May 13, 2008 – The New York Times – By STEPHANIE SAUL
Some public health experts are questioning why menthol, the most widely used cigarette flavoring and the most popular cigarette choice of African-American smokers, is receiving special protection as Congress tries to regulate tobacco for the first time.
The legislation, which would give the Food and Drug Administration the power to oversee tobacco products, would try to reduce smoking’s allure to young people by banning most flavored cigarettes, including clove and cinnamon.
But those new strictures would exempt menthol — even though menthol masks the harsh taste of cigarettes for beginners and may make it harder for the addicted to kick the smoking habit. For years, public health authorities have worried that menthol might be a factor in high cancer rates in African-Americans.
The reason menthol is seen as politically off limits, despite those concerns, is that mentholated brands are so crucial to the American cigarette industry. They make up more than one-fourth of the $70 billion American cigarette market and are becoming increasingly important to the industry leader, Philip Morris USA, without whose lobbying support the legislation might have no chance of passage.
“I would have been in favor of banning menthol,” said Senator Judd Gregg, Republican of New Hampshire, who supports the bill. “But as a practical matter that simply wasn’t doable.”
Even the head of the National African American Tobacco Prevention Network, a nonprofit group that has been adamantly against menthol, acknowledges that the ingredient needed to be off the bargaining table — for now — because he does not want to imperil the bill’s chances.
“The bottom line is we want the legislation,” said William S. Robinson, the group’s executive director. “But we want to reserve the right to address this issue at some critical point because of the percentage of people of African descent who use mentholated products.”
Supporters of the tobacco legislation, including the Senate bill’s sponsor, Edward M. Kennedy, the Massachusetts Democrat, say the bill addresses the potential health risks of menthol by giving the F.D.A. the authority to remove cigarette additives, including menthol, if they are proved harmful.
Menthol is particularly controversial because public health authorities have worried about its health effects on African-Americans. Nearly 75 percent of black smokers use menthol brands, compared with only about one in four white smokers.
That is why one former public health official says the legislation’s menthol exemption is a “cave-in to the industry,” an opinion shared by some other public health advocates.
“I think we can say definitively that menthol induces smoking in the African-American community and subsequently serves as a direct link to African-American death and disease,” said the former official, Robert G. Robinson, who retired two years ago as an associate director in the office of smoking and health at the Centers for Disease Control and Prevention.
The current lead scientist on tobacco related issues for the C.D.C, Terry F. Pechacek, said the legislation’s exemption for menthol was an issue being discussed in the scientific community. “I would just say this is an area of clear scientific interest and it merits very careful attention.”
The legislation could soon be up for vote in both chambers of Congress, where it has broad support. It is by no means a sure bet — though not because of the menthol exemption.
Despite the support of Mr. Kennedy and 56 co-sponsors in the Senate, the legislation faces some determined opposition from tobacco-state lawmakers who resist industry regulation. And the White House has said it opposes the legislation, arguing that F.D.A. regulation could create the false impression that tobacco is safe.
The legislation is largely a result of negotiations during sessions in 2003 and 2004 between lawmakers, antismoking groups and Philip Morris — the only major American cigarette company that supports the effort to regulate the industry.
“My recollection is that we were able to eliminate the use of flavored cigarettes, strawberry, mocha, and all this stuff that is clearly targeted at young kids and to start them smoking tobacco,” Mike DeWine, the former Ohio senator who helped arrange a series of negotiations between Philip Morris and an influential antismoking group, the Campaign for Tobacco-Free Kids, said in a recent telephone interview. “Where the compromise was made as I recall was on menthol,” Mr. DeWine said.
While Philip Morris and other tobacco companies acknowledge the health hazards of smoking, they contend that menthol does nothing to worsen those risks. One of the government’s current top public health scientists on tobacco, however, says there are few definitive answers about the health impact of menthol cigarettes. Still, he points to several studies that suggest menthol smokers may be exposed to higher levels of dangerous compounds than nonmenthol smokers.
“There are multiple lines of evidence, generally consistent, suggesting that there’s reason for concern,” said Dr. Pechacek, the associate science director of the office on smoking for the C.D.C.
Of 45 million smokers in this country, the American Lung Association identifies about 33 million as non-Hispanic whites and 5 million as African-American. Historically, statistics showed that a somewhat higher percentage of African-Americans smoked than whites. Recent figures, though, indicate about the same rate of smoking for both groups — in the 21 to 22 percent range.
But the use of menthol cigarettes is disproportionately an African-American phenomenon, which critics say has been reinforced by decades of advertising aimed at black consumers. Concerns about menthol have circulated since at least 1998, when the C.D.C. reported that menthol “may increase the absorption of harmful smoking constituents.”
Four years later the C.D.C., along with the National Cancer Institute, sponsored a meeting in Atlanta on menthol cigarettes and disease rates in African-Americans. The official report from that meeting said the research up to that point had been inconclusive, but it called for further studies.
In five large studies of menthol to date, only one has found higher rates of cancer among menthol smokers than nonmenthol smokers, and only in men. But a growing body of evidence suggests that menthol makes it harder to kick the smoking habit — a view shared even by many scientists who say that menthol in cigarettes is not itself dangerous.
A tobacco company spokesman, Brendan J. McCormick, said menthol was “an ingredient and a flavor preference that is widely preferred by more than a quarter of adult smokers out there, and it’s got a long history of use.”
Mr. McCormick works for the Altria Group, the parent company of Philip Morris USA, whose Marlboro Menthol is the second-largest menthol brand in this country and also the fastest growing.
Last year, to counter concerns about menthol, a mint extract that can also be made synthetically, Philip Morris scientists published a 26-page paper in Regulatory Toxicology and Pharmacology, a peer-reviewed scientific journal. After examining dozens of studies on menthol, the company’s scientists said they found little evidence that menthol cigarettes were any more harmful or addictive than other types or that they encouraged people to start smoking at younger ages.
Its support of the tobacco legislation has put Philip Morris at odds with other cigarette companies, which generally oppose regulation. As the American industry’s biggest player, Philip Morris says it is willing to let the F.D.A. oversee tobacco because as the company tries to develop products that are less harmful, it wants a regulatory agency to evaluate and approve those products. The company also says it would prefer national tobacco regulations rather than a hodgepodge of state and local rules. But the company’s rivals complain that the legislation could help Philip Morris, with its best-selling Marlboro franchise, further entrench itself as the industry’s dominant player by placing new restrictions on cigarette marketing, making it difficult for rivals to use advertising to catch up. Besides banning the marketing of cigarettes on the basis of most flavorings — other than menthol — the new rules would also place additional limits on the types and placement of signs and magazine advertising for tobacco products.
Even with the menthol exemption, the legislation is opposed by Reynolds American, whose R. J. Reynolds unit sells menthol brands that include Kool and Salem. Another opponent is Lorillard, which makes Newport, the best-selling brand among African-Americans and the menthol market leader over all.
“Bottom line, the scientific publications to date have not concluded that menthol cigarettes are more hazardous or addictive than nonmenthol cigarettes,” a Lorillard spokesman, Michael W. Robinson, said in a written response to questions. Lorillard is a subsidiary of the Loews Corporation.
Scientists who study smoking have identified various disparities in the health of black and white smokers. National Cancer Institute data shows that African-American men get lung cancer at a rate 50 percent higher than white men — a gap that most scientists say cannot be fully explained by historically higher rates of smoking by black men.
One theory suggests that menthol in cigarettes, by providing an additional pleasurable sensory cue to smokers, reinforces addiction.
“There is evidence from different studies that it’s harder to quit menthol cigarettes,” said Dr. Neal L. Benowitz, a pharmacologist and professor at the University of California, San Francisco and one of the nation’s leading tobacco researchers. He calls menthol a “public health risk.”
In work published in 2006, Dr. Mark J. Pletcher and colleagues at that same university analyzed smoking behavior for 1,535 people over 15 years. Their findings suggested that menthol smokers were 30 percent less likely to quit smoking and 89 percent more likely to relapse than other smokers.
One African-American woman, Joya Robinson of North Brunswick, N.J., said she began smoking Newport in 1988 and developed a pack-a-day habit. After several unsuccessful attempts to quit, she is now enrolled in a tobacco dependence program. “It’s the hardest thing I’ve ever done,” Ms. Robinson, 46, said.
Dr. Pechacek, the C.D.C. official, said a combination of menthol and genetic factors that predispose African-Americans to certain cancers may be in play for black smokers.
“There is sufficient reason to maintain a strong public health interest in it,” he said.