August 13, 2002
By AMY WALDMAN
BOMBAY, Aug. 6 - 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
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.
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 Raghavendra, 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
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
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
"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
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
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
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
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
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."