Why Big Tobacco’s investment in e-cigarette maker Juul ought to alarm you

By Dr. John Maa, Special to CALmatters

For years, I tried to convince my uncle to stop smoking. I watched as he lost one tooth after another from tobacco-related oral health disease.

He’d tell me to stop worrying, that he was not one of the people who would get sick from smoking.

In time, he needed urgent open-heart surgery and a valve replacement, spent a month in the hospital recovering, and finally stopped smoking.  He became a better statistic – a former California smoker who finally quit and returned to good health.

His story is one example of the power of nicotine addiction. As a general surgeon, I’ve seen others struggle to quit. I worry many more are being addicted today by a different delivery system, e-cigarettes.

There’s an unprecedented epidemic of vaping among teenagers, as recognized by U.S. Food & Drug Administration Commissioner Scott Gottlieb and U.S. Surgeon General Jerome Adams. The federal government is moving to limit the sale of flavored vaping liquids in convenience stores nationally.

My concern was heightened when the company that brought America the “Marlboro Man” bought a 35 percent stake in the leading vaping company.

First, a little history: In October 2018, Altria, the world’s largest cigarette maker and a source of tobacco-related health harm worldwide, announced it was alarmed by the epidemic of youth e-cigarette use, and would end sales of its e-cigarette product, Mark Ten. It claimed it did not want contribute to “the issue.”

Two months later, Altria made a hedge bet by investing nearly $13 billion in Juul, the market leader in vaping products. In exchange, Altria secured a 35 percent stake in Juul and seats on Juul’s board of directors.

This deal enables Altria to profit regardless of whether combustible or electronic cigarettes ultimately dominate the nicotine delivery market. It also allows Juul to expand its market share.

Now, shelf space reserved for Altria’s Mark Ten product is available for Juul. Altria also can offer Juul global distribution, not to mention its lobbying and legal expertise in dealing with FDA regulators.

Altria members on Juul board of directors have a commitment to shareholders. That will present a conflict of interest in discussions of the necessary research into Juul’s safety that might impact future combustible cigarette sales.

It must have been a rude awakening for the Juul employees, some of whom had begun their careers in tobacco control. They joined the firm to research solutions to end the smoking epidemic, and not to be part of Big Tobacco.

After Altria swooped in, Juul paid $2 billion in bonuses to its employees to persuade them not to leave the company.

In 1998, Altria’s Philip Morris signed on to the Tobacco Master Settlement requiring tobacco companies to pay states more than $200 billion to help cover the cost of tobacco-related disease. California was a party to that suit.

Two decades later, smoking remains the leading cause of preventable death and disability in America and worldwide. Public health experts understand that it’s a short step from vaping to smoking. That’s why we must act before e-cigarettes hook the next generation to nicotine.

California Attorney General Xavier Becerra should work with the Federal Trade Commission, the US Surgeon General, and the Food and Drug Administration to ensure the Juul-Altria partnership complies with all existing laws, and work to end the vaping epidemic among teenagers. The health of a future generation depends on it.


Dr. John Maa is a general surgeon in San Francisco, [email protected] He wrote this commentary for CALmatters.

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