20 November 2018
Laurent Huber and Chris Bostic
The FDA recently announced its intention to ban menthol flavoring in cigarettes. Commissioner Scott Gottlieb should be commended for this initiative and those of us working in public health will do all we can to support him in what is sure to be a major fight with Big Tobacco. Banning menthol will go a long way to reduce smoking in the U.S., especially among African-Americans.
We should use this moment to reflect more broadly on the role of cigarettes in our society. No one wants his or her child to smoke — ever. And for good reason. Long-term cigarette consumers lose, on average, a decade of their lives and can suffer from debilitating diseases along the way. The vast majority of smokers want to quit, have tried to quit and wish they had never started. They continue to smoke because cigarettes have been highly engineered to be as addictive as possible.
The tobacco industry thinks of cigarettes as nicotine delivery devices. Their business model is addiction and while they do not benefit from the ensuing deaths, they seem unconcerned that the main platform for delivering that addiction is by far the most dangerous consumer product in history. Cigarettes are unreasonably dangerous and inherently defective. In fact, cigarettes today are far more dangerous than the cigarettes available in 1964, when the U.S. Surgeon General first linked smoking with disease.
In many places in the U.S., one might be forgiven for thinking that the tobacco wars have been won. We have driven down overall prevalence and roughly half of Americans live in places where they are not exposed to cigarette smoke in public places, but the statistics paint a different picture. Certain communities and localities have been left far behind. Tobacco has become a disease of the poor and the marginalized, groups that can least afford its devastating consequences.
Someone dies from tobacco use every 4.5 seconds. In the 20th century, tobacco killed an estimated 100 million people. That is a death toll larger than both world wars. Because of Big Tobacco’s move into the developing world, the death toll in the 21st century will be one billion. Something more must be done.
Here in the U.S., tobacco use costs more than $300 billion and kills more than 480,000 people every year (virtually all of those deaths are from cigarette use). That is one-fifth of all deaths. In spite of all of our efforts, thousands of children become smokers every day, becoming “replacement smokers” for the tobacco industry. Cigarettes are a burden on society like no other commercial product.
So why do we put up with it? Maybe we don’t have to. In 1964, with nearly half of all adults smoking, a cigarette-free world was inconceivable. Thanks to dramatic reductions in smoking through raising the price of cigarettes, marketing restrictions and smoke-free air laws, a world in which cigarettes are no longer sold as a legitimate commercial product is within reach.
Unfortunately, the FDA cannot end the sale of cigarettes on its own. The 2009 “Family Smoking Prevention and Tobacco Control Act,” which gave FDA authority over tobacco products — explicitly forbade the FDA from doing so.
The reason is obvious: The tobacco industry has made many friends in Congress and those friends knew that if the FDA applied the same yardstick to cigarettes as it does to every other consumer product, it would have no choice but to ban them. The tobacco industry and their products have enjoyed extraordinary protection for more than half a century, but there is another way forward. The 2009 act also explicitly reserved for the states the power to ban the sale of tobacco products. In states where it is not preempted, local cities and counties can phase cigarettes out of the market on their own. Change often starts at the local level and that’s where this journey can begin.
There can be little doubt that the age of the cigarette will eventually end. But what are we waiting for?
Cigarettes are more than a public health issue. As the Danish Institute for Human Rights concluded upon ending an assessment of Philip Morris International in 2017, “there can be no doubt that the production and marketing of tobacco is irreconcilable with the human right to health.” It is time to put health and justice ahead of commercial profit and political donations.
Chris Bostic is the deputy director for policy at Action on Smoking and Health. Laurent Huber is the executive director at Action on Smoking and Health.