The global tobacco control strategy led by the WHO and the (Bloomberg-funded) NGOs has left many confused on what their goal is. Campaigns against tobacco harm reduction tools like e-cigarettes and nicotine pouches leave more consumers with little choice but to continue smoking. The strategy of ever higher taxes, access restrictions or bans and the removal of flavours is knowingly pushing tobacco and nicotine product trade into unregulated black markets. Weak studies and poor methodology give their positions no credible ground.
Academics and researchers are left wondering what these seemingly intelligent, articulate people are doing. Ex-smokers are ignoring them and their policies.
I have long argued that the tobacco control activists are not interested in public health, but rather are running anti-industry campaigns. When Big Tobacco, facing market risks, moved into selling vaping and nicotine pouch products, the WHO and Bloomberg’s flotilla of NGOs recalibrated their campaigns to stop these innovative, lower risk products.
The tobacco control movement’s contradictions and hypocrisy regarding the sale and consumption of gutka is perhaps the best evidence of where these activists’ interests lie. It is certainly not with protecting public health.
What is Gutka?
Gutka (or gutkha) is a chewing tobacco mixed with the betel (areca) nut and a variety of spices and additives. Chewing betel nut (or betel quid) is a tradition that dates back more than 2000 years. This chewing tobacco is sold in small packets, and is consumed by placing it between the cheek and gum. It is inexpensive, easy to use and marketed in many flavours.
As an addictive psychoactive stimulant containing arecoline, gutka is the fourth most widely used drug. It has been called the “suicide masala” because of the speed at which it can kill its users. Chewing betel nut mixed with tobacco can result in euphoria, psychosis and hallucinations. The WHO’s IARC has classified chewing betel or areca nuts as a Group 1 carcinogen, claiming that in certain parts of India where gutka is widely consumed, oral cancer is the most common form of cancer. It is also linked to obesity and Type 2 diabetes.
Globally, around 600 million people consume gutka (others claim only 360 million consume smokeless tobacco), mostly in rural areas of Southern Asia and the Asian Pacific. Whatever the figure, compared to the 1 to 1.2 billion smokers, gutka consumers should be a significant part of the tobacco control campaign. The WHO FCTC communications platform should have a substantial campaign warning against the dangers not only of smoking but also of gutka ... but they don’t. The FCTC Knowledge Hub only shares two short articles on gutka, and only on the problems of enforcing the gutka bans in India.
I first heard about gutka only when I was researching an article on Palau’s request for the United Nations to classify nicotine under international drug control restrictions (like heroin or crystal meth). While it was obvious the tiny chain of Pacific islands was merely serving as a mercenary for Western anti-nicotine activists, someone should have noticed that over 42% of Palau’s population is addicted to the psychoactive stimulant, gutka. The Palau anti-nicotine UN initiative did not mention gutka once, nor did their president, Surangel S. Whipps, Jr., who also used his speech at last month’s UN General Assembly to attack Big Tobacco while posturing how he is all about “putting public health over profit”.
How do you spell “hypocrisy”?
Bloomberg’s Silence on Gutka
Given that gutka contains tobacco, nicotine, flavours, is addictive and has significant health consequences, the Bloomberg-funded tobacco control NGOs should have significant campaigns against this chewing tobacco mixed with the psychoactive betel nut stimulant. Bloomberg Philanthropies’ $2 billion flotilla of campaign groups, including Vital Strategies, Campaign for Tobacco-Free Kids, the Union or the Global Alliance for Tobacco Control, do not have any campaigns to get people to stop using gutka. ... Crickets. They are too busy getting developing countries to ban vaping and continue smoking tobacco products (or chewing gutka).
Gutka should fall under the MPOWER regime as a tobacco product, but it does not. MPOWER is the WHO strategy to enforce their tobacco control measures, organised and implemented by Bloomberg NGOs. Gutka is banned in the United States and a number of Indian states (where there are over 200 million gutka consumers), but here it gets curious. Many Indian states banned the manufacture, distribution and sale of gutka using food-safety laws, not MPOWER or any other tobacco control framework.
It is not that the Bloomberg NGOs were ignorant of gutka. Johns Hopkins’ Bloomberg School of Public Health was the only Bloomberg-funded body that conducted dedicated research, not on the health risks from gutka consumption but on the impact of the gutka ban in five Indian states. This was not a campaign to ban the chewing tobacco product but just to measure the success of the Indian state bans.
Johns Hopkins should have reported back to the other Bloomberg-funded NGOs that the bans were anything but successful. While regulated gutka packs were banned, Indian companies started selling pan masala and tobacco in separate pouches side-by-side and consumers just mixed their own product. Other cases involved gutka packs sold in India labelled as “mouth fresheners” or “For Export Only”.
Somewhere within the Bloomberg network is a Johns Hopkins report gathering dust, where they admit the failure of a tobacco ban that led to double packs, the higher risks of contamination, misuse and black markets. Still these tobacco control groups continue to argue for more tobacco and nicotine bans, higher taxes and market obstacles.
Bloomberg’s tobacco control silence on a tobacco-based product like gutka is both hypocritical and shameful. Why did the Bloomberg NGOs give gutka a free pass?
It’s all about Industry
The WHO tobacco control campaign is not a public health campaign. Not in the least. If these NGOs were seriously committed to improving public health, then banning gutka across Asia would have been a main campaign strategy.
The activists behind the programme were never fighting tobacco, they were fighting Big Tobacco. In the fifth FCTC COP, when e-cigarettes were first considered as a smoking cessation strategy, the WHO admitted that they could not risk reversing decades of success in denormalising the tobacco industry by promoting products resembling cigarettes or smoking. Their blind eye to the health risks from gutka simply confirms this bias.
While there are many large companies manufacturing and selling gutka, the market varies from region to region. In countries like Taiwan, for example, which has a significant oral cancer rate, most sales of betel nut (known as green gold) are through small businesses. These companies are not known corporations in the US or Europe and don’t fall under the Big Tobacco business category widely reviled in western media. The WHO’s FCTC tobacco control bias against industry is about stopping the large tobacco companies from marketing new products and opening up new markets.
If a Big Tobacco company entered the gutka market to tap into its 600 million consumers, there would no doubt be a major Bloomberg-NGO led campaign against the chewing tobacco. Gutka would fall under the MPOWER regime and states would be pressured to ban the tobacco-betel nut product. They would surely campaign on the addictive nature of gutka, its health risks, the gateway effect, “youth chewing”, the betel nut beauties, the attractiveness of the lime or spicy flavours...
Instead, they only seem to be monitoring evidence of interference from Big Tobacco in South and South-East Asian countries on cigarette marketing. A good example was when two Bloomberg-funded NGOs did a tobacco control report on tiny Palau, and while they acknowledged at the outset that more than 42% of the population enjoy chewing betel nut (mixed with tobacco), the focus of the report was on whether the Pacific island chain had any interference from recognised tobacco lobbyists or cigarette companies (ie, if they were implementing the FCTC guidelines on isolating Big Tobacco). Their conclusions were glowing, saluting Palau for banning e-cigarettes in 2023 to meet Bloomberg’s MPOWER strategy (while turning a blind eye to their gutka health epidemic).
The reality is clear. The tobacco control NGOs, almost all funded by Michael Bloomberg’s network of influence, are fighting against industry rather than fighting for public health. This is a common post-capitalist strategy seen in other activist campaigns. Rather than providing incentives for reducing CO2 emissions, climate NGOs attack Big Oil for providing the energy we need; rather than promoting healthy diets, food activists campaign against Big Food for offering consumers a variety of choices.
While tobacco control NGOs pretend they are protecting public health, their anti-industry bias is leading them to campaign against reduced-harm products that save lives and look the other way as a significant population of smokers becomes confused and continues to consume dangerous tobacco products. They generate studies to highlight insignificant e-cigarette risks, amplify dead arguments like youth vaping, ban flavours and pretend that the gateway effect is a real thing. As long as someone keeps paying their salaries, the lies and hypocrisy will keep flowing.
WHO member states are blindly implementing the FCTC guidelines unaware that it is nothing more than an anti-industry campaign leading to greater negative health consequences. While their weak studies and emotion-laden denormalisation rhetoric are succeeding in convincing those like the European Commissioner for Health on the imperative of banning tobacco harm reduction products, there are very few academics and intellectuals willing to risk their careers by standing up to challenge these righteous zealots. This is an issue dominated by cowards and hypocrites.
Michael Bloomberg is playing to win, and will likely pump a third billion into this anti-industry witch-hunt ... but somewhere over the decades and endless flow of funding, he seems to have forgotten what the game was about.