AMA takes no action on tobacco bill challenge

Is menthol a flavor that should be banned from cigarettes?

That's a tricky question, according to the American Medical Association whose members on Tuesday found themselves opposing some government health heavyweights.

Menthol flavoring would not be banned under a bill before Congress that gives control of tobacco products to the Food and Drug Administration. The bill would ban flavor additives such as mint, clove and vanilla, which appeal to young people.

Menthol is preferred by more than 75 percent of black smokers, according to government estimates. Fewer than 25 percent of whites smoke it.

"If we're banning things such as clove and peppermint, then we should ban menthol," said Dr. Louis Sullivan, health secretary from 1989 to 1993 under President George H.W. Bush and one of seven former health secretaries who sent a letter to lawmakers voicing opposition to the menthol exemption. "If it doesn't happen, this bill will be discriminatory against African-Americans."

Normally, the nation's largest organization of doctors probably would agree. But in this case, the AMA president and many delegates support the menthol exemption pushed by the cigarette industry. The AMA voted Tuesday to refer the decision on menthol to its board, effectively silencing the doctors who wanted the organization to speak out against the exemption.

The reason is that the menthol exemption helped congressional leaders reach a bipartisan compromise on legislation that would put cigarettes under government regulation. Supporters say it would give the FDA authority to reduce harmful ingredients in cigarettes, require new health warnings and bar misleading labels such as "light" and "mild."

Dr. Ron Davis, a preventive medicine specialist who is wrapping up his one-year term as president, said removing the menthol exemption from the bill might derail the legislation.

And while other flavor additives are aimed at luring young smokers, menthol is different, he said. Banning it would merely drive mature black smokers to other brands, said Davis. "It would change the entire political dynamic."

Menthol cigarettes such as Kool were marketed during the 1960s in advertising campaigns targeting urban blacks, according to the National African American Tobacco Prevention Network. That group withdrew its support from the tobacco control bill last month over the menthol exemption and found allies in the former health secretaries.

The exemption harms the black community, said Robert McCaffree of the American College of Chest Physicians, the group that introduced the AMA proposal. He noted that cigarette maker Philip Morris USA supports the bill and the exemption.

William S. Robinson, executive director of the African American Tobacco Prevention Network, said the group believes a superior tobacco control bill could be crafted without the support of Philip Morris, which makes several menthol brands.

"We understand from an industry perspective why menthol is off the table," Robinson said. "We think part of it is because menthol represents almost 30 percent of the $70 billion U.S. cigarette market."

Philip Morris spokesman Bill Phelps said the bill would give the FDA authority to remove ingredients that are determined harmful to health.

"Based on our scientific judgment, menthol does not increase the inherent hazards of smoking," Phelps said.