Where There’s Smoke, There’s Fire: The Juul Journal Controversy

A July 2021 post on MedPage Today discussed the fact that e-cigarette maker Juul had spent $51,000 to publish an entire special issue of articles in the American Journal of Health Behavior (AJHB) that promote the use of e-cigarettes. The special issue includes 11 studies focused on “the implications of switching from cigarettes to Juul systems, and dual use of cigarettes and Juul products” (Torjesen, 2021). 

Juul partnered with Pinney Associates and the Centre for Substance Use Research (CSUR) to conduct these studies (Basen, 2021). According to the Pinney Associates website, they help “pharmaceutical companies and consumer healthcare clients to reduce their regulatory risk and enhance the commercial value of their life sciences products” (Pinney Associates, 2021). The company began working exclusively with Juul Labs, Inc. in 2019 “to advance relative risk-based regulation of nicotine and tobacco products” because “smokers should not have to suffer unnecessarily and risk dying prematurely because of how they get their nicotine” (Pinney Associates, 2021). 

CSUR’s website states that they are an “independent research centre” with a goal of ensuring that those within the e-cigarette industry “have access to high quality behavioural research that can further their own goals of reducing the harms associated with the use of combustible tobacco products” (CSUR, 2021). The CSUR website even touted the recent special issue of AJHB as “reporting on the impact of the JUUL e-cigarette on adult smoker behavior” and later praised Juul’s commitment to “strengthening the evidence base around the contribution of electronic nicotine delivery systems in reducing the multiple harms of smoking” (CSUR, 2021). 

According to MedPage Today, “Juul staff contributed to every article...while Pinney staff worked on 10 of them and CSUR staff conducted data analyses for seven” of the 11 articles published in this AJHB special issue. While AJHB policy is to charge researchers to publish in their journal, it is unusual for a company to purchase an entire issue. 

A Juul news release from April 2021 stated that following Juul’s Premarket Tobacco Product Applications (PMTA) filing in July 2020, the 11 studies published in this special issue were a result of Juul’s regulatory team shifting their focus to publishing “key research underlying our application through peer-reviewed manuscripts.” The FDA is currently considering this filing and was expected to announce a ruling yesterday (September 9, 2021) on whether or not Juul vaping products could remain on the market. However, the FDA delayed this decision saying it needed more time to rule on Juul’s products according to an article published in The Washington Post and an NPR story that aired on All Things Considered yesterday.

AJHB has faced criticism following the publication of the special issue. The backlash has resulted in the retirement of Elbert Glover, the journal’s executive editor at the time of the issue’s publication, and the resignation of three editorial board members. While Juul claims that the company “must engage with the public health community on the science and facts underlying our products,” critics including David Dayen, executive editor of The American Prospect, point out that all articles published in the AJHB special issue “take the Juul party line that e-cigarettes help convert smokers away from combustible tobacco products, and thus aid public health” (Basen, 2021). 

“After decades of tobacco companies paying previously credible scientists to produce studies designed to reach a predetermined outcome to foster their marketing goals and mislead the public about the overall state of the evidence, one thing should be abundantly clear: research funded by tobacco companies cannot be treated as a credible source of science or evidence. No credible scientific journal should allow a tobacco company to use it for this purpose.”

Matthew Myers, president of Campaign for Tobacco-Free Kids (Torjesen, 2021)

Elbert Glover, AJHB’s now retired editor-in-chief, defended the journal's decision to publish the special issue in a recent BMJ news article and explained that “to reject a paper [based] on who funded the work rather than science is wrong '' (Torjesen, 2021). Glover also claimed that all manuscripts went through the full review process with no special treatment, and nothing was hidden during the review process (Torjesen, 2021). However, this claim was refuted by a reviewer who alleged that “reviewers were not informed of Juul’s role until they questioned ‘fishy’ aspects of the studies” (Redden, 2021). The unnamed reviewer explained she even recommended one study be rejected because it was so biased and made her think there was “No way it wasn’t funded by Juul” (Redden, 2021). 

This situation is a reminder of the importance of thinking critically about research. Publication itself in a peer-reviewed journal is not enough to ensure that the research is good research. Things to consider when evaluating research include: potential conflict of interest (i.e. author affiliation and/or funding sources), bias, appropriate study design, sample size (and if the sample is representative of the wider population), data collection methods, and the use of appropriate statistical measures and methods.

The funding source of research that produced an article is perhaps the most relevant of these criteria in the case of the AJHB Juul special issue. A recent systematic review and meta-analysis analyzed articles published in peer-reviewed journals and assessed whether or not funding sources supported or opposed substitution of tobacco or nicotine products as harm reduction (Hendlin et al., 2019). Of the 826 articles reviewed, “23.9% disclosed support by industry; 49% of articles endorsed THR [tobacco harm reduction]; 42% opposed it, and 9% took a neutral or mixed positions” (Hendlin et al., 2019). The article concluded that “non-industry funded articles were evenly divided in stance, while industry-funded articles favored THR” and that “public health practitioners and researchers need to account for industry funding when interpreting the evidence in THR debates” (Hendlin et al., 2019).

Do you want to learn more about how to evaluate a resource’s credibility? Himmelfarb Library can help! Check out the following video for more information about evaluating a resource's credibility

References:

Aubrey, A. (2021, September 9). The FDA will take more time to determine if benefits of Juul Products Outweigh Harm. All Things Considered. https://www.npr.org/2021/09/09/1035610408/the-fda-will-take-more-time-to-determine-if-benefits-of-juuls-products-outweigh-

Basen, R. (July 13, 2021). Juul bought out medical journal for $51K: E-cig maker sponsored nearly a dozen studies, took over journal as it awaits FDA ruling. Medpage Today. https://www.medpagetoday.com/special-reports/exclusives/93555?xid=nl_mpt_investigative2021-07-21&eun=g1151854d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=InvestigativeMD_072121&utm_term=NL_Gen_Int_InvestigateMD_Active

CSUR: Centre for Substance Use Research. (2021). Centre for Substance Use Research website. https://www.csures.com/

Hendlin, Y. H., Vora, M., Elias, J., & Ling, P. M. (2019). Financial Conflicts of Interest and Stance on Tobacco Harm Reduction: A Systematic Review. American journal of public health, 109(7), e1–e8. https://doi.org/10.2105/AJPH.2019.305106

Perrone, M. (2021, September 9). FDA delays decision on e-cigarettes from vaping giant Juul. The Washington Post, https://www.washingtonpost.com/health/fda-delays-decision-on-e-cigarettes-from-vaping-giant-juul/2021/09/09/3bb84966-119e-11ec-baca-86b144fc8a2d_story.html

Pinney Associates. (2021). Pinney Associates homepage. https://www.pinneyassociates.com/

Redden, E. July 13, 2021. Buying Off an Academic Journal? Inside Higher Ed. https://www.insidehighered.com/news/2021/07/13/e-cigarette-maker-juul-pays-51000-fund-special-issue-juul

Torjesen I. (2021). Academic journal is criticised for publishing special issue funded by tobacco industry. BMJ (Clinical research ed.), 373, n1247. https://doi.org/10.1136/bmj.n1247