The To­bacco War

The to­bacco in­dus­try has taken off its gloves and is go­ing af­ter anti-to­bacco lob­by­ists

Governance Now - - BUTT SERIOUSLY - Ar­chana Mishra

To­bacco com­pa­nies are not known to be the fairest of fight­ers in mar­ket bat­tles. But philip mor­ris in­ter­na­tional (pmi) seems to have gone to ex­tremes in its grand strat­egy to sweep the in­dian mar­ket, where an es­ti­mated 2 mil­lion peo­ple take up smok­ing ev­ery year. a pre­sen­ta­tion on the in­dian mar­ket by philip mor­ris (the mak­ers of marl­boro cig­a­rettes) that has been ac­cessed and re­leased by reuters news agency re­cently sin­gles out some anti-to­bacco groups for spe­cial at­ten­tion. and from among anti-to­bacco lob­by­ists, it marks out the pho­to­graph of dr K srinath reddy – a prom­i­nent car­di­ol­o­gist from aiims, an ex­pert on pub­lic health, and chair­man of the pub­lic health Foun­da­tion of india (PHFI) – with a red cir­cle. Dr Reddy’s photo finds its place among those of seven other global ad­vo­cates of anti-to­bacco poli­cies, in­clud­ing dr Ju­dith mackay, for­mer ad­vi­sor to the Who; prof rob moodie, aus­tralia-based pub­lic health ex­pert who ad­vo­cates a ded­i­cated to­bacco tax; and prof si­mon chap­man, an ac­claimed to­bacco-con­trol ac­tivist. But none of these is marked out in red.

“I deem it an hon­our,” says Dr Reddy. “I re­gard the to­bacco in­dus­try mark­ing me out as a prin­ci­pal ad­ver­sary the best pos­si­ble recog­ni­tion of my im­pact as an ad­vo­cate and agent of change.” HRIDAY, or Health Re­lated In­for­ma­tion Dis­sem­i­na­tion among Youth, which he set up in 1992, dur­ing his ten­ure at aiims as a car­di­ol­o­gist, ed­u­cates youth about the dan­gers of to­bacco and al­co­hol and en­cour­ages them to fol­low nu­tri­tious di­ets. Be­sides, phfi has been at the fore­front of anti-to­bacco ad­vo­cacy among pol­i­cy­mak­ers.

The sin­gling out of dr reddy and some groups may be part of a global of­fen­sive by to­bacco gi­ants. On July 19, World health or­gan­i­sa­tion (Who) pub­lished its re­port on the global to­bacco epi­demic, in which dr dou­glas Bettcher, its direc­tor for pre­ven­tion of non-com­mu­ni­ca­ble dis­eases, pointed to the con­tin­u­ous in­ter­fer­ence of the to­bacco in­dus­try in gov­ern­ment pol­icy-mak­ing as a deadly bar­rier to ad­vanc­ing health and de­vel­op­ment. dr Bettcher did not name any coun­try, but from how pmi’s strat­egy hon­chos put forth their roadmap for india, it’s clear that india is in their crosshairs.

“The to­bacco in­dus­try is known to tar­get to­bacco con­trol ad­vo­cates the world over through tac­tics of in­tim­i­da­tion, ha­rass­ment, mis­in­for­ma­tion and covert at­tacks on their or­gan­i­sa­tions,” says dr reddy. “i’m not sur­prised to see the philip mor­ris doc­u­ment in­clud­ing me in the se­lect group of pub­lic health cham­pi­ons who have been com­mit­ted ad­vo­cates of global to­bacco con­trol. how­ever, the fact that my pho­to­graph has been spe­cially marked out with a red cir­cle in­di­cates that i am be­ing spe­cially tar­geted for my role in ef­fec­tively ne­go­ti­at­ing for strong pro­vi­sions in the Frame­work con­ven­tion on To­bacco con­trol (Fctc) and or­gan­is­ing the first In­ter­na­tional Con­fer­ence on To­bacco con­trol and ad­vo­cat­ing for ef­fec­tive to­bacco con­trol mea­sures in India.”

im­por­tantly, dr reddy has been rep­re­sent­ing india in im­por­tant to­bacco con­trol con­fer­ences. in 2003, he was a key ne­go­tia­tor of the in­dian del­e­ga­tion, ap­pointed by the gov­ern­ment for the FCTC, the world’s first pub­lic health treaty re­lated to to­bacco. Last year, when the sev­enth ses­sion of the con­fer­ence of the par­ties (cop7) was held in India for the first time, Dr Reddy was once again ap­pointed key ne­go­tia­tor by the in­dian gov­ern­ment. his or­gan­i­sa­tions have worked in tan­dem with the health min­istry on the ex­ter­nal eval­u­a­tion of the na­tional To­bacco con­trol pro­gramme in 2012-13.

in all, the philip mor­ris doc­u­ment (of 2014) lists 12 in­dian anti-to­bacco or­gan­is­tions un­der the head ‘cor­po­rate Af­fairs Ap­proach and Is­sue’. Be­sides dr reddy’s or­gan­i­sa­tions, on the list are the vol­un­tary health in­sti­tu­tion of india (vhai), hriday, the in­sti­tute of pub­lic health (Kar­nataka), and the mad­hya pradesh and ra­jasthan vol­un­tary health as­so­ci­a­tion. it also in­cludes state-run agen­cies like Gu­jarat To­bacco con­trol cell and the direc­torate of pub­lic health and pre­ven­tive medicine, Tamil nadu. While the doc­u­ment sticks to eu­phemism, there is no sub­tlety about what the to­bacco gi­ant wants to achieve: [from] “track­ing, re­spond­ing or chal­leng­ing these or­gan­i­sa­tions when ap­pro­pri­ate to play­ing po­lit­i­cal games to have a po­lit­i­cal cover and win.”

says Bhavna mukhopad­hyay, ex­ec­u­tive direc­tor of vhai, “We are on the hit-list of these com­pa­nies be­cause our work is mak­ing a dif­fer­ence in terms of to­bacco con­sump­tion. We are able to in­flu­ence poli­cies and hav­ing an im­pact.” The VHAI works with the health min­istry in its na­tional To­bacco con­trol pro­gramme (ntcp). its rep­re­sen­ta­tives were on the ex­pert com­mit­tee on in­creas­ing the size of the pic­to­rial warn­ing man­dated on all to­bacco prod­ucts to 85 per­cent of the pack­age. The or­gan­i­sa­tion also pro­vides ex­per­tise and shares ev­i­dence on anti-to­bacco use. at the cut­ting edge, it works on the im­ple­men­ta­tion and com­pli­ance of the cig­a­rettes and other To­bacco prod­ucts act (cotpa), 2003, by sen­si­tis­ing im­por­tant stake­hold­ers and sup­port­ing the lo­cal ad­min­is­tra­tion with tech­ni­cal ex­per­tise and by cre­at­ing pub­lic aware­ness. as to tar­get­ting by to­bacco gi­ant philip mor­ris, like dr reddy, she says it’s a “badge of hon­our”.

For mukhopad­hyay, the fall in num­ber of to­bacco users by 81 lakh, ac­cord­ing to the Who Global adult To­bacco sur­vey-2 (2016-17), is a big dent on the to­bacco busi­ness. “Take these fig­ures as a de­cline in the num­ber of to­bacco buy­ers. This plunge in to­bacco con­sump­tion from 34.6 per­cent in 2009-10 to 28.6 per­cent in 2016-17 shows how to­bacco com­pa­nies have lost busi­ness in all these years,” she says.

Gov­er­nance Now con­tacted philip Mor­ris’s Delhi of­fice for com­ments, but they re­fused to share con­tact de­tails or e-mail ids of ex­ec­u­tives.

Hit­ting the kitty

The phfi, the in­sti­tute of pub­lic health (Kar­nataka) and vhai’s state unit in as­sam re­ceive funds from Bloomberg phi­lan­thropies, provider of the big­gest anti-to­bacco funding in asia. The group has since 2012 spent al­most $4 mil­lion on 12 anti-to­bacco ad­vo­cacy groups. in the last six months, how­ever, the funding of these or­gan­i­sa­tions

“I deem it an hon­our,” says Dr K Srinath Reddy. “I re­gard the to­bacco in­dus­try mark­ing me out as a prin­ci­pal ad­ver­sary the best pos­si­ble recog­ni­tion of my im­pact.”

has been dis­turbed. The for­eign funding li­cences of the phfi, the as­sam vol­un­tary health as­so­ci­a­tion (which works as an au­ton­o­mous unit vhai, as do all of its state-level units), and the in­sti­tute of pub­lic health were not re­newed: the ter­mi­na­tion of the For­eign con­tri­bu­tion reg­u­la­tion act (Fcra) li­cence means they can­not ac­cept funds such as those pro­vided by Bloomberg phi­lan­thropies.

a Jan­uary state­ment from the in­sti­tute of pub­lic health says: “un­for­tu­nately, we have not been pro­vided any rea­son for the re­fusal to re­new our Fcra registration. on re­peated e-mails and for­mal in­quiries, no rea­son has been pro­vided yet and we con­tinue to sin­cerely ap­peal to the gov­ern­ment to pro­vide us with rea­sons for this re­fusal.” It goes on to say: “In the lack of any rea­son forth­com­ing, we are forced to be­lieve that vested in­dus­try in­ter­ests could have played role in ma­lign­ing and mis­rep­re­sent­ing iph’s work. We have made a sin­cere ev­i­den­tial ap­peal to con­cerned au­thor­ity ad­duc­ing facts and fig­ures about IPH’S pub­lic health ac­tiv­i­ties over time. un­for­tu­nately, this ap­peal was also de­nied with­out pro­vid­ing any in­for­ma­tion on the rea­sons.”

sim­i­larly, it has been three months since dr reddy’s phfi lost its Fcra li­cence; again, there has been no re­sponse from the gov­ern­ment to ques­tions on why the li­cence has not been re­newed. al­though there has been talk that phfi may have been tar­geted be­cause of dr reddy’s per­ceived close­ness to the the pre­vi­ous upa regime and Dr Reddy has of­fered to quit to make way for some­one else to run the show so that the work con­tin­ues, there are sin­is­ter un­der­tones to the whole af­fair and how sharply the blow was struck. Peo­ple from the field are in­clined to be­lieve that the to­bacco lobby might have been at work.

Flank at­tack

The on­slaught takes some de­vi­ous tacks. says ashim sanyal of con­sumer voice, a vol­un­tary ac­tion group that filed a suit against the ‘Made for Each other’ cam­paign of Wills cig­a­rettes, an ITC brand, “Lob­by­ing is gen­er­ally through putting frontal faces. There are to­bacco farm­ers who are made to stand as rep­re­sen­ta­tives on be­half of to­bacco in­dus­tries.” He was re­fer­ring to groups such as the Fed­er­a­tion of all india Farm­ers as­so­ci­a­tion (Faifa), which has been putting up posters of for­lorn farm­ers and seek­ing to “pro­tect their liveli­hood” against the on­slaught of “for­eign-funded anti-to­bacco lob­bies”.

Faifa, a so­ci­ety reg­is­tered un­der the andhra pradesh so­ci­eties registration act, 2001, was set up in 2015 and is head­quar­tered in Gun­tur. andhra pradesh is one of the ma­jor to­bac­co­pro­duc­ing states of india. Faifa came into the lime­light when india hosted cop7 (or the sev­enth con­fer­ence of the par­ties, where all par­ties to the Frame­work con­ven­tion on To­bacco con­trol meet for dis­cus­sion) last year. it de­manded that the prime min­is­ter boy­cott the con­ven­tion; it was riled the most when the Who’s Fctc con­ven­tion sec­re­tariat re­jected its ap­pli­ca­tion for the sta­tus of ob­server at the con­fer­ence. Gen­er­ally, the me­dia, in­dus­tries and pri­vate or­gan­i­sa­tions are not al­lowed to at­tend the con­ven­tion be­cause they might have con­nec­tions to the to­bacco in­dus­try.

Faifa then went to delhi high court on the grounds that the con­fer­ence guide­lines are not bind­ing on the in­dian gov­ern­ment as there is no do­mes­tic law en­acted by par­lia­ment to adopt/ im­ple­ment the treaty. it’s pe­ti­tion also said that india’s host­ing of and par­tic­i­pa­tion in cop7 went against the in­ter­ests of to­bacco farm­ers. The ar­gu­ment runs some­what like this: the Fctc (which, un­der ar­ti­cle 21, speaks of pro­vid­ing al­ter­na­tives to wean to­bacco farm­ers away from the cash crop) is not en­acted by par­lia­ment nor is there any in­dian law mak­ing it bind­ing on the coun­try, whereas the To­bacco Board act of 1975, an in­dian law, is for pro­mo­tion of to­bacco cul­ti­va­tion. so the gov­ern­ment should rather go by an in­dian law. “We are work­ing on be­half of farm­ers. our liveli­hood should

FAIFA, a group that represents to­bacco farm­ers, has al­leged that for­eign-funded NGOS are out to harm poor farm­ers. It thanked the govt for act­ing against some anti-to­bacco NGOS.

not be af­fected,” says Mu­rali Babu, gen­eral sec­re­tary of Faifa, him­self a to­bacco farmer, though by no means a small farmer: he told Gov­er­nance Now he owns 40 acres of to­bacco-pro­duc­ing land. he says Faifa is funded through con­tri­bu­tions from farm­ers.

Faifa was most vis­i­ble in delhi and other ma­jor cities with its poster cam­paign last year; even to­day, its posters are seen on sev­eral auto-rick­shaws in delhi and on hoard­ings at prom­i­nent places. it uses the ap­peal of sym­pa­thy­seek­ing, pitch­ing the case of small to­bacco farm­ers fac­ing the on­slaught of for­eign-funded ngos that lobby against to­bacco use. it de­ploys ev­ery kind of red her­ring ar­gu­ment – that anti-to­bacco lob­bies might ac­tu­ally en­cour­age ci­garette smug­gling, through which for­eign ci­garette com­pa­nies want to put lo­cal to­bacco pro­duc­ers out of busi­ness. (it’s well known that some big ci­garette mncs have been un­der the shadow of ci­garette smug­gling charges.) here is what Faifa’s web­site says:

“Fctc ar­ti­cle 6 with rec­om­men­da­tions for im­pos­ing ex­ces­sively high tax­a­tion on to­bacco prod­ucts will have se­ri­ous liveli­hood im­pact for in­dian ci­garette to­bacco farm­ers. Le­gal Cig­a­rettes are al­ready sub­jected to very high and dis­crim­i­na­tory tax­a­tion in the coun­try which has led to a shift of con­sump­tion to smug­gled cig­a­rettes which do not use lo­cal to­bacco. This af­fects neg­a­tively the de­mand for to­bacco grown by us and sup­plied to the do­mes­tic le­gal in­dus­try.”

“To­bacco tax­a­tion poli­cies should not cre­ate ar­bi­trage op­por­tu­ni­ties for un­scrupu­lous anti-so­cial el­e­ments which would fuel smug­gling in India and across the globe.”

An­gle of at­tack

But then, Faifa’s pe­ti­tion to delhi high court, while plead­ing the case of farm­ers, makes par­tic­u­lar men­tion of Bloomberg phi­lantro­phies and the funds granted to dr reddy’s phfi. (The Bill and melinda Gates Foun­da­tion also finds men­tion.) It says the min­istry of health re­port on to­bacco con­trol in india is jointly sup­ported by the cen­tre for dis­ease con­trol and pre­ven­tion

Foun­da­tion (cdc), one of the en­ti­ties ad­min­is­ter­ing Bloomberg grants; and that dr reddy re­ceives grants from Bloomberg and is a con­trib­u­tor to the to­bacco re­port. pub­lic health cam­paign­ers won­der why a farm­ers’ or­gan­i­sa­tion, in­stead of pre­sent­ing the le­git case of farm­ers, would par­tic­u­larly go against an anti-to­bacco cam­paigner and those who fund him. of course, big farm­ers stand to lose huge prof­its if to­bacco con­sump­tion goes down dras­ti­cally through the ef­forts of peo­ple like dr reddy. There is also a case to be made for small to­bacco farm­ers, who may find it dif­fi­cult to shift to an equally prof­itable al­ter­na­tive crop or oc­cu­pa­tion. But rich to­bacco grow­ers have al­ready prof­ited enough over many gen­er­a­tions to be able to di­ver­sify into other busi­nesses. con­sid­er­ing the sus­tained cam­paign and its pointed tar­get­ing, there seems to be more than what meets the eye, namely, those posters and cam­paign hoard­ings de­pict­ing poor farm­ers.

in april, when the me­dia was abuzz with the news of phfi’s Fcra li­cence not be­ing re­newed, Faifa was prompt to put up a hoard­ing out­side nir­man Bha­van which houses the health min­istry, thank­ing the gov­ern­ment for tak­ing ac­tion against anti-to­bacco ngos and call­ing for pun­ish­ing them. it was al­most glee­ful. it’s not clear if this should be read in the light of philip mor­ris’s pre­sen­ta­tion, which marked out dr reddy in red, but sev­eral ex­perts work­ing in pub­lic health have won­dered how an or­gan­i­sa­tion of poor farm­ers can af­ford such an ad­ver­tis­ing cam­paign: a blitz of ads on au­torick­shaws, hoard­ings in prime lo­ca­tions that stayed for al­most a month. its ads have also been ap­pear­ing in news­pa­pers. asked why dr reddy was be­ing tar­geted in its pe­ti­tion while there are so many ngos work­ing on to­bacco pol­icy con­trol, Faifa’s mu­rali Babu, says, “We are be­ing tar­geted, we are not tar­get­ing any­one. our con­cern is the liveli­hood of farm­ers.”

re­cently, Faifa has also jumped into the fray in the PIL in Bom­bay high court on the LIC stake in ITC and other to­bacco com­pa­nies (see pro­file of lead pe­ti­tioner su­mi­tra hooda ped­nekar on page 24). ad­vo­cate aseem pan­garkar of MZM Le­gal, who is fight­ing the case on be­half of pe­ti­tion­ers su­mi­tra and oth­ers, says, “Farm­ers have noth­ing to do with the case! it is com­pletely a fi­nan­cial is­sue, which de­mands dis­in­vest­ment of pub­lic fund from ci­garette man­u­fac­tur­ing com­pa­nies. Faifa’s in­ter­fer­ence is a way to di­vert at­ten­tion.” Faifa has also started a cam­paign op­pos­ing the five per­cent GST on raw to­bacco, say­ing that it’s an un­re­al­is­tic tax that will “se­verely en­dan­ger their liveli­hoods”.

dr reddy, on the other hand, speaks of how a case was made for poor to­bacco farm­ers. he says, “While ne­go­ti­at­ing the Fctc and also at cop7, the in­dian del­e­ga­tion ar­gued pow­er­fully and suc­cess­fully for in­clu­sion of pro­vi­sions and de­tail­ing of mea­sures to support tran­si­tion to eco­nom­i­cally vi­able al­ter­nate crops and oc­cu­pa­tions. i put forth those ar­gu­ments with the strong con­vic­tion that it is the duty of govern­ments to im­ple­ment multisectoral ac­tions to as­sist smooth and sus­tain­able tran­si­tion while pro­tect­ing so­ci­ety from the ill ef­fects of to­bacco. The an­swer lies not in slow­ing down to­bacco con­trol but in speed­ing up the tran­si­tion.”

Cost to coun­try

pol­icy ex­perts are wor­ried more about the in­creas­ing health­care bur­den on the gov­ern­ment due to to­bacco-re­lated dis­eases like cancer, tu­ber­cu­lo­sis and heart dis­ease. Be­sides, the loss of so many lives and man­days trans­lates into steep de­cline in na­tional pro­duc­tiv­ity. The ju­di­ciary and par­lia­ment, too, have pointed this out. in 2001, the supreme court, in the murli s de­ora vs union of india case, ob­served, “Treat­ment of to­bacco-re­lated dis­eases and the loss of pro­duc­tiv­ity caused therein cost the coun­try al­most ₹13,500 crore an­nu­ally, which more than off­sets all the ben­e­fits ac­cru­ing in the form of rev­enue and em­ploy­ment gen­er­ated by the to­bacco in­dus­try.”

also, the par­lia­men­tary stand­ing com­mit­tee on science and tech­nol­ogy,

Even the supreme court noted, in a 2001 case, that to­bacco costs the coun­try ₹13,500 crore an­nu­ally, which more than off­sets the ben­e­fits ac­cru­ing in the form of rev­enue and em­ploy­ment gen­er­a­tion.

en­vi­ron­ment and forests, in 2016 dis­cour­aged ex­pen­di­ture in­curred by the gov­ern­ment in re­la­tion to to­bacco-re­lated dis­ease treat­ment and death caused by it. it rec­om­mended dis­in­cen­tivis­ing to­bacco pro­duc­tion and en­cour­ag­ing farm­ers to move to other prof­itable crops.

Long reach

against all that, lob­by­ing goes a long way: the ten­ta­cles of in­dus­try reach right up to par­lia­men­tar­i­ans. The de­lay in the im­ple­men­ta­tion of pic­to­rial health warn­ings cov­er­ing 85 per­cent of ci­garette pack­ets is a fine ex­am­ple. In Oc­to­ber 2014, gov­ern­ment an­nounced the in­tro­duc­tion of larger pic­to­rial warn­ings. as planned, the de­ci­sion was to come into ef­fect on April 1, 2015. dilip Gandhi, the BJP mp from ah­mad­na­gar who steered the 15-mem­ber sub­or­di­nate leg­is­la­tion com­mit­tee, in­ter­acted with rep­re­sen­ta­tives from the to­bacco lobby. eight of its mem­bers were op­posed to hav­ing big­ger warn­ing pho­tos.

Gandhi was later quoted by The In­dian Ex­press as say­ing, “no in­dian study has es­tab­lished that to­bacco causes cancer. Whether it ac­tu­ally causes cancer or other dis­eases is sub­ject to a study in the coun­try. That has never hap­pened. and the ba­sis of our stance to­wards to­bacco prod­ucts is ba­si­cally that stud­ies that have hap­pened in a for­eign set­ting.”

it is ex­pected that plain pack­ag­ing of to­bacco prod­ucts – where the warn­ing or mes­sage to quit will cover al­most the en­tire pack, with very lit­tle space for the brand name – will be next big thing. The idea is to al­low the sale of cig­a­rettes and other to­bacco prod­ucts with­out any brand as­so­ci­a­tion. coun­tries like aus­tralia have al­ready im­ple­mented this mea­sure. pro-to­bacco lob­by­ists will be jump­ing in to op­pose the mea­sure as much as they can. They are also ex­pected to lobby vig­or­ously against higher tax­a­tion of to­bacco prod­ucts, which the na­tional health pol­icy 2017 rec­om­mends. prab­hat Jha, a to­bacco tax­a­tion ex­pert and founder of the cen­tre for Global health re­search, says, “The prob­lem is that govern­ments don’t raise taxes on all lengths of cig­a­rettes, so the to­bacco in­dus­try then pushes more of cheaper, shorter ci­garette (which are also be­ing used as a lure for bidi smok­ers to make the switch). so what is needed is a big tax but also a smart one that pre­vents such ma­nip­u­la­tion.”

Ac­cord­ing to Jha, in the past five union bud­gets, tax on to­bacco has been raised twice by a mod­est ex­tent, which has hiked the price of shorter cig­a­rettes. The chal­lenge, ac­cord­ing to him, is tax­a­tion on beedis. “note that beedi tax­a­tion in india is hard, and it will con­tinue to be dif­fi­cult un­less all beedi man­u­fac­tur­ers are reg­is­tered and mon­i­tored. The hope is that with GST registration now re­quired, they can be reg­u­lated first, af­ter which tax­a­tion can be in­tro­duced. in con­trast, the ci­garette in­dus­try is smaller and can be taxed more ag­gres­sively.”

Taxes alone will not work. To­bacco con­trol calls for a mul­ti­pronged ef­fort: if pro­vid­ing to­bacco farm­ers with an al­ter­na­tive is im­por­tant, equally im­por­tant is ed­u­ca­tion against to­bacco use and ef­fec­tive pol­icy in­ter­ven­tions. in the last two, it’s the vol­un­tary sec­tor that has played a ster­ling role. The health costs of to­bacco use – at the in­di­vid­ual and the na­tional lev­els – are too high to ig­nore the ag­gres­sive and cyn­i­cal war the to­bacco lobby has un­leashed on such ngos.


The health costs of to­bacco use, at the in­di­vid­ual and na­tional lev­els, are too high to ig­nore the ag­gres­sive and cyn­i­cal war the to­bacco lobby has un­leashed on vol­un­tary groups.

Cour­tesy: Vhai

A FAIFA hoard­ing thank­ing the gov­ern­ment for act­ing against anti-to­bacco cam­paign­ers

Arun ku­mar

Pic­to­rial warn­ings may be fur­ther in­creased. The new idea is plain pack­ag­ing – no brand­ing

A slide from the Philip Mor­ris pre­sen­ta­tion, with Dr Reddy’s photo cir­cled in red

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