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An Open Letter to Juul (and Dr. Mark Rubenstein):

It was recently reported by the L.A. Times that you, Juul Labs, have hired Dr. Mark Rubenstein as your medical director from the University of San Francisco to oversee your research in an effort to legitimize Juul. It’s hard not to be skeptical of your motivation, Juul. How do you propose to curb the teen vaping craze, which the US federal government has labeled an “epidemic?” 

 As a former social work educator, NIH-NIAA principal investigator, and US Dept of Education grants and clinician specializing in addiction, I can’t help but wonder what you will do. Since Juul is responsible for 72% of the teen vaping market, will you take Juul off the market

Let’s consider a few key facts in the argument for why you should remove Juul from the market:

  1.   Juul has a higher concentration of nicotine which can affect brain development. 
  2.   Vaping can interfere with memory and attention processing. Research has shown that adolescents who began smoking at a young age had markedly reduced frontal cortex, an area critical for a person’s cognitive behavior and decision making (as reported by Yuan M, Cross SJ, Loughlin SE, Leslie FM. Nicotine and the adolescent brain. Journal of Physiology. 2015;593(16):3397-).
  3.   Vaping is addictive (period). 
  4.   Juul pods can cause damage to lung development and increase preterm births and deliveries. In addition to this patented formula, Juul pods contain a greater amount of benzoic acid (44.8 mg/mL), compared to other e-cigarette brands (which are in the range of 0.2 to 2 mg/mL). According to the Center for Disease Control and Prevention (CDC), benzoic acid is known to cause coughs, sore throat, abdominal pain, nausea, and vomiting if exposure is constant, which is the case when using Juul.
  5.   Note the Center on Addiction’s additional facts and concerns about e-cigarettes. 
  6.   Bottom line, e-cigarettes and vaping are not risk free. E-cigarettes and vaping are not used exclusively by people who want to quit smoking. They are often used in addition to smoking cigarettes, rather than in place of them.
  7.   Nicotine can affect brain development in young people.
  8.   There is little consistency amongst products.
  9. There is no evidence that aerosol from these products is safe.
  10. The spread of e-cigarettes and other vaping devices may be re-normalizing smoking behaviors.

So Dr. Rubenstien and Juul, I ask you:

Do you have children or grandchildren of your own? Are you willing to see vaping normalized and risk the children in your lives becoming addicted to nicotine (or marijuana, as it’s being reported that many kids are vaping it as well)?

Are you willing to be responsible for stunting these kids brain development? Are you willing to ignore that according to the CDC there have been approximately 94 possible cases of severe vaping across 14 states

As a clinician and an addictionologist, I ask where are your ethics? We Know Gen Z has the highest level of anxiety and depression we have seen, and now adding to this is the mounting dangers posed by JUUL. 

I ask, humbly, where have all your ethics gone?

Dr. Louise Stanger