What does one do with a newly introduced food product that is industrially manufactured and commercially marketed on a large scale, but has been shown conclusively to cause serious life threatening disease? The solution seems obvious—ban such a product. The process however, can be far more difficult than one would envisage.

Gutka in India is one example. It is a generic name for a product that contains tobacco, areca nut, and several other substances in powdered or granulated form and is sold in small aluminum foil sachets. The only known use of this product is that it is put in the mouth and then chewed and sucked. Later, it is generally spat out, or sometimes swallowed. As a commercial product,gutka was introduced less than three decades back, but today there are thousands of manufacturers ranging from small to very large, with a combined annual turnover in the order of several hundred million American dollars.

In addition to a major life threatening disease—mouth cancer—caused by oral use of any tobacco product,gutka causes another serious disease: oral submucous fibrosis. In this disease, fibrous bands develop in the mouth, mucosae loses their elasticity, and the ability to open the mouth reduces progressively. In extreme cases, victims may be only able to open their mouths enough to pass through a drinking straw. This disease does not regress and has no known cure. The most serious aspect of the disease is that it has a very high potential for cancer development: the relative risk is almost 400 times that of a non-user.

Oral cancer, like lung cancer, takes a long time to develop. The effect of gutka on the incidence of oral cancer therefore is not yet apparent, especially because the background incidence of oral cancer is already very high in India. However, oral submucous fibrosis among users seems to develop very fast and there have been many reports on the evolving epidemic of oral submucous fibrosis. This has generated considerable concern in the media.

There have been some attempts to curb and regulategutka promotion and use. In one such attempt, public interest litigation to ban the substance was filed in a state high court. The high court’s judgment directed the central government to find out whether gutka was a dangerous product. The Central Committee on Food Standards duly conducted hearings and investigations and concluded that it was a dangerous food product. The committee recommended an outright ban.

Understandably, this raised hopes among India’s tobacco control community that the government would now take action. But thegutka lobby swung into action and after many months, there have only been conflicting signals and statements from government officials, and no substantial progress. For example, one powerful minister declared that the government would not ban the product as that would affect many areca nut farmers. The health minister could only announce that the government would launch an educational campaign against gutka use. This is despite the fact that the largest manufacturer is on record saying: “Yes, gutka is harmful, and we have no objection to a ban; but the government should ban cigarettes first.”