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.

Friday, May 14, 2021

Huge Increase in U.S. Deaths in 2020, and Covid Played a Huge Role

I have spent the past 30 years studying how people die in the United States, which is why I have been so passionate about making cigarette smoking history.  Unfortunately, too many Americans were either apathetic or completely belligerent about practical and commonsense harm reduction solutions to reduce smoking-attributable deaths, so every year half a million lives were prematurely and needlessly tossed away for over two decades.

In 2020 we had the Covid-19 tragedy, in which apathy and belligerence to commonsense pandemic precautions once again killed a lot of Americans.  We now have the first set of numbers from the CDC as proof.

As seen in the chart at left, deaths from all causes in the U.S. skyrocketed from 2.85 million in 2019 to 3.36 million last year.  We expect all-cause deaths to slightly increase each year because of steady population growth (currently about 330 million) and steady ageing of that population.  In fact, during the previous 10 years, on average deaths increased by about 43,000.  But in 2020 deaths were up by almost 504,000.  That jump is unprecedented in the past 50 years. 

One bogus claim heard commonly last year was that Covid was mainly killing the elderly who were about to die anyway from some other disease.  But the CDC numbers destroy such frivolous notions.  The agency recorded 345,323 Covid deaths, which ranks third to heart diseases and cancer in the following chart.  Note that heart disease deaths also had a sharp increase in 2020, while cancer deaths were about the same.

Modest increases were also recorded for injuries, stroke and Alzheimers disease, as noted in the next chart.   


So it’s clear that Covid deaths didn’t “replace” other causes.  In fact, the charts suggest that Covid might have contributed in some way to extra deaths from heart diseases, stroke and even diabetes, which is seen in the next chart.


One group of diseases that Covid had no influence on was influenza/pneumonia, which saw no significant change. 

Keep in mind that absolute numbers of deaths only tell part of the mortality story.  Eventually the CDC will release data on age at death, from which rates can be calculated and more detailed comparisons made with previous years.  I guarantee that there won’t be any good news there.




Monday, May 10, 2021

THR Discussion With Christopher Balkaran on a Strong and Free Podcast


I recently had an interview with Christopher Balkaran, the talented Canadian producer of the Strong and Free Podcast.  Christopher is currently exploring tobacco harm reduction, and he gave me ample time to discuss many aspects of safer tobacco products.  My interview is available here.  If you are especially interested in any of the following topics, I’ve listed the times for quick access.  

1.  Why I jumped from a conventional academic career into tobacco harm reduction research and policy…without a parachute.  At 0:45 to 1:40 minutes

2.  One of my main goals: to correct purposeful misinformation about tobacco products, serving the dream of a “tobacco-free society,” that has misled even medical professionals, including me. At 2:20 to 3:55 minutes

3.  I affirmed my opposition to any drug use by adolescents.  At 5:10 to 6:05 minutes

4.  How harm reduction can help smokers, regardless whether they are unable or unwilling to abstain completely from nicotine and tobacco.  Harm reduction… including this advocate…does not judge smokers.  At 7:10 to  and 24:50 to 25:45

5.  How nicotine is no more dangerous than caffeine.  At 8:15 to 9:10 minutes. 

6. How millions of people enjoy using nicotine and tobacco and derive significant benefits; the danger is in the delivery system, smoke versus smoke-free.  At 9:50 to 11:50.

7.  The history of tobacco use dates back long before Columbus “discovered” America.  At 13:25 to 14:25.8.  The campaign to prohibit all nicotine and tobacco didn’t start with e-cigarettes and vape products.  It started in the 1980s when the reputation of smokeless tobacco use was irrevocably ruined by specious claims.  At 15:35 to 17:15

9.  For prohibitionists, all tobacco products aren’t just dangerous, they are evil.  Those claims are now institutionalized by U.S. FDA regulation, which requires tobacco companies to be absolutely silent about their products unless they can prove that they are safer than cigarettes.  At 17:15 to 18:40

10.  “Most men lead lives of quiet desperation.”  Why offering smokers safer substitutes has mattered to me since childhood.  At 21:20 to 23:40

11.  My work to bring to a worldwide audience the “Swedish Experience” with snus use, which has resulted in the lowest smoking-related mortality among men in the developed world. At 27:15 to 36:10

12.  The emerging IQOS heat-not-burn tobacco success story in Japan shows us how a world-class case of corporate self-cannibalization in the free-market setting could save millions of lives. At 36:35 to 43:00

13.  Why inhaling 7,000 chemicals along with nicotine for decades is worse than vaping. And the incredible reduction in these chemicals in IQOS.  At 45:15 to 47:55

14.  Prohibition (of alcohol) failed miserably 100 years ago…so we are going to repeat our mistakes by Prohibition of tobacco?  At 50:00 to 53:50

15.  Tobacco prohibitionists control the media, so they refuse to defend or debate their mission.  This makes them the opposite of strong and free.  At 55:10 to 56:25

Please watch this interview…and post your comments on YouTube.  Let’s keep the discussion going.