Intolerable False Statements by FDA’s Mitch Zeller

Mitch Zeller, director of the FDA Center for Tobacco Products, should stop making false statements about smokeless tobacco.

The FDA earlier this week expanded its smokeless tobacco campaign, arranging a series of interviews for Zeller (example here), whose script included two provably false statements.

   “Every year more then [sic] 2,000 new [mouth or throat] cancer [cases] are diagnosed in the United States solely caused by smokeless tobacco use.”

This number is a pure fabrication.  No medical authority, including the FDA, has ever produced such a figure, which is more than 50% higher than the agency’s estimate of two years ago (here). Even that number was a gross exaggeration, due to a serious technical error confusing the historical risks of dip and chew (essentially zero) favored by American men with the higher risks of dry powdered snuff preferred by women (here).

The Zeller number is further undercut by last year’s American Cancer Society report which omitted smokeless tobacco as a cause of cancer (here).   

Zeller also produced this false statement in his latest publicity tour:

2.     …“a white spot inside your lip or gum that you know if you’re seventeen eighteen years old and you see that and you don't pay any attention to it, it can progress to things like cancer.”

A white patch, as I have documented (here), is simply a reaction to the irritating effect of the tobacco, similar to the development of calluses on a worker’s hand.  The link between white patches and cancer is virtually zero for dippers and chewers.

As director of an FDA center, Zeller has a profound responsibility to enhance public health and adhere to scientific truth.  He damages his own credibility and that of his agency by making false statements. 

Another Smokeless Tobacco Myth: The Dangerous White Patch

If you use smokeless tobacco for a long time and hold it in the same place in your mouth, the surface of your lip or cheek, called the mucosa, where the tobacco sits might thicken and turn white. A layer of white keratin is reacting to the irritating effect of the tobacco.  The reaction is similar to the development of calluses on a worker’s hand.  White patches in the mouth related to smokeless tobacco are nearly always benign.

Physicians and dentists refer to these spots as “leukoplakia” – “leuko” meaning white and “plakia” meaning plaque or patch.  Regrettably, many health professionals don’t know that smokeless use is far safer than smoking and that a wealth of research shows that smokeless tobacco-related callouses hardly ever turn into anything more serious. 

As an oral pathologist, I have decades of experience examining these patches and I have researched this issue extensively.  A 1990 study (abstract here) is typical; it showed that white patches were common in baseball players who chewed and dipped.  Upon biopsy, all were benign.  The link between white patches and cancer is virtually zero for dippers and chewers. 

On the other hand, white patches in smokers are matters of concern.  Smoke permeates the lining of the mouth, throat, airway and lungs, delivering thousands of toxic agents.  As I discussed in a 1995 journal article, studies show that white patches in smokers are much more likely to be associated with mouth cancer (abstract here). 

Too many doctors have blindly included smokeless tobacco in their anti-tobacco crusade without learning the facts. You ought to share this blog entry with your physician and dentist, and tell them that more information is available in my book (here and here).