A Review of the FDA's Ban on Menthol: Two Sides

This piece was co-authored with Taran Singh, whose byline can be found after the contents of the commentary.

Menthol is a chemical that comes from mint plants used in a variety of products. Everything from cough drops and gum to cigarettes, the general purpose of menthol is to create a cooling sensation when consumed.

In cigarettes, menthol is used as a cooling agent in the throat and airways to reduce the irritation that smoking tends to cause in these areas. In turn, this allows smoking to be a smoother and less harsh process for smokers, creating a more pleasurable experience.

In late April, the Food and Drug Administration (FDA) proposed new regulatory guidelines that would prohibit the sale of menthol cigarettes, citing concerns of lower quit rates, youth usage, and more. The two authors take a stab at discerning the data involved with this discussion and explaining the implications. Taran Singh writes the affirmative position on the proposal, while Siddharth Gundapaneni takes the negative.

While providing a less harsh process for smokers may seem like a good practice by cigarette manufacturers, allowing the tobacco industry to mask the harshness of their products with menthol will inevitably lead to dire consequences. 

By giving the illusion that cigarettes and the process of smoking isn't as harsh as often portrayed, two consequences arise. The first is that it discourages chronic smokers from quitting. This in turn could lead to tobacco related illnesses such as cancer, which arise from genetic mutations caused by the carcinogens in tobacco. According to the American Cancer Society, tobacco use is a leading cause of cancer as smoking causes about 20% of all cancers and 30% of cancer deaths. It most often causes lung cancer, and 80% of lung cancer diagnoses and deaths can be attributed to smoking.  

Part of the FDA’s rationale to ban menthol in cigarettes is that it would make cigarettes harsher in sensation, which would encourage users to quit. According to one study from Canada, which banned menthol cigarettes in 2017, the United States would see approximately 1.3 million smokers quit if the outcomes mirrored Canada. Over the next 40 years, the FDA’s models estimate a 15% reduction in smoking if menthol cigarettes were banned and the avoidance of between 324,000 to 650,000 deaths attributed to tobacco use over the same time. 

The second consequence is that it encourages non-smokers, the majority of whom are young adults or teenagers, to experiment with cigarettes and nicotine. The Centers for Disease Control and Prevention’s data shows that in 2021, 34% of high school students tried some sort of tobacco product, and 2% smoked cigarettes in the past 30 days. The frequency of cigarette smoking among high schoolers may seem insignificant, but this is because electronic cigarettes are more popular among the youth with about 11% of high schoolers admitting to using electronic cigarettes in the past 30 days. 

The problem with experimenting with tobacco is that its addictive chemistry frequently leads to experimenters becoming chronic smokers. Per the CDC, nearly 90% of adults who smoke daily first tried smoking at age 18. In addition, 99% of daily adult smokers tried their first cigarette by age 26. By continuing to allow the tobacco industry to conceal the toxic nature of their products with menthol, the youth population today will inevitably become the next generation of smokers. 

Given the facts on the devastating health effects that cigarette smoking causes and the overwhelming evidence that regulation is both needed and efficient to curtail this public health crisis, it is imperative that the FDA issue these new standards and ban menthol flavored cigarettes.

In wake of the FDA’s proposal to ban cigarettes containing menthol, it’s important we examine the realistic implications of such a policy, as opposed to complacently supporting the intentions. 

One of the primary facets of the FDA’s rationale lies within the addictiveness of the substance. While there’s no doubt that menthol cigarettes are very addictive and can bring about significant health issues, the question is whether they serve as a better alternative to other substances on the market. The FDA posits that menthol smokers tend to have a more difficult time quitting the substance as opposed to non-menthol smokers, and thus menthol is a substance worth regulating.

Contrary to this, a study published in the Journal of the National Cancer Institute indicates that among the studied population, quit rates among current smokers of menthol were 4.3%, as opposed to 4.5% for non-menthol smokers, a statistically insignificant difference. This difference remained roughly constant across ethnic groups.

Furthermore, much literature has also shown that lung cancer rates were lower among menthol smokers compared to their non-menthol smoking counterparts. Similar trends were found regarding lung cancer mortality, as would be expected. In the European Union, where menthol cigarettes have already been banned, about 40% of menthol smokers switched to non-menthol cigarettes following the ban. Considering the relatively higher risk of lung cancer associated with non-menthol cigarettes, this is not a trend we should desire to have mirrored in the United States. 

What’s more, such regulations like that being taken up by the FDA, have implications that disproportionately affect already marginalized populations. A recent survey on drug use indicates that 81% of Black and 51% of Hispanic smokers prefer menthol to non-menthol cigarettes. A ban on menthol cigarettes will not stop people from buying menthol cigarettes, similar to the failure of prohibition and marijuana regulation, but rather will create a black market. This black market will undoubtedly harbor cigarettes with unknown contents and will thus make purchasing the product users are already addicted to, all the more unsafe. 

Similarly, in the cases where black markets are not utilized, workarounds to such regulations will come about. In the European Union, menthol smokers have found numerous alternatives in “mentholizing” filters, menthol flavor inserts, and simply adding menthol for those that roll their own cigarettes. 

The fact of the matter is, for better or for worse, human nature will drive people to continue their consumption of addictive products. Whether we as a society want to make their compromised lives even more difficult, or want to actually help them, rests in the hands of regulatory bodies like the Food and Drug Administration. Furthermore, it’s important that the people in a free society scrutinize every bit of research the FDA cites, to make sure that they are really keeping our best interests in mind.

Taran Singh is a rising sophomore at New York Institute of Technology. As a student in a combined medical program, he is interested in evaluating health policy and its implications on society.