Harm Reduction

Seductive additive boosting addiction or harmless flavoring? ACSH examines the evidence on and complexities regarding menthol as an ingredient in tobacco products, an ingredient whose banning is often debated. Additional Authors: William T. Godshall, M.P.H. SmokeFree Pennsylvania Gio Gori, Ph.D. Health Policy Center Geoffrey Kabat, Ph.D., M.S. Yeshiva University
The FDA has assembled a panel to study mentholated cigarettes and advise on how the government should regulate them. The panel’s recommendations are expected by next March. “The menthol issue is very complex, both economically and medically,” says ACSH’s Dr. Gilbert Ross. “A few months ago, I thought it was a slam dunk that the FDA would ban it because of the members of the committee, but the more I’ve read on the issue, the more I believe that there’s no scientific evidence for banning menthol.”
A front-page article in today s Wall Street Journal reports, Confronted with the inexorable decline of cigarette sales, Reynolds is transforming itself into a company that also offers an array of smokeless alternatives -- including strips, lozenges, and snuff. Reynolds push into the products comes amid an intensifying debate among public-health professionals about how oral forms of tobacco should be regulated.
A piece by Thomas A. Maugh II about the journal PLoS Medicine rejecting any studies produced with tobacco money appeared in the Los Angeles Times on February 26, 2010 and quoted ACSH's Jeff Stier on a contrary note (as did an L.A.
ACSH staffers were (almost) speechless when we found out that the New Jersey State Senate voted unanimously to restrict the use of e-cigarettes as though they were equivalent to standard, life-threatening cigarettes. "This is a big step in the wrong direction," says ACSH's Jeff Stier, "because while there are no controlled studies yet, we know that many smokers are successfully using e-cigarettes to quit smoking cigarettes. And to treat e-cigarettes as if they are as dangerous as cigarettes is a huge leap based on no data whatsoever." "There is nothing worse than ignorance in action," says ACSH's Dr. Elizabeth Whelan. "We're talking about the release of what is essentially water vapor in public places. There are no harmful chemicals involved."
Despite the fact that revenues from tobacco taxes and the 1998 Master Settlement Agreement among forty-six states and cigarette makers are at record highs, many states have cut funding for tobacco prevention programs by over 15 percent in the past year. "Lawmakers and activists argue that we need to raise taxes to educate people, whether it's about smoking or obesity or whatever, and once the item is taxed and the money is there, it doesn't happen," says ACSH's Dr. Elizabeth Whelan. "Ironically, if states are dependent on tobacco funding to close budget gaps, it makes them less likely to want smoking to come to an end," says ACSH's Todd Seavey.
A report by the World Health Organization reveals that tobacco use kills 5 million people worldwide each year. The WHO attributes 600,000 of those deaths to exposure to secondhand smoke. "As ACSH points out in our publication on the health effects of environmental tobacco smoke (ETS), ETS can have serious impacts on nonsmokers, including increased risk of asthma, ear infections, and more," says Dr. Whelan. "Still, it is unlikely that it causes 600,000 deaths each year, but then again, we cannot make a science-based estimate on what mortality from ETS might be."
The Substance Abuse and Mental Health Services Administration reports that the rate of smokers twelve to seventeen years old using menthol cigarettes rose to 48 percent in 2008 from 44 percent in 2004. "Why are they all of a sudden studying this?" asks ACSH's Jeff Stier. "It's interesting that a federal agency is now weighing in on this issue. There's an effort to create a record to make the case that young people are smoking menthol more in order to provide the FDA with the justification to ban menthol. They're focusing on its appeal to young smokers rather than the toxicology or health effects of menthol in order to justify a ban. The FDA tobacco legislation provides for this approach."
The National Cancer Institute reports that one- and two-year survival rates for patients with advanced lung cancer have increased slightly over the past twenty years. "There has been some improvement, but it's quite minimal," says ACSH's Dr. Elizabeth Whelan. "This just emphasizes the seriousness of lung cancer. It's a disease is so severe that we're celebrating even very small improvements in survival rates." Dr. Ross adds, "The good news is that as smoking rates continue to decline, the incidence of lung cancer will certainly follow suit. This far outweighs the minimal increment in survival rates noted in this report."
ACSH's friend and co-author of our 2006 report on tobacco harm reduction Bill Godshall passed along a study published in the Annals of Oncology about cancer rates in Europe. He wrote: "Despite having the highest smokeless tobacco usage rate, a new study finds that Swedish males have lowest mortality rate for mouth cancer in Europe. With the lowest cigarette-smoking rate in Europe, Swedish males also have the lowest lung, larynx, and overall cancer mortality rates in Europe. Unfortunately, the study's authors failed to acknowledge any of these important findings (i.e., in regards to Sweden's high smokeless tobacco use or low cigarette use)."
This Thursday, November 19th, marks the 33rd "Great American Smokeout," in which smokers are encouraged to quit, even if only for one day. The goal is to make that Day One in the life of a smoker as a successful ex-smoker. So how are we doing so far? Not so great. The latest statistics compiled by the CDC show that in 2008 there were still over 45 million addicted smokers in our nation--and worse, the fraction of the adult population who smoked rose slightly to 20.6% from 2007's 19.8%. This slightly reverses the declining trend in smoking rates we have gotten used to, since it was 24.1% in 1998.
Under the tobacco regulation bill recently passed by Congress, flavoring in cigarettes will be banned to diminish the attraction of smoking to youth smokers, with the exception of menthol. Menthol-flavored cigarettes represent 27 percent of the market and are the product of choice for 75 percent of African-American smokers. When the bill is signed into law, the FDA will be required to study the medical effects of menthol which has a mild anesthetic property that could exacerbate the dangers of smoking by reducing the harshness of the tobacco and the FDA will have the authority to ban it if they find it unhealthy.