Kevin Burns, CEO of Juul Labs — maker of the best selling e-cigarette on the US market — has stepped down. He will be replaced by K.C. Crosthwaite, a former executive at Altria, one of the world’s largest tobacco producers.
In December 2018, Altria purchased a 35 percent stake in Juul, which put the company’s value at a staggering $38 billion. The move raised eyebrows since the e-cigarette company’s purported goal was making cigarette smoking obsolete.
But installing a tobacco industry CEO, after a cigarette company purchased a major stake in Juul, raises a question: Has Juul become Big Tobacco?
“Before, Altria was a minority stakeholder to Juul and they denied they were part of Big Tobacco,” said Michael Eriksen, dean of the school of public health at Georgia State University and a former director of the Centers for Disease Control and Prevention’s Office on Smoking and Health. “Now with Altria executive being CEO, that’s no longer possible, and it changes that dynamic.”
Juul, which sells nicotine vape products with flavors like mango and mint, also announced Wednesday it will suspend all broadcast, print, and digital product advertising in the US, and refrain from lobbying against the Food and Drug Administration’s proposed ban on e-cigarette flavors. Federal prosecutors in California, meanwhile, are investigating the company, as is the Federal Trade Commission, several state attorneys general, and the FDA.
These moves come amid an epidemic of a mysterious vaping-related respiratory illness, which has killed seven people, as well as the release of data showing record levels of e-cigarette use in adolescents.
In that context, Eriksen added, “A major issue that is emerging is whether Big Tobacco can be trusted to be an agent of harm reduction and benefit the public health.” With its new tobacco CEO, and several investigations into the company’s practices underway, we may soon find out.
Juul has been under scrutiny amid rising rates of teen vaping
Juul’s rise as the dominant seller of e-cigarettes coincided with an explosion in youth vaping. The best data on vaping trends in America shows it’s not adult smokers who are primarily using e-cigarettes; it’s kids.
According to a new survey on adolescent substance use, published recently in the New England Journal of Medicine, 1 in 4 high school seniors reported using nicotine e-cigarettes in the past 30 days. Among 10th graders, that rate is 1 in 5, and among eighth graders, it’s 1 in 11. Even greater numbers of kids reported vaping in the past year. These figures, from the National Institutes of Health’s Monitoring the Future survey, represent “significant increases” in each of the three grade levels tracked between 2018 to 2019, the researchers wrote.
Another newly published study, in JAMA, shows e-cigarette use is staying stable or even declining in adults. Just 2 percent of adults ages 45 to 64 reported using e-cigarettes in 2018, according to the study. The number is even lower — 1 percent — for adults 65 and older.
Just ahead of Juul’s shakeup, the company was scolded by federal regulators for marketing to kids. On September 9, the FDA sent a warning letter to Juul Labs, saying the company violated federal regulations by marketing its products as safer than smoking — including to schoolchildren — before receiving FDA approval to make those claims.
The letter reflected the growing concerns among health experts about the potential consequences of more kids getting hooked on highly addictive nicotine vaping products and the company’s role in that epidemic.
In another sign the US government is taking youth vaping more seriously, on September 11, the Trump administration announced it was planning to ban flavored e-cigarettes in the coming months. Since Juul’s products are marketed for their flavors, that would make selling in the US difficult for the company.
States are also cracking down on e-cigarettes
But it’s not just the feds cracking down. On Tuesday, Massachusetts’s governor announced a four-month ban on e-cigarette products in the state, also declaring a public health emergency over the vaping-related respiratory epidemic, which has so far sickened at least 530 people across the country.
Still, Juul reaffirmed the company’s commitment to helping smokers quit. In the press release, Crosthwaite said: “I have long believed in a future where adult smokers overwhelmingly choose alternative products like Juul. That has been this company’s mission since it was founded, and it has taken great strides in that direction. Unfortunately, today that future is at risk due to unacceptable levels of youth usage and eroding public confidence in our industry.”
On the same day, Philip Morris announced an end to its discussions about a merger with Altria and said the companies would instead focus on jointly bringing the “heat-not-burn” tobacco device IQOS to the US as “part of their mutual interest to achieve a smoke-free future.”
Though the merger appears to be off the table for now, one tobacco industry watcher said she thought the companies could revisit it soon. “Obviously the timing of the merger wasn’t right given escalating [negative] regulatory headlines,” Bonnie Herzog at Wells Fargo wrote in a newsletter Wednesday. “But we still see the merits of this combination and wouldn’t be surprised if talks resume at some point in the future when the environment is better.”
The known and unknown health risks of e-cigarettes
The scrutiny on vaping, and the related respiratory illness epidemic, is a reminder that e-cigarettes aren’t risk-free.
Juul delivers mega doses of nicotine — a highly addictive substance that targets the brain’s reward circuitry, potentially making young people more prone to substance-use disorders later. Nicotine in e-cigarettes has also been linked with a heightened risk of seizures, according to the FDA.
Each Juul pod contains 59 milligrams of nicotine per milliliter of liquid. Juul claims that’s equal to a pack of cigarettes in terms of nicotine, but tobacco experts told me the precise equivalency is difficult to determine and may be even higher. Juul also contains three times the nicotine levels permitted in the European Union, which is why it can’t be sold there.
Trying to break a nicotine addiction is extremely difficult — and the symptoms of nicotine withdrawal are especially difficult for young people to manage. They include cravings, nervousness, restlessness, irritability, mood lability, anxiety, drowsiness, sleep disturbances, impaired concentration, increased appetite, headache, and weight gain.
In the short-term, e-cigarettes have also been linked with lung irritation and injury (when the devices go haywire and explode). Longer-term health risks that doctors are watching include e-cigarette’s potential cardiovascular effects and whether those effects increase the risk of heart attacks, high blood pressure, chronic obstructive pulmonary disease, and coronary artery disease.
Public health experts still contend vaping is safer than smoking cigarettes, which is still the leading cause of preventable death. But we’re learning more and more, safer doesn’t mean safe.
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