TAIPEI, Taiwan -- Lu Toh peels off a bandage on his inner thigh and shows a credit card-size black scab. Doctors cut out a patch of skin from the spot to repair damage caused by cancer that was eating a hole through his cheek.
The 49-year-old engineer knows oral cancer didn't single him out randomly. Like many other Taiwanese, he invited the disease by chewing little green betel nuts sold at roadside stalls across this island."I wish I'd never started chewing it," Lu says, shaking his head slowly. "I really regret it."
Although many consider betel to be a national symbol and a harmless natural stimulant, the olive-size nuts are the target of a new campaign that claims they are killing Taiwan's people and damaging the environment.
But efforts to discourage betel chewing traditionally hits stiff resistance on Taiwan, where the government says the nuts are the No. 2 cash crop and where one of every nine people enjoys munching them.
Betel nuts, known as "Taiwanese chewing gum," are usually sprinkled with spices and other flavorings, served with a wedge of pepper or wrapped in a leaf, then sold at roadside drive-up stalls islandwide. They taste like a cross between black licorice and toothpaste.
Women clad in miniskirts and bikini tops are often used at the stands to attract customers, mostly taxi drivers and other blue-collar workers who chew the nuts like tobacco or snuff and claim they provide a mild buzz.
Habitual chewers can be spotted by teeth and lips stained red by betel juice, which some people spit on sidewalks and floors, leaving splotches that are difficult to remove.
When Lu started chewing betel 20 years ago, he said he had no idea it could cause cancer. The popular belief was the nuts would stimulate the gums.
Lu's oral surgeon, Dr. Hahn Liang-juinn, has made it his life mission to get Taiwanese to stop chewing betel nuts. The Taipei hospital ward where he works is filled with men whose mouths are swollen from surgery and have feeding tubes snaking through their nostrils.
Hahn crisscrosses the island, lecturing at city halls, schools, hospitals and any other place where people will listen to him.
"Think of Taiwan as being an organism and the betel nut trees are the cancer cells," he says.
As betel has grown in popularity over the past decade, the number of deaths from mouth cancer has more than doubled. There were 549 deaths in 1991, but by 1997 -- the most recent statistics available -- 1,163 people died from the disease, according to government figures.
Nearly 90 percent of Taiwanese with mouth cancer have chewed betel nut and most also smoke, increasing the risk of the illness, Hahn says. Although such cancers usually start on the tongue, most Taiwanese patients have cancerous growths on the inside of their cheeks, the spot where betel nuts are chewed, he says.
The nuts pack a deadly combination of cancer-causing juices and bristles that protrude from the nut as it's chewed and irritate the gums and wall of the mouth, the doctor says. The irritation speeds up the cancerous growths, which look like white, cauliflower-shaped warts. --
The Taipei city government is considering outlawing betel chewing in public spaces, but otherwise there are no national regulations on the nut.
With a big smile showing his red teeth, betel nut seller Huang Kuan-Hsi dismisses the health warnings as exaggerated. Huang, who says he owns 20 betel stands around the island, says the nuts are harmless if chewed in moderation.
"Even instant noodles can kill you if you eat too much of it. They have preservatives," Huang says, as a 20-year-old woman clad in a short, tight dress peels a pile of the nuts beside him at his roadside stand in a Taipei suburb.
A pickup truck pulls up and the woman climbs down from her high bar stool designed to give traffic a good look at her legs. She sells the driver a box of five betel nuts for 50 Taiwan dollars ($1.65).
"We chew it for the same reason American baseball players chew gum and tobacco," Huang says. "As long as your jaws are moving, you'll stay wide awake."
Huang says banning betel nut would create economic chaos, throwing tens of thousands of people out of work.
A typical betel farmer can earn four times the income of a rice farmer, and the crop's total value in 1997 was $13.2 million, the government says.
At a mountainside farm about an hour's drive from Taipei, farmer Su Ho-jin says he couldn't resist the profit potential of the betel nut.
Ten years ago, Su cut down his forest of acacia trees and planted 10 acres of betel nut trees in neat rows. Organic chickens that he also raises cluck and scratch in the dirt around the trees.
"The great thing about the trees is that they'll start bearing fruit about seven years after you plant them, and they'll keep doing it for 50 years," Su says.
Su says that when he planted the trees, he had no idea betel nuts were a health threat and he probably wouldn't have started if he had known. But now he's stuck with a small plantation and has no choice but to continue harvesting.
For Chen Hsin-hsiung, forestry professor at National Taiwan University, the scariest thing about betel nuts is what they are doing to the environment.
Chen says the thousands of acres of new plantations that have popped up in the past 20 years, many on the sides of mountains, are causing erosion and groundwater problems. The trees don't have enough foliage to catch adequate amounts of rainwater, and their shallow roots don't stop soil from being washed away, he says.
When an earthquake hit Taiwan last September, many betel groves were swept down mountainsides because the trees couldn't grip the soil amid the shaking, Chen says, showing pictures of fallen trees piled up at the bottom of mountains.
Chen acknowledges Taiwan has a tough choice: Protect the economy or the environment?
"I think we ought to chose the environment," he says. "If you destroy it, it's much harder to get it back."