Last week The New England Journal of Medicine published a point/counterpoint about menthol cigarettes, the subject of a recent report from the Food and Drug Administration's Tobacco Products Scientific Advisory Committee. The report (PDF), issued in late March, concluded that "removal of menthol cigarettes from the marketplace would benefit public health in the United States" but cautioned that "a black market for menthol cigarettes could be created, criminal activity could ensue, and different methods might be used to supply such a black market."
Boston University public health professor Michael Siegel criticizes the advisory committee for kicking the issue back to the FDA without "a clear and strongly stated recommendation that the FDA ban menthol cigarettes to protect the public's health." Neal Benowitz and Jonathan Samet, two members of the committee, defend their work as responsive to their legislative mandate, which was to consider the impact of menthol cigarettes on smoking-related disease. They concluded that mentholation does not seem to make cigarettes more dangerous but that it encourages people (especially African Americans and teenagers, who disproportionately favor menthol brands) to start and continue smoking by making the smoke tastier and less irritating. The same argument, of course, could be made about any feature designed to make cigarettes more appealing.
Siegel argues that forcing Newport and Kool consumers to smoke harsher, fouler-tasting cigarettes would encourage them to quit. "There are 19.2 million menthol-cigarette smokers in the United States," he writes, "and if even a fraction of them quit smoking in response to a menthol ban, it would have a profound effect on public health." He adds that the absence of menthol brands would cut down on smoking initiation. "Approximately half of people who are just starting to smoke usually smoke a menthol brand," he says, "and if even a fraction of those people were to be deterred from initiating smoking, this, too, would have a profound public health benefit." Siegel does not really address the black market issue, except to say that Lorillard, which makes Newports (the No. 1 menthol brand), pushed the same argument, which also was adopted by the Campaign for Tobacco-Free Kids when it argued against a menthol ban as part of the Family Smoking Prevention and Tobacco Control Act. He suggests the anti-smoking group's main motive was appeasing Philip Morris, which makes several menthol brands and would not have backed a bill that banned them.
For both practical and moral reasons, I don't agree that banning menthol cigarettes is a good idea, any more than banning cigarettes in general would be. But Siegel is on target when he notes the absurdity of banning rarely used cigarette flavors that supposedly appealed to children, as the tobacco control act did, while allowing the one flavor that is actually popular to stay on the market:
It is difficult to understand the rationale for a policy that bans every other type of cigarette flavoring — including chocolate, strawberry, banana, pineapple, cherry, and kiwi — yet exempts the one flavoring that is actually used extensively by tobacco companies to recruit and maintain smokers….Ironically, it is because removing menthol would actually improve the public's health by reducing the consumption of cigarettes that we are not going to see such an action from the federal government. There is no political risk in banning chocolate and strawberry cigarettes, since no companies are currently selling such products and they play no role in smoking initiation. Menthol, however, is a major contributor to smoking initiation and continued addiction, and for this reason, it will continue to enjoy the protection of a federal government that seems afraid to alienate any corporation, whether it's part of Big Pharma, Big Insurance, or Big Tobacco.
It does seem to be the case that Philip Morris, the market leader and the one big company that backed the tobacco control law, saw it as a way to rig the rules in its favor. More on the controversy over cigarette flavoritism, including the question of whether it is racist, here and here.
