Yearly Archives: 2002

Vaccine prevents cervical cancer

  • 11/20/2002
  • Robert Bazell
  • New England Journal of Medicine

Experimental injection found 100 percent effective against virus that causes disease.

Early testing shows an experimental vaccine to be 100 percent effective against the virus that causes cervical cancer, raising doctors’ hopes of someday sending the lethal disease into retreat in the same way as smallpox and polio. “IT APPEARS to be the real thing,” said Dr. Christopher Crum, a pathologist at Brigham and Women’s Hospital in Boston. “You’re looking at some very compelling evidence that this vaccine will prevent cervical cancer.” It remains unclear how long the protection might last. Even so, researchers say a vaccine could reach the market within five years or so. The findings were published in this week’s New England Journal of Medicine.

TARGETING HPV

Vaccines work by teaching the body’s immune defenses to recognize invading viruses and bacteria. Most types of cancer, by contrast, are blamed largely on genetic mutations and environmental factors. However, virtually all cases of cervical cancer are caused by a sexually transmitted virus – the human papilloma virus. A vaccine for cervical cancer is urgently being sought because the disease strikes about 450,000 women worldwide each year, killing about half. It is the leading cancer killer of women in the developing world. In the United States, where Pap tests are widely used for screening, it develops in about 13,000 women annually and kills about a third.

The new vaccine, aimed at the viral strain Type 16 responsible for about half the cases of cervical cancer, was tested on women ages 16 to 23 at 16 sites around the country in a study led by Merck & Co. and the University of Washington. Merck developed the vaccine and funded the research. The women were watched on average for almost a year and a half. Of 768 women who got vaccine injections, none showed Type 16 infections or precancerous tissue. Of 765 who took dummy injections, 41 came down with persistent infections, and nine developed precancerous tissue. Inoculated women built up almost 60 times the concentration of virus-fighting antibodies seen in naturally infected women. Some researchers had suspected that the mucous membrane on the cervix would pose a barrier to such antibodies.

PROOF OF PRINCIPLE

“For us, this is proof of principle.” said Merck researcher Kathrin Jansen. There was a lot of doubt in the beginning not by me, but by others, that said it would be very difficult to prevent infection. In an accompanying editorial, Crum said the vaccines developed to fight diseases like smallpox and polio are now reference points in medical history. “If the promise implicit in the study is realized, we could, in our lifetime, see the gradual but progressive dismantling to the barriers to preventing cervical cancer.” he said. “However, in part because cervical cancer is caused by multiple strains, it is not clear whether the disease can ever be wiped out.” Laura Koutsky, a disease specialist at the University of Washington, also cautioned: We really only know about the short-term duration of the antibodies. Whether the antibodies persist for five years or more is not known at this point. Dr. Douglas Lowy, a National Cancer Institute researcher, agreed that patients must be tested over longer times. But he and others agreed that a vaccine – probably one targeted at multiple viral strains encompassing the vast share of cases – might reach market fairly quickly. Crum said the cost of the vaccine would probably be offset by the savings of not having to perform as many Pap smears, about 50 million of which are done in the United States alone each year.

The smear test is widely credited with cutting the cervical cancer death rate, even though half the cervical cancers that appear in the United States each year show up in women who regularly receive the Pap test. “We could, in our lifetime, see the gradual but progressive dismantling of the barriers to preventing cervical cancer. “Crum said. The captives of our current system, both patients and their caregivers, may be set free. Such a vaccine could also stop other harm done by the virus, including genital warts in both men and women and rare forms of penile, anal, vaginal and oral cancer. Researchers said the vaccine might also be taken by men to keep them from infecting their female partners. Eight to 14 percent of Americans have some type of papillomavirus infection. A vaccine is already used to combat the hepatitis B virus, a sexually transmitted agent blamed for some cases of liver cancer.

The Associated Press and Reuters contributed to this report.

November, 2002|Archive|

Cancer survivor shows Shady Spring students what can happen if you dip

  • 9/18/2002
  • West Virginia
  • Bev Davis
  • Register-Herald

When Gruen Von Behrens speaks, kids listen. It’s more than his words, however, that captures their full attention. His face deformed and scarred from 27 different surgeries to correct damage caused by oral cancer, the 25-year-old Illinois native offers teens a passionate message – look at the results of spit tobacco use and beat the addiction while there’s still time.

“I started dipping when I was 13. I thought it was a cool thing to do. I can tell you this. Looking the way I do now is not cool,” he told more than 100 Shady Spring High School sophomores gathered Tuesday for a special assembly in the school’s cafeteria.

Von Behrens suspected he had mouth cancer several months before he had the courage to see a doctor. “My tongue was completely split and it was all white and yucky looking. I knew it was cancer, but I didn’t want to face it. Cancer has made my life a living hell. Every time I turn around, they are putting me in the hospital, either to have surgery or some kind of treatment. Do you think it’s cool to have your girlfriend kiss you and you can’t even feel it? Trust me, it isn’t. It’s terrible,” he said.

Students sat in rapt silence as the cancer victim told his story. When he asked how many of them knew someone who uses spit tobacco, scores of hands went up. RESA I tobacco prevention specialist Lori McGraw asked students how many thought spit tobacco was a safer alternative to smoking. About the same number of people responded. “It’s not a safe alternative. No matter what you see in the commercials, no matter how many sports heroes use it, no matter how many relatives you had who used it and never got cancer, you never know who will be the one who gets it,” McGraw said.

McGraw also made the contention that advertisers will not use people such as Von Behrens in their ads. “You’ll never see a cancer victim in a tobacco ad. You see beautiful, healthy people. Tobacco companies will not show you what can happen when you use their products,” McGraw said. “You can’t hide something like this,” Von Behrens said, pointing to his misshapen jaw line. “I’m not here today for me. I’m here for you. You can’t quit unless something drives you to do it. I hope I can be that motivation for you.”

Following the presentation, students said they were impressed by what Von Behrens had to say. “It’s scary,” 15-year-old Belinda Cook said. “I don’t use tobacco, but I think what he had to say would scare me enough to quit.” Christopher Burroughs, 15, agreed. “I don’t use tobacco, either, but I think we should listen to him because he’s right. There’s a big price to pay for a small habit.” Ashley Scott, 15, also a non-user, said she hoped those who use tobacco would take the speaker’s message to heart. “It’s good that he came and talked to us. When you can actually see what tobacco use can do, it really makes you think,” Scott said.

Principal Daniel Moye said the school has seen a drop in tobacco use on school grounds from more than 200 a few years ago to only 11 last year. “When we catch them, we call the police and have them fined. It seems to be working.” He said he hopes the first-person account given by Von Behrens will have a lasting impact on the students. “We can tell students not to use tobacco and we can talk until we’re blue in the face, but when they see someone like him and hear what he has to say, it makes a stronger statement than we ever could.”

Von Behrens is visiting several southern West Virginia schools as a representative of the National Spit Tobacco Education Program. Promoters of his tour say they are particularly concerned about the high incidence of tobacco use among teens in West Virginia. According to the 1999 Youth Risk Behavior Survey, West Virginia had the third worst male spit tobacco use rate in the nation at 28.6 in grades nine through 12. The rate among adult males is the highest in the nation, a dubious distinction West Virginia has held since 1996.

September, 2002|Archive|

Risk of mouth and throat cancer rises with amount of alcohol not duration

  • 9/15/2002
  • Aviano, Italy
  • Dr. Silvia Franceschi
  • International Journal of Cancer, 85:787-790

The higher the consumption of alcohol the greater the risk of cancer of the mouth or pharynx, Italian researchers report in a recent issue of the International Journal of Cancer. Also, while duration of drinking has no bearing on the risk, they found that the risk persists after quitting alcohol.

Dr. Silvia Franceschi, of the Centro di Riferimento Oncologico in Aviano, Italy, and colleagues interviewed 754 men and women in either Switzerland or Italy with incident cancer of the oral cavity and pharynx. The subjects answered questions regarding lifetime smoking and drinking habits. The investigators also interviewed 1,775 control subjects who were in the hospital for acute, non-neoplastic diseases.

Drinkers of 20 alcoholic drinks per week or less showed similar odds ratios for oral cavity or pharynx cancer as never drinkers. But above that level, the risk of oral cavity or pharynx cancer increased with the number of alcoholic drinks per week. The odds ratio for individuals who consumed 91 drinks per week or more was 11.6 compared with never drinkers.

Dr. Franceschi’s group reports that the risk in former drinkers was 1.9 times that of current drinkers. However, former drinkers who had also quit smoking had a lower risk than current drinkers.

“The direct association between alcohol intake and risk of cancer of the oral cavity and pharynx is strongly dose-dependent but apparently unaffected by duration of alcohol consumption,” Dr. Franceschi and co-authors say. The authors note that “no clear benefit from drinking cessation had emerged up to at least 10 years after stopping” in this group.

“The persistence of risk elevation several years after drinking cessation suggests that the role of alcohol is complex and it probably affects more than one stage of oral carcinogenesis,” the authors say.

September, 2002|Archive|

Patient’s Cancer Missed 19 Times

  • 9/10/2002
  • Yorkshire, UK
  • BBC News

The government is being urged to review cancer care services after a man suffering from oral cancer was misdiagnosed by different doctors on 19 separate occasions. Father-of-three Steve Harley, 41, now faces a far tougher fight against the disease because the tumour has spread.

Whereas doctors might have been able to remove the cancer if he had been diagnosed earlier, it is currently inoperable, and specialists are using chemotherapy to try to shrink it before trying surgery. Mr Harley is now facing an intensive seven-week course of radiotherapy. If that fails, he faces losing his tongue, larynx and voice box – and his overall chances of survival are far lower. Mr Harley’s MP, Eric Illsley, warned the government in the House of Commons on Wednesday that Mr Harley’s case highlighted serious failings in health provision in England.

The businessman, from Barnsley, south Yorkshire, first developed throat pains in July last year. He says he visited his GP, who told him it was probably an infection and sent him home with antibiotics. However, it failed to clear up, and he visited the GP on seven further occasions, each time being told that nothing could be found. He says he was not sent for further investigations despite reporting symptoms that were clear signs that something could be wrong – a persistent and agonising earache in addition to the earlier sore throat.

He eventually saw four different GPs, five hospital doctors and three specialists. “I did ask fairly early on whether the GP thought I had cancer, and he said no.” Even if he had been referred, specialist services in Barnsley were less than ideal – one ear, nose and throat expert was off sick, and the other had left.

Mr Harley said: “I went privately to try and speed the system up. I think the education of GPs and consultants is obviously sadly lacking. “I understand that there is a test that could be done fairly early which could have spotted it.”

Intense pain

He made repeated trips to accident and emergency departments to request stronger painkillers. He said: “I was given low priority – all they did was take my blood pressure.” He says the doctors believed that, despite reporting intense pain, he was simply seeking attention. He told the BBC that on one occasion, a doctor said to him: “If I were your brother, I would tell you to go home and live your life.” The cancer was eventually spotted after he had lost two stones in weight because the tumor was beginning to block his throat.

What this comes back to is the need for education and training of doctors

Mr Illsley told the Commons: “This was a man with private medical insurance. I wonder what it would have been like for anyone who was a NHS patient in these circumstances. “I am becoming a little tired of standing in this chamber complaining about poor health treatment that my constituents receive.”

Professor Mike Richards, the newly-appointed “National Cancer Director”, said that while he could not guarantee that cases like this would not happen in future, the service overall would be improved. He said: “We certainly need to invest more in communication skills because we know from patients that all too often they weren’t adequately heard by doctors and the way they were treated was not as good as it should have been.”

Oral cancers can initially have the appearance of ulcers or other normal mouth problems. If such problems fail to clear up by themselves or to respond to treatment, doctors are advised to be suspicious and refer for further tests. Oral cancer is one of the more dangerous cancers, as only one in two people survive – early diagnosis improves survival chances. Approximately 3,400 people are diagnosed with the disease every year in the UK.

Sue James, chief executive of Barnsley District General Hospital NHS Trust, described the case as a “tragedy”, but said the hospital had done all it could on the occasions when Mr Harley attended its casualty department. She said: “The A&E department is there to treat accidents and emergency situations. It’s much better for people with long term conditions to be referred to their GP.” Professor Gordon McVie, Cancer Research Campaigns Director General, said: “Throat cancer is rare but this is no excuse. “While GPs are not used to seeing a patient’s mouth as often as a dentist is, for example, specialists should know better.”

September, 2002|Archive|

ADA Awarded 1.2 Million Dollar Grant

  • 10/1/2002
  • Chicago
  • American Dental Association

The American Dental Association (ADA) announced yesterday it received a grant of $1.2 million from the National Cancer Institute to develop and implement a continuing education program for oral health care professionals in the fight against oral cancer.

“Despite advances in oral cancer treatment, only about half of all persons diagnosed with it survive more than five years,” says ADA President Dr. D. Gregory Chadwick. “We want to see those survival numbers go up, and that is why we are so extremely pleased with this award because it will help bring prevention and early detection to the forefront in our battle against oral cancer.”

The American Cancer Society (ACS) estimates some 28,900 oral cancer cases will occur this year, resulting in 7,400 deaths. Incidence rates are more than twice as high in men as in women and are greatest in men over age 40. Risk factors include cigarette, cigar or pipe smoking, use of smokeless tobacco and excessive consumption of alcohol. However, 25 percent of oral cancer victims do not smoke or have any other known risk factors.

The five-year grant will focus on oral cancer prevention, with long-range goals of increasing the number of dentists who counsel at-risk patients about stopping tobacco use, according to principal investigator Dr. Sol Silverman, professor of oral medicine, University of California at San Francisco. Through this program, he added, we also will lay the foundation to increase detection of oral cancer at its earliest, most curable stage.

“Initially, our project will target practicing dentists in the United States for additional education on oral cancer prevention and reducing risks of the disease for their patients,” Dr. Silverman explains. “We also will explore the potential use of this continuing education program for other health care professionals, including dental hygienists, nurse practitioners and primary care physicians.”

A key component of the project’s prevention program will include tobacco-cessation training for dentists, according to project collaborator Dr. K. Vendrell Rankin, associate professor, Baylor College of Dentistry, The Texas A&M Health Science Center.

“Any type of tobacco use is a major risk factor for oral cancer,” said Dr. Rankin, who will oversee the design and implementation of the tobacco cessation part of the educational program. “For example, cigar smokers have a four to 10 times greater risk of dying from cancer of the oral cavity, throat or esophagus compared with nonsmokers.”

Dr. Rankin, a tobacco cessation expert, said the additional education for dentists is essential because 12 percent of 8th graders and nearly 30 percent of 12th graders become regular tobacco users. It is estimated that between two and three thousand youth in the United States become regular tobacco users each day, she added.

“The age group most likely to benefit from tobacco cessation information from dentists is the group that visits their dentist with greater frequency than their physician,” she explained.

According to the ACS, cancer can affect any part of the oral cavity, including the lip, tongue, mouth and throat, with five-year and 10-year survival rates placed at 54 percent and 39 percent, respectively.

Signs to look for include:

* a sore that bleeds easily or does not heal;
* a color change of the oral tissue;
* a lump, thickening, rough spot, crust or small-eroded area; or
* pain, tenderness or numbness anywhere in the mouth or on the lips.

Responding to the need for increased education and awareness of oral cancer is not new to the ADA. Just last year, the dental association conducted a national oral cancer public service campaign, encouraging the public to take an active role in learning the signs of the disease that kills nearly one American every hour.

The oral cancer awareness campaign featured two different public service advertisements that appeared on a variety of outdoor venues, including billboards, bus-shelter signs and commuter bulletins. Both featured a small, white spot on the tongue with the message, “It’s tiny now. Don’t let it grow up to be oral cancer. Testing is now painless. See your dentist.”

OCF Note: This new ADA program will be headed up by Dr. Sol Silverman, a member of the Oral Cancer Foundation Advisory Board, and strong supporter of OCF’s efforts. We have high hopes that with Dr. Silverman at the helm of this new project that it will begin to make a dent in both the public’s awareness of oral cancer, and the dental professions involvement in aggressively looking for it.

Also we would like to state that in OCF’s opinion the ADA has not previously given enough attention to the issue of oral cancer. In the last two paragraphs of this news article taken from a release of theirs, they state that “Responding to the need for increased education and awareness of oral cancer is not new to the ADA. Just last year, the dental association conducted a national oral cancer public service campaign, encouraging the public to take an active role in learning the signs of the disease…” We would like to state that it was a 2.5 million dollar grant from OCF supporter Oral CDx president Mark Rutenberg which instigated this program, and made it possible. Without his efforts the campaign most likely would not have happened.

September, 2002|Archive|

The Oral Cancer Foundation is selected to National Cancer Institutes list of resources

  • 9/1/2002
  • Bethesda, MD
  • The National Cancer Institute

The National Cancer Institute, a branch of the National Institutes of Health, has chosen the Oral Cancer Foundation as a resource to be added to the NCI Fact Sheet, a guide which it provides to the American public, and in particular to those people with cancer and their family members, that lists organizations which provide information and services to those with cancer. “Knowledge is empowering when fighting a killer such as cancer. The NCI has always been the primary source for the dissemination of information regarding all cancers to both professionals and the public, providing timely, unbiased, and accurate information. OCF is proud to have met the criteria established by the NCI for inclusion in its list of resources for patients and families”, said Brian Hill, OCF’s founder and Executive Director. The Oral Cancer Foundation is a non-profit entity created for the purpose of raising the awareness of oral cancer in both the professional and public sectors. Providing information, resources, and support to patients and family members, as well as caregivers, are core goals of the foundation.

September, 2002|Archive|

Oral Cancer Survival Rate Remains Unchanged Over the Last Thirty Years

  • 8/15/2002
  • Atlanta
  • Cancer Journal for Clinicians

An estimated 28,900 Americans will be diagnosed with oral or pharyngeal cancer and nearly 7,400 will succumb to the disease, according to a review published in the July/August issue of CA: A Cancer Journal for Clinicians, a peer-reviewed journal from the American Cancer Society.

This disease most commonly has been found in middle-aged and older individuals, and it has affected more men than women. However, authors Brad W. Neville, DDS, and Terry A. Day, MD, FACS, say that “a disturbing number of these malignancies is being documented in younger adults…[and the] disparity in the male:female ratio has become less pronounced over the past half century, probably because women have been more equally exposing themselves to known oral carcinogens such as tobacco and alcohol.”

Along with a review of the epidemiological and clinical features of oral and oropharyngeal squamous cell carcinoma, Neville and Day emphasize early detection as the best method of prevention.

“In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades,” say the authors.

August, 2002|Archive|

Pacemaker Could Improve Tongue Reconstruction

  • 8/14/2002
  • Berlin
  • Hannah Cleaver
  • Reuters Health

A “pacemaker for the tongue” could soon help victims of mouth cancer or accidents to control a reconstructed tongue built from transplanted muscle, animal studies in Germany suggest.

Currently, surgeons can fashion replacement tongues from neck muscles for people who lose their tongue to cancer or trauma. The muscles are grafted onto the base of the person’s original tongue.

But controlling the rebuilt organ, in order to eat and talk, is a major problem and reconstructed tongues need to be kept active to avoid shrinkage through disuse. “The reconstructed tongue initially makes passive movements, which are produced by contractions of the surrounding floor of the mouth as well as pharynx and chewing musculature,” said Professor Stephan Remmert, from Luebeck University Hospital, at last week’s German Ear, Nose and Throat Conference in Baden-Baden.

To give patients better control of the tongue, Remmert is using pacemaker technology to boost nerve signals to the reconstructed organ. He told Reuters Health that the main aim of the work was to filter the most important signals that the brain sends to the main tongue nerve, the hypoglossus. “Then we can amplify the signal and send it on to the new musculature,” Remmert said. “It has to be amplified enough to generate quite powerful movements.” In experiments on domestic pigs, the group is surrounding the severed end of the hypoglossus with electrodes to measure, reproduce and send its signals. Much of the other technology needed has already been developed, or is in development, much of it from the cardiac pacemaker field, he said.

Although the results of the animal experiments are promising, they will not be directly transferable to people. Still, Professor Remmert thinks clinical trials on people could be feasible within 2 or 3 years. As with heart pacemakers, he said the tongue pacemaker would eventually be implanted–under the collarbone and connected to the tongue by a wire.

August, 2002|Archive|

Sweet but Deadly Addiction is Seizing the Young in India

  • 8/13/2002
  • Bombay, India
  • Amy Waldman
  • Tata Memorial Hospital

Promoted by a slick and many-tentacled advertising campaign, gutka, an indigenous form of smokeless tobacco, has become a fixture in the mouths of millions of Indians over the last two decades. It has spread through the subcontinent, and even to South Asians in England.

But what has prompted particular concern here is the way that in the last 10 years, gutka – as portable as chewing gum and sometimes as sweet as candy – has found its way into the mouths of Indian children. Young people have become gutka consumers in large numbers, and they have become an alarming avant-garde in what doctors say is an oral cancer epidemic. That, among other factors, has prompted the state of Maharashtra, which includes Bombay, to take an unusual step. It enacted a five-year ban, the longest permitted by law, on the production, sale, transport and possession of gutka, a $30 million business in the state, effective Aug. 1. Several other states have undertaken similar bans, although some have been stayed by the courts.

It is easy, on the streets of Bombay, to find young men like Raga Vendra, now 19, a railway worker who began taking gutka at age 11. It is also easy to find gutka sellers, like Ahmed Maqsood, who say they have had customers as young as 6.

Dr. Surendra Shastri, the head of preventive oncology at Tata Memorial Hospital, noticed about five years ago that his patients were getting younger, by about eight to 10 years. “High school and college students were coming in with precancerous lesions,” he said. “Usage was starting much earlier.” India has 75,000 to 80,000 new cases of oral cancers a year – the world’s highest incidence, and about 2,000 deaths a day are tobacco related.

A 1998 survey of 1,800 boys ages 13 to 15 from a wide range of socioeconomic groups found that up to 20 percent were already using three to five packets of gutka daily. The price is low: sometimes less than two cents a packet. The contents, a mixture of ingredients including tobacco, are usually placed in the cheek lining, savored, then expelled.

Gutka was the product of a packaging revolution that made an Indian tradition portable and cheap. Many Indians have long chewed paan, a betel leaf wrapped around a mixture of lime paste, spices, areca nut and often tobacco. But obtaining paan required a visit to a paanwallah – it was too messy to be transported. All of that changed with gutka, a dried version of the concoction, but without the betel leaf, preserved and perfumed with chemicals and sealed in a plastic or foil pack.
Gutka could be used at will, at work or at home or at school, and it was used, in very large quantities. Sales of gutka and its tobaccoless counterpart, paan masala, are now more than $1 billion a year, having quintupled during the
1990’s. “What caused this boom of oral cancers was this packaging of tobacco,” said Dr. A. K. D’Cruz, the lead head-and-neck surgeon at Tata Memorial Hospital. “Convenience got them hooked.”

Many consumers say they welcome the ban, because they see no other way to curb their addiction. Even some vendors like Mr. Maqsood have embraced it, saying they felt they were trading in toxins. “The chemicals used in gutka were poisonous,” he said. “I have seen some customers who can’t open their mouth.”

The ban’s critics, gutka manufacturers among them, argue that countless other tobacco products remain on the market. While vendors, fearing large fines, are largely observing the ban for now, gutka can easily be bought just a state away. Gutka manufacturers contend that the ban stemmed less from concern about children than from a desire to protect cigarette makers, who are fighting for market share. The gutka makers have begun running an ad that argues that if gutka is banned, cigarettes should be as well. “No government in the world has been able to stop cigarettes,” Dr. Shastri countered. The gutka ban, he noted, is possible only because of a law allowing the state to ban harmful foodstuffs.

“The gutka makers say the ban will have spurious effects,” he continued. “I don’t care – 70 to 80 percent of children won’t have access to the black market, or to smugglers. We will prevent children from taking it up.”

Gutka is seen by doctors as particularly insidious because it contains many unhealthful additives, like magnesium carbonate, and is cheap. For children and teenagers, smoking cigarettes remains taboo. Gutka has no social stigma among peers, and it is easy to hide from parents.

Padmini Samini, who started an antitobacco advocacy group after her father got oral cancer, said she had found cases in which gutka makers had given free samples to children after school. Some of it was sweetened so much to mask the harsh tobacco taste, she said, that children considered it candy. Gutka manufacturers managed to erase whatever stigma was tied to using tobacco with paan by marketing campaigns that made gutka use glamorous and socially acceptable.

For about a decade India’s version of the Oscars has been sponsored by Manikchand, one of the top-selling brands. Gutka manufacturers have sponsored religious festivals, distributing free samples. In television commercials, gutka
gives actors the power to perform superhuman feats. That may be why Abinash Parab, an ordinary laborer, thought he needed gutka to do his heavy lifting job. Until two weeks ago he was using 20 to 25 packets of Manikchand a day. “There was a sense of intoxication” from gutka, he said. What stopped him was not the ban; it was the wards he passed through at Tata Memorial Hospital when he went to get ulcers in his mouth checked out. Tumors bulge from cheeks and jaws. There are holes where larynxes used to be.

About 30 percent of the cancers in India are in the head and neck, compared with 4.5 percent in the West. Furthermore, Dr. D’Cruz added, “most of our cancers come a decade earlier than the West.” They come in the cheek and jaw, often preceded by submucosal fibrosis, a hardening of the palate that can make it almost impossible to open the mouth.

Rasiklal Manikchand Dhariwal, the founder of Manikchand and the country’s king of gutka, says he has no such health problems, despite being a user himself. The fruits of gutka’s popularity are visible at his 14,000-square-foot home in Pune, where he lives behind guarded gates in immodest opulence. He exports gutka to 22 countries, and calls his product a health promoter and job producer, noting that hundreds of thousands of Indians farm tobacco for their livelihood.

Manikchand, he said, is made with the highest level of quality control. He compared its scent to a “French perfume.” As long as the brand is of high quality, he said, it is fine for children, although his product is now marked “not for minors.” He disparaged his competitors for making shoddy, possibly injurious products. He also blamed consumers for overdoing it. “If you take anything in excess it will also harm, no?” he said. “Even milk.”

August, 2002|Archive|

Screenwriter Eszterhas Has Cancer

  • 8/9/2002
  • New York
  • AP

“Basic Instinct” screenwriter Joe Eszterhas has throat cancer after a lifetime of smoking, and is urging Hollywood to stop glamorizing cigarette use the way he says he did.

Eszterhas writes in an op-ed piece in Friday’s New York Times that he was diagnosed with the disease 18 months ago. Much of his larynx is gone, he says, and he has difficulty speaking and being understood. “Smoking was an integral part of many of my screenplays because I was a militant smoker. It was part of a bad boy image I’d cultivated for a long time — smoking, drinking, partying, rock ‘n’ roll,” the 57-year-old writes. “Smoking, I once believed, was every person’s right. … I don’t think smoking is every person’s right anymore. I think smoking should be as illegal as heroin.”

Eszterhas says he has trouble forgiving himself for the rampant cigarette use in his films. “I have been an accomplice to the murders of untold numbers of human beings. I am admitting this only because I have made a deal with God. Spare me, I said, and I will try to stop others from committing the same crimes I did.” The writer of other guilty-pleasure movies, including “Flashdance,” “Sliver” and “Showgirls,” says there are “1,000 better and more original ways to reveal a character’s personality” than with cigarettes.

In 1992’s “Basic Instinct,” Eszterhas explains, smoking is part of the sexual subtext. ” Sharon Stone’s character smokes; Michael Douglas’ is trying to quit. She seduces him with literal and figurative smoke that she blows in his face,” he says. “In the movie’s most famous and controversial scene, she even has a cigarette in her hand.”

Eszterhas says he has stopped smoking and drinking since his cancer was diagnosed, and now walks five miles a day and attends church on Sunday. “My hands are bloody; so are Hollywood’s. My cancer has caused me to attempt to cleanse mine,” he writes. “I don’t wish my fate upon anyone in Hollywood, but I beg that Hollywood stop imposing it upon millions of others.”

August, 2002|Archive|