When Juul won ‘nicotine arms race,’ did it ace out FDA regulatory threats, too?

fdachiefgottlieb-300x300Punked, dunked, and owned — if you’re young enough, that’s how you say your team has crushed a competitor. The lingo might well describe, too, the situation for now between e-cigarette maker Juul and Scott Gottlieb, commissioner of the federal Food and Drug Administration.

He has talked tougher and tougher with Juul as part of the FDA’s crackdown on vaping and e-cigarettes, a craze among the young that is eroding decades of efforts by health advocates to reduce Americans exposure to and abuse of nicotine and cancer-causing cigarettes and other tobacco products.

Gottlieb has told Juul officials he may summon them to his offices in the nation’s capital for more scoldings, this after the agency has chased and chastised vendors across the country, including Walgreen’s and Circle K stores, about keeping vaping products, e-cigarettes, and tobacco out of minors’ hands.

The commissioner has gone so far as to Tweet that Juul and other makers face “existential threat,” if they won’t stop what he views as improper advertising, marketing, and sales of their products, including liquids that youngsters “vaporize” (and don’t burn in e-cigarettes) for a jolt or “high” from their nicotine.

But as much as he keeps jawing at vaping enterprises, Juul may have skunked the commissioner: Juul led a crush by makers to boost nicotine concentrations in their vaping liquids and delivered via trendy e-cigarettes to young users, according to research by Dr. Robert Jackler, founder of Stanford Research into the Impact of Tobacco Advertising.

He found Juul won a “nicotine arms race,” releasing its original 5 percent concentration nicotine pods in the United States in 2015, when most competitors were selling products in the in 1-2 percent range. Now, several competing brands reach into the 5-7 percent range.

Experts say a single 5 percent pod, typical of what a teen might use in a Juul, delivers the same nicotine as a pack of cigarettes, making vaping and the device, “potently addictive to nicotine-naive teenagers,” Jackler told CNN News.

With vaping, and Juul, in particular, e-cigarette makers have used chemical gimmicks to mask nicotine’s bitter taste and found an efficient way to deliver the harmful substance. “Nicotine gets delivered to the brain very rapidly,” Dr. Frank T. Leone, director of the Comprehensive Smoking Treatment Program at Penn Medicine, who was not involved with Jackler’s new paper, told CNN.

Teachers, parents, and addiction experts have described ordeals in trying to help youths who want to quit e-cigarettes do so. Nicotine is highly addictive, and experts say it is damaging to developing young people’s health and their brains. Research also shows that e-cigarettes, particularly for teenagers who were disinclined before, too often act as a gateway to cigarette smoking and tobacco abuse.

The Obama Administration had won brutal battles to crackdown on e-cigarettes. But Gottlieb, shortly after his confirmation as FDA chief in the Trump Administration, delayed the actions. He said he wanted more study of e-cigarettes, and if they could benefit adults who want to quit damaging cigarette smoking. He also decried addictive nicotine, not necessarily tobacco, as a key challenge to Americans’ health.

While Gottlieb and the agency dithered, Juul jumped in, hyping its small, fashionable e-cigarette device and vaping. Both became best-sellers. Juul, which dominates the market, since has cut a deal with a major Big Tobacco company. It now owns a part of the firm, along with cigarette maker holding an interest in a legal marijuana enterprise.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage inflicted on them by nicotine addiction and tobacco abuse. Cigarette smoking is declining. But it persists as an out-sized contributor to leading causes of Americans deaths due to several different types of cancer (notably lung cancer), heart disease, as well as respiratory injury and disease. An estimated 16 million Americans are burdened with smoking-related disease. This is unacceptable. So, too, is talk without defensible action: The commissioner already should be held accountable for his part in allowing vaping and e-cigarettes to potentially damage the health of a generation. If he wants to escape the opprobrium he has earned, thus far, he should ban e-cigarettes for minors and be done with it. Talk is cheap and ineffective now.

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