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E-Cigarettes Meant to Create Nicotine Addicts, Expert Says

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BRUSSELS — The U.S. public health agency, the U.S. Food and Drug Administration (FDA), has banned the sale of Juul-branded e-cigarettes in the United States. According to Pierre Biesel, PhD, member of the Belgian National Tobacco Coalition, the purpose of these products is primarily to increase the number of smokers. There is no scientific evidence that e-cigarettes help quit smoking.

To justify its decision, the FDA determined that Juul Labs, with its USB stick-shaped vapes and flavored nicotine refill cartridges, had not demonstrated that the marketing of its products was “suitable for protecting public health.” The San Francisco-based startup has been accused of being instrumental in the surge in teen vaping, as its ads and marketing campaigns targeted high school students in particular.

In 2021, Juul Labs paid $51,000 to dedicate the entire May-June issue of the American Journal of Health Behavior to publishing 11 studies it funded to demonstrate that its products help smokers quit. Although all articles were peer-reviewed (the twelfth article was rejected), scholars have questioned the legitimacy of this process. The American Prospect described the publication as “taking academic corruption to a new level.”

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A 2021 study published in Tobacco Control found that less than half of Juul Labs-sponsored clinical trials were published correctly. Under government pressure, the company suspended sales of flavored cartridges popular among young people in 2019 and agreed to revise its marketing strategy.

MediQuality interviewed Bizel, who is also the director of lifestyle habits at the Hainaut Health Observatory in Le Havre, Belgium.

MediQuality: So, the Juul e-cigarette is widely known today as a Trojan horse that attracts young smokers?

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Beezel: Absolutely. Of course, here in Belgium, the Juul product was taken off the market in 2019. But this is clearly an electronic cigarette and capsule made specifically for young people. It looks like a USB stick and can be charged on your laptop using separate pods that offer different flavors. It is clearly intended to attract teenagers and young adults. This type of product is not intended for responsible adult smokers who are looking for a way to quit smoking.

These e-cigarettes can only serve to create addiction as early as possible and then increase the number of smokers. Like other currently available products such as Puffs, the goal remains the same: These fluorescent or candy pink disposable e-cigarettes, which produce almost no smoke and are very discreet, have a very high nicotine content and attract the consumer to regular use. After all, it is a product made by nicotine vendors.

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The Belgian Alliance for a Tobacco-Free Society sees e-cigarettes primarily as a means to attract new customers. And, according to the Belgian High Council of Health’s recent opinion on the matter, these are “not harmless products.” These are not harmless products, and therefore young people need to be protected from them.

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This device can certainly play a role in smoking cessation. [smoking], but only in a specific context, with support, as is required for any therapeutic drug-assisted weaning. Otherwise, the efficiency will be very low. Without consultation, without a doctor, without behavioral support, relapse is almost inevitable. The device can be a tool, like many other tools, provided it is used in a therapeutic context. Unfortunately, no e-cigarette manufacturer – Juul or any other – has applied for permission to sell this type of product for the purpose of quitting tobacco. Therefore, drug agencies in different countries have not been able to evaluate their possible positive impact on the elimination of tobacco consumption and to approve them.

No matter what kind of cigarette-like aerosol may be presented, no manufacturer can say that these are smoking cessation devices. Manufacturers promote the device as another way to smoke or as an alternative, but it is not officially a smoking cessation tool. And we, academics or researchers, are trying to determine the possible benefits of a product that has not actually been claimed to help quit smoking. There is ambiguity in this.

MediQuality: Will the pharmacy-proven device be the only acceptable e-cigarette?

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Bizel: Yes, but that’s not the goal of the manufacturers’ strategy at all. Their goal is to bypass the medical sector, tobacco addiction specialists, and quit helplines and have a consumer product that will produce the maximum number of nicotine-addicted smokers. They are not at all interested in establishing themselves in the therapeutic sector. That is why we clearly state that the only guarantee of effectiveness is observation, gradual dosing, etc.

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This is a market looking for long-term dependency because there is no time limit for those currently using the product. It should also be noted that 70% of e-cigarette users also smoke regular tobacco, as shown in the national health survey conducted by the Belgian Public Health Institute Sciensano and in a survey conducted by the Belgian Cancer Foundation. They are dual users. This raises questions about the effectiveness of e-cigarettes as a way to quit smoking, because if they were that effective, their users would quit smoking. In fact, e-cigarettes increase the total amount of nicotine consumed, which in turn increases the number of products in circulation and the profits of manufacturers. If we look at the big picture, e-cigarettes don’t change anything in terms of cigarette sales either in Belgium or globally. The same amount of regular tobacco is still sold. And this new product allows manufacturers to make a profit in both cases.

MediQuality: Is Juul e-cigarette gone forever?

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Beezel: It would surprise me if the Juul e-cigarette was back on the market. But other e-cigarettes remain widely available. Another very interesting measure recently taken in the US is to reduce the amount of nicotine in every cigarette. The reduction is significant, since it is 90% of the nominal content. It is important. But this reduction should be checked to make sure it is implemented correctly, especially given the variety of types of nicotine – nicotine salt, nicotine free base, etc. This measure should greatly contribute to the denormalization of cigarettes. The initiative is part of an ambitious public health program to reduce cancer deaths, which US President Joe Biden has pledged to reduce by 50% over a 25-year period. But there has to be a reaction from the five big tobacco companies, so it won’t happen overnight.

This article was translated from the MediQuality website.

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