Why the FDA might ban menthol cigarettes

A comprehensive scientific review of menthol cigarettes released Tuesday by the Food and Drug Administration (FDA) doesn't paint a very rosy picture.

Adding mint flavoring to cigarettes, the years-long review found, makes it easier to take up smoking, harder to quit, and is disproportionately more harmful to public health than regular smokes.

The peppermint oil extract itself probably isn't to blame for causing lung cancer, emphysema, or other smoking-related diseases, the FDA says. But there's something more than just the flavoring at work. People not only start smoking menthols earlier in life; menthol smokers also light up earlier in the morning, wake up to smoke more at night, have lower rates of quitting smoking and higher rates of relapsing if they do quit.

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Menthols, which account for about a third of all U.S. cigarette sales, had a near-death experience in 2009. That's when Congress passed the Tobacco Control Act, which gave the FDA new powers to regulate cigarettes and banned several types of flavored cigarettes — clove, chocolate, and fruit-flavored smokes, for example. Lawmakers exempted menthol in part because of lobbying from minority groups.

Menthols, it turns out, are really popular with black smokers, more than 75 percent of whom opt for the minty cigarettes. About 30 percent of Latino smokers also choose menthols. Among white smokers, a little more than 20 percent smoke menthols. Three major African American groups urged Congress to leave menthols alone, arguing that it would unfairly affect black smokers and citing concerns about creating a black market for Kools, Newports, and Salems. Law enforcement groups also endorsed the latter fear.

After the brush with a ban in 2009, menthols faced a new challenge in 2011, when a congressionally mandated group of outside experts empaneled by the FDA found that mentholated cigarettes pose a special public health risk. Many anti-smoking advocates expected the FDA to act after that study, but the tobacco industry pushed back, issuing its own study that found no added risk from menthols. Big Tobacco also sued the FDA over its choice of experts behind the agency's initial study.

The newest study could be the beginning of the end for menthols in the U.S., though. The FDA insisted that a ban isn't inevitable, but it did open a 60-day public comment period to help "determine what, if any, regulatory action with respect to menthol in cigarettes is appropriate." That could mean anything from putting restrictions on advertising to an outright ban. The European Union took a step toward banning menthols earlier this month.

A ban in the U.S., or even new regulation, isn't a slam dunk, though. One thing that is? More studies. One of them will look at whether there's a physiological property to menthol that makes it more addictive or alluring to certain ethnic groups. Marketing plays some role in the black preference for menthols, the FDA concedes, but at least one study suggests that a genetic variant common among African Americans encourages a predilection for menthols.

Two new studies, published Tuesday, also suggest further avenues for study. One, in the journal PLOS One, found that menthol and nicotine affect the same receptors in the human brain, potentially dulling the pleasurable effects of nicotine, and thereby making people smoke more to get the same feeling as regular cigarettes. The other one, in Frontiers in Pharmacology, found that menthol scrambles nicotine's interaction with receptors around the body, amplifying some effects and muting others.

"Today I cannot tell you that menthol cigarettes are more addictive," says Nadine Kabbani at Virginia's George Mason University, who helped write both studies. "But I can tell you that they're increasingly found to have biological and biophysical properties that go beyond flavor." Mixing menthol with tobacco is "almost like spiking your vodka with beer," she adds.

If studies like this bear scrutiny, it will be hard to argue, as the tobacco industry does, that menthols are just the same as regular cigarettes.

And if the FDA bans the minty cigs, we'll find out something else: Are menthols so alluring as to command black-market prices?