A Juul-sponsored study suggests its e-cigarettes could help adult smokers cut back, but some researchers aren’t convinced (MO)

REUTERS/Ronen Zvulun

A study paid for by e-cigarette company Juul, which is partially owned by the tobacco giant behind Marlboro cigarettes, suggests the devices may help adult smokers cut back on smoking.
The authors of the paper concluded that smokers who started using the Juul significantly curbed their use of traditional burned cigarettes.
While some adults switched completely to vaping, others continued to both vape and smoke — a potentially troubling phenomenon called "dual use." The dual users still appeared to be smoking less, though.
An outside researcher raised some red flags about the study, suggesting that the author may have a conflict of interest and calling the journal in which the work appeared "predatory."

For the first time in its roughly two-year history, e-cigarette company Juul has funded a study on its devices that was reviewed by outside experts.

The vetting, a process called peer review, is widely considered to be the gold standard for health research.

The paper found that adult smokers who tried the Juul went on to smoke fewer burned cigarettes, which is an important finding for the e-cig company. Over the course of 3 months, some of them appeared to give up on cigarettes entirely.

Others continued to smoke while also vaping — a potentially troubling phenomenon called "dual use." The dual users still appeared to be smoking less, however, another positive finding.

"We are identifying that between 30% to 40% of smokers initiating using Juul manage to completely cease their smoking by 90 days," Neil McKeganey, the lead author of the paper and a sociologist who founded the Scotland-based research consulting firm CSUR, told Business Insider.

Juul began selling its e-cigarettes in 2017 and quickly swallowed up the competition to now make up nearly 80% of total e-cigarette sales, according to Nielsen data. Then, in December, the tobacco company behind Marlboro cigarettes acquired more than a third of Juul in a $13 billion deal.

Juul has faced scrutiny for that deal as well as for aggressively marketing its sweet-flavored e-cigarettes to teens. An addictive drug, nicotine appears to blunt emotional control as well as decision-making and impulse-regulation skills in youth.

The company maintains that its products are not intended for teens, but instead are designed to help smokers turn away from deadly burned cigarettes and onto vaping, which may be healthier. That’s why the new study, which looked at whether adult smokers who tried Juul e-cigs ended up smoking less, was so important.

One outside expert was cheered by the findings, noting that it appears to support the idea that e-cigarettes like Juul could help curb smoking among the wider population of adult smokers.

Another was not so convinced. He said the findings should be interpreted with caution because in his view, the author has a conflict of interest, and the study appeared in what he called a low-quality journal.

Positive findings, several caveats

Sarah Johnson/FlickrJuul invited adult smokers to participate in the new study online or by way of a note included in the packaging of its "Starter Kits," which include the e-cigarette device, four nicotine pods, and a charger. Nearly 8,000 people filled out the corresponding online survey and responded to a series of follow-up questions 3 months later.

Among those smokers, the total number of cigarettes smoked over the course of the 3-month study dropped dramatically, from roughly 2 million cigarettes a month to about 550,000 per month.

"If valid, this supports the idea that e-cigarettes, including Juul, have the potential for harm reduction of smoking at the population level," Gideon St. Helen, an assistant professor in residence medicine at the University of California at San Francisco’s Center for Tobacco Control Research and Education, told Business Insider.

However, the study also has some caveats.

For example, the work was based on self-reports, meaning that while people who chose to participate in the study were asked to respond honestly, their responses could have been inaccurate. They were not formally evaluated with biochemical testing. That’s an issue that’s common in studies in the social science field.

In addition, the researchers did not analyze smokers’ exposure to toxins, meaning that even though participants smoked fewer cigarettes, they could still have ended up exposing themselves to the same levels of toxins by smoking differently.

"Cigarette reduction does not necessarily mean harm reduction," St. Helen said, "because smokers can compensate by smoking each cigarette more intensely."

Smokers who do this can end up taking in similar levels of nicotine and toxicants as when they were smoking more cigarettes, he added.

Also, about 47% of participants in Juul’s study said they’d stopped smoking entirely.

While positive for those who appeared to quit, that figure also means that more than half of the adults in the study were still continuing to smoke burned cigarettes. This phenomenon, known among researchers as "dual use," troubles public health researchers because it suggests that people are being exposed both to toxicants from cigarettes and also to toxicants from e-cigs.

McKeganey, the lead study author, acknowledged that dual-use is a concern. However, he said he personally believes that most smokers who start using the Juul are doing so in an attempt to quit. McKeganey added that he felt his research suggested that the Juul might help.

"Our goal is to help all adult smokers completely switch off combustible cigarettes and eliminate their consumption entirely," Juul CEO Kevin Burns said in a statement.

Conflicts of interest

One researcher told Business Insider that although Juul’s study findings appeared positive, he would interpret the results with caution because of concerns about the author’s previous work and the journal in which the findings appeared.

In his biography, McKeganey notes that he has worked on studies with other tobacco companies and says those studies were "designed to assist those companies with their applications for regulatory approval for their reduced-risk products.”

Robert Jackler, a practicing Stanford physician and the principal investigator behind a study on tobacco advertising, told Business Insider that he felt that undermined the quality of Juul’s latest study.

Jackler said that in his view, McKeganey’s biography, "makes clear that the research is not hypothesis-driven, but rather [designed] to arrive at a desired result."

McKeganey disagreed. He said US regulators are asking companies like Juul to evaluate their devices with research and he is helping them to do so.

Jackler also pointed out that the journal in which Juul’s study appeared ranks very low in terms of a measure of its overall impact on the scientific literature, something known as its "impact factor." To put that in context, while this journal’s impact factor is 0.17, the well-regarded Journal of the American Medical Association, or JAMA, has an impact factor of 47.7. Jackler also called this journal "fee-based and predatory."

"They will publish virtually anything if you pay their fee," he said.

McKeganey said the current journal’s impact factor did not bother him. He said his research consulting firm is in the process of submitting several papers to a wide range of peer-reviewed journals, some of which are considered low-impact and others which are considered higher-impact.

"I am less preoccupied with [the] ranking of individual journals and more concerned to ensure that our research contributes to debate," he said.

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Source: Business Insider – ebrodwin@businessinsider.com (Erin Brodwin)