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Debate Sharpens Over Menthol Cigarettes

Public Health Experts and Industry Representatives Disagree on Regulation of Menthol Cigarettes

By Matt McMillen
WebMD Health News

Reviewed By Laura J. Martin, MD

March 31, 2010 -- Representatives from three major tobacco companies, speaking before a committee tasked with advising the federal government on tobacco regulation, defended menthol cigarettes against charges that they put smokers' health at greater risk than regular cigarettes.

"Menthol does not make cigarettes more harmful," says William R. True, senior vice president of Lorillard, the maker of the best-selling menthol cigarette, Newport. Representatives from R.J. Reynolds and Altria, the parent company of Philip Morris USA, also spoke.

Several public health experts, meanwhile, argued for a total ban of the additive, referring to its role in cigarettes as "sweetening the poison."

So began the second and final day of the Tobacco Products Scientific Advisory Committee's inaugural meeting in Washington, D.C. The committee, formed following the passage of the Family Smoking Prevention and Tobacco Control Act in June 2009, has a year to review available research -- both publicly available studies as well as unpublished tobacco industry documents -- in order to determine where the balance should lie.

"We need to review all the evidence and get insight into the scope of the research that has not been published," says committee chairman Jonathan M. Samet, MD, of the Keck School of Medicine at the University of Southern California.

The committee spent the afternoon hashing out the types of information it would require in order to make its recommendations. Much of what they hope to review concerns industry marketing practices, the chemical makeup of menthol and what effects it has on human physiology, as well as any role it might play in a person's decision to start smoking or their efforts to quit.

A decision to ban menthol outright would have a huge impact on the tobacco industry, as menthol cigarettes account for approximately a quarter of the market. But, argue advocates of such a ban, the FDA has already banned all other flavored cigarettes.

"There's no distinction, no logic" to allowing menthol cigarettes to remain on the market while other flavors are banned, says Philip Gardiner, PhD, of the University of California's Tobacco Related Disease Research Program.

Who Smokes Menthol Cigarettes?

Much of the day's discussion focused on a few key issues. Foremost among them was the appeal of menthol cigarettes for different ethnic groups, including African-Americans, and also for young smokers, who many believe favor menthols because they mask the harshness of regular tobacco.

African-Americans account for more than three-quarters of the market for menthol cigarettes. Gardiner, who says this a social justice issue, calls the opportunity for the FDA to ban menthol "a historic opportunity. ... At a minimum they should rein in [tobacco companies'] predatory marketing campaigns that have bombarded the African-American community."

Cheryl Healton, PhD, professor of public health at Columbia University and president and CEO of the American Legacy Foundation, also supports a ban, in particular because of menthol's appeal to young and new smokers.

"If you want [young people] to start smoking, give them something that tastes like candy," she says. "And guess what? Young smokers smoke more menthols."

The tobacco companies disagree. "Youths smoke what is accessible to them," True says.

Pediatrician Dana Best, MD, MPH, director of the Smoke Free Project at Children's National Medical Center in Washington, D.C., who was not involved with the meeting, says kids often don't have much of a choice when it comes to what they smoke. After all, they can't legally buy cigarettes, so they take what they can get, where they can get it. It makes studying their habits very difficult.

In fact, researchers trying to study kids' smoking behavior are often confronted with a real catch-22. "You have to get their parents' permission to study them, but kids don't want their parents to know they smoke."

In her practice, she sees patients who fall into the two categories of most concern to the panel: youths and minorities, particularly African-Americans. So what would be the result of a ban on menthol?

"It would be another step along the path toward making cigarettes more unpalatable," says Best, who acknowledges that little is known about the health risks of menthol in cigarettes.

In fact, much of the publicly available data regarding menthol cigarettes is inconclusive or contradictory, and the issue before the committee will likely remain quite contentious over the next 12 months. However, says committee member and Harvard professor of public health Greg Connolly, "I hope everything we do shows respect and dignity to smokers. We are here to help smokers."

SOURCES: William R. True, senior vice president, Lorillard.

Philip Gardiner, PhD, Tobacco Related Disease Research Program, University of California.

Cheryl Healton, PhD, professor of public health, Columbia University; president and CEO, American Legacy Foundation.

Greg Connolly, professor of public health, Harvard University.

Dana Best, MD, MPH, director, Smoke Free Project, Children's National Medical Center.

Jonathan M. Samet, MD, Keck School of Medicine, University of Southern California.

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