The FDA this week issued a “preliminary” report after more than two years of study, concluding that menthol isn’t inherently dangerous in cigarettes, but that by masking the harsh flavor, it induces more people to start smoking and makes it harder for them to stop. The report was seen as a step toward an eventual ban on menthol in cigarettes – the one flavoring not already prohibited by federal law.
Now, public health experts say, it’s time to take menthol out of cigarettes.
“It makes smoking a blowtorch taste like rice pudding,” says Harvard School of Public Health Professor Gregory Connolly, director of the school's Center for Global Tobacco Control. “And unfortunately, what’s in that rice pudding is very heavy toxins that go right to the lungs and you wind up with lung cancer, heart disease, stroke, emphysema, and so forth.”
Connolly, and several other local public health experts, says there’s no scientific doubt that menthol in cigarettes is a problem. And it’s one that disproportionately harms African-Americans and young people – who have a marked preference for menthol.
“If you ask me what is Public Health Enemy #1 for the African-American community in terms cancer: it’s Newport cigarettes – the menthol in cigarettes,” Connolly says.
Historically, the tobacco industry began heavily marketing menthol cigarettes to blacks in the 1970s as a way to boost smoking rates.
“I believe they did see there was more of an interest within the urban community for these [menthol] products and they took it and ran with it,” says Nikysha Harding, director of the tobacco prevention and control program at the Boston Public Health Commission, which also supports a ban.
“Obviously, I think there is a really large social piece to the use of these products,” she says.
Teens, too, tend to get hooked on cigarettes by smoking milder-tasting menthols. If someone stays away from all cigarettes until they’re 21, their chances of ever smoking drops below 3 percent, according to Dr. Jonathan Winickoff, a tobacco researcher and pediatrician at MassGeneral Hospital for Children (and a long-time personal friend).
A survey Winickoff published two years ago found that more than 2/3ds of blacks and more than half of all smokers want menthol banned from cigarettes.
"The very people the industry is saying want it, 'we need to protect them by keeping it in' – they want it removed," Winickoff says.
The American Academy of Pediatrics supports the FDA’s steps toward a ban on menthol, says Winickoff, a spokesman for the academy on tobacco-related issues. “We agree with the science, we agree with the [recent] FDA action and we hope that they proceed with final rule making,” he says. “It’s well overdue.”
The tobacco industry argues that cigarettes with menthol have the same health effects and those without the flavoring, and so shouldn’t be regulated differently.
Industry spokespeople have also warned that a ban on menthol will lead to a black market for mentholated cigarettes that will drive up illegal activity. The convenience store industry, which earns about 20 percent of its income from cigarette sales, also opposes a ban.
The government also stands to lose substantial amounts of money if smoking rates fall precipitously, perhaps explaining part of its hesitation to act, Winickoff says. The taxes on $25 billion in cigarette sales pay a lot of government salaries.
Harding says she hopes the federal government will also move to tighten regulations around small, flavored cigars. For the first time in 2011, smoking of non-cigarettes, like flavored cigars, surpassed the level of smokers among Massachusetts’ teens, according to state data. Last year, Boston set a minimum price to discourage their use, raising the cost from 69-cents each to more than $2.50. Harding says the city needs federal help to do more.
Connolly says there’s no question that menthol has to be taken out of cigarettes, but he’s okay with a slow phase-out instead of an outright ban.
The FDA report is the first of a 3-step process the government must follow, including public comment, drafting a proposed rule and then a final one. At each stage, the tobacco industry is expected to put up roadblocks, and Winickoff says he expects the industry will sue if a ban is put into effect.
Whatever is decided, Connolly says, should be done with the input of African-Americans – rather than just by well-meaning white people like him. Buy-in from African-Americans will be essential for menthol regulations to work, he says.
“If we win on menthol and do the science right and involve the black community, we set an extremely important precedent,” he says. “If successful, it’s probably going to be one of the most important public health steps in at least this 25 years.”
Karen Weintraub is a Health/Science journalist based in Cambridge.