A misguided FDA crusade
Calls for an all-out ban on flavorings began as a limited fight over menthol. This minty flavor is big business. The second-most-popular cigarette in the United States, Newport, has been sold only in menthol form for most of its history. Menthol also is the second-most-popular flavor (after “tobacco”) in the fast-growing e-cigarette market.
But menthol remains in many public health officials’ sights. The European Union has voted to ban it from cigarettes starting next year. Chicago has outlawed the sale of menthol cigarettes near schools, a directive that covers most of the city, and the Baltimore City Council is considering similar regulations. The FDA, which was granted broad power to regulate cigarettes and banned flavors like clove and cherry in 2009, has been fiddling with the idea of a national ban on menthol since 2013.
In the United States, it appears that cities are cracking down on menthol to target a specific portion of the population. About 80 percent of African-American smokers prefer menthol cigarettes. Both Chicago (33 percent) and Baltimore (63 percent) have large black populations.
Despite this widespread hostility, there’s little evidence that menthol cigarettes are appreciably worse than any other kind (which is to say that they’re very unhealthy). Some research suggests menthol cigarettes are somewhat harder to quit and slightly more popular among teenage smokers. But all common nicotine products are very addictive, and most youthful smokers start with plain old tobacco flavor.
It also bears noting that, except for a few niche brands, nearly all cigarettes are flavored in one way or another, although the common flavorings tend to be subtle. First-time smokers will find any additive-free cigarette much less tolerable than the options currently on the market. But that’s the point: A menthol ban is a foot in the door to banning almost all current brands of cigarette.
Michael Siegel, a former FDA official and professor at Boston University’s School of Public Health who is among those leading the effort to ban menthol, is straightforward about the goal. If menthol is banned, he stated in an email, there will be “hardly a justification for the FDA to not simply ban all additives.”
“Since all the additives are put in with a marketing purpose in mind, banning the additives will, by definition, make it harder to sell these products, reducing sales,” Siegel wrote.
Some surveys of menthol smokers suggest many would quit smoking if menthols were pulled from the market. But empirical evidence demonstrates that smokers today have a very hard time quitting. No particular method of quitting works more than 10 percent of the time. New York City, home to the nation’s highest cigarette taxes and most concerted public health efforts, has actually seen smoking rise since 2010.
Five decades of stern public health warnings, high taxes, marketing restrictions and smoking bans brought the share of adults who smoke down from almost half to less than a quarter. But progress has largely ceased. For those who continue to smoke, all-out cessation may be nigh on impossible.
If someone like Siegel, who favors increased use of e-cigarettes to reduce the harm of tobacco, were in charge of public health policy, a ban on menthol and other flavorings might be worth further review. It almost certainly would have to be coupled with public education campaigns encouraging smokers who can’t quit to find other, safer sources of nicotine. E-cigarettes also would have to continue to be available in the very flavorings that cigarettes would then lack. Someone who enjoys “dark chocolate mint”-flavored vapor solution is unlikely to want to go back to harsh tobacco.
But the prevailing tilt of public-health policy has been away from this tobacco harm reduction approach. Major cities like New York, Chicago and Los Angeles already have banned vaping in most indoor public places. Sen. Richard Blumenthal, D-Conn., has launched an effort to ban flavored e-cigarettes nationally. In California, the Sonoma City Council has voted to ban e-cigarette flavorings and other municipalities are considering the same.
The confluence of these trends in public health—toward banning flavorings and treating e-cigarettes the same as their deadlier combustible cousins—could get ugly fast. It could herald a new Prohibition. It would be Prohibition in all but name for cigarettes, as the law would allow few attractive alternatives for those who crave nicotine.
This policy probably would reduce smoking at least a little, saving some lives. But with thousands of smokers still craving a nicotine fix, an already-ample black market for cigarettes would explode. According to the Tax Foundation, the black market for cigarettes has already surpassed the legitimate market in two states (New York and Arizona). And at least one cigarette-smuggling ring has been linked to international terrorism: In 2005, Buffalo businessman Aref Ahmed was convicted of smuggling cigarettes and funneling his profits to terrorist training camps.
When the FDA last held public hearings to consider banning menthol, many of the objections and calls for reconsideration came from law-enforcement groups like the National Troopers Coalition and the National Black Police Association. Most cigarette smugglers doubtless won’t fund terrorism, but a ban on menthol or flavorings generally could amount to handing a sizable portion of the tobacco industry’s more than $30 billion in 2014 U.S. revenues over to criminal gangs.
In the right context, more stringent regulation of cigarette flavorings could make sense. But the preponderance of evidence indicates that banning menthol and other additives would have uncertain benefits and significant costs. A ban on flavorings for e-cigarettes might actually increase the number of people who smoke and discourage would-be vapers from quitting combustible cigarettes altogether. For now, governments concerned about cigarette additives and e-cigarette flavors are best off leaving things alone.