Dueling ads currently playing out on the nation’s TV screens show both sides in an escalating conflict involving manufacturers, health experts and federal regulators.

PSAs produced by the FDA warn American children about the dangers of e-cigarette use, or vaping. Meanwhile, e-cigarettes – whose makers have so far managed to evade the ban on tobacco advertising, despite the fact that the devices contain tobacco – are portrayed as health aids which can assist smokers in quitting the use of conventional cigarettes.

Recent hearings in the House Committee on Oversight and Reform Subcommittee on Economic and Consumer Policy focused attention on Juul Laboratories, the e-cigarette maker with the largest market share in 20171. Juul e-cigarettes resemble USB flash drives, contain a high nicotine concentration and flavors that health advocates say make the devices appeal to young people.

Testimony during the hearings by Juul Co-Founder and Chief Products Officer James Monsees raised the ire of the American Heart Association (AHA), whose CEO, Nancy Brown, accused manufacturers of exploiting teenagers “to drive up nicotine addiction and boost corporate profits.”

Brown said the two days of congressional hearings added to the “already overwhelming evidence that Juul has systematically addicted youth and adolescents to its products.

“Student Caleb Mintz testified that Juul demonstrated its products to 9th graders in his New York school and described e-cigarettes as ‘totally safe.’ Nurse Rae O'Leary testified that Juul treated Native American tribes as ‘guinea pigs’ when it sought to provide its products for free to members of the Cheyenne River Reservation in exchange for a six-figure payment. Stanford University researcher Dr. Robert Jackler said Juul’s initial marketing effort was designed to create a ‘cult-like following.’  Dr. Jonathan Winickoff, a member of the American Academy of Pediatrics, and Matthew Myers, president of the Campaign for Tobacco-Free Kids, also testified about the epidemic of youth e-cigarette use.  

“Incredulously, Juul Co-Founder and Chief Products Officer James Monsees testified that the company ‘never wanted’ teenagers to use its products while admitting Juul rushed its products to market to evade FDA regulation and continues to market flavors that appeal to kids. Juul Labs CEO Kevin Burns previously told CNBC he was ‘sorry’ that teenagers are using e-cigarettes. Yet Juul has relied on tobacco industry tactics to aggressively target youth and adolescents. Marlboro manufacturer Altria owns a 35 percent stake in Juul, and tobacco companies have a long history of targeting underage users, including social media promotions for products that are available in thousands of flavors that appeal to kids. The evidence is clear that the tobacco industry’s predatory practices directly contributed to a 78 percent rise in use among high schoolers and a 48 percent increase among middle schoolers in 2017-18 alone.”

A smoking cessation aid?

Juul calls its product “a satisfying alternative to cigarettes.” On its website, the company says is mission is “to improve the lives of the world's one billion adult smokers by eliminating cigarettes.”

Dr. Michael Blaha, M.P.H., director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, said e-cigarettes likely expose user to fewer toxic chemicals than traditional cigarettes, which contain about 7,000 chemicals. However, Blaha said e-cigarettes are just as addictive as conventional cigarettes because they contain nicotine, which research suggests may be as addictive as heroin and cocaine. Additionally, nicotine raises your blood pressure and spikes your adrenaline, which increases your heart rate and the likelihood of having a heart attack.2

E-cigarettes are not currently approved by the US Food and Drug Administration as a smoking cessation aid.

Regulatory possibilities

Brown wants the FDA to:

  • Remove flavored e-cigarettes from the market, including mint and menthol flavors;
  • Prohibit all marketing practices, including those on social media, that are shown to appeal to children;
  • Suspend online sales of e-cigarettes until effective age verification mechanisms are established;
  • enforce rules that prevent the sale of products that were not commercially marketed as of August 8, 2016, or were modified after that date, without premarket review.  

The AHA is also calling on federal, state and local lawmakers to support proposals to:

  • Increase the sales age to 21 for all tobacco products;
  • Raise tobacco excise taxes; Implement comprehensive clean indoor air laws;
  • Support comprehensive coverage of evidence-based tobacco cessation therapies;
  • and Eliminate the sale of tobacco in pharmacies and other health-related outlets.

1. https://tobaccocontrol.bmj.com/content/28/2/146

2. https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping