Cigarettes. As any listener to our podcast knows, it takes only the mere mention of these repulsive products to get me on a rant. So this week NEJM gave me the opportunity with two perspectives on mentholated cigarettes, a device of the devil if ever there was one.
Here's the background: in 2009 the Family Smoking Prevention and Tobacco Control Act was passed, giving the FDA power to regulate certain tobacco products with the goal of protecting the public's health. As is the case with many other drugs and devices, Congress then effectively tied the agency's hands by exempting menthol flavored cigarettes from this act.
If you're not a smoker, or even if you are, you may not know that menthol-containing brands of cigarettes account for 30% of the domestic cigarette market. The Tobacco Products Scientific Advisory Committee, which was created by the act cited above, recently released a report citing studies showing that the addition of menthol to cigarettes soothes the throat of a new smoker, making the experience of drawing smoke into one's lungs less unpleasant, and therefore ensuring that the neophyte smoker will continue to smoke and become addicted. The addition of menthol also makes smoking cessation more difficult. Yet the report concluded, in decidedly wimpy language, "Removal of menthol cigarettes from the marketplace would benefit public health in the United States," but did not make a specific recommendation to the FDA. Thus the agency has no leg to stand on in attempting to regulate these products.
The political wranglings that led to the ultimate exclusion of mentholated cigarettes from regulation reads like many other exposes of the political machine so effectively governing our country. Sickening, really. Especially imaginative was the creation of a straw man to bolster the argument that menthol should be excluded: that of the development of a potential black market for such cigarettes.
To be fair, there is research clearly demonstrating that when desired products are regulated or taxed heavily, such markets develop and people find ingenious ways to escape such strictures. Research from Johns Hopkins shows, for example, that many people use the Internet to find Native American reservations and the like to purchase cigarettes less expensively, since they aren't taxed to the same degree as those available locally in many states. Yet it is my firm conviction that such behavior simply argues for a robust federal tax on ALL cigarettes, or better yet, abolishment of cigarettes altogether.
Indeed, when I reflect on the simple existence of cigarettes at all I shudder. How is that as a society we allow a product to be sold that has absolutely no benefit to anyone outside of cigarette manufacturers and their stockholders, but causes abundant harm? And this is not just harm to individuals but to all of us in the form of lung cancer, emphysema, heart disease, and early death, reflected in health insurance costs and personal suffering. Empowered to make just one public health decision, I would abolish cigarettes right now. Okay, rant over.
Other topics this week include a lack of benefit seen in screening for ovarian cancer in JAMA, and two others from NEJM: a new agent for breast cancer prevention and successful management of hepatitis C treatment via telemedicine. Until next week, y'all live well.