Short Wave - Big Vape: The Incendiary Rise of Juul E-cigarettes

Episode Date: May 27, 2021

Juul Labs seemingly started out with the aim to reduce smoking, but the company's e-cigarettes came to symbolize something very different: a teen vaping epidemic. Host Maddie Sofia talks with Time health writer Jamie Ducharme about the science and marketing behind the rise and subsequent controversy surrounding Juul Labs. Plus, a look at what might be next in the future of e-cigarettes.Click here for links to studies mentioned in this episode. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Jamie Descharm didn't know just how big this story would become when she started reporting it. She's a health writer at Time magazine and just released a new book called Big Vap, The Incendiary Rise of Jewel. I think for most people, it felt like Jewel kind of exploded overnight, like all of a sudden everybody you knew had one of these devices. But the truth is, it was a long time coming. The two founders of Jewel Labs met in 2000. as graduate students at Stanford. Their thesis project?

How to make combustible cigarettes obsolete. Both of these guys were smokers. They both had kind of conflicted feelings about that habit, and they were looking for something better. Over the next decade or so, these guys came up with a bunch of cigarette alternatives, but none really took off, until 2015, when Jewel hit the market.

Which was by far their most sophisticated product. I mean, it looks like a flash drive, if you've ever seen one. It's very sleek. And it has these very potent, very palatable little nicotine cartridges that you can vaporize into, you know, a very user-friendly little wisp of vapor. And as it rose in prominence, you probably know it became very popular with teenagers and sort of set off this firestorm in the media. It's meant to help adult smokers quit, but teens are being enticed by the cool factor. Students vaping in hallways vaping in classrooms.

But this morning, the company behind that pen is in hot water. The FDA has issued a ban on most flavored e-cigarettes, including fruit, candy mint. At the same time, parents are launching their own efforts and asking why the government isn't doing more. So what started out as a project aimed to seemingly reduce smoking became something very, very different. It seems like a classic villain story of this company out to hook young people. And some people argued that that is what happened. But at the same time, there is a lot of. is pretty compelling data that the e-cigarette could potentially help some people stop using cigarettes.

So it's a really complicated equation where, on one hand, yes, absolutely you want to restrict access to these products for teenagers. But at what point does that restriction on access for young people cut into the ability of adults to use these products for their intended purpose? Today on the show, we talk Big Vap with Jamie Dushar. The science and marketing behind the rise and subsequent controversy of Juul Labs, and take a look at what might be next in the future of e-cigarettes. I'm Maddie Safaya, and you're listening to Shortwave, the Daily Science Podcast from NPR.

Okay, Jamie, let's get into some of the data about e-cigarettes, and Jewel in particular. Sure. So one thing to know about the data on e-cigarettes, well, I guess two things to know. One is that there are two very distinct camps of researchers who do not find a lot of common ground on this. topic. There's one camp that thinks e-cigarettes are, if not as bad as cigarettes, almost as bad. And then there's a camp that thinks they are just an incredibly impactful public health tool.

So you're going to find studies that come to almost every possible conclusion on these things. And the other thing to keep in mind is that they just haven't been on the market that long. So there isn't much long-term data on them. I mean, there's no data on how they affect the body over decades because they just haven't been available that long. But with all of those caveats thrown out, there was a recent Cochrane review that looked at a bunch of studies on their ability to help adults stop using cigarettes. And it did find that e-cigarettes seem to be better than nicotine replacement therapies like patches and gums and these kind of traditional products. Somewhere on the order of about 10% of adult smokers might find success with them, which doesn't sound terribly impressive, but it is better than a lot of these other products on the market. Yeah, I mean, we've done a little reporting on this.

And 10% is like not nothing when it comes to helping people quit smoking. That's actually pretty good, right? It is pretty good. And especially when you think about how many people in the world smoke cigarettes, I mean, 10% is not a huge percentage, but it could be a pretty large raw number. So it's nothing to sneeze at for sure. Yeah. Okay.

And so those are the data that suggests that Juell might help people stop smoking. Where does the research stand on like which is better for you, like a cigarette versus? versus Jewell? Do we know that? Yeah. So one thing to say is that a lot of these studies just look at e-cigarettes as a category, which is difficult because there's a lot of different products on the market. So unfortunately, I don't have a ton of data about Jewel in particular. Right, right, right. But when you're talking about vaping versus smoking, it does seem that while vaping is not good

for your lungs, it is better for your lungs than smoking. So there's one study that came out in 2019 that found that if you vape versus not using any tobacco product, your risk of developing respiratory disease is about 1.3 times higher, but still lower than if you smoked cigarettes. So it's kind of a lesser of two evil situation, is how I would phrase it. So you're saying like still dangerous but less dangerous. Exactly. Okay. Okay. So can we talk a little bit about why?

Like, you know, like why that is when we're comparing e-cigarettes to combustible cigarettes? So a lot of people think or have this association that nicotine inherently is bad for you. And while, you know, you don't ideally want to be consuming any stimulant, it does seem that the combustion, the process of lighting a cigarette on fire and inhaling all those byproducts and the potential toxins and carcinogens that come with that, that's really, it seems. the most dangerous part of the process. So e-cigarettes don't have actual fire. It's just sort of heating this nicotine extract and creating a vapor that the person can inhale. So there was actually a recent study

in Lancet Respiratory Medicine that found that if an e-cigarette can deliver nicotine in a way that is similar to a cigarette, kind of the same rough potency, the same delivery method, it can help people smoke fewer cigarettes and then actually corresponds to lower carcinogen levels in their urine. So that's a fancy way of saying, basically,

it exposes people to fewer of the toxins that are produced when a cigarette is lit on fire. Right, right. Okay. And so those are the data that are kind of suggesting that, you know, there's less junk in e-cigarettes, which means that they could be, you know, less bad for you. They're potentially somewhat effective in helping people get off of, combustible cigarettes, but there's also some data that you wrote about that it's like a little bit concerning, of course. Do you want to talk to me a little bit about that? Sure. So some studies have found some pretty concerning potential health risks associated with e-cigarettes. They do seem to

raise your risk of heart issues. There are potentially flavoring components that could lead to respiratory disease, including one you've probably heard about popcorn lung, which is very very visceral. and some early research does find that using an e-cigarette can lead to some DNA changes that could indicate cancer. I mean, nothing has come out and said e-cigarettes give you cancer, but that's not a result that you want to find that it could change the DNA. The only other thing I wanted to say is that there is some pretty compelling data that if you both vape and smoke at the same time, that appears to be worse for you than doing either

of those things alone. and that's important because a lot of people who vape still smoke on the side because they haven't been able to switch completely. So when we're talking about health benefits associated with e-cigarettes, it's kind of contingent on, you know, cutting out cigarettes entirely. And that is something that's really difficult to do. Yeah, that's really important. All right. So let's switch gears a little bit here and talk about how e-cigarettes and Jule in particular got into such deep water, both with the public and with the FDA. Yeah, so pretty shortly after Jewell launched, there started to be signs that young people were using these products.

If you've ever seen Jewel's launch campaign, it's very bright and colorful and social media friendly. And that started spreading online. Influencers started using these products. And before too long, some people from the tobacco control community started saying, hey, these ads look awfully similar to what the tobacco companies used to use. and the tobacco companies are kind of infamous for targeting teenagers. Right. So that set off a lot of alarm bells, particularly when not long after it did come out that teenagers were starting to use jewel products. Right.

After a while, that became a big enough problem that the FDA started calling teen vaping an epidemic, which is not a word they throw around loosely, so it was pretty serious. By 2019, something like 27.5% of high school students in the U.S. were vaping, which is a pretty staggering statistic. And I think that was just so disturbing to so many people both in public health and in the general public that that became the narrative about Jule, that it was this product that teenagers were using and addicted to and that was potentially erasing decades of progress on tobacco control. And all of that's, I mean, you can argue either way, but all of those criticisms are valid. It just sort of glosses over the fact that there are some adults who use these products

in their intended way and to have actually had some success with them. Yeah, yeah. And I think also, you know, around this time, when we're talking about public perception of e-cigarettes, then there's also this mix of like illicit products that I think got kind of mixed in, right? So tell me about how that also kind of worked its way into the public perception of e-cigarettes and Jule in particular. I think the best example is during the summer of 2019, there was this very mysterious lung disease going around. Some really dramatic images of teenagers in hospital beds, you know, unconscious, really serious

lung damage that was eventually traced back to vaping. And when this news broke, I think everyone's mind, or at least I'm guilty of saying my mind, went towards a jewel because that was the household name. That was the dominant vaping product on the market. And then as the research came together, federal health authorities actually determined that the damage seemed to be related to illicit THC vaping products that had this oily kind of additive in them that seemed to be causing lung issues. And I think that did a really good job of highlighting how diverse this market is.

Like there are these kind of mass market nicotine vaping products that we all know about, but there's also a black market and a gray market operating below the surface that is, you know, almost definitely more dangerous than the stuff you can buy at the drug. store. So, okay, Jamie, so what is next for the future of e-cigarettes? Because we're kind of in this period where some things are about to be decided. Is that right? That's right. The FDA is currently analyzing applications submitted by e-cigarette makers, including Jule, that essentially are out to convince the FDA that the benefits of these products, their ability to give adult smokers a better option than cigarettes, outweigh any downsides associated with them. Most notably, I would say that

teenagers have used these products and become addicted to them. Right. So if the FDA decides that they are potentially impactful enough for adult smokers to overlook the teenage use data, they will likely continue to be sold more or less in their current form. But if they decide that that youth use data and the health risks that are associated with vaping are, you know, concerning enough, we could be looking at either restrictions on the way the products are sold or potentially a market without e-cigarettes at all.

I mean, you've spent a lot of time steeped in this story. I mean, you obviously wrote a book about it. What are you particularly looking for and paying attention to as the FDA does this review or like what you're particularly interested in this? I mean, I just have no idea what the FDA is going to do, to be honest with you. So I'm kind of on the edge of my seat waiting for that decision because, I mean, the FDA came out so strongly against teen use of these products. Like, it felt like every day there was a new FDA statement about how concerning the teen addiction epidemic was that I almost think it's going to be hard for them to then turn around and approve these products. But at the same time, I mean, the data is not perfect. There are certainly some concerns associated with vaping, but it does seem like they're better than cigarettes. So I could just really see the decision going in either direction. and I'm kind of fascinated about what they will choose to do.

Okay, Jamie Ducharm, thank you so much for bringing this reporting to Shortwave. It was super, super interesting and good luck with your book. Thank you so much. I appreciate you having me on. If you want to learn more, check out Jamie's book, Big Vape. It's out now. This episode was produced by Britt Hansen, fact-checked by Rasha Reedy and edited by Giselle Grayson. I'm Maddie Safaya. Thanks for listening to Shortwave from NPR. What happens after a police officer shoot someone who's unarmed? For decades in California, internal affairs investigations,

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