Monday, February 11, 2013

Menthol Cigarets Cause Less Cancer

Tastes great, less cancer.
The scientific literature unequivocally shows that menthol cigarets cause less cancer than ordinary cigarets, and yet this information (which could save lives, obviously) is being withheld from the public by FDA, which conducted some of the research.

NCI estimates that 159,480 Americans will die of lung cancer in 2013. About 90% of those deaths will be smoking-related. If the scientific studies are right, around 50,000 lives per year would be saved (in the U.S. alone) if smokers converted to menthols.

For the past two years, authorities in the U.S. and the European Union have been trying to vilify menthol cigarets in preparation for pulling them off the market. There's only one problem. The scientific literature shows that menthol cigarets are less hazardous than non-mentholated cigarets.

In a 2011 paper in the Journal of the National Cancer Institute ("Lung Cancer Risk Among Smokers of Menthol Cigarettes"), researchers found:

In multivariable analyses adjusted for pack-years of smoking, menthol cigarettes were associated with a lower lung cancer incidence (OR = 0.65, 95% CI = 0.47 to 0.90) and mortality (hazard ratio of mortality = 0.69, 95% CI = 0.49 to 0.95) than non-menthol cigarettes.

(OR means "odds ratio" and CI is "confidence interval.)

In another recent study involving 4,832 smokers, reported in Nicotine and Tobacco Research, 2012 Oct;14(10):1140-4, FDA's own Brian Rostron concluded:

We found evidence of lower lung cancer mortality risk among menthol smokers compared with nonmenthol smokers at ages 50 and over in the U.S. population.
The mortality risk wasn't just slightly lower. For smokers 50 and older it was 41% lower.

The fact that mentholated cigarets don't cause more cancer isn't by itself surprising since menthol is not carcinogenic. The protective effect of menthol is what's surprising. But even that isn't hard to figure out. Inflammation is known to play a role in the development of cancer and there is good evidence that anti-inflammatory substances (like ibuprofen) have cancer-preventive properties. Menthol is strongly anti-inflammatory, especially for lung tissue.

FDA Is Killing People 
By not disseminating this information -- the fact that menthol cigarets are 30% to 40% less cancer-causing than regular cigarets -- the Food and Drug Administration is essentially letting people die needlessly. It's fair to ask why.

The most likely answer is that it's politically incorrect to say that one type of cigaret is safer than another. It goes against the government anti-smoking agenda. 

But FDA's mandate is to protect the public. So there's little justification for withholding information from consumers about products that are known to be less deadly than other products. Sure, the information is (technically) "public." But how many consumers take the time to dig through the scientific literature? Should they even be expected to? FDA has an obligation to tell people which cigarets are safest. Especially when the toxicity difference is significant -- up to 41%, according to FDA's own research.

But Will Menthols Be Banned?
It doesn't appear menthols will be banned any time soon in the U.S. On March 18, 2011, the Tobacco Products Scientific Advisory Committee (an advisory panel to the FDA) concluded that removing menthol cigarets from the market would "benefit public health" in the United States but stopped short of recommending that the Food and Drug Administration take any action, probably to avoid stirring racial tensions. The Congress of Racial Equality, the National Black Chamber of Commerce, the National Organization of Black Law Enforcement Executives, and the National Black Police Association have all urged the FDA not to ban mentholated cigarets, based on fears that such a ban would only create a vibrant underground market in illegal cigarets, sending more African Americans to prison. Menthols are known to be more popular among African Americans than among whites.

Europe is a different matter. It appears increasingly likely that the EU will succeed in getting menthols (and slims and vanillas) taken off the market by 2016. In December, the European Commission put forward a proposal that would ban all flavored cigarets as well as packs containing fewer than the usual 20 sticks. The new measures would also require pictorial and other warnings that cover 75% of the surface area of every pack of non-flavored cigarets.

As I reported yesterday, lung cancer rates among smokers have soared at such a rapid rate in recent decades (specifically, from 1964 on) that scientists are now at a loss to explain the increase. Lung cancer rates among U.S. smokers went up 15-fold from 1930 to 1990. In the same time period, per-capita cigaret consumption only doubled. Researchers have tried but failed to explain what's going on.  

We do know one thing for sure, though. Menthol has nothing to do with it.