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A risky stimulant thrives in China’s capital of chewing

BETEL NUTS assail the nostrils before they thrill the tongue. At a shop in Xiangtan, a city in the central province of Hunan, they are sold in a dried form—dark and wrinkled in blue-and-white porcelain bowls, with flavourings of spice, mint, orange and cinnamon oil. They sell for a few yuan apiece (under $1). A local song celebrates their ability to induce a bit of a buzz: “The more you chew the betel nut, the livelier you’ll feel...Spit one out and pop another in.” People in Xiangtan exchange them in greeting. From teenagers to elderly mah-jong players, the city’s residents chomp furiously to get their fix of the nut’s main stimulant, arecoline.

In 2017 China’s regulators named arecoline as a carcinogen (long after the World Health Organisation had done so). Also that year doctors in Hunan published findings that oral submucous fibrosis, a disease from chewing betel nuts that often leads to cancer, was “widespread” in the province, with rates much higher than elsewhere in China. They predicted oral-cancer cases would become a “humanitarian catastrophe” in Hunan, rising from almost 25,000 in 2016 to 300,000 in 2030. Something to chew on, you would think.

Yet demand for the nut is swelling. Sales at the largest firms are growing at a yearly rate of 10%, according to the Hunan Betel-Nut Association in Xiangtan, where the...

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