New Delhi, Sept. 6: A leading cancer specialist has called on the government to investigate whether a "tobacco lobby" has influenced arms of the government to initiate action against public health organisations engaged in India's tobacco control efforts.

Kailash Sharma, director of academics at the Tata Memorial Hospital, Mumbai, has cited leaked government and tobacco industry documents to seek a probe into whether a Union home ministry note allegedly depicting tobacco control as an unhealthy activity had been instigated by the lobby.

"While the tobacco industry lobbies to enhance business, public health activities are lobbying to save (people) from death, disease and deprivation," Sharma wrote in letters to Prime Minister Narendra Modi, home minister Rajnath Singh, health minister Jagat Prakash Nadda and national security adviser Ajit Doval.

His appeal comes against the backdrop of the home ministry's decision to bar three public health institutions working with the health ministry on tobacco control efforts from receiving foreign funds. Public health experts estimate that tobacco-linked illnesses kill about 9 lakh people in India each year.

The government has over the past year revoked or refused to renew the Foreign Contribution (Regulations) Act licences of the Public Health Foundation of India (PHFI), a Delhi-based education and research think tank, the Institute of Public Health (IPH), Bangalore, and the Voluntary Health Association of Assam.

In his letter, Sharma said that while NGOs had played "a pivotal role in augmenting the government's efforts to accelerate tobacco control", leaked documents from a multinational tobacco company had "revealed a sinister plan to demolish India's tobacco control efforts by targeting activists and NGOs".

News agency Reuters had after a global investigation reported this July that Philip Morris International (PMI), the company which sells Marlboro, is "running a secretive campaign to block or weaken" provisions in a global treaty intended to save millions of lives by curbing tobacco use.

Citing confidential company documents and a 2014 PMI power-point presentation, the Reuters report said the company "works to subvert the treaty on multiple levels", targeting tobacco control conferences and lobbying at the country level where treaty decisions are turned into legislation.

Reuters last month released another report that cited a "note" from the home ministry's intelligence division that said "foreign interests making foreign contributions... for purposes of lobbying against an established economic activity raises multiple concerns", including, it said, "adverse economic impact" on 35 million people.

Sharma's letter reflects speculation among some public health experts that the government's action might have been instigated by tobacco lobbying. "Please investigate if the (note) has been instigated by the tobacco lobby to derail the efforts of government and tarnish our image internationally." "Many of us share these concerns - about 40 per cent of the patients we see on any given day in our hospital have head and neck cancers that are related to tobacco," Sharma told The Telegraph.

A senior home ministry official denied influence of the tobacco sector and said the decisions on the FCRA licences were justified "because of FCRA-related irregularities". The PHFI is facing charges of opening multiple bank accounts without informing the ministry and misusing foreign funds by working with the anti-tobacco lobby, the official said.

But the speculation is linked to the contents of the leaked documents.

One page of the PMI presentation, available through a link provided by Reuters, is titled "What are we aiming for" and lists "build allies across several ministries", and "ability to influence the influencers", but without any reference to India.

Another page titled "Engage the Prime Minister" appears to suggest the engagement with Modi would seek to block "enactment of extreme anti-tobacco measures in the lead" to a global tobacco control conference India hosted in November 2016. A PMI spokesperson said the company "did not seek to, or ever engage, with the Prime Minister of India".

In an email response to queries, the spokesperson said the PMI, like any other company, interacts with governments and shares its views with decision-makers. "Despite some cinematic depictions, our views on tobacco regulation are far from secret. No amount of industry conversation stops a policy-maker from acting independently. Multiple points of view are paramount for effective decision-making and our teams will continue to make our views known in all countries where we operate."

The PMI presentation, on a page with photographs of eight professionals spearheading anti-tobacco campaigns in India, had featured a red circle around the image of K. Srinath Reddy, the president of the PHFI and a long-term advocate of tobacco control. "It would be an honour to be seen as enemy Number One by the tobacco industry," Reddy said.

Reddy and IPH officials assert that their institutions have always worked in concert with the Union health ministry's National Tobacco Control Programme, for which the government had allocated over Rs 315 crore over the past three years.

"Public statements by tobacco industry leaders, posters and hoardings by a tobacco farmers' organisation specifically targeting tobacco control advocates have created a climate of hostility that coincided with the (government) action against several public health NGOs," Reddy said. A petition filed by the tobacco farmers' organisation had called for action against foreign-funded institutions engaged in tobacco control efforts.

"It is difficult for us to say whether there is a link between such demands and the action," Reddy said. "But tobacco control is accepted government policy and the health ministry has been steadfast and strong in its commitment to tobacco control. Government policy should remain insulated from industry lobbying."

Over the past decade, India has banned smoking in public places, imposed conditions on the depiction of tobacco products in films and television, prohibited tobacco advertisements at points of sale and raised the size of graphic pictorial warnings to 85 per cent of the surface area of tobacco packets. The latest survey on global adult tobacco use released earlier this year indicated a 17 per cent drop in tobacco consumption in India over the past five years.

"The growing tobacco control efforts along with the decline in tobacco use would likely have rattled the tobacco lobby," said Narayanan Devadasan, director of the IPH, Bangalore. "We have approached court. Our finances are in perfect order, we have done no wrong," Devadasan said.#