Health Care

Should Menthol Cigarettes Be Prohibited

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Here’s a word of advice to the Food and Drug Administration (FDA) regulators deciding this week whether or not to ban menthol cigarettes smoking: Cool it. If the FDA sows this wind, I fear we will reap the whirlwind.

It was only last year that the agency prohibited the sale of all other flavored cigarettes, but would outlawing menthol be a good idea?

The FDA’s power to ban it goes back to the 2009 “Family Smoking Prevention and Tobacco Control Act” — the law giving the Food and Drug Administration (FDA) authority to regulate tobacco. That bill contained a provision barring all flavorings except menthol.

At first glance, the decision to ban other flavorings may seem curious. After all, the only real player in the flavored cigarette market was, and is, menthol, which is smoked by about 30 percent of our nation’s 45 million adult famous smokers — and perhaps three-quarters of African-American smokers. The other flavored cigarettes — such as cherry, banana, and chocolate — are smoked by hardly anyone.

But the law finally giving the FDA jurisdiction over tobacco products was cobbled together over the course of some years. And, while the negotiators were such classic Washington figures as Sen. Ted Kennedy (D-Mass.), Rep. Henry Waxman (D-Calif.), and representatives of public health groups led by the Campaign for Tobacco-Free Kids’ Matt Myers, also involved were executives of Altria, America’s largest cigarette company (formerly Philip Morris).

How Altria got a say in the behind-the-scenes decisions about regulating cigarettes is a tale for another day, but here’s the short version: without its support, there would have been no bill at all.

So, if Altria was the one who wanted menthol spared, does it then follow that we should outlaw it? Generally, what’s good for Big Tobacco is bad for everyone else. But we at ACSH decided to investigate the question by commissioning a study to evaluate the actual health effects of menthol in cigarettes. Our peer-reviewed position paper was released earlier this year and was communicated to the responsible committee of the Center for Tobacco Products (CTP), the division of the FDA established by the new law.

The results surprised us: extensive review of the relevant literature documented the absence of adverse health effects attributable to menthol in cigarettes. As compared to non-menthol cigarettes, we found no increased risk of cancer, heart disease, lung disease, or any of the myriad other debilitating or lethal effects of smoking.

Some members of the public health community, including some members of the committee charged with advising the FDA on menthol’s fate, have asserted that other “softer” (less reliably measured) factors call for a ban, such as lower quit rates and higher youth preference for menthols. Another concern is the higher rate of lung cancer among black smokers.

While this discrepancy is real, the higher rate has not been found to be causally related to menthol-flavoring in cigarettes.

Why not just ban menthol anyway, given the concerns swirling about it? Who cares what the medical facts say about menthol — wouldn’t a ban just upset the cigarette-makers who addict young people to menthols, cutting into their profits?

Unfortunately, that is not the major downside of a menthol ban. Given the fact that models smokers who prefer menthol rarely change to non-menthol, the more likely scenario post-ban is the development of a massive, widespread black market in contraband menthols, thanks to criminal smugglers supplying plentiful smokes to anyone who’ll pay the premium for them — no questions asked, no I.D. cards checked, no taxes paid.

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