Thursday, June 10, 2021

The War on Tobacco Flavors Is Another Element of the TIP-TOE Game Plan: Tacit Incremental Prohibition - Tobacco Elimination


In a recent interview with Strong and Free Podcast producer Christopher Balkaran, I explained why in the 1990’s I jumped from a conventional academic career into tobacco harm reduction research and policy analysis.  When I challenged conventional wisdom about smokeless tobacco, finding many of the attacks on it as unsupported and dishonest, I exposed a number of inconvenient truths about the tobacco control community. 

Alas, the first recognition of an important concept is frequently ignored, and eventually forgotten.  Dr. Philip Cole, my only tobacco research colleague and coauthor for nearly 10 years, wisely observed, “Our tobacco work will be ignored and vilified.  I prefer the latter, because it means that someone is noticing.

Today, there is a fresh push to ban tobacco flavoring, particularly menthol cigarettes and all vapor products.  The effort is largely driven by the Campaign For Tobacco-Free Kids and their allies, ostensibly to protect children from a lifetime of nicotine addiction.  

The drive to ban flavors is not new.  In 2010, I commented on one of the first studies demonizing mint and wintergreen flavors in dip products.  The next year, I coined TIP-TOE, or Tacit Incremental Prohibition - Tobacco Elimination, as a moniker for the prohibitionists’ effort “to employ an escalating series of legislative and regulatory controls in order, over time, to remove all tobacco products from the marketplace.”  I noted that zealots “believe that a world without nicotine is both desirable and achievable, yet they are not courageous enough to demand outright prohibition. Instead, they’ve implemented the subtle TIP-TOE strategy of chipping away at consumer rights and industry initiatives… They would ban tobacco products that are almost risk-free, while assuring continued market dominance by vastly more hazardous cigarettes.  Using TIP-TOE tactics, tobacco prohibitionists are sprinting toward a public health disaster.” 

Flavor bans have predictable results, some of which are unintended by their prohibitionist promoters.  In the next blog I’ll discuss one consequence of the 2019 San Francisco flavor ban.   



Wednesday, June 2, 2021

Ethan Nadelmann on Tobacco Harm Reduction: We’ve Seen This Before


Ethan Nadelmann is a world-class, eloquent, passionate expert.  Spend 18 minutes watching his inspirational speech, “We’ve Seen This Before: Tobacco Harm Reduction Opponents Mimicking Old Drug War Tactics and Rhetoric.”

Nadelmann founded the [Alfred] Lindesmith Center, which honors the Indiana University sociology professor who pioneered drug harm reduction research and policy development.  Nadelmann, who also founded the Drug Policy Alliance and was described by Rolling Stone as "The driving force for the legalization of marijuana in America," was the keynote speaker at last month’s E-Cigarette Summit. 



Monday, May 24, 2021

Menthol Cigarettes & Race: FDA Shades the Facts


The FDA announced on April 29 its decision to ban menthol cigarettes, saying it had “strong scientific evidence” that the action would “reduce tobacco addiction and curb deaths.”  It claimed that “menthol increases the appeal of tobacco” and makes cigarettes “more addictive and harder to quit by enhancing the effects of nicotine.”  The agency, however, failed to explain why menthol cigarettes, despite such appeal, are favored by fewer than 30% of American smokers. 

Media coverage of the ban featured the claim that menthol cigarettes “disproportionately addict – and kill – Black Americans,” as the Washington Post headlined a story that contained this statement: “Black men have the highest rates of lung cancer in the United States, according to the Centers for Disease Control and Prevention.”

In 2018, I answered the question, “Who smokes menthol cigarettes?” using the 2015 National Health Interview Survey (NHIS), which was the last CDC report on the number of menthol smokers.  Although federal officials claim that menthol cigarettes pose an existential threat, they only collect information about them every five years in the NHIS, their main instrument for tracking smoking.

The 2015 NHIS found 10.7 million menthol smokers; 61% were white and 32% were Black.  Here is a further breakdown of race and gender, from highest to lowest numbers:

Table 1. Number of Menthol Smokers in the U.S., NHIS 2015

Race/GenderNumber (millions)

White women3.8
White men2.7
Black men1.8
Black women1.6


If menthol cigarettes addict and kill smokers, these numbers reflect the victims’ race and gender distribution.

Let’s look at lung cancer mortality rates (LCMR) and numbers of deaths from the CDC’s most recent five years of data.  The rate is the number of deaths per 100,000 population per year (among persons 45+ years), so it’s the best way to compare different-sized groups.  The number of deaths is related to both the rate and the size of the group.

Table 2. Age-adjusted LCMR (per 100,000 persons per year) and number of deaths from lung cancer, 2012-2016

Black men18449,578
White men151371,140
White women102306,234
Black women9335,158

*Various groups with different LCMRs

While Black males have the highest lung cancer mortality rate, it is not because they smoke menthol; it is because they smoke more than white men and women, and especially Black women.

Mitch Zeller, director of the FDA’s Center for Tobacco products, played the menthol ban as a race issue: “For far too long, certain populations, including African Americans, have been targeted, and disproportionately impacted by tobacco use.” [Federal officials always say “tobacco” when they mean “smoking’?] 

The numbers prove Zeller is wrong.  While he asserted that Blacks “have been targeted,” far more whites than Blacks smoke menthol.  Zeller claimed that Blacks have been “disproportionately impacted,” but while Black men have the highest lung cancer death rates, Black women have the lowest, at about half the rate of the former.