E-cigarette company Juul is now doing health research, but its first study could bring more questions than answers

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On Saturday, for the first time in its roughly two-year history, e-cigarette company Juul presented some data from a clinical trial of its devices.
The company has a reputation for aggressively marketing its dessert-flavored nicotine products to teens, some of whom, research suggests, may now be at a higher risk of using regular cigarettes.
But Juul, which is now partially owned by Marlboro maker Altria, is now conducting scientific research.
In general, that research is considered a key step toward ensuring that a new product is not causing undo harm to people.
But the study still leaves many unanswered questions about the overall health of vaping, and also leaves unaddressed the issue of use by teens.

Juul, a Silicon Valley e-cigarette startup with a reputation for aggressively marketing its dessert-flavored nicotine products to teens, is now doing health research.

On Saturday the company, which is now partially owned by Marlboro maker Altria, presented a poster summary of a clinical trial comparing people who exclusively used its devices against people who smoked traditional cigarettes at an annual meeting for the Society for Research on Nicotine and Tobacco.

The poster is the first clinical research that Juul has shared publicly. The full study, sponsored by Juul and comparing the drop in levels of smoking-related biomarkers in smokers who quit for five days but used its devices against smokers who quit and did not vape, has not yet been made public.

According to ClinicalTrials.gov, the government's database for such research, Juul recently completed at least five other clinical trials including its devices, which have been on the market since 2017. The company is in the process of conducting at least three more, according to the database.

For the study presented on Saturday, a group of researchers from Juul and outside lab Celerion looked at 90 adult smokers. Over five days, the researchers analyzed nine biological clues known as biomarkers that are thought to provide insights into disease or illness. In this case, they looked specifically at cancer-causing biomarkers linked with smoking tobacco-based cigarettes. E-cigarettes do not contain tobacco.

The researchers then divided the participants into groups and had some groups abstain from nicotine completely. Others smoked normally. Still others used only Juul e-cigs.

The findings suggested positive results for the smokers who quit and completely transitioned to Juul devices. In both the abstinence group and the Juul group, all of the measured biomarkers decreased dramatically. On average, the levels dropped by 85.3% in the non-vaping, non-smoking group and 85% in the Juul group. That suggests that using Juul e-cigarettes in isolation is not linked with some of the potentially cancer-causing effects of smoking regular tobacco cigarettes, the authors concluded.

The study also has some important limitations.

Unanswered questions about vaping and health

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Most experts agree that compared with traditional smoking — which involves inhaling burned tobacco — vaping is likely healthier. However, a growing body of research suggests that using e-cigarettes comes with health risks of its own.

Juul's analysis did not look at the overall health impacts of using e-cigarettes. Instead, it looked at a small set of biomarkers that are known to be negatively impacted by tobacco use. E-cigarettes don't contain tobacco.

A press release summarizing Juul's paper suggested that the study "reaffirm[ed] the potential for vapor products as a viable alternative to combustible cigarettes."

That conclusion may be premature based on the study, which took place over the course of five days and included 90 people. Most research comparing cigarettes and e-cigarettes is conducted over the course of several years and includes thousands of participants.

Previous biomarker research on e-cigarettes has suggested the devices could be linked with negative health effects. Few of these studies have included Juul devices, however.

For example, a recent analysis of biomarkers in e-cigs other than the Juul suggested that vapers inhale toxic substances like lead, nickel, chromium, and manganese in levels higher than what's considered safe by the EPA. Inhaling those metals has been tied to health problems in the lungs, liver, immune system, heart, and brain, as well as some cancers, according to the US Department of Labor's Occupational Health and Safety Administration.

Another concern experts have raised with previous e-cigarette research is when scientists exclude users who switch between vaping and smoking, the group of people whom they say make up the majority of e-cig users.

For the vaping portion of Juul's study, the researchers looked only at people who exclusively vaped, not people who switch back and forth. That could mean that it ignores the health impacts of real vape use, which could include vaping and smoking rather than just vaping.

The study also leaves unaddressed the issue of teen vaping, which recent studies from the Food and Drug Administration suggest were in large part a result of Juul's skyrocketing popularity. A single Juul pod, the refillable cartridge in the Juul e-cig, contains the same amount of highly addictive nicotine as a pack of traditional cigarettes.

Several studies have suggested that teens who use e-cigarettes eventually transition to regular cigarettes, and these may be young people who otherwise would not have smoked.

DON'T MISS: The FDA just called out e-cig startup Juul and tobacco giant Altria for backing away from a pledge to fight teen vaping

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