Editorial: Licensed to kill

Published in The Hindu on April 2, 2012

That tobacco products are singularly responsible for a large number of cancer deaths in adults has once again become strikingly clear. According to a paper published recently in The Lancet, in India, tobacco-related cancers were found in 2010 to be responsible for some 1,20,000 deaths — 84,000 in men, and 36,000 in women — among adults aged 30 to 69. That tobacco-related cancers constitute about 30 per cent of the total mortality (3,95,000) from all cancers in the same age group is proof of the lethal effects of tobacco products. Oral cancer was found to cause more than twice as many deaths as lung cancers. The reasons are not difficult to find. According to the 2009-2010 global adult tobacco survey, 170 million Indians chewed tobacco, and 120 million smoked. While a majority of rural women chewed tobacco, many men in urban and rural areas chose to chew and smoke. Tobacco that remains in close contact with the sensitive mucous membrane of the oral cavity for extended periods is a potent and lethal carcinogen. What makes tobacco use all the more dangerous is that besides causing organ-specific cancers, it increases the risk of death from other medical causes. In urban areas, smoking-related deaths are more from heart attacks, while tuberculosis and respiratory diseases are the main causes in the rural areas. With smoking accounting for five per cent deaths among women and 20 per cent among men, a 2008 study published in the New England Journal of Medicine estimated about one million deaths in 2010 in the 30 to 69 age group.

Evidence from elsewhere paints an equally compelling picture. We know from a study that the mortality rate from lung cancer in 2009 in the American State of Utah was nearly 75 per cent lower than Kentucky. The reason: the prevalence of smoking in Utah was 10 per cent compared with 25 per cent in Kentucky. The single-minded pursuit of governments around the world should, therefore, be to reduce tobacco consumption through all means. The most effective way is to ramp up taxes. France has shown the way by tripling taxes between 1990 and 2005 and halving consumption. Using powerful pictorial warnings, as in many other countries, rather than the currently used ineffectual ones, and rotating them every year instead of once in two years, is yet another means. Maximum gain can be achieved by resorting to both these measures simultaneously. The government showed great eagerness to introduce into the national immunisation programme the human papillomavirus (HPV) vaccine to prevent cervical cancer, the most common cancer among women in 2010. Sadly, it seems to lack the gumption to clamp down on killer tobacco products. Will the latest research results stir it into action?