 |
| About Bioline | All Journals | Testimonials | Membership | News |
|
||||||
|
||||||
Indian Journal of Medical Sciences, Vol. 61, No. 6, June, 2007, pp. 317-319 Editorial Areca nut use in India Gupta PrakashC Healis - Sekhsaria Institute for Public Health, Navi Mumbai Code Number: ms07048 The use of areca nut and betel quid are practices of great antiquity in India. The association of these practices with oral cancer was noted over 100 years back; yet the chewing of areca nut in India was considered to be a comparatively innocuous practice that had complete sociocultural acceptance. In recent years, however, it has emerged as a significant public health problem. Conversion of a normal cultural practice into a public health problem started probably about 400 years back after tobacco was introduced into India by European traders. In addition to its use for smoking, as the Europeans demonstrated, tobacco somehow got mixed with betel quid and began to be chewed. When did it actually happen, we do not know; but association with a culturally accepted substance gave tobacco also a similar status. [1] During the second half of the 20 th century, the causal association between chewing of betel quid with tobacco and oral cancer was well established, and it could no longer be regarded as a completely innocuous practice. [2] The major culprit was clearly tobacco in the quid; however, probably because of its ′exotic′ appeal, areca nut was erroneously thought of as playing a more important role. [3] Areca nut was comparatively off the hook in scientific writings and evaluations [4] ; although by 1980s, it was clear that areca nut chewing was responsible for oral submucous fibrosis - a progressive debilitating disease without any known cure, and that was established as a precancerous condition. [5] Up to the 1980s, available data showed oral submucous fibrosis as a comparatively rare disease, occurring generally among older individuals, mostly betel quid chewers. By 1990s, the situation had changed; the population prevalence of oral submucous fibrosis had increased manifold and it had become a disease mostly occurring among young individuals. [6] As a precancerous condition, more submucous fibrosis should mean more oral cancer; and a significant increase in the incidence of oral cancer among young individuals was verified. [7] The reason for this sudden increase in oral submucous fibrosis was not difficult to identify. During 1970s and 1980s, chewable mixtures containing areca nut (generic name - pan masala), quite often tobacco as well (generic name - gutka), were industrially manufactured and marketed. The industry used full power of media, including the electronic media, to advertise and market their products, specifically targeting young individuals. The industry had a phenomenal growth, and it was successful in hooking an entire new generation. The paper in this issue of the journal provides some new evidence and reiterates several of the statements made here. [8] It shows that a phenomenon that started from the northern parts of India has reached deep south and even penetrated into rural areas. It shows that a large proportion, nearly half of all areca nut users, comprises those using industrially manufactured products. It also shows that most of the users are young individuals. Thus the new epidemic of oral submucous fibrosis and oral cancer among young individuals should be expected to reach all corners of India, if it has not already done so. The tobacco products are covered by a recent Act, and the Act includes gutka. Therefore gutka cannot be directly advertised now. Areca nut products, however, are marketed by the same manufacturers using identical brand names. They are not covered by the Act, and therefore the areca nut products bearing identical brand names as tobacco products are still advertised and promoted using all possible media, including electronic media. That obviously functions as surrogate advertising for their tobacco-containing product gutka, which is their main product. There is now ample reason to bring areca nut products into the ambit of the Act covering tobacco products. In a recent exercise, the International Agency for Research on Cancer of the World Health Organization evaluated areca nut as a carcinogenic substance with the help of newer data, [9] reversing its earlier evaluation (vol. 37). [4] The strength of the evidence was considered sufficient to conclude that the use of areca nut causes cancer among humans. Bringing areca nut products into the ambit of ′tobacco products′ Act is absolutely essential to decelerate the rapidly evolving epidemic of oral submucous fibrosis and oral cancer among young individuals in the country. References
Copyright 2007 - Indian Journal of Medical Sciences |
| |||||||||
