The Washington Post
It has been more than a decade since Congress passed the Tobacco Control Act, the landmark law that empowers the Food and Drug Administration to regulate tobacco products, but only now is the agency close to bringing the law’s full power to bear on a primary driver of preventable disease: combustible cigarettes.
The FDA announced last week that it would ban menthol in cigarettes, the only flavoring tobacco companies are still allowed to add. This is a positive step. But it should be only the prelude to what would be perhaps the biggest single move to discourage cigarette use the federal government has ever taken. The FDA can require tobacco companies to cut the amount of nicotine in cigarettes to minimally addictive or non-addictive levels, which the Biden administration is also considering.
In the 2009 Tobacco Control Act, Congress expressly banned flavored cigarettes, except in the case of menthols, because of racial sensitivities: Many African American smokers prefer menthols. But it would not have been discriminatory to ban menthol flavoring along with all the others; it is discriminatory, and specifically harmful to the Black community, to permit the sale of a product that is especially harmful to African Americans while acting to protect the public health of others.
Mitch Zeller, director of the FDA’s Center for Tobacco Products, points out that tobacco companies targeted African Americans for addiction, and failing to regulate a product that disproportionately harms Black people only enhances deadly racial health disparities.
The FDA cites studies suggesting that banning menthols would encourage nearly 1 million people to quit smoking, about a quarter of them Black, in the first year to year and a half. The ban would prevent some 633,000 deaths, 237,000 of them among African Americans. Concerns that a ban would lead police to target Black smokers are more than understandable, given historical and present policing disparities. But the ban would criminalize production and sale of menthol cigarettes, not possession or use. The potential benefit to African Americans outweighs these concerns.
Moreover, banning menthols is not just about helping the Black community. Menthol flavoring also promotes youth cigarette use because it masks the harshness of tobacco smoke.
But the FDA has yet to embrace the really big prize in tobacco policy: reducing the amount of nicotine in cigarettes to very low levels.
On its own, nicotine is not nearly as harmful as all the other chemicals that smokers breathe in when they light up. If they could get their nicotine fix only through cigarette alternatives, such as gums, patches or e-cigarettes, they would do far less damage to their bodies. Or they could take the opportunity to quit entirely. A 2018 FDA study found that 5 million adult smokers could quit smoking within a year, that more than 33 million people might never become smokers over the course of this century, and that the smoking rate could collapse from 15% to 1.4%.
As it pushed people onto alternatives, the FDA would have to take care to carefully regulate e-cigarettes. But 8 million people’s lives could be saved.
It is past time to make this move.