JACKSONVILLE, Fla. – The nation's largest e-cigarette maker will stop advertising its devices in the U.S. and replace its chief executive as mysterious breathing illnesses and an explosion in teen vaping have triggered efforts to crack down on the largely unregulated industry.
Juul Labs and other e-cigarette makers are fighting to survive as they face backlash from two public health debacles. Federal and state officials have seized on the recent outbreak of lung illnesses -- including nine reported deaths -- to push through restrictions designed to curb underage vaping.
The Centers for Disease Control and Prevention said it does not yet know the specific cause of these lung injuries, which has many parents concerned.
"(It) scares me to death because my kids know and report to me that kids are vaping at school," said Tobacco-Free Jacksonville Co-Chair Ann Gipalo.
The Florida Department of Health will not release a breakdown of how many vaping-related cases have been reported in Florida, but the Florida Department of Health in Duval County said it has had no cases of vaping-related illnesses reported. Clay County has received one.
The Jacksonville Fire and Rescue Department said it has had 29 cases in which it was called out for vaping-related symptoms. Gipalo believes the number of vaping-related illnesses will drastically rise once everyone is on the same page.
"Pediatricians don’t normally ask kids yet if they vape, and sometimes, they get the terminology wrong. So they'll say, 'Do you vape?' And these kids say, 'I Juul.' And they don't know that's the same thing," Gipalo said.
The CDC has released interim recommendations for health care providers, health departments and the public:
- Until we know more, if you are concerned about these specific health risks, CDC recommends that you consider refraining from using e-cigarette or vaping products.
- If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
- If you have recently used an e-cigarette or vaping product and you have symptoms like those reported in this outbreak see a healthcare provider.
- Regardless of the ongoing investigation:
- Anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC or CBD oils) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer.
- Youth and young adults should not use e-cigarette products.
- Women who are pregnant should not use e-cigarette products.
- Adults who do not currently use tobacco products should not start using e-cigarette products.
No major e-cigarette brand has been tied to the ailments, including Juul, which said it won't fight a Trump administration proposal for a sweeping ban on e-cigarette flavors that can appeal to teens.
Governors in Michigan and New York moved to outlaw vaping flavors this month, while Massachusetts said Tuesday that it will ban all vaping products for four months, the first such step in the country.
"I think this rush to judgment is extraordinary, and we might be looking at the demise of vaping,'' said Kenneth Warner, professor emeritus at University of Michigan School of Public Health.
Warner and some other experts believe vaping has the potential to dramatically reduce the deadly toll of traditional cigarettes among adult smokers. But he said Juul made "enormous mistakes'' in its early advertising campaigns, which featured young models, bright colors and youth-oriented catchphrases.
E-cigarettes have been largely unregulated since arriving in the U.S. in 2007. The Food and Drug Administration has set next May as a deadline for manufacturers to submit their products for review.
Exempt from restrictions on traditional tobacco marketing, Juul until now has advertised its e-cigarettes in print, TV, radio and online. It's also replacing its CEO with a senior executive from Altria, the maker of Marlboro cigarettes that paid $13 billion for a 35% stake in Juul in December.
The new chief, K.C. Crosthwaite, said in a statement that Juul has long focused on providing adult smokers with alternatives but recognized that there's "unacceptable levels of youth usage and eroding public confidence in our industry.''
Health experts generally consider e-cigarettes less harmful than traditional cigarettes because they don't contain all the cancer-causing byproducts of burning tobacco. But there's virtually no long-term research on the health effects of the vapor produced when e-cigarettes heat a liquid with nicotine.
Health officials are investigating hundreds of recent cases of the lung illness. Many patients said they vaped THC, marijuana's intoxicating chemical, with bootleg devices, but officials have not yet implicated any common product or ingredient.
Meanwhile, underage vaping has reached epidemic levels, health officials say. In a government survey, more than 1 in 4 high school students reported using e-cigarettes in the previous month despite federal law banning sales to those under 18.
Former FDA Commissioner Dr. Scott Gottlieb cautioned that the illnesses and teen vaping are separate problems that will likely require unique solutions.
"I think conflating the two is risky because it might force us down the wrong path,'' said Gottlieb, who stepped down in April.
He said banning legal e-cigarettes could push users toward riskier, illicit vapes.
Vaping opponents met Juul's changes with skepticism.
"Juul's announcement today is aimed at repairing its image and protecting its profits, not at solving this crisis,'' said Matthew Myers, president of the Campaign for Tobacco-Free Kids. "Policymakers must stand up to Juul and protect our kids by banning flavored e-cigarettes.''
Juul devices went on sale in 2015, and the company quickly propelled itself to the top of the market with a combination of high-nicotine pods, dessert and fruit flavors, and viral marketing. The San Francisco company now controls roughly 70% of the U.S. e-cigarette market.
In the last year, Juul tried to reposition itself as a brand for middle-aged smokers looking to wean themselves off cigarettes. But the FDA warned the company this month that its product hasn't yet been approved to help smokers quit.
Juul has tried to head off a crackdown with a series of voluntary steps, including halting retail sales of several flavors and shutting down its social media presence. But political pressure has only increased.
The company faces multiple investigations from Congress, several federal agencies and state attorneys general. President Donald Trump said this month that the government will move to ban thousands of flavors.
"We must strive to work with regulators, policymakers and other stakeholders, and earn the trust of the societies in which we operate,'' Crosthwaite said in a statement.
He was chief growth officer for tobacco giant Altria and replaces Juul's CEO, Kevin Burns.
Altria and Philip Morris International said Wednesday that they were calling off merger talks a month after floating a deal that would have created the world's largest tobacco company.
Altria's stake in Juul was considered a key factor in the deal, which would have given the e-cigarette maker access to Philip Morris' global network and resources.
Tim Hubbard, of University of Notre Dame, said Juul has "failed spectacularly'' in managing the public perception of its e-cigarettes.
"Bringing in a traditional tobacco executive who knows how to market and manage government relationships with deadly products matches the firm's needs,'' Hubbard said in an email.