E-Cig Giant Juul Touts Positive Study in a Questionable Journal

Alicia Ault

March 20, 2019

Juul Laboratories, which dominates the US e-cigarette market, is promoting a study claiming of one of its products "dramatically" cuts adult smokers' cigarette consumption.

But experts are casting doubt on the quality of the study, warning that it is published in a "predatory journal." Such publications, they caution, actively solicit authors with offers of low fees and an easy and rapid route to publication, which often results in the publication and promotion of less-than-rigorous research.  

The current study suggests adult smokers who bought a Juul starter kit reduced cigarette consumption by 52% over a three-month period; it was published February 18 in the open-access Journal of Pulmonary and Respiratory Medicine.

The Juul study was submitted December 2, accepted on February 11, and published on February 18 after going through peer review.

50% Reduction in Cigarette Use?

In the study, led by Neil McKeganey, PhD, codirector of the Centre for Substance Use Research (CSUR), Glasgow, United Kingdom, US smokers over age 21 who bought a Juul starter kit at one of approximately 10,000 stores were invited to participate in a survey of their cigarette use.

Some 9272 smokers participated, of whom 7721 provided data on the frequency and intensity of their smoking at baseline and at a 3-month follow-up. Respondents received a $30 gift card.

All data were self-reported. The study showed that the total number of cigarettes smoked by all participants declined from 2,074,664 cigarettes in the 30 days prior to baseline, to 551,863 cigarettes in the 30 days before the 3 months' assessment.

For those still smoking at the 3-month follow-up, the number of cigarettes smoked declined from 1,144,688 in the month prior to baseline to 551,863 in the month before the final assessment, for a 51.8% reduction, the investigators report.

Although self-reporting is widely used in survey research, "it is always better to get independent confirmation of smoking status with cotinine and exhaled carbon oxide, which would allow you to distinguish between people who had and had not quit smoking," Stanton Glantz, PhD, professor of medicine and director of the Center for Tobacco Control Research and Education, University of California San Francisco, told Medscape Medical News. "This is particularly important in a study like this where there is a strong incentive to understate smoking." 

The study sample of adult smokers is likely different from the population of all Juul users, most of whom are under 21, he added.

Predatory Journals on the Rise

The Journal of Pulmonary and Respiratory Medicine is published by Gavin Publishers, which had been flagged by Beall's List (a controversial but oft-cited list now carried on by Stop Predatory Journals) as a predatory operation.  

For instance, Gavin offers individual and institutional "memberships" for $5000-10,000 a year, promising to "give access to the author for publishing an endless number of manuscripts in the time period of membership."

Predatory journals are becoming increasingly common, besieging scientists with solicitations to submit research. The bar for publication is low, notes David Moher, PhD, a senior scientist in the clinical epidemiology program at the Ottawa Hospital Research Institute, in a 2017 article published in the journal Nature.

Medscape Medical News attempted to contact those involved with the Journal of Pulmonary and Respiratory Medicine for comment. These include two scientists — editor-in-chief Ibrahim Faruqi, MD, University of Florida College of Medicine, Gainesville; and executive editor Vera Krymskaya, PhD, University of Pennsylvania, Philadelphia. Neither responded to several email requests. The publisher's contact for the journal also did not respond.

Such publications readily accept manuscripts, often charge less than premium medical journals, and in one study of a sample of the journals, "consistently failed to report key information necessary for readers to assess, reproduce and build on the findings."

"What they are publishing is likely fake, false and/or unreproducible," Moher told Medscape Medical News. "They are undermining what we consider 'trusted' sources," he said.

Authors are publishing in these journals because they are being duped, or sometimes because they are being deliberate, using the publications as part of their promotion and tenure portfolios and for grant applications, said Moher, citing an upcoming paper by his group looking into researchers' motivations for publishing in such journals.

When asked why it chose the Gavin journal to publish its research, Juul referred questions to lead author McKeganey. However, McKeganey did not respond to several requests for comment.

A Juul spokesperson said she believes McKeganey wanted to get the results into print quickly and referred Medscape Medical News to quotes from McKeganey published by Business Insider.

In that March 4 story, McKeganey was asked to respond to charges that the journal was predatory and had a low impact factor. He said he was unperturbed.

"I am less preoccupied with [the] ranking of individual journals and more concerned to ensure that our research contributes to debate," McKeganey told Business Insider.

Juul Under FDA Fire

Juul has been under fire by the US Food and Drug Administration (FDA), which has claimed the company targets teens. It would be important for Juul to show regulators — and investors — that its device helps adult smokers quit.

With one third of the market share, Juul is currently the dominant e-cigarette company in the US. Data recently published by the Centers for Disease Control and Prevention (CDC) in JAMA show the company's sales increased 641% — from $2.2 million in 2016 to $16.2 million in 2017.

In 2018, Altria, the parent company of Philip Morris and many other tobacco makers, purchased a $35% stake in the company for $13 billion.

Glantz is principal investigator for the $20 million, 5-year Tobacco Centers of Regulatory Science (TCORS) grant, originally funded in September 2013 by the US Food and Drug Administration and the National Institutes of Health and renewed in September 2018.

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