Juul Bought an Issue of a Science Journal. Here's What the uhh... Studies Say

Juul Labs recently sponsored an entire issue of a national scientific journal and devoted it entirely to publishing research funded by the company. 

According to a recent report from The New York Times, the company paid $51,000 to devote the entire May/June issue of the American Journal of Health Behavior to research on the effects of Juuls and other electronic nicotine delivery devices (ENDS) on smokers and nonsmokers. The company also paid an additional $6,500 to make the entire issue publically available. 

“The findings from several studies in this issue clearly point to JUUL as an effective smoking cessation tool which has not been seen so convincingly in other studies where other ENDS products mostly have been used,” the issue’s introduction reads.

All of the studies published in the issue were written by researchers either employed by Juul Labs Inc. or funded by the company, according to the conflict of interest disclosures shared in the journal.

Though it has become standard practice for researchers to pay to be published in science journals, David Dayen of The American Prospect pointed out that purchasing an entire scientific journal issue allows Juul to use it “as “proof” that its products have “a public-health benefit, the key question currently before the FDA.”

Much of the research featured in the studies focuses primarily on the smoking habits of certain age groups—to fight the notion that they negatively impact young or underaged customers—as opposed to the actual effects of nicotine addiction on ENDS users. One of the studies even claims that ENDS and Juul products can be “expected to avert millions of premature deaths in the US.”

To dig a bit deeper into the 219-page issue, Motherboard read some of the studies and is summarizing them here:

"Prevalence of ENDS and JUUL Use, by Smoking Status, in National Samples of Young Adults and Older Adults in the U.S."

Seeming purpose of study: To prove that the overwhelming majority of Juul users already smoked cigarettes, which is important because Juul wants to position itself as a smoking cessation tool, not a new mechanism to get people addicted to nicotine.

Key Quote: "JUUL use by adult never smokers was uncommon; overall, our findings suggest that < 1% of the adult never smokers are currently using JUUL"

Conflict of Interest: This study was co-authored by two full-time employees of Juul Labs Inc and a consultant who works exclusively with Juul Labs Inc on tobacco harm reduction. Juul Labs Inc approved the research and provided comments to the study draft before publishing.

“Smoking Trajectories of Adult Never Smokers 12 Months after First Purchase of a JUUL Starter Kit”

Seeming purpose of study: This study analyzed participants who reportedly never smoked before purchasing Juul Starter Kits, perhaps to combat the notion that their products are attracting nonsmokers. 

Key quote: Participants showed that they were much less likely to smoke with each passing day a Juul was used instead. They also showed patterns of “light and intermittent” smoking though researchers deduced that this was “not suggestive of continuing smoking.”

Conflict of interest: Juul contracted the Centre for Substance Use Research to design and conduct this study. It was also co-authored by a Juul consultant who coordinated the issue.

"Modeling the Population Health Impact of ENDS in the U.S."

Seeming purpose of study: Using a population health model, researchers measured how ENDS could potentially impact the rate of smoking and premature deaths. This study helps maintain the issue’s overall claim that Juuls and ENDS are an alternative to cigarettes, although the study does acknowledge multiple times that the long term effects of ENDS are still unknown. The study says that ENDS will prevent 2.5 million premature deaths between now and the year 2100.

Key quote: “The population model presented in this paper projects that—after considering both potentially beneficial and potentially harmful transitions and based on the available evidence to date—the (continued) availability of ENDS in the US is likely to have a positive impact on population mortality. In the Modified Case with ENDS available, 2.5 million premature deaths are prevented by the year 2100.”

Conflict of interest: Three of the co-authors are current full-time employees at Juul, and two were full-time employees at the time. The conflict of interest disclosure also notes that Juul Labs Inc approved of the research plan and provided comment on a final draft of the paper. 

"Dual Use of Cigarettes and JUUL: Trajectory and Cigarette Consumption" 

Seeming purpose of study: To study how smokers used cigarettes and the Juul Starter Kit in tandem to study whether using Juul products helps smokers quit or transition away from smoking cigarettes, although it pointedly doesn’t address whether it helped users overcome their nicotine addiction altogether. 

Key quote: “Among dual users, approximately 60% reduced their cigarette consumption substantially (by ≥ 50%); average reductions in cigarette consumption were > 80%. Only a small minority (3%-10%) substantially increased cigarette consumption.”

Conflict of interest: This study was co-authored by two consultants from PinneyAssociates as well as a former full-time employee from Juul Labs Inc. The Centre for Substance Use Research conducted and designed the study after being contracted by Juul.

"Improving Retailer Compliance for Tobacco Purchases: Pilot Study Findings"

Seeming purpose of study: This was a pilot program conducted in 171 stores using a system that Juul Labs Inc developed to require age verification and limit the quantity of Juul products that can be purchased. This is intended to restrict people who are underaged from buying their products at retail locations, even as federal laws regarding tobacco and ENDS become stricter. 

Key quote: “Implementation nearly eliminated failures of compliance with age-verification and failures to enforce bulk-purchasing limits. This suggests that broader implementation of this type of enhanced access controls can effectively reduce transactions that could be sources of underage access to tobacco products. Brick-and-mortar retail continues to be an access point for ENDS products among those who are underage—either for lack of age-verification or bulk purchases of product that, in turn, are resold or shared among underage users.”

Conflict of interest: This study was conducted by former and current Juul Labs Inc employees and consultants. Juul Lab Incs approved of the research plan and also provided comments on the study before it was published.

Tobacco consultant Karl O. Fagerström, who was not paid by Juul Labs, concluded that the research clearly shows that the Juul is an “effective smoking cessation tool.” The “tricky end” to work towards, he writes, would be finding “a regulatory system that promotes ENDS and JUUL use for smokers, and at the same time keeps ENDS entirely away from never-smokers.” 

A statement issued later on from a Juul employee and a tobacco harm reduction consultant retained by Juul to coordinate the issue stated that each of the studies were peer reviewed and overseen by the journal’s editor. One of the proposed studies was rejected by the editors. The New York Times reported that three members of the journal’s editorial board resigned over the arrangement.

The Food and Drug Administration will be deciding in September whether Juul devices are beneficial enough as an alternative to smoking to keep them on the market despite the risk they pose.