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The e-cigarette company Juul Labs funded a special issue of the American Journal of Health Behavior, which dedicated its entire May/June issue to 11 articles authored by Juul scientists or contractors that on the whole found reductions in adult smoking rates as smokers switched to electronic nicotine products.
The New York Times reported last week that the company paid $51,000 to sponsor the special edition of the journal, including a $6,500 open-access fee to make it freely available to the public. Three editorial board members resigned over the arrangement.
A Juul spokesman told the Times that journal editors rejected one of the company's submissions.
As the Times reported, Juul is currently in a battle with federal regulators to keep its products on the market. The Food and Drug Administration is balancing arguments that Juul’s nicotine-based products provide a safer alternative to smoking against the potential harms of e-cigarettes to young people who never previously smoked but become addicted to nicotine through Juul products.
The Centers for Disease Control and Prevention says there is an epidemic of e-cigarette use among youth. In 2018, researchers publishing in the CDC's Morbidity & Mortality Weekly Report found that one in five high school students and one in 20 middle school students used e-cigarettes.
Altria, the tobacco holding company and parent company of Philip Morris, owns a 35 percent stake in Juul.
The 11 research articles published in the American Journal of Health Behavior’s “special issue on JUUL use” were authored by researchers who at the time the studies were conducted were employed by Juul laboratories or consulting or research groups that contract with the company. All the studies were funded by Juul Labs Inc.
The Philadelphia Inquirer quoted a tobacco regulatory scientist who critiqued two studies for the special issue, who said she and other reviewers were not informed of Juul’s role until they questioned “fishy” aspects of the studies. The scientist -- who was not named -- shared an email with the Inquirer that the journal’s editor in chief, Elbert Glover, sent to potential reviewers that did not note Juul’s sponsorship and that offered $75 to reviewers if they could turn a review around in one week. The manuscripts themselves redacted the sponsor's name.
The scientist told the Inquirer one of the studies she reviewed was so biased that she recommended it be rejected. “I thought, ‘No way it wasn’t funded by Juul,’” the scientist told the Inquirer.
After she questioned Glover about it, he sent another email, according to the Inquirer.
“It has been brought to my attention that some reviewers were unaware that the special issue on e-cigarettes is being funded by JUUL,” Glover wrote. “My apologies for not alerting everyone … I honestly did not believe it to be a concern as the comprehensive reviews always purge weak or biased manuscripts.”
Glover, a professor emeritus in the Department of Behavioral & Community Health at the University of Maryland, College Park, did not respond to requests for comment. He previously defended the arrangement to the British Medical Journal, which first reported on the special issue funded by Juul.
“To reject a paper on who funded the work rather than science is wrong,” Glover told the BMJ. “We periodically have published tobacco funded papers with no little concern from anyone. However, an entire issue seems to have created a minor stir with overzealous tobacco researchers who do not tolerate any tobacco industry manuscript to be published.”
“We do not condone discriminatory censorship as evidenced by the fact that not all papers submitted were accepted,” Glover said. “Moreover, all the manuscripts were sent through the full review process and not treated any differently than any other paper. There was nothing special with the issue other than being funded by the tobacco industry.”
Glover also said, “It was clearly stated in the review process and in the special issue who the sponsor was, nothing was hidden. In addition, every paper clearly noted who the funder was -- again, nothing was hidden.”
An article published in Preventative Medicine in 2019 analyzing 94 different articles on e-cigarettes and health found that studies funded by the tobacco industry were much less likely to identify potential harms compared to non-industry-funded studies. The authors found that 95.1 percent of papers in which authors did not state a financial conflict of interest found potential harm compared to 39.4 percent of papers with a stated conflict of interest. Only 7.7 percent of the tobacco industry-related studies found potential harms.
Some journals have policies barring publication of studies funded wholly or in part by the tobacco industry.
“The tobacco industry has a very long and well-established history of funding research going back decades,” said Yvette van der Eijk, an assistant professor in the National University of Singapore’s Saw Swee Hock School of Public Health. “What we do know is it’s not really research; it’s essentially a PR strategy because generally the goal of scientific research is to forward knowledge, is to create data to forward our scientific knowledge or it can support health. But their goal is to sell cigarettes -- or, in Juul’s case, e-cigarettes.”
“This is the first time I’ve heard of a tobacco company buying an entire issue of a journal,” van der Eijk said. “But of course they have paid a lot of money for consultants to put out research that is effectively supporting the company’s arguments.”
Ivan Oransky, co-founder of Retraction Watch, a publication that reports on journal retractions and scientific integrity, described the special Juul issue as “an extreme version of the model that pharma uses.”
“Pharma will have these sponsored issues of journals,” said Oransky, who is a distinguished writer in residence at New York University's Arthur Carter Journalism Institute. “What Juul is trying to do and what pharma is trying to do or any industry player tries to do is get the imprimatur of peer review so they can say, ‘Look, we have peer-reviewed publications that say x, y, z’; -- I have to imagine knowing full well that they are in fact bypassing what most people think of as sort of rigorous peer review.”
James Heathers, a researcher who studies methodological issues in science, said it would be highly irregular to reveal the funder of a study midway through the peer-review process, and that affiliations would typically be identified at the outset or not at all.
"Blinded and unblinded review both have a place, for obvious reasons," Heathers said. "But ‘blinded until the reviewers get an odd feeling about their assigned tasks’ is not."
Heathers said his question for the editor in chief would be "How much and how competently did those reviewers attack the science? This is why open review is a good idea," he said.
"Although obviously the point applied equally to the critics," Heathers added. "Let's hear your primary objections to the research papers. You don't get to damn things by association, even these associations."
A Juul spokesman declined to comment for this article. Representatives of the company and a consultancy that works with it sent a letter to the BMJ in May arguing that “the appropriate focus should be on the scientific content of the research, rather than its funding.”
“Our intention with these publications was to provide the nicotine and tobacco research community -- as well as the broader public health community -- with the opportunity to evaluate the research for themselves,” the letter states. “All of the papers were subjected to the journal’s standard peer-review and editorial process and we believe the underlying science is strong. The research contributes to the understanding of vaping products and their role in public health.”