Digging Into the Debate About Banning Menthol Cigarettes

On this episode of the Princeton Pulse Podcast, we dig into the ongoing debate about banning menthol cigarettes in the United States. 

We’ve known for decades that menthol cigarettes are more addictive and ultimately more harmful than tobacco-flavored cigarettes. Yet they’re still around, attracting young smokers, increasing health disparities, and causing preventable deaths. That is why the FDA has proposed policy to prohibit their sale. Research clearly suggests that a federal ban could save up to 650,000 lives over the course of 40 years, and that one third of them would be Black Americans. Despite those findings, however, the policy is stalled under the influence of a presidential election year and lobbying by Big Tobacco.

Host Heather Howard, a professor at Princeton University and former New Jersey Commissioner of Health, delves into the historical context and the costs of delayed policy intervention with two guests: Keith Wailoo, a professor of history and public affairs at Princeton and author of the book "Pushing Cool: Big Tobacco, Racial Marketing, and the Untold Story of the Menthol Cigarette"; and Carol McGruder, founding member and co-chair of the African American Tobacco Control Leadership Council (AATCLC).
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Learn more about the AATCLC’s advocacy for the menthol cigarette ban at www.SavingBlackLives.org. 

Visit www.keithwailoo.com to learn more about Keith Wailoo’s research, his latest book ("Pushing Cool: Big Tobacco, Racial Marketing, and the Untold Story of the Menthol Cigarette"), and other publications. 

The Princeton Pulse Podcast is a production of Princeton University's Center for Health and Wellbeing (CHW). The show is hosted by Heather Howard, a professor at Princeton University and former New Jersey Commissioner of Health and Senior Services, produced by Aimee Bronfeld, and edited by Alex Brownstein. You can subscribe to The Princeton Pulse Podcast on Apple Podcasts, Spotify, or wherever you enjoy your favorite podcasts.

Transcript

 Episode #12: Digging Into the Debate About Banning Menthol Cigarettes

SPEAKERS
Keith Wailoo, Carol McGruder, Heather Howard

 Heather Howard  00:02

Hi, and welcome to the Princeton Pulse Podcast. I'm Heather Howard, professor at Princeton University and former New Jersey Commissioner of Health and Senior Services. On campus and beyond. I've dedicated my career to advancing public health. That's why I'm excited to host this podcast and shine a light on the valuable connections between health research and policy. Our show will bring together scholars, policymakers, and other leaders to discuss today's most pressing health policy issues, domestically and globally. We'll highlight novel research at Princeton, along with partnerships aimed at improving public health and reducing health disparities. I hope you'll listen in as we put our fingers on the pulse and examine the power and possibilities of evidence informed health policy.

Heather Howard  00:51

Welcome. Research suggests that a ban on menthol cigarettes could save up to 650,000 lives over the course of 40 years. One-third of them, according to a recent study, would be black Americans. Why is this community paying the highest price? And why are these dangerous products still on the market? We'll probe these questions and more on today's podcast episode. 

Heather Howard  01:14

The science is clear. We've known for decades that menthol cigarettes are more addictive and ultimately more harmful than tobacco flavored cigarettes. Yet they're still around, attracting young smokers, increasing health disparities, and causing preventable deaths. The FDA has responded by proposing policy that would prohibit the sale of menthol cigarettes in the United States. However, their efforts are stalled under the influence of a presidential election year and lobbying by big tobacco. Here with me today to weigh in on the debate, provide important historical context, and discuss the real human cost of delayed policy intervention are two distinguished guests. In the studio with me is Keith Wailoo, a professor of history and public affairs at Princeton University and author of the book "Pushing Cool: Big Tobacco, Racial Marketing, and the Untold Story of the Menthol Cigarette." Also joining the conversation is Carol McGruder, founding member and co-chair of the African American Tobacco Control Leadership Council, an advocacy group that is fighting for the menthol cigarette ban. Keith, Carol, welcome to the show.

Heather Howard  02:24

Carol, let me start with you. Can you tell us a little bit about your background and how you came to anti-smoking work and the work of the Leadership Council? 

Carol McGruder  02:33

Sure, I would love to. I came to commercial tobacco control by a total fluke. It was the secret sauce. I think what defines the African American Tobacco Control Leadership Council is that we were all activists for our community on different issues. And so when we got into tobacco, we were able to bring the skills and the fight and the disappointments and the triumphs of all the things we've worked on to this cause. Also, since we had no funding, we weren't tethered to any particular institution or organization. So in those first couple of years of our inception, we were really able to lay it out the way we thought it should be, to be able to say it the way we thought it should be said, and to be able to speak to who we thought we should speak to. 

Carol McGruder  03:24

Personally, I have worked with HIV/AIDS. I was the president of the board of the Black Coalition on AIDS in San Francisco, one of the last few organizations for AIDS. I also did intimate work with black infant mortality and maternal health way before the current issue with our high black maternal death rate. I worked on that 30 years ago. Tobacco just kind of seeped in there. And it was just really a job for me. I didn't know anything about it when California passed the Prop 99 tobacco tax. I was looking for work. A friend said, "Are you interested?" And I said, "Sure." It was only after I really began to study how the tobacco industry has systematically, perniciously, and racistly targeted the Black community for decades, oftentimes with the complicity of our own organizations, and the silence on the issue of the number one killer of Black people, the number one preventable cause of death. It just captured me. And the thing that really sealed it for me was I had gone away to study in France. I had my favorite aunt who had emphysema, a heavy, heavy smoker. She lived in LA. I lived with her. She helped to form me as a young woman. And I knew when I went to France, I would not have money to come back. I knew she was going to die while I was gone. I purposely took my mother, who was her first cousin, down to visit her and knew I would never see her again, with my little toddler. Then she died when I was in France. It was when I came back that I started this work. And so she was a woman who was so strong, so funny, so intelligent, so bright. Her nicotine addiction was the shame of her life. She felt so complicit in her illness and death that she never complained. She just took her lumps, took her licks, as she went through the five year progression and died from emphysema and COPD at the age of 58. As you get to that age and then pass it, you realize how young that person was, and how much living and how much need our family has for that person - in the family and in the community. It really put me in touch, in an intimate way, with the harm that was done. She's been dead now for 30 years, so I can see the trajectory of her family, and where her family would be if she were still alive and still able to be that grounding foundation for our families. So that's how I got into tobacco control. And that's really why I'm so passionate about it. I have really lived it. And I really understand the harm that it does to our community. 

Heather Howard  06:10

Carol, thank you for sharing, both your personal connection and the deep roots of your advocacy and your public health work. That's so compelling. Thank you. 

Heather Howard  06:20

Now, Keith, your research straddles history and health policy. How did you come to this particular issue and this book?

Keith Wailoo  06:27

My background is in the history and sociology of science and medicine. And most of what I have studied are efforts to advance and improve the health of the American population generally, in which the story of drugs is most often a positive story of increasing longevity and addressing health issues. But over the course of my career, which started in the 1990s when I finished my Ph.D., I was able to watch another drug, tobacco, and to track its devastating implications for health and wellbeing along the lines of what Carol just described. At the same time that people are trying to mitigate the harms of society that actually undermine people's health, we don't often think about the fact that there are purveyors of products that are also systematically undermining the health and wellbeing of Black folks, or consumers in general. 

Keith Wailoo  07:38

In my first job at Chapel Hill, in the medical school, right at the end of my first six years, something happened where the States' Attorneys General sued the tobacco industry. And there was a settlement in 1998, a master settlement agreement, that made it crystal clear that the industry finally acknowledged the health deficits, the health devastating effects of smoking. And it threw open, for the public to see, all of these internal documents, all of the communications. This was a product of the settlement. You're able to actually look into all of the machinations by this industry as a result of this. And the reason why the States' Attorneys General were suing is that they were trying to recover the costs of caring for people who had been deceived by the industry for decades, people like the one that Carol just described - her relative and loved one. So in some ways, as a historian, it's an unprecedented opportunity to pull back the curtain and to see how this product became so popular, not just menthol cigarettes, but cigarettes in general. That's the kind of impulse that led me into this project. What I found is the story that I tell in "Pushing Cool." 

Heather Howard  09:09

And so you're a historian, but it's very relevant to policy today, obviously, because we've got this proposal at the FDA, which I want to get into. But Carol, before we get specifically to what's pending - this policy window we've got now -- and the relevance of Keith's research, I'm struck by when you look at the statistics on smoking, we're in a lot better place than we were even just from 2005 to 2021. We've seen a dramatic decrease in smoking rates. We still have 11.5% of Americans smoking now, but it was as high as 21% less than 20 years ago. This menthol problem brings home why we have so much more work to do. Can you tell us more about who the menthol smokers and why the human tool we're talking about is so important? 

Carol McGruder  10:07

Certainly, I'd love to. When we look at an 11.5% prevalence, it hides the disparities that we see. We know that for African American smokers, the smoking prevalence rate is way higher. We could do a program on each one of these things I'm going to hit on, but I'm going to hit on them quickly. When Karen Bass was the mayor of Los Angeles and the first Black woman speaker in California, we had a press conference about the methodology for collecting smoking prevalence data. At that time, it was done with random digit dialing on landlines. This was before cell phones were so prevalent. I don't have a landline now, but a lot of the people who smoke -- the folks who I work within the city and might even be related to -- are not going to respond to a random digit survey. There's a lot of suspicion. They don't care, so they're not captured in the smoking prevalence data. When collecting data about who smokes, they're not going to people who stand on the corner, they're not going to juvenile hall. These, of course, are areas that there would be higher smoking prevalence. When we looked at geographical neighborhoods that were more Black, there was a higher smoking prevalence in segregated communities. They're not legally segregated, but where there are clumps of African Americans. There's already a big discrepancy, a big difference between what we think we know [and the actual numbers]. Our position is that it's even worse than that. [The prevalence is highest] among the people who need resources the most, who need the most attention. We know that the gaps get wider, and that smoking is correlated with lower education, etc. There's a divide happening, and there's a big divide in our own Black community. I can see it in my own family. I have a branch with doctors and lawyers, and I have another branch that are still very much suffering from all of the inequities that we face as Black people in this country. 

Carol McGruder  12:40

So when we look at the statistics, we know that 85 to 90% of Black people who do smoke, smoke a methylated tobacco product, and with that there's a younger generation that we don't capture. And those are the folks who are really smoking the Swisher Sweets, the little cigars. And so there are two actual rules that the FDA is supposed to put out, one of them about menthol, but what about also little cigars and cigarillos? That gets very little attention. Those products were left on the market, and not under the purview of the FDA, when Obama signed that act in 2009. There was just no reason why those weren't included. The industry interferes and we have a delay, from 2009 to 2024. We've been so focused and bracketed on menthol, but there's another issue out there as well, which are these little cigars and cigarillos that really have gotten very little attention. And that was even more inexcusable than menthol. Because there was just no reason at all, except we're just going to leave that out there and let the FDA wind through the process to bring them in under the umbrella to regulate them. It could have been done under President Obama with a stroke of a pen in 2009.

Heather Howard  14:00

I want to make sure we get to that. But first, Keith, you mentioned that there was, early in your career, the opening of these troves of cigarette company documents and history. And you've been able to mine that in your book. Can you tell us about when menthol was added to cigarettes and the history of it? Why [it occurred] and what that's meant? 

Keith Wailoo  14:28

There's a long history, dating back about 100 years, where the cigarettes were harsher. And menthols were added by a couple of brands as a “therapeutic.” There's nothing therapeutic about menthol, except that people associate it with lozenges and Vicks Vapor Rub, etc. It gives you the feeling of your airways opening, but it's a deceitful feeling. Your airways do not open. But that's where the menthol cigarettes first started, promising a kind of therapuetic sensibility. A very small proportion of smokers smoked them in the '20s and '30s, mostly as a break cigarette. So the advertisements were things like "For smokers throat, take a menthol," or, "If April showers make you cough like crazy, refreshing Kools taste fresh as a daisy." That's the Kool advertisement from the '40s, when the first public health information linking smoking to cancer first emerged in the '50s and then again in the '60s. This is where the industry realized and then pushed a new kind of therapeutic promise, which is that menthol smoking was safer than non-ventilated smoking, that filtered smoking was safer than non-filtered smoking -- once again deceitful, untrue, but it spoke to people's anxieties. And so what you find in the records is an awareness, early on, that menthol smokers were anxious about their health and were looking for safety. And that's what was being offered. In 1960, if you'd said a disproportionate number of menthol smokers are Black or Latino, people in the industry would have laughed at you because they knew that menthol smokers were health-oriented smokers. The pivot happened in the early- to mid-1960s. At the same time that the industry was pushing menthols to college campuses, to youth smokers, as well as to health smokers, they were being pushed out of the college market by regulators who said, "We do not want you hooking children." And so one of the things they did was withdraw from the college market, but they used the same tactics -- free samples, couponing, giveaways, promotion campaigns -- in Black communities starting in the mid-1960s. So the story of how we ended up where we are today starts with this deliberate attempt to actually build markets. 

Keith Wailoo  17:16

Now, the thing I would say about where we are today is that we're not at the end; we're at the end of how the story changed. The story changed because people got wise to these tactics and, over the course of starting in the '60s into the '70s, we've had systematic bans against many of these tactics. TV and radio ads were pulled off the air in early 1970. As I said, there were bans on college advertising in the '60s. Oh, here's another one... free giveaways to troops in Vietnam, which is what the industry used to do. We've had bans on billboards. We've had bans on indoor smoking. All the way through this, the menthol cigarette has remained a growth area, but also an on ramp to smoking, an initiation tool. And so, when Carol said that, in 2009, Congress had the opportunity, it gave the FDA, for the first time in U.S. history, responsibility for regulating tobacco products. And it banned most flavored cigarettes with characterizing flavors, but exempted menthols. And the only reason we're here today is because of that exemption and how long it's taken the FDA to deliberate on the question. We are at a moment when the FDA has completed its work. They have weighed the scientific and the public health evidence. And if logic and public health were the prevailing considerations, the menthol cigarette would be banned. All of that has been settled. In my view, we are at the last-ditch effort, where the defenders of menthol, which is the industry, have been trying to figure out ways to amplify the politics of it, because they don't have the science on their side and they don't have the public health on their side. But what they have is the ability to suggest that there will be political consequences if you banned the menthol cigarette. I, for one, don't actually buy it, because this is part of the tobacco playbook. This is what you're able to see when you look at the history of menthol. Whenever these bans emerge, you see an effort to politicize it in defense of an incredibly lucrative kind of product.  

Heather Howard  19:55

Carol, I'm going to come to you on the current politics, but, Keith, this is also where your book does such an interesting job of mining the history that the current politics today is informed by. Starting in the '60s, you tell the story of how tobacco companies were not just creating this racial market, but they were also creating allies using race. Can you talk about that and why that's informing today?

Keith Wailoo  20:19

When you think about the voices out there, who are defending the menthol cigarette today, they're mostly people who are benefiting financially from the menthol cigarette sales because they are on the payroll or dependent on the industry's success. That's been true since the 1960s. So publishers, publishers of Black newspapers and Ebony Magazine, depended on tobacco ads for revenue, and as a result, often, not always, but often looked the other way when the rates of tobacco-related illnesses started to rise. The most shocking example is in the mid-1960s when Nat King Cole developed lung cancer. A deep and extensive smoker, a spokesperson for Chesterfields, had developed cancer. Ebony Magazine covered his life because he is an icon of the civil rights movement. He is a crossover musician. We still know his music today. However, when he died, they did a wonderful obituary on him that didn't mention smoking once. In that same issue of Ebony Magazine, there were four menthol ads. They bought silence from publishers. They bought silence from, for a period of time, the NAACP -- financing them, supporting them. Not anymore. Once the NAACP stopped taking money from tobacco, guess what, they started to talk about why menthol was devastating. And that had implications for Black people. They also financed some of the elected representatives in Congress who were part of preventing the menthol ban in the 2009 legislation. The reason why we're here is because of this strategy. So when you hear that there is a pollster today, who has been financed by Altria to do a poll that suggests that there are going to be political consequences for banning the menthol cigarette, I go back and I go, "Check. That's from the tobacco playbook." When you hear that there are civil rights leaders, who are respected in their community for speaking on behalf of the health and wellbeing of Black people, who are opposed to the menthol cigarette, but they've taken money from the industry, I say, "Check. That's from the tobacco playbook." Benjamin Hooks, the executive director of the NAACP, actually defended the industry's right to come out with Uptown Cigarettes in 1990, and market it to Black Philadelphia. And he said that banning those billboards that are targeted to Black people was racist, because it suggested that black people couldn't make decisions for themselves. That was out of the tobacco playbook. So anybody you see that's speaking on behalf of menthol, is speaking from a script that is made and crafted by the industry. And so that's what history teaches us. I could go on and on and on. But I'll stop there.

Heather Howard  23:43

Carol, you got this deep history of public health advocacy. You're on the frontlines. How do you see this racial playbook playing out? 

Carol McGruder  23:50

I would say exactly what Dr. Wailoo has said. The playbook is there. And they're using the replay. It's fascinating, if it wasn't so awful, to see them roll out the same strategies. And they work. They don't work the way they used to, but it diverts our attention to fight amongst each other, which is part of their playbook as well. They deflect who is the wizard behind the curtain. [I think about] Ben Shade, who is the head of the NNPA, the National Newspaper Publishers Association. Print is dying, but it's what's left of our Associated Press. How our Black press can take money from Newport cigarettes, for example, when [they're harming Black people.] This is the thing that's so important. Our Black press was created to free us from slavery. Our first paper was Freedom's Journal. A Black newspaper would change hands 50 times before it was tossed because people didn't have money, and that was the importance and the role that our media played with us. And so when we talk about Ebony and Jet, I remember as a child, literally waiting for these magazines to come out because this was our news. This was our people talking to us. And so Newport was able to get in there. Ebony and Jet are the house that Newport built, because of that revenue. And then other groups didn't want to advertise with Black people at that time. If your product was seen being used by Black people, that was lessening the value of it. So all of these things converged for this perfect storm, to sow the seeds that still remain today.  

Carol McGruder  25:42

I just want mention the documents, that Dr. Wailoo talked about, at one of the repositories at the University of California, San Francisco. You can actually go online right now and you can put in somebody's name, and it will pull up the information, the internal documents and papers that the industry never thought would see the public light of day. It names names, and it tells who did what. In a paper that's 20 years old, "Smoking with the Enemy" by Dr. Juergen Ruth, Malone, and others at UCSF, they really just lay it all out. That became our playbook, as tobacco control advocates, of who we needed to reach out to and to educate. And so while we see our Ben Chavis and the NNPA being the spear for the tobacco industry. To flip their pernicious, racist targeting that the industry has put upon us and now say that the police are going to kill Black people... because if we take these products off the market, it's going to create a black market. This is not about the individual; this is about the head of the snake. And so that comparison between crack and all of our horrible history with substance abuse, and the war on drugs, is really the war on Black and Brown men. This is not that. And so we have learned a lot. And so the people who are fighting for the tobacco industry to keep these products in our community, I wish they would fight for resources for reparations from the industry. And you'll never hear them mention the three words "the tobacco industry," when they're talking. It's as if the cigarettes just floated from the sky, somehow. We're a grown people, we can choose what we want. It's not like they were there seeding this through all the different layers... through the media, through our elected officials. You know, I can remember in California, I couldn't get a call back from some of our Black elected officials because they were taking their money. As an activist, you would hit this wall of silence, where they wouldn't talk to you about it, because they knew they were taking their money. But now it's gotten so shameful that most of our elected officials, especially the lower down you go -- local city council people, the state people -- they're not openly taking the money and championing the tobacco industry causes the way that they used to. But they’re there. It's still there. As with our Congressional Black Caucus Foundation, they still take money from the industry. And we really want to put an end to that.

Heather Howard  28:07

So Carol, let's go back to when you described what the FDA is proposing. Congress, in several cases, has enacted federal legislation that banned flavors, but then they exempted menthol. They raised the age of sale for tobacco to 21. So Congress has taken action, but the issue now sits with the Biden administration, right? The FDA proposed, two years ago, to ban menthol cigarettes and cigarillos, as you mentioned. But where's the action right now for people? 

Carol McGruder  28:44

Right now, as far as I know, the rule has left the FDA and is with the OMB Office of Management and Budget. That office has a little musical chairs [going on]. A lot of tobacco industry people come in and out of that office. So it's there, and the hang up is, as far as we can see, the pressure that the tobacco industry is putting on using African American leaders to say that Black people don't want this. Because now we're in this political season. That's so crazy [to say that] if you take menthol cigarettes off the market, Black people are going to jettison and not vote with the Democratic Party. We talk about our groups that used to be complicit, and you mentioned NAACP. So through hard, tedious work and really positive engagement with our people, the NAACP passed a national resolution in 2016 supporting these efforts. President Derek Johnson has publicly stood with us. We had a White House Zoom meeting about this, after they were kind of embarrassed about having met with the other side. Shavon Arline-Bradley, who's the head of the National Council of Negro Women, is standing firm. And so when a Black organization stands up to the industry and stops taking their money, they're always there, like a lover in the corner trying to woo them back. And so that they stand firm, good times and bad times, on the morality of this issue is very important. We're very excited to have groups that really do have a constituency, groups that really do have influence on Black voters, like Delta Sigma Theta Sorority Incorporated, one of the first and largest organizations to take a stand on this. When they did, that really opened the doors to many of our other organizations. As I mentioned, the National Association of Colored People, NAACP, national resolutions, where they get out and they speak on this issue. Presidents of our local branches will come to city council meetings. The other side is about who's getting the money from the industry. And there's no real mass constituency date. When we had our law passed in California, they actually paid homeless people to come to the Capitol that day, and to say they wanted their menthol cigarettes. So there are just so many shameful things that are happening. We want the average person. That is what's happening. When your politician comes to talk to you, ask them what they're doing about tobacco because that was an issue that always got pushed to the back. Because we have all these other pressing things. Tobacco is always a backburner issue. And even now that we're in this season of craziness nationally with our political system, we've had the conversation that maybe we should sit tight a little bit and see what's going to happen. But we decided, come hell or high water, we are going to persevere our course. We didn't listen to conventional wisdom to get this far, where we are. And we are going to keep going. And so we really want the Biden administration to know that we are not going to stop because of all this other craziness. This is an issue. We are not going anywhere. So we had a funeral march in DC. We are not going anywhere. And there are enough people, enough organizations, who get it and they are not going anywhere, either.

Heather Howard  32:02

Before we wrap, I have one question for each of you. Keith, Carol's talked about the political season we're in now, but we're also at an interesting moment. You end your book, “Pushing Cool,” by honing in on the collision of this debate about menthol cigarettes with the pandemic, and the national reckoning on police violence. And they're sort of all coming together at this moment. If we step back, how do you see these colliding forces?

Keith Wailoo  32:33

Let me just say one thing before I get to that, because it's in relationship to what Carol just mentioned. The industry and its allies would like you to think that the strangulation of George Floyd or the murder of Eric Garner, who was selling loose cigarettes on a street corner in Staten Island and died in Minneapolis, is a sign of things to come. If you ban the menthol cigarette, they want you to think that a ban will somehow produce more police surveillance, more violence against Black men, notwithstanding the fact that it hasn't happened in California, where menthols have been banned. Nothing like this has shown up in Massachusetts, or in cities where menthols have been banned. It's made up, but it plays into people's fears. This is out of the playbook. One question that we don't ask, and where I end, is how did those menthols get onto the street corner in the first place? Well, this is where history actually has some documents. There is a document from Black St. Louis 1967, where one of the makers of Camel menthols explains that Black men don't get information from the television and radio, they get information on the street. So our job is to give people what they call "boast material" to hand out on the street corner. But you have to find people who are influencers, the barber, the bellhop, the numbers runner, the taxi driver, give them the free samples and have them spread the word because the whole idea is to make it look like the love of Camel menthols is emerging naturally from the street. And you don't make it look like you had a role to play. One Black psychologist they hired, a consultant, talked about the importance of creating the images that depict people "in the way Black people see themselves," erasing any hint of being "what the white man thinks of us," and carefully edited so that the nature of its appeal has been divested of any exploitation or manipulative connotations. This was the strategy of the industry. So you ask why I ended the book where I did. Those who would associate menthol bans with more Eric Garners have it wrong. It's the industry that has been responsible for the slow extraction of health, the ability to breathe, and the extraction of wealth from Black communities over the course of decades. They're the ones who are part of the slow strangulation of Black folks. And the only difference between that and the disproportionate deaths from COVID, and the disproportionate deaths from police violence, is that we don't have the industry on camera. It's something that happens slowly. It happens over a lifetime. It doesn't happen over minutes. It doesn't happen over weeks. It happens over decades. But it's the same outcome: I can't breathe. It's the same outcome. Carol started with emphysema, COPD, lung cancer. The industry would like you to think that they're on the side of Eric Garner. They are not on the side of Eric Garner. They're the people who are helping to hold down those individuals. And the one person I would end with is an anti-billboard activist, Mandrake, who's gotten a lot of attention. He's in my book. He was asked about the industry's targeted billboard marketing. And he has this quote, where he talks about the fact that these companies try to package the image of being the champions of the downtrodden, the image of credibility, when, in fact they're the pushers of drugs of illusion, which has the side effect of diminishing the opportunities for real success. That's 1990. That's the story that's been going on for decades. And that's where we are right now. We're about to sort of end that charade. And this claim about creating more Eric Garners is just part of the charade.

Heather Howard  37:14

Carol, let's end where we began, which is that we know tobacco is the leading preventable cause of disease, disability and death. You have such an impressive record of advocacy and public health issues. Are we on the cusp of momentous progress here? What do you think?

Carol McGruder  37:34

I do think we are on the cusp of momentous progress. And I think that even if the FDA doesn't do it, we have a real, genuine movement. We have all hands on deck. There was a time when many of our public health colleagues, who we're working with today very closely, just didn't think they could get menthol and it was bargained away. Now people are believers. We know that we will keep pushing the FDA to do the right thing. And to protect Black people the way they protected others. And to protect Black children the way they protected other people's children. But even if they don't, we're in this to win it. And so we will continue working, city by city, state by state. We got California. We got Massachusetts. Maine is in play and other states. I want to set the expectation that this is not magic. So people say, "Well, does it work?" It hasn't been given enough time to even evaluate it. Because we've had decades of the targeting. We've had decades of not having our needs met or totally ignored. So let's put that time in, and let's tweak as needed. Here in California, we passed the law. The industry put a referendum on the ballot. We got that done. Now they have new non-menthol products that chemically mimic menthol. And now our state is involved. One of the companies is suing the state of California. So this back and forth. The next phase of this is called the end game. We're not going to continue to play whack a mole and chase them, because we just can't. I don't want to spend the rest of my life doing this, facing the industry. But there's no reason for this industry to exist. There's nothing that it contributes to society, our health, our money, the environment. Our kids who had never tried nicotine are now addicted to nicotine. And there's this whole back and forth. But the reality is, there's nothing good that comes from these products. And so we need to be looking at how to systematically end this thing once and for all. We're not going to keep chasing this industry that will just change its clothes and morph into something else, that will continue to deflect, to delay, to deny, to confuse. The data's in. And we just we need to act. So we really want to encourage the Biden administration to stand up and do the right thing, to protect Black people, protect our children. As Dr. Wailoo said, this has been seeded for decades. And it self-perpetuates. They don't have to do that much because they planted all the seeds around and they keep growing. Our job is to pull them up and to stand strong. We just want to make it so that it's not politically correct anymore to associate with these entities, for them to fund anything at our HBCUs. And so we want to get it to the bottom of the Howard University survey, and who that is, and how it really is a poorly crafted survey in and of itself. But where's the funding coming from? And how can they get in there with Howard University? We're really curious to find that out. So we continue loving each other and supporting each other and fighting the good fight. 

Heather Howard  37:42

Well, thank you both. Carol, you've given us a vision of the end game, and it's deeply informed by Keith's work on the history. Thank you both for a great discussion.

Carol McGruder  41:13

Thank you. Thank you.

Keith Wailoo  41:14

Thank you, Carol.

Heather Howard  41:16

Thank you for listening to the Princeton Pulse Podcast, a production of Princeton University's Center for Health and Wellbeing. The show was hosted by me, Professor Heather Howard, produced by Aimee Bronfeld, and edited by Alex Brownstein. We invite you to subscribe to the Princeton Pulse Podcast on Apple Podcasts, Spotify, or wherever you enjoy your podcasts.