Tobacco Product Regulation, 2009. Available at http://whqlibdoc.who.int/publications/2009/9789241209557_eng.pdf?ua=1
    [3] Nutt et al, 2014. Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach. Available at http://www.karger.com/Article/FullText/360220
    [4] The advancement of the scientific basis for the EU Tobacco Products Directive – Letter from practicing scientists to the European Union. 2011. Available at http://www.clivebates.com/?page_id=461

  • Shalini Anand

    While there are no drawn out connections bwn the various smokeless tobacco groups, interestingly, the strategies used by most of these groups are very similar. In fact, bordering on the same arguments. The blog is essentially about how the cigarette and smokeless tobacco companies are in cohorts with each other at times. They may or may not support each other openly, but as we dig deeper into the legacy documents and look at some of the trends in the past, they do. And this trend is being found to be similar, globally. That is where the India example is coming. The Legacy documents reveal a similar trend in the past in Europe, which is really the point.

    Another point you’ve made is about the how the Indian smokeless tobacco products do not make a huge dent in the US market. But since the ban on sale of gutka in India, Indian manufacturers are focusing on the exports (that’s not banned). Again, this is a developing trend.

    The point we are drawing through the 1979 documents again is not whether the products are similar or not, but that of a cigarette company taking interest in the smokeless tobacco products. We are comparing that ‘trend’.

    In terms of the harmful effects of smokeless tobacco, a lot of experts in India have argued about it’s health harms vs the damage caused by cigarettes (http://ibnlive.in.com/news/100-million-deaths-due-to-smoking-in-last-100-years-in-india/305160-75.html). Again, this is really about comparing trends and how both smokeless and cigarette companies have mutual interests and act together or against each other case by case.