The fundamental right of a consumer is to be empowered to make an informed choice based on credible information prior to purchasing a product or service. The regulator has to ensure that the products and services made available to the consumers are safe, adhering to the global best standards and are made available without any discrimination and unfair trade practice. Thus laws are framed based on a consultative process to develop the best standards and mandate the role of the regulator. With the fast changing healthcare priorities, the rapidly growing healthcare industry, the Governments role in shaping quality healthcare delivery systems is through preventive and promotive healthcare policies, which is the vision and mission statement for sustainable development and healthy lifestyle.
On the occasion of World Health Day, April 7, 2022, a group of citizen-consumer-patient groups and associations of India came together to deliberate, discuss and evaluate the changing dynamics of the Government policies and the growing need for an empowered and informed consumer choice under the theme ‘Our planet, Our health’ in the interest of the citizens.
In the recent past, we have experienced several unreasoned bans being imposed by the Government, the most recent being the Delhi meat ban controversy which further begs us to question whether the choice of what to eat and when to eat should be left to the consumer or become a policy decision, also adversely affecting the livelihoods of the providers and the various players engaged in the supply chain. Such irrational policy at times makes us wonder about our Constitutional Rights as citizens of India.
A bunch of medical groups, doctor associations, gynaecologists that came together unanimously were of the view that a one size fits all approach in policy negatively affects the health of patients. There should be sufficient rationale behind bans and bans must not become a substitute for effective governance. We see that there is a dichotomy in the policies framed by the Government where on the one hand combustible cigarettes are allowed and a category of harm reduction alternatives are blindly dismissed without even going into an evaluation of their possible efficacy. Alcohol is banned in States like Nagaland, Bihar, Gujarat, and they are apparently the driest wettest States in the country! Not only that, but the deaths caused by the incessant use of spurious alcohol is rampant and so unfortunate. Cannabis carries a lot of health benefits, but the usage of this product is full of prejudicial controversy, misinformation and speculation which makes the medical use of cannabis almost non-existent in India till date.
Regulation can help in reducing the illicit market, but regulation must be based on proper research and standard setting exercise with sufficient knowledge being made available to the stakeholders, consumers and giving due consideration to patient safety. Standards will also help build consumers’ and regulators’ confidence in the products. In India, the opinion of medical practitioners is divided over the bans on certain kind of medicines, fixed-dose combination drugs while the developed world permits only such proven formulations that are backed by clinical trials. There is an urgent need to give due credence to data, scientific research and clinical trials before a ban is imposed and not resort to it only because it is easy and serves the purpose of an interested group or a particular category of business entities.
Tobacco addiction is one such example where the Government has taken a lot of initiative in controlling the menace. India ratified the first ever international public health treaty focusing on the global public health issue of tobacco control in 2004 by signing the Framework Convention on Tobacco Control (FCTC). Since then, there have been checks and balances placed by introduction of helplines, ban of smoking in public places, de-addiction centres, nicotine replacement therapies (though, not available at discounted prices or free of cost), pictorial and other warnings which have certainly led to a decline in reducing tobacco consumption but the question that lingers is, whether it is sufficient? Harm reduction from tobacco is the future since long-term users of tobacco would otherwise need to be engaged in a ‘continuum of care’ patient-centric mode which places a challenge in a healthcare delivery system that offers partial and piece-meal services. The consequential harm from smoking is a global concern and many countries are adopting a smokeless regime going forward not only for the benefit of the environment but in the interest of larger public health. In our group discussions, doctors specialising in their respective fields explained the helplessness they face when a patient approaches them with sheer exasperation from being unable to quit. Gynaecologists and dermatologists shared their concerns on the rising rates of infertility in women and the related aging and skin issues that are a corollary to this painful addiction.
A wide range of products which are sold globally as viable alternatives to conventional tobacco products (specially who have unsuccessfully tried to quit smoking cigarettes) including e-cigarettes, all forms of electronic nicotine delivery systems, Heat Not Burn products, e-hookah and like devices, were banned by way of an ordinance in haste without following the due process of public consultation and representation and subsequently made into a Law. As we know, a plethora of tobacco products are regulated under the schedule to Cigarettes and other Tobacco Products Act 2003, for example gutka, pipe tobacco, hookah tobacco; etc but there was no consideration given to appropriately regulate these harm reduction alternatives as a choice to the consumers.
Such alternatives are regulated and legally made available to the consumers in more than 60 countries worldwide including many countries in Europe and in the UK (E-cigarettes), Scandinavia (Snus) and others.
As the World No Tobacco Day 2022 is around the corner let us all come together to champion on the theme “Protect the environment” as we all know tobacco pollutes the planet and damages the health of all people. Countries across the world regulate and calibrate the consumption by providing options on harm reduction and environment protection. Let us look at options which science and innovation can provide to reduce consumption of conventional tobacco products and empowers the consumers to make such choice, which enables them to support campaigns like what has been proposed this year on the occasion of WNTD 2022.
We urge that the Government must empower consumers to make better informed personal decisions. Not just in quitting any form of tobacco use where that is possible, but also for moving into the lowest risk alternatives in the meantime. We believe that an informed consumer can make sensible decisions by gaining an insight about a product prior to its purchase.
Credible public health bodies globally have encouraged the use of alternatives for harm reduction as well as for mitigating exposure to non-smokers after due consideration of compelling empirical evidence regarding their safety. The Indian Government must also encourage research and look into the science behind alternatives and reconsider imposing irrational bans so that the interest of the public at large is taken care of, and India is not singled out while the world outpaces with its technological developments. We must encourage health analysts, and researchers to help develop a progressive and evolving regulatory framework in the interest of the most vulnerable citizens.
Authored by:
Prof Bejon Kumar Misra, International Consumer Policy Expert, India
