The case against menthols

Menthol cigarettes are “cool” — literally and figuratively. They soften the harshness of tobacco smoke, and their popularity continues to increase, particularly among young people and African Americans. Some health experts feel it’s high time they were banned.

This month, a scientific advisory panel for the U.S. Food and Drug Administration delivered a 231-page report on the public-health risks of menthol cigarettes after reviewing scientific literature and seeking comment from researchers and the tobacco industry. The panel’s bottom line: “Because there are menthol cigarettes, we have more smokers,” says Dr. Jonathan Samet, an expert in pulmonary medicine and environmental health at USC, who was chairman of the committee.

Here’s a closer look at how menthol cigarettes differ from regular cigarettes and why tobacco-control advocates want them outlawed.

What is menthol and what does it do in cigarettes?

Menthol is a naturally occurring aromatic compound — it can also be synthesized in labs — that has cooling, anti-itch and pain-relieving properties. It’s found in a variety of products, including throat lozenges and chest rubs for colds.

Most cigarettes have some menthol. The FDA’s current focus is on brands specifically marketed as menthol cigarettes, such as Newport, Kool and Salem, which contain significantly more.

Adding this much menthol to cigarettes reduces the harshness of smoke and blunts the irritating effect of nicotine in the airways.

Why has menthol been treated differently from other cigarette flavors, which were banned in 2009?

The 2009 Family Smoking Prevention and Tobacco Control Act gave the FDA the authority to regulate the manufacture and marketing of tobacco products. Later that year, the agency banned the sale of candy-, fruit-, and clove-flavored cigarettes. Though menthol cigarettes were not included at that time, the legislation charged the FDA with putting together a comprehensive review of the products, which the panel has now done.

Peter Jacobson, a professor of health law and policy at the University of Michigan in Ann Arbor, says that menthol is a much bigger target involving much bigger tobacco companies. “The FDA was smart to not take everything at once. It’s given the agency time to build momentum and to build a body of evidence,” he said.

Are menthol cigarettes a bigger health risk than regular cigarettes?

Samet says the panel looked at two possible ways that menthol cigarettes might pose a greater risk to public health, and found significant supporting evidence for one of them.

First, they examined whether adding menthol makes cigarettes more dangerous for individual smokers, perhaps by delivering a higher dose of nicotine or other toxic chemicals in the smoke, or causing higher rates of smoking-related diseases. The panel found insufficient evidence to make that case.

Concurring with the panel’s conclusion, a study published last week in the Journal of the National Cancer Institute found that lung cancer rates were actually lower in people who smoked menthol cigarettes than in those who smoked nonmenthol cigarettes. The researchers selected 440 lung cancer patients and 2,213 control subjects — matched for age, race and gender but without lung cancer — from a much larger population study of 85,806 people living in the Southern U.S. They found that menthol smokers were 12 times more likely to have lung cancer than nonsmokers, whereas nonmenthol smokers were 21 times more likely to have cancer.

The second way that menthol cigarettes might cause more harm than regular cigarettes would be if they increased smoking rates. The panel did find evidence for this, particularly in younger smokers.

Samet says research shows that with menthol cigarettes, a teen experimenting with smoking is more likely to become a regular smoker and then an addicted smoker. And these young years are crucial for establishing or not establishing a habit.

“During those formative years — that’s when the uptake of cigarette smoke really may lead to more dependence,” says Dorothy Hatsukami, professor of cancer prevention and psychiatry at the University of Minnesota in Minneapolis, who also served on the FDA panel.

In the case of adults, the science says that nonwhite populations had more difficulty quitting smoking if they smoked menthols compared with people who smoked nonmenthol cigarettes. African Americans favor menthol cigarettes more than any other demographic: More than 80% use them.

So what’s the upshot? Will menthol cigarettes be banned?

It’s unclear. Although the advisory panel concluded that banning menthol cigarettes would benefit public health, it did not explicitly recommend that step. The FDA has yet to review the report and may consider ways to restrict menthol cigarettes short of an outright ban. It has set no timeline for making a decision.

health@latimes.com