A long overdue public health initiative or a mistake?

Edited 3:40 pm ET on 4/29/21

The FDA announced plans to prohibit the sale of menthol cigarettes and all flavored cigars, including menthol flavor, with an aim to “significantly reduce disease and death” caused by these products.

“Banning menthol—the last allowable flavor—in cigarettes and banning all flavors in cigars will help save lives, particularly among those disproportionately affected by these deadly products. With these actions, the FDA will help significantly reduce youth initiation, increase the chances of smoking cessation among current smokers, and address health disparities experienced by communities of color, low-income populations, and LGBTQ+ individuals, all of whom are far more likely to use these tobacco products,” said Acting FDA Commissioner Janet Woodcock, MD, in a statement. “Together, these actions represent powerful, science-based approaches that will have an extraordinary public health impact. Armed with strong scientific evidence, and with full support from the Administration, we believe these actions will launch us on a trajectory toward ending tobacco-related disease and death in the U.S.”

Menthol increases the appeal of tobacco products, particularly among kids and young adults, the FDA explained—and the additive can make tobacco products more addictive and therefore more difficult to quit. According to the CDC, more than half (54%) of kids ages 12-17 years who smoke use menthol cigarettes, and that number increases to around 70% when looking at Black kids from the same age group.

“For far too long, certain populations, including African Americans, have been targeted, and disproportionately impacted by tobacco use,” said Mitch Zeller, JD, director of the FDA’s Center for Tobacco Products, in a statement. “Despite the tremendous progress we’ve made in getting people to stop smoking over the past 55 years, that progress hasn’t been experienced by everyone equally. These flavor standards would reduce cigarette and cigar initiation and use, reduce health disparities, and promote health equity by addressing a significant and disparate source of harm.”

The FDA noted that if the ban is implemented, it will impact manufacturers, distributors, wholesalers, importers, and retailers in order to keep the products out of the U.S. market—the agency “cannot and will not enforce against individual consumer possession or use of menthol cigarettes or any tobacco product.”

Department of Health and Human Services secretary Xavier Becerra issued a statement backing the proposed bans, saying that the decision “reflects the Biden Administration’s commitment to improve the health of all Americans and to tackle health disparities in our most marginalized communities. Tobacco-related death and disease must become a part of America’s past. These public health measures will save lives.”

Other public health experts also applauded the move, with Richard Besser, MD, president of the Robert Wood Johnson Foundation and former acting director of the CDC calling the FDA action a “historic, lifesaving step,” in a statement, according to NBC News. “Banning menthol cigarettes will most assuredly save lives, eliminate great suffering, and reduce health care costs.”

Harold Wimmer, president and CEO of the American Lung Association, also praised the move in a statement, saying that banning menthol cigarettes and flavored cigars “has the potential to save thousands of lives.”

“We expect the tobacco industry to throw everything they have at stopping this bold, game-changing proposals but President Biden and his Administration should not be deterred,” he added. “As our nation works to address a myriad of racial inequities, it can and must also address the public health injustices caused by the tobacco industry targeting Black and Brown communities with menthol cigarettes. In the meantime, while we wait for a rule to be enacted, we urge states and localities to take immediate action to prohibit the sale of menthol cigarettes, cigars and other flavored tobacco products.”

Dipti Itchhaporia, MD, president of the American College of Cardiology (ACC), also backed the decision, writing that menthol cigarettes “are well-known to increase youth initiation to smoking; they also increase addiction to nicotine and reduce success in smoking cessation. We also know that menthol cigarettes have an incredibly high toll in the disease and death in the Black community, worsening existing and unacceptable health disparities. The ACC, the public health community, the FDA and Congress must work together on this vital issue with clear public health benefits of reducing tobacco-related death and disease.”

In its own statement, the American Medical Association (AMA) said that the impetus for this decision from the FDA came from a lawsuit filed on June 17, 2020, by the AMA in conjunction with the African American Tobacco Control Leadership Council (AATCLC), Action on Smoking and Health (ASH), and the National Medical Association (NMA). The lawsuit charged that the FDA failed to act on menthol cigarettes, “contrary to the duties imposed by the Family Smoking Prevention and Tobacco Control Act,” which was signed into law in 2009.

“Today’s action by the FDA to ban menthol-flavored cigarettes, while long-overdue, is a major step toward preventing a new generation from becoming tobacco users and saving lives… We urge the FDA to move swiftly to implement the ban and remove these harmful products from the market without further delay,” AMA president Susan R. Bailey, MD, wrote.

“AATCLC, ASH, AMA, and Pollock Cohen LLP are thrilled that the FDA has finally decided to take long delayed action in order to protect the health and lives of African Americans,” the AMA added. “This victory marks another battle won in the war against the tobacco epidemic.”

ACLU Calls Ban a Mistake

But the proposed ban was not universally cheered, especially among those who see it as an infringement of individual rights.

“At this pivotal moment, as the public demands an end to police violence erupting from minor offenses, we call on the Biden administration to rethink its approach and employ harm reduction strategies over a ban that will lead to criminalization,” Aamra Ahmad, senior legislative counsel with the American Civil Liberties Union (ACLU), wrote in a statement. “As we approach the one-year anniversary of the murder of George Floyd — only a few years removed from the killing of Eric Garner, a Black man killed by NYPD for selling loose, untaxed cigarettes — the racially disparate impact of the criminal legal system has captured the nation’s attention. It is now clear that policies that amount to prohibition have serious racial justice implications.”

Based on this history, Ahmad and the ACLU expressed “serious concerns that the ban implemented by the Biden administration will eventually foster an underground market that is sure to trigger criminal penalties which will disproportionately impact people of color and prioritize criminalization over public health and harm reduction.”

The ACLU also issued a letter to HHS secretary Becerra and FDA commissioner Woodcock expressing its concerns, comparing the proposed move to the current debate over the legalization of cannabis—whereas Congress is currently trying to determine how to discontinue cannabis prohibition and move towards legal, regulated adult sale, “in order to reverse the human catastrophe of decades of criminalization,” this latest move would move menthol cigarettes in the opposite direction, the ACLU argued.

John McKenna, Associate Editor, BreakingMED™

Cat ID: 143

Topic ID: 86,143,730,143,192,725,489,925