Sweet but Deadly Addiction Is Seizing the Young in India

                      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
                      in England.

                      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
                      much earlier."

                      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
                      immodest opulence.

                      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."