The menthol ban: no basis in science

By Greg Stevens

The question of the health risks of menthol cigarettes has been settled since 2011, when Dr. William J. Blot and his colleagues at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, conducted a prospective study among 85,806 people. The results were published on 23 March 2011 in the Journal of the National Cancer Institute. The study included non-smokers, menthol cigarette smokers, and non-menthol cigarette smokers, and included people of different races and who smoked at different rates.

Menthol cigarette smokers had significantly lower lung cancer rates than non-menthol cigarette smokers, although both had a higher lung cancer rate than non-smokers. Smokers who preferred menthol cigarettes also smoked fewer cigarettes per day than those who preferred non-menthol cigarettes. The rate for quitting was similar between both menthol and non-menthol smokers.

In April of 2011, Peter Lee published an article in the BMC Pulmonary Medicine journal that reviewed the results across a large number of studies, in order to get a wide spread of data for comparing factors such as age, race, gender, length and intensity of use, and menthol versus non-menthol cigarettes.

No difference

The conclusions were straightforward: mentholation had no effect on lung cancer risk. It doesn’t matter whether you’re a girl or a boy, black or white, young or old, or even whether you are a long-term or recent smoker: smoking mentholated cigarettes puts you at no greater risk of lung cancer than smoking regular cigarettes.

Moreover, because this study pulled together information from a large number of other studies conducted over the last decade, they were also able to review a broad range of related results in the literature.

Seven studies compared how often people “puff” on menthol cigarettes and non-menthol cigarettes. Four found no difference, and three found people puffed less often on menthol cigarettes.

Six studies investigated puff volume: one found larger puffs for the mentholated cigarettes, three found smaller puffs, and two found no difference.

Studies have found no effect of mentholation on the levels of toxins in people’s system; they have found no effect on the age at which people start to smoke; they have found no effect on the ability to quit.

Rather, just to be clear: out of sixteen studies on the effects of mentholation on quitting, ten of them (including the two largest) showed no effect, while the remaining six showed a lower rate of quitting menthol cigarettes after the first month of use but the same rate of quitting for both menthol and non-menthol cigarettes after the first month.

These two large-scale 2011 studies in many ways reflected the climax of a decade’s worth of effort, during which researchers desperately tried to show that menthol cigarettes are worse for you than regular cigarettes. They tried, and they failed.

Ideology, not science

But science and facts have never gotten in the way of a good ideological crusade.

In March of 2012, Brazil banned menthol along with all other types of “flavoured” cigarettes. Their rationale?  According to the Chair of the Framework Convention Alliance, Paula Johns, it was “a critical step in limiting the tobacco industry’s tactics for luring young people to start smoking”.

In October of 2013, the European Parliament voted to ban menthol and other “flavoured” cigarettes, beginning in 2022.  This was explicitly stated as part of a strategy to help lower the rate at which young people start smoking. Minister for Health James Reilly said that he believed the ban on flavoured cigarettes was as “an important step” that would prevent “the next generation from ever getting hooked”.

In other words, these governments are banning menthol cigarettes on the grounds that they are too delicious, and children might like them.

Have any scientific studies actually demonstrated that children presented with menthol cigarettes are more likely to begin smoking than children presented with non-menthol cigarettes? Has there been a study that has demonstrated that children who smoke menthol cigarettes would have chosen to not smoke at all, rather than to smoke non-menthol cigarettes, if the menthol cigarettes had not been available?

Predictably, the answer to both questions is No.

Instead, anti-smoking activism websites report statistics like this one: “In October 2013, The Centers for Disease Control and Prevention (CDC) reported that more than two out of every five middle and high school students who smoke use flavored little cigars or flavored cigarettes.”

This fact is useless in isolation. It does not tell you whether these students exclusively use flavored cigarettes or use them in addition to non-flavoured cigarettes. Nor can you guess whether these students would or would not have started smoking non-flavoured cigarettes if the flavoured ones were not available.

Instead, the statistic is presented as nothing more than innuendo: you are supposed simply to assume that these children were pristine and pure and would never have done anything wrong in their lives… if it hadn’t been for the terrible influence of the flavoured cigarettes!

So in addition to there being no scientific evidence that menthol cigarettes are more harmful than non-menthol cigarettes, there also is no scientific evidence that menthol cigarettes are more likely to cause smoking in young people than non-menthol cigarettes. Instead, there is a lot of hand-waving and suspicion and story-telling.

Yet, ridiculously, it seems as though the crusade against menthol cigarettes is winning.

Streaky bacon

It has not succeeded everywhere. Despite the EU galloping into the banning of flavoured cigarettes, the Danish Parliament voted unanimously against such a proscription. “It’s not illegal to smoke, and we feel the same way as all of the other parties in the Parliament. We see no reason to ban menthol,” said health spokesperson for the Liberals, Jane Heitman.

Eva Kjer Hansen, chairwoman of the Danish Parliament’s Committee on European Affairs, described their position most succinctly: “We have a large majority in agreement that menthol cigarettes should be allowed, because we are opposed to just banning everything.”

How is it that the Danes are the only ones behaving intelligently on this matter? The avenue that all of these governments should be pursuing is the one mechanism that actually has been scientifically proven to change the behavior of children: education.

After all, in the end adolescents who wants to start smoking cigarettes – or anything else for that matter – will surely find a way in. The best way to prevent harm to young people is to give them the information that they need to make better decisions.

Still gross

Finally, it is worth pointing out that none of these arguments should be construed as an endorsement of menthol cigarettes, or of cigarette smoking in general. Tobacco is a disgusting, disease-causing drug that kills people slowly, makes them stink, and doesn’t even have decency to give them a proper high in the mean time.

But given that thousands of people choose to kill themselves in this manner, making a legal distinction between flavoured and unflavoured cigarettes is profoundly absurd. It will not serve the functional goal of reducing lung cancer. It will not serve the functional goal of decreasing the rate at which young people “experiment” with smoking.

If any political party is really interested in “stamping out smoking” altogether, the answer is in education, not in nit-picking the “flavours” that companies are allowed to put in their products.

Now read:The menthol ban isn’t just stupid – it’s racist