“Singing from the same song sheet” is a rather overused metaphor that describes a group of people or organizations aligned in the collective pursuit of a common goal. In Washington, it’s political speak for being on the same page, all wanting the same thing.
It’s practiced every day, with precision, in the way the Biden administration advances its broader policy agenda. It’s why we see government agency officials and White House representatives always in lockstep, on message, working together to promote the president’s objectives.
So it was a very rare moment when it came to light last month that Robert Califf, the commissioner of the U.S. Food and Drug Administration, had privately urged fellow public health professionals to pressure the White House to make good on its 2021 pledge to ban menthol cigarettes.
Califf likely didn’t intend for those conversations to end up in Politico. But the fact he encouraged his network to lobby President Biden to honor that 2021 commitment reveals the FDA is at odds with its own administration’s attempts to stall implementation of the years-old Biden-proposed regulation.
Why has the Biden administration dragged its feet on this important public health initiative? Because a vast majority of Black smokers use menthols, and in an election year, when every vote matters, President Biden can ill-afford to alienate any potential constituency.
The tobacco industry has targeted the Black community with menthol advertising for decades and those efforts have had a devastating impact on public health. Eighty-five percent of African Americans who smoke use menthol cigarettes (compared to 29 percent of white smokers), and the highest rates of lung cancer in the United States impact Black men.
Over 18 million Americans smoke menthol cigarettes, “with particularly high rates of use by youth, young adults, and African American and other racial and ethnic groups,” the FDA found in 2019.
Tobacco kills 45,000 Black lives each year. Just two years ago the Biden administration and the FDA were united in stopping these preventable deaths. Today they seem miles apart.
Anti-smoking advocates celebrated Biden’s 2021 call to ban menthols. The Truth Initiative at the time said it was a “tremendous win for public health.” Now, some are worried it will be tied up in perpetuity, as the White House has scheduled “dozens” of meetings with ban opponents that have received funding from the tobacco industry.
The science is clear. Menthol interacts with the brain and enhances nicotine’s effects. The U.S. Centers for Disease Control and Prevention has determined young adults are more likely to try menthol cigarettes first, and those who do are more likely to become addicted.
“Studies indicate that most young people smoke menthol cigarettes,” says Sven-Eric Jordt, Ph.D., Associate Professor of Pharmacology at the Yale School of Medicine. “So they are being exposed to higher levels of nicotine and other toxic substances at a young age, which may lead to rapid addiction and ultimately to the development of smoking-related disease.”
Menthols are also harder to quit. The CDC states menthol users have lower rates of success in giving up the habit compared to non-menthol users, and that Black menthol users “may be even less successful in quitting than other population groups.”
Since 2009, the FDA has had the power to regulate tobacco products under the Family Smoking Prevention and Tobacco Control Act. That same year, the FDA moved quickly to ban cigarettes and rolled tobacco products that contained certain flavorings, citing their appeal to young smokers, but menthols were notably exempted.
Last year, the Biden administration twice delayed its 2021 decision to ban menthols and kicked the can to this March for implementation. March is now here, so the question is: Will the Biden White House continue to value tobacco company profits over the health of thousands of Black Americans?
“I don’t know how Black Lives Matter if you’re willing to put 45,000 lives at risk,” said Yolanda Richardson, president of the Campaign for Tobacco-Free Kids.
A federal ban on menthols is achievable if the political will is there. Massachusetts and California have bans already in place. We are at the doorstep of an important public health moment that can reduce the total number of smokers, prevent young people from becoming addicted and save human lives.
But until the White House resets its compass and starts working collaboratively with the FDA to rid the nation of menthols once and for all, thousands of Black Americans will continue to die.
Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.