The profile of the smoking population in the developing world has changed dramatically in recent decades. The era when smoking was normative among adults is gone, to be replaced by one in which those people still smoking tend to be low income and/or have mental health and alcohol/drug problems.

You might think that this new world of smoking would lead smoking cessation researchers to focus intensely on how to help smokers who have comorbid problems. But as my colleague Anna Lembke and I describe in the current issue of Tobacco Control, just the opposite is true:

One review of the smoking cessation trial literature found that 40% excluded depressed smokers, 55% excluded smokers with alcohol use disorders and 59% excluded those taking psychiatric medications. One critic described the practice of excluding smokers with mental health issues as a ‘scandal’, which is reasonable given the stunning 62% rate of smoking among people with schizophrenia, the 42.6% rate of binge drinking among all smokers, and the enormous tobacco-related health damage in the seriously mentally ill population.

Smoking cessation research is one of too many cases where the science that is supposed to guide medical practice for all patients is generated primarily by studying relatively healthy, wealthy, happy and young research subjects. A scandal indeed.