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CASE UPDATE: Surgeon General Issues Warning Regarding E-Cigs, Particularly Juul
Dec. 18, 2018 - In a rare move, the U.S. Surgeon General issued a warning to the American public regarding the dangers of e-cigarettes, particularly in reference to the increase in teenage use. "We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes," Surgeon General, Jerome Adams said in a statement, adding, "We must take action now to protect the health of our nation's young people."
The advisory specifically referenced Juul multiple times because of the brand's popularity in high schools, and now junior high schools. By issuing the warning, the Surgeon General is taking a strong stance against the rise of e-cigarettes because of the dangers associated.
Juul – manufactured by Juul Labs – is the popular new USB-shaped smoking device that has recently captivated the e-cigarette market. Its sleek concealable shape and an array of flavors make it the favored choice for both adult and teen smokers. But contrary to Juul Labs’ claims that “Juuling” is a safe alternative to smoking cigarettes, recent studies have found that Juul and other e-cigarettes actually expose users to a number of dangerous health risks commonly associated with cigarettes. Researchers have also found links to risks not commonly associated with traditional cigarettes, such as e-cigarette users’ higher likelihood of developing bronchiolitis obliterans (more commonly referred to as “popcorn lung”). While research into Juul is still in its early stages, experts are already warning personal injury law firms, such as TorHoerman Law, to be prepared for a future massive influx of e-cigarette lawsuits. With the continued rise in Juul’s popularity, paralleled by continued research illustrating Juul’s health risks, a Juul lawsuit is an unfortunate likelihood.
If you use Juul or any other form of e-cigarettes, we urge you to read the following information as well as conduct your own research on Juul dangers before you continue using these products.
E-cigarettes have become extremely popular just in recent years, with E-cigarette use increasing 10-fold between 2011 and 2016. Juul currently holds more than 50% of shares in the e-cigarette market – a major market that is expected to be worth $86.43 billion by 2025 – making it by far the most popular e-cigarette available to consumers, with futures expected to reach $43+ billion.
There are a number of factors that can be attributed to Juul’s ability to break through the flooded e-cigarette market and establish itself as the leading brand for e-cigarettes, but the largest contributing factor is Juul Labs’ successful ‘healthy alternative’ advertising campaign.
Through the campaign, Juul Labs advertises its staple product as a safe alternative to traditional cigarettes, and an effective way to quit smoking. The manufacturer boasts that Juul does not contain the many toxins and chemicals that are found in cigarettes, so Juul users do not have to worry about being exposed to the health risks associated with those chemicals – and that’s true. Juul does not contain the same dangerous chemicals as traditional cigarettes do, making users less likely to develop injuries associated with those chemicals specifically found in cigarettes.
But while the e-liquid in Juul pods may contain less harmful chemicals, the concentration of nicotine in each Juul pod is cause for concern.
Juul and e-cigarettes put users at risk of developing injuries associated with nicotine use. Because, although some users are unaware, Juul pods do actually contain high quantities of nicotine. In general, e-cigarettes contain a lower dose of nicotine, ranging from 6 to 30 milligrams of nicotine per millilitre of liquid. Juul contains a much higher concentration of nicotine: 59 milligrams of nicotine per millilitre of liquid.
In fact, according to Juul Labs, one Juul pod contains about the same amount of nicotine as one pack of cigarettes. Experts argue that a Juul pod actually contains more nicotine than a pack of cigarettes because some of the nicotine in cigarettes is lost to filtration, whereas the nicotine released in a Juul pod is unadulterated by filtration – Juuls don’t have filters. This high dose of nicotine puts users at risk of both nicotine-related injuries and nicotine addiction.
Although Juul is advertised as both a safe alternative to cigarettes and an effective way to quit smoking, neither of these claims are actually supported by fact.
There is no evidence to support the claim that Juul is a reliable tool for quitting smoking – on the contrary, Juul contains as much, if not more nicotine than cigarettes. Because nicotine is the substance responsible for giving cigarettes their addictive nature, there is no reason to believe that Juul will help alleviate addiction. Some other e-cigarette brands offering lower mg/ml of nicotine may be more beneficial in lowering nicotine dependence.
A research study has revealed that high levels of nicotine concentrations found in JUUL e-cigarettes are “sufficiently high to be cytotoxic, or toxic to living cells, when test in vitro with cultured respiratory system cells.”
Of the hundreds of electronic cigarette products analyzed by the research team, JUUL was the only product with high enough nicotine concentrations to be toxic in standard cytotoxicity tests.
Of the eight different flavors manufactured and sold by JUUL Labs, the study found differing levels of cytotoxicity. “We found some flavor chemicals, such as ethyl maltol, also correlate with cytotoxicity, but nicotine seems to be the most potent chemical in JUUL products, due to it very high concentration,” according to the research team leader Prue Talbot, professor in the Department of Molecular, Cell and Systems Biology at the University of California, Riverside.
Although federal regulations limit the sales of JUUL products to individuals 21 years and older, JUULing still remains prominent in among adolescents, primarily middle-school and high-school aged youth. James F. Pankow, a professor of chemistry as well as civil and environmental engineering at Portland State University, Oregon and a member of the research team, explained that experts are still unsure of the long-term adverse health effects with chronic JUUL use. There is a growing concern amongst experts and the FDA that high doses of nicotine found in JUUL products could affect the still-developing adolescent brain, especially when considering the cytotoxic effects JUUL products have been found to have.
Like Juul, e-cigarette manufacturers often advertise their products as being a safe alternative to cigarettes; free of the many harmful chemicals found in cigarettes. However, what most e-cigarette companies fail to warn consumers of is that their products contain diacetyl: a chemical that, if vaporized, is highly toxic and can have detrimental health effects to those who are exposed to its vapors. The most common injury associated with diacetyl vapor exposure is bronchiolitis obliterans (popcorn lung), a rare condition that damages your lungs small airways, making it difficult to breathe and causing individuals to experience aggressive coughing spirts. If untreated, popcorn lung can degenerate into total respiratory collapse, which can be fatal.
In its natural form, diacetyl is a harmless additive, used to enhance the flavoring of e-liquids. But when heated in an e-cigarette, diacetyl is transformed into its hazardous vaporized state.
Unlike many other e-cigarette devices, Juul products do not contain diacetyl.
So, the health risks of e-cigarettes differ depending on which brand you choose. If you choose to Juul, you are choosing to use a product that has a higher concentration of nicotine than normal cigarettes but does not contain dangerous diacetyl vapors. If you choose to use most other e-cigarettes, you are choosing a product that has a lower concentration of nicotine compared to cigarettes, but you are likely also putting yourself at risk of developing popcorn lung. Either way, you are still putting your health at risk.
Cigarettes are bad for you – but e-cigarettes are by no means a lesser of two evils. E-cigarettes, be it Juul or any other popular brand, still put you at risk of developing a serious and potentially fatal injury.
If Juul and other e-cigarettes are still dangerous, why have the number of users been steadily increasing over time?
E-cigarettes feature two characteristics that make them appealing to smokers: enticing flavors that cut out the “bad taste” of cigarettes (1) and a concealable shape that allows them to be smoked virtually anywhere (2).
Juul offers users a range of enticing flavors, such as fruit medley, mango, cool cucumber, and crème Brulee. These flavors not only taste better but also reduce some of the social stigmas of smoking by eliminating the smoking odor. Federal law prohibits cigarette companies from selling flavored tobaccos, citing flavor’s appeal to youth smokers. But Juul and other e-cigarettes are able to circumnavigate these laws because they are not technically selling a flavored tobacco, but rather a flavored e-liquid containing nicotine. A number of advocacy groups are currently challenging e-cigarette manufacturers’ ability to offer flavors in the US legal system, but at this time flavors are still available to consumers.
The presence of diacetyl in e-liquids is due to these flavors. While not all flavors include diacetyl, many do. Diacetyl is most prevalent in both sweet and buttery flavors: flavors like butterscotch, coffee, candy, peppermint, and chocolate.
E-cigarettes vary in shape, size, and design. But most e-cigarettes are either small enough to conceal from others or they designed to look more like an electronic device than a smoking apparatus. Either way, it is hard for most non-users to distinguish an e-cigarette for what it really is. E-cigarettes almost never give off a smoky aroma. Almost all e-cigarette exhalants are waterbased, so they put off a “cloud” of what is essentially water vapor. For these reasons, e-cigarettes are easier to conceal and their use in public is more socially accepted.
Juul distinguishes itself from other e-cigarettes because it is the most easily concealable of all e-cigarettes. Juul’s sleek shape is often confused with a USB-drive and the fact that it is charged using a USB outlet only further aids to this confusion. The device is small enough to fit in the closed palm of a person’s hand, unlike most other e-cigarettes which are much larger. Juul vapor is water-based and almost completely odorless, so users can smoke it indoors, in public, or in group settings without other’s noticing.
Juul’s sleek & concealable shape, a range of enticing flavors, odorless vapor exhalant, and mischaracterization as a healthy alternative to cigarettes has led it to become the name-brand of e-cigarettes. Juul has helped to end the social stigmas surrounding smoking.
This is unfortunate, especially for the anti-smoking advocacy groups who have been on a decades’ long mission to build those social stigmas around smoking. Those stigmas were built on a foundation that attacked the health effects of cigarettes, cigarettes off-putting smell, and the dangers of secondhand smoke. Juul Labs claims to offer a solution to all of these issues: Their product is supposedly safe, odorless, and there is no secondhand smoke.
Unfortunately, the demographic that seems to be most susceptible to this false advertising are teenagers. Until recently, nicotine use amongst teens had been on a steady decline since the mid-1990’s. But with the introduction of Juul and other e-cigarettes, nicotine use is once again on the rise amongst teens.
At least 11% of middle school and high school students admit to using Juul.
According to an analysis from the Centers for Disease Control and Prevention and the Food and Drug Administration, around 33% of these teen users say that the availability of flavors is the main reason that they use this product. Another 39% attributed their use to a family member or friend who also used them. 17% claimed that they used Juul products because they believed them to be less harmful than other forms of tobacco – and the misconceptions about the health risks associated with Juul / e-cigarettes are rampant in the teenage demographic.
In fact, a majority of youth e-cigarette users think they vaped only flavoring, not nicotine, the last time they used an e-cigarette, according to a study conducted at the University of Michigan. Another study, conducted by the Truth Initiative, found that 63% of Juul users between 15 and 24 years old did not know that the product always contained nicotine – a chemical known to be harmful to adolescent brain development.
Juul Labs has come under scrutiny by a number of advocacy groups who claim that Juul’s advertising campaign is aimed towards teens. The advocacy groups cited bright colors, youthful imagery, paired with fruity flavors offered by Juul – all of which they believe is an effort to hone in on the youth market.
Juul has also become something of a social phenomenon, taking over social media platforms, such as Instagram, which is popular with youth culture. On any given platform, you can find trending hashtags like #DoItForTheJuul, where teens post images of themselves using Juul and other e-cigarettes.
Juul’s concealable shape and odorless fume exhalant also make it attractive to teens, who have found it easy to use at home, in public, and even in school, under the watchful eye of adults.
Matt Myers, head of the Campaign for Tobacco-Free Kids, says that the youth’s fascination with Juul and e-cigarettes could quite possibly develop into a future health catastrophe – a whole generation of young adults could become addicted to nicotine for life.
Personal injury attorneys are preparing for a high frequency of Juul lawsuit cases & e-cigarette lawsuit cases, which are expected to begin building over the next few years. Juul lawsuits/e-cigarette lawsuits will range from diacetyl related injuries, smoking-related injuries, to false advertising and failure to warn consumer cases.
Currently, TorHoerman Law is filing e-cigarette lawsuit cases for any individuals who e-cigarettes and, as a result, developed bronchiolitis obliterans (popcorn lung). If you used Juul or another e-cigarette and suffered any injury besides popcorn lung, TorHoerman Law will still take your information, though we are not filing these lawsuits at this time.
For a free no-obligation Juul lawsuit/e-cigarette lawsuit case consultation, contact the offices of TorHoerman Law today. One of our experienced investigation team members would be happy to discuss your potential Juul lawsuit/e-cigarette lawsuit, free of charge.
November 30, 2018 - The FDA has warned yet another e-cigarette liquid maker for advertising products depicting food for children. Electric Lotus LLC, a California-based company, has been issued a warning for "advertising its e-cigarette liquids with nicotine in a way that may cause the products to resemble kid-friendly food like juice boxes and cookies."
November 14, 2018 - JUUL Labs announced that it will be suspending in-store sales of their most popular fruity e-liquid pod flavors. The company also plans to take the first step towards eliminating its social media presence, which many have charged with being one of the larger contributing factors to JUUL’s appeal to minors.
JUUL will still offer in-store sales of mint, menthol, and tobacco e-liquid pods for individuals who are trying to quit smoking cigarettes. However, sales of fruity flavors, such as mango, fruit, creme, and cucumber, thought to be more enticing to teenagers, will be limited to online purchases only. The company says its working to develop technology to ensure that retailers comply with age requirements and restrict access to its products.
This is likely a preemptive step, as e-cigarette manufacturers prepare for new industry sanctions and regulations expected to be announced by the FDA later this week. In an effort to combat the escalating number of teenage smokers, the FDA plans to unveil a ban on sales of flavored e-cigarettes in convenience stores and gas stations and strengthen the requirements for age verification of online sales of e-cigarettes. JUUL Labs, which retains more than 70% of domestic e-cigarette market shares, will surely be in the FDA’s crosshairs as the agency initiates these new regulations.
Kevin Burns, a spokesperson for JUUL Labs, says that the company will be deleting all of its social media accounts as well as continuing in efforts to monitor and remove inappropriate material from 3rd party accounts. Burns says that this is all an effort to remove JUUL entirely from participation in the social conversation.
"To remove ourselves entirely from participation in the social conversation, we have decided to shut down our U.S.-based social media accounts on Facebook and Instagram," Burns explained. "Our presence on Twitter will be confined to non-promotional communications only."
October 31, 2018 - According to Buzzfeed News, "Juul offered to pay schools as much as $20,000 to introduce a vaping curriculum that would explicitly place more of the blame on peer pressure," However, “Juul consultants...encouraged students to try meditation and mindfulness exercises as an alternative to the vape pen, but failed to teach them about the dangers of vaping, experts said." Also, "according to an analysis of the curriculum published earlier this month in the Journal of Adolescent Health, Juul did not include information about how young people are especially susceptible to nicotine addiction." Experts in the analysis "also expressed concern that the company didn’t mention its marketing or flavors."
October 25, 2018 - In response to the FDA crackdown on e-cigarette manufacturers marketing to youth, one company decided to pull their MarkTen Elite and Apex by MarkTen pod-based products from the market. Altria will also be narrowing down their e-cigarette flavor options to tobacco, mint, and menthol. In a letter to the head of the FDA, Altria CEO Howard Willard III issued the following statement:
"We believe e-vapor products present an important opportunity for adult smokers to switch from combustible cigarettes,” said. "Yet, the current situation with youth use of e-cigarette products, left unchecked, has the potential to undermine that opportunity for adult smokers."
October 16, 2017 - The U.S. Food and Drug Administration on Friday asked 21 e-cigarette companies, including the makers and importers of Vuse Alto and Myblu, to cough up information about whether more than 40 products are being illegally marketed.
This comes amid claims from consumers that the e-cigarette companies are using tactics to market their products to underage teenage consumers. Juul labs recently came under heat for potential illegal marketing practices, leading the FDA to conduct a full review of the manufacturers marketing practices. If found in contention with the rules and regulations of marketing, these companies could find their products removed from the US market all together.
October 12, 2018 - The FDA issued a warning to China-based HelloCig Electronic Technology Co. for selling vaping e-liquid products containing active ingredients used in erectile dysfunction drugs Cialis and Viagra. While the ingredients are approved for those specific pharmaceutical drugs, they are not approved for e-cigarette products.
According to the FDA Commissioner Scott Gottlieb, "Prescription drugs are carefully evaluated and labeled to reflect the risks of the medications and their potential interactions with other medicines, and vaping active drug ingredients is an ineffective route of delivery and can be dangerous. There are no e-liquids that contain prescription drugs that have been proven safe or effective through this route of administration."
October 2, 2018 - The FDA seized more than 1,000 documents from Juul Labs headquarters in San Francisco in a surprise inspection. The inspection “followed a request in April for documents that would help the agency better understand the high rates of use and appeal among youth of Juul products.”
According to a report by the Center for Disease Control and Prevention, Juul sales surged between 2016 and 2017. Retail sales data published in JAMA found that Juul’s sales increased from 2.2 million devices sold in 2016 to 16.2 million in 2017, with many of those customers being under the age of 18. The FDA said the surprise inspection was conducted because of a particular interest in whether Juul deliberately marketed to minors.
October 2, 2018 - Studies conducted have shown that e-cigarettes can contain dangerous chemicals that could be putting user's health at risk. These chemicals include formaldehyde, a probable carcinogen, that is released when heated by high-voltage batteries and diacetyl, a flavoring chemical, found to be associated with bronchiolitis obliterans or Popcorn lung, a dangerous respiratory disease.
CNN reported that a previous study looked at 51 of the 7,000 e-cigarette flavors currently marketed to consumers and found that diacetyl rates were higher than laboratory normal levels in 39 of the flavors. The Center on Addiction reported similar findings and stated that "Diacetyl and other chemical flavorings found in e-juice may be considered safe to ingest in small quantities, but are dangerous when inhaled deeply and repeatedly into the lungs."
March 21, 2018 - In an effort that anti-smoking advocates are calling way overdue, the FDA is investigating the safety of menthol and other flavoring additives in tobacco products to determine if these additives should be more heavily restricted or even banned. This investigation comes as e-cigarettes continue to gain overwhelming popularity amongst consumers.
The FDA wants to determine whether these potential health risks necessitate readdressing the restrictions placed on e-cigarettes and other tobacco products containing flavoring additives.
Earlier this week, Commissioner Scott Gottlieb, MD, announced that the FDA has issued an advanced notice of proposed rulemaking (ANPRM) – a process of collecting data and hearing expert testimony on the costs and benefits of tobacco flavoring additives to determine whether these products should be more heavily restricted or even banned.
The FDA conducted an ANPRM to determine whether to ban methanol and other flavoring additives in 2013. To the detest of anti-smoking groups, no changes followed this ANPRM.
The current ANPRM pertains to e-cigarettes and other non-combustible tobacco products. Flavor additives in combustible tobacco have been banned since 2009.
Almost all popular e-cigarettes contain some form of flavoring additive. Gottlieb noted that the intention of the flavoring additives in these products was obviously to appeal to the youth, middle-school and high-school students.
Gottlieb said that he recognized the validity of the argument that these flavors help adult smokers to wean off of cigarettes. However, Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, disagreed with the validity of this claim. Myer explained that while there is an abundance of evidence that e-cigarette flavorings are associated with increased use among teens and young adults, there is almost no evidence that the flavoring will help cigarette smokers to quit.
If the FDA does decide to restrict or ban some or all tobacco flavoring additives, the agency will conduct a follow-up comment period. Robin Koval, president of Truth Initiative, said that in the best case scenario, it will be several years before the restrictions or bans are put into effect. "The FDA is taking the right actions, so we are optimistic that they are serious about this," Koval said. "But time is of the essence. This has taken way too long."
January 31, 2018 - A study published in Proceedings of the National Academy of Sciences suggested that the nicotine in e-cigarettes seems to cause damage to DNA in ways that would increase the risk of certain cancers for e-cigarette users. According to lead researcher Moon-shong Tang, professor of environmental medicine at New York University School of Medicine, the study showed that the vaporized nicotine not only damaged DNA but also its ability to repair itself.
The study is the first research to produce evidence that e-cigarettes could be carcinogenic.
"It is certainly concerning, and certainly gives pause if one were to say e-cigarettes were safe and could be used by all people without consequences," said Dr. Roy Herbst, chief of medical oncology at Yale Cancer Center and chair of the American Association for Cancer Research’s Tobacco and Cancer Subcommittee.
In fact, this is not the first study to expose the dangers of smoking these devices. Previous research has connected e-cigarettes to the life-threatening respiratory disease known as popcorn lung.
Tang and his colleagues conducted the research using laboratory, which they exposed to e-cigarette vapor containing nicotine and liquid solvents. The researchers also exposed mice to nicotine and liquid solvents separately.
While previous studies conducted on the safety of e-cigarettes have used e-liquids heated at high levels of electricity, which resulted in other dangerous chemicals such as diacetyl being exposed, Tang’s team used lower levels of electricity, at or below the voltage that most all e-cigarettes operate.
In testing the nicotine-solvent combination, as well as the solvent alone, the researchers found that the nicotine alone, and not the solvent, produces the effects that caused damage to the DNA.
The researchers conducted similar tests on cultured human lung and bladder cells and found the same effects.
Not all animal research results in similar outcomes when tested in humans, so researchers cannot say for certain that a human trial would result in similar DNA damage. However, if further research does confirm Tang's results, Herbst says that could mean that e-cigarettes may carry their own cancer risk.
Tang and his team are currently conducting research on the long-term effects of exposure to the nicotine in e-cigarettes using similar methods.
From his research, Tang could not say whether he found e-cigarettes to be more dangerous than traditional cigarettes. "We just cannot guess with the data we have," Tang explained.
February 8, 2016 - E-cigarettes are adult products that should be kept out of the hands of children. That is the focus of legislation that passed both the U.S. House and Senate that will potentially save the lives of many children, as the debate regarding the regulation of the e-cigarette industry continues.
President Obama signed the Child Nicotine Poisoning Prevention Act of 2015 into law on January 29. It requires manufacturers to put childproof caps on the small bottles of liquid nicotine used in e-cigarettes. Liquid nicotine is sold in concentrated form for use in e-cigarettes and is often packaged in easy-to-open, brightly colored vials with appealing flavors. Just a single teaspoon of highly concentrated liquid nicotine is potent enough to kill a small child, according to the American Association of Poison Control Centers.
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Miller, Ryan W. “Viagra and Vape? FDA Warns e-Cigarette Company Selling Erectile Dysfunction Drug in e-Liquid.” USA Today, Gannett Satellite Information Network, 14 Oct. 2018, www.usatoday.com/story/news/nation-now/2018/10/12/vape-liquid-viagra-cialis-fda-warning-e-cigarette-company/1619474002/.
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Thompson, Azure. “Are Nicotine-Free E-Cigarettes Harmful?” Center on Addiction, 1 Oct. 2018, www.centeronaddiction.org/e-cigarettes/tobacco-replacement/are-nicotine-free-e-cigarettes-harmful.
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Last Modified: April 17th, 2019 @ 02:38 pm
If you are a Juul user, or use any other form of e-cigarettes, and have developed any injuries associated with traditional cigarette use, such as cancer, or if you have developed bronchiolitis obliterans (popcorn lung), contact TorHoerman Law today for a free no-obligation consultation for your potential Juul lawsuit or e-cigarette lawsuit.
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