Absence of evidence is not an evidence of absence” is a dictum which any rational individual always need to keep in mind. Presumably therefore, the absence of Indian evidence against tobacco hazards does not imply that the Indians are likely to behave differently than people anywhere in the world. We all know that the colour of blood of all human beings is red irrespective of their being blacks or white, or for that matter, Indians or Americans. Similarities aside, the fact remains that there is no dearth of Indian evidence on tobacco related harms. Obviously, the recent Parliamentary Committee Report on the subject is an act of short
THE INDIAN EVIDENCE ON TOBACCO HAZARDS
sightedness.
It seems that the Committee has conveniently decided to overlook the bulk of reports and research publications on the subject which have accumulated in the last few decades. The writer of this article himself has been engaged in clinical work on tobacco related disease since 1970s. One of my first paper which was published in 1982 in the international journal Thorax clearly showed relationship of lung cancer with tobacco smoking. The relative risk for smoking was reported as about three times more than in non-smokers. Similarly, higher risks were reported in the publications from Mumbai for several different types of cancers.
Cancer Registry Reports from India have regularly appeared which clearly show a significant relationship of cancers with both cigarettes and bidis. Most significant are the important Reports published by the Ministry of Health and Family welfare, Government of India which summarize the Indian evidence. A 2008 Report “Bidi Smoking and Public Health” was entirely devoted to bidi smoking. Only god can help if we continue to harp on the “lack of evidence’.
It is important here to understand that the cause and effect relationship in medicine is established on basis of multiple studies which are necessarily not possible to undertake in experimental laboratories. It is different from the experiments conducted in basic science laboratories. For causal relationship of diseases, one has to rely heavily on clinical and epidemiological data. Factually, these two types of studies constitute the core of medical research which represents factual relationships. From public-health view-point, it is more important to demonstrate clinical and epidemiological relationships with risk-factors than the experimental relationships. In any case, there are enough analytical studies and biochemical laboratories to show the presence of a large number of cancer-producing chemical in tobacco and their cancer-producing effects on experimental animals.
While Indian evidence on tobacco hazards including the cancers is substantial, there is far greater evidence from the American and the European continents. I must lay stress on the fact that factual information on disease causation is quite universal. It is quite true that there may be small differences in disease relationship in different countries. Some of the clinical risks and disease manifestations may vary depending upon local cultural, socio political and economic factors. But the basis facts in science remain the same. Why only cancer? This is also true for other diseases like asthma, hypertension, diabetes and everything else. Factually speaking scientific research is universal in its application. We must not trivialize the issues by limiting the scope of research findings to a particular region on a country. We must also remember that we heavily rely on the Western data for most of cancer related research including on its diagnosis and treatment. It is irrelevant that the International companies have their own motives. That they have. But we also need to keep the health interests of the Indian people in our minds.
Cancer is not just one disease- it is a general terms for a large number of different diseases with similar a characteristic of relentless progression to early death. Cancers of lung, blood and brain have different rates of progression than cancers of tongue, mouth and jaws. Nonetheless, all forms of cancers will result in permanent disfigurement and disability. Interestingly, the only other commonality between most cancers is the relationship to tobacco which remains as the root cause. Undoubtedly, tobacco is the strongest cancer providing consumer product. There can be no greater truth than what was said by the WHO Director General, Dr Gro Brundtland: “A cigarette is the only consumer product which when used as directed kills its consumer.”
The same sentiment was truthfully echoed by Anne Edwards by Philip Morris, the major multi-national tobacco company: “What I think is clear is if someone came to us with a cigarette today and said, hey, here is a new product, I’m going to bring it to market. Would it be allowed in the market anywhere? No, it would not. It is a very harmful product” (on Sex, Lies and Cigarettes)
Tobacco is also responsible for a large number of non-cancer diseases. It can be easily listed as the number one cause for a majority of heart attacks, strokes, chronic respiratory diseases and general ill health. In women of child bearing age, tobacco is responsible for infertility, prematurity and low birth weight of new born babies, and abortions.
Smoking is not just injurious for a smoker. It damages the health of non-smokers who live in the company of smokers. This is a type of second hand or passive smoking which is directly related to cancers and other diseases. Such relationship which was first shown amongst non-smoker wives of smokers from Japan, has been also reported from a large number of other countries.
The only valid argument which the Committee has put forwards is related to the loss of jobs for bidi workers and tobacco farmers. A large number of studies are now available which show that the overall economic loss from tobacco related hazards is far more than the revenue loss from tobacco. A number of remedies including alternate crops have been suggested in several reports to compensate for the losses of farmers. Undoubtedly, the health is the most crucial issue and tobacco-control forms the core for National Disease Control Programmes of Government of India. One cannot lose sight of the fact that the Government of India is signatory to the International Frame Work Convention on Tobacco Control. The country is committed to undertake several mandatory steps to reduce consumption and production of tobacco
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Dr Surinder K. Jindal, MD, FCCP, FAMS, FNCCP
(Ex-Professor & Head, Department of Pulmonary Medicine
Postgrad Instt of Med Edu & Res, Chandigarh, India)
Medical Director, Jindal Clinics, SCO 21, Dakshin Marg, Sector 20 D,
Near Guru Ravi Das Bhawan, Chandigarh, India 160020.
Email: dr.skjindal@gmail.com
Website: jindalchest.com
Ph. Clincis: +91 172 4911000, Res. +91 172 2712030/ 31
