NEJM lights up TPSAC s menthol cigarette evaluation

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Two perspective pieces addressing the menthol cigarette problem appear in today’s New England Journal of Medicine. One, by ACSH advisor and Boston University School of Public Health Professor Dr. Michael Siegel, argues that, by refusing to recommend clearly that the FDA ban menthol cigarettes, the Tobacco Products Scientific Advisory Committee (TPSAC) contradicted the scientific literature featured in its report and thus failed in its mission to provide a public health solution.

That banning menthol cigarettes would benefit public health is self-evident...the TPSAC report, in its only actual recommendation, warns the FDA against banning menthol cigarettes because of the potential for a black market; it expresses this concern in language almost identical to that used by Lorillard [the manufacturer of the leading brand of menthol cigarettes] and its consultants. Far from issuing a call for a ban on menthol cigarettes, then, the advisory committee has punted the issue back to the FDA.

ACSH's Dr. Gilbert Ross takes issue with Dr. Siegel’s analysis, as he testified before the TPSAC in November of last year, presenting ACSH’s report, The Mentholation of Cigarettes: A Position Statement of The American Council on Science and Health. “It is clear that mentholated cigarettes, per se, are no more harmful to smokers than nonmentholated varieties. Everybody agrees with that assessment — the TPSAC and Dr. Siegel. However, in his recommendation that menthol be banned, Dr. Siegel seems to jump right over the fact that banning mentholated cigarettes would lead to a huge black market, potentially thwarting any public health benefit that could be derived from taking mentholated cigarettes off of the market.”

Meanwhile, University of California, San Francisco’s Dr. Neal Benowitz and University of Southern California Department of Preventive Medicine’s Dr. Jonathan Samet defended the TPSAC report in a separate NEJM editorial. As members of the TPSAC (Dr. Samet was the Chair), they posit that the advisory panel was not intended to address “the regulatory options and did not have the time or expertise to analyze regulatory scenarios, including any involving inadvertently opening a door for the introduction of contraband menthol cigarettes into the U.S. market.” Instead, they propose that the evaluation of a potential menthol cigarette ban is an FDA prerogative.

ACSH’s Dr. Josh Bloom emphasizes that this is an incredibly complex issue; it isn’t obvious which course of action will be more beneficial to public health. He wonders, “Which would have a greater public health impact: on the downside of a menthol ban are the young people who would start smoking bootleg cigarettes; the upside — the public health benefit — would be those who now smoke menthols but would quit altogether, plus those who would not start at all, if mentholated cigarettes are banned.”