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Panel’s questions will delay large cigarette packet warnings, says expert

An Indian parliamentary panel has raised questions about whether the health ministry’s move to increase the size of health warnings on cigarette packaging would reduce tobacco use, Reuters has reported.

The panel also raised concerns about whether this move would affect the livelihood of farmers who cultivated tobacco or increase its illegal trade and asked the ministry to state which tobacco ingredients were harmful and could cause cancer and how many cancers were linked to tobacco use.

Health warnings must currently cover 40% of one side of the packet or 20% of both sides. The new recommendation, announced in October 2014, said that health warnings would have to cover 85% of each side of the packet, of which 25% would be text and 60% would be a picture. It was meant to be enforced from 1 April 2015, but implementation was delayed until 1 April 2016.

Pankaj Chaturvedi, a surgical oncologist at Tata Memorial Hospital and a member of the committee that recommended larger graphical warnings, told The BMJ that the 32 questions raised by the panel would only serve to further delay the ministry’s proposal. He said that the purpose of the panel was to monitor various legislations and suggest any possible concerns to the appropriate ministry—not to stop a public health move that would prevent millions of youngsters from picking up a habit that kills every third user prematurely.

Previous studies have estimated that in 2012 about 110.2 million Indians smoked cigarettes and that 18.3% of cancers among women and 42% of cancers among men in the country were linked to tobacco usage.

Chaturvedi said that the list of questions echoed the same illogical concerns that were expressed publicly by an earlier panel, which included members directly involved in the tobacco industry. “A picture can speak a thousand words,” Chaturvedi said, stressing the importance of pictorial warnings as the most effective way to educate people, many of whom could be ignorant, illiterate or partially literate, or very young.

He cited the example of Australia, which has gone a step further to reduce tobacco use by allowing only plain packaging of cigarettes. “The expert committee constituted by ministry of health deliberated on several aspects of pictorial warnings—type of picture, size of picture, international best practices, public opinion, field research, etc—before their final recommendation,” he said.

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