This is a tale of two tobacco users and the very different medical advice they received.

In 2005, two physicians and a dentist published a report in the American Journal of Psychiatry:

Ms. A, a 52-year-old woman with schizoaffective disorder, bipolar type, started smoking shortly after her first psychotic episode at age 19 and, on average, smoked about 1½ packs per day for 33 years. She had attempted to quit using pharmacotherapy, nicotine gum, or patches in combination with cessation classes. Both gum and patch treatments were ineffective since they did not control her craving for cigarettes.

Her motivation to quit was strong because of the sequelae of smoking: bronchitis, isolation from others, and destabilization of her psychiatric illness from frequently awakening to smoke. Her brother with a bipolar disorder had experienced severe burns over most of his body and died secondary to a fire caused by his smoking. For her, smoking had become a constant reminder of his suffering, which led to nightmares and further isolation. She was afraid to jeopardize the health and safety of others.

One year ago, she was cross-titrated over a 1-week period to oral pouches. Since that time, she has not resumed smoking, and her psychiatric and medical symptoms have stabilized. Before her cessation of smoking, she lived an isolated existence. Now she resides with and cares for her parents. For Ms. A, ceasing to smoke was a life-changing event.

A disabled veteran with post-traumatic stress disorder sent me this email:

My doctor has been pounding me regarding mouth cancer and me dipping. I have good oral hygiene, but she insists I will get cancer. I now find myself worrying sick every time I have a wrinkled gum, or cut from a chip….etc.

Please give me advice.

Should I be concerned and quit dipping and switch to a vape or gum??  It is about to drive my wife nuts, it seems I’m always looking at my mouth now, and the doctor has her convinced too that I’m at a 4 times more likely [to get mouth cancer] than a non dipper. Your input to ease my mind please. I do not have a laptop, but saw your book. Can’t read it on the phone. So thought I’d ask. My grandfather, right here in Kentucky smoked Pall Mall nonfilter cigs for 65 years…he died from a bleeding stomach ulcer caused by aspirin… I NEED TRUTH AND PEACE OF MIND. So I don’t become ocd more than I am since she gave my wife all these statistics. I’d rather hear the blunt truth.

Should I be worried?

I’m 41, dip a can in a day and half, have dipped for 17 years since I went in the Army. I have high BP…(according to them) 140/84..

Appreciate it very much if you would kindly respond.

I asked the writer to put me in contact with his physician, so that I could provide her with factual information and resources for the benefit of all her patients.

These stories are polar opposites, but equally poignant. Doctors in 2005 successfully switched a patient with severe mental problems from cigarettes to smokeless tobacco, citing two of my studies (here and here) as the scientific basis for their humane and “life-changing” guidance. In 2017, a misinformed physician tormented a disabled veteran about smokeless tobacco’s negligible mouth-cancer risk.

Too many doctors cause unnecessary suffering among tobacco users and their families. Their actions are influenced by the misguided crusade against smokeless tobacco conducted by many government agencies and prohibitionist organizations. This harmful disinformation effort must end.


Image by  Andrei_R