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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now let's take a look at one of the most fraught subjects in public health these days, vaping. You might say, there's a guava, ice-scented cloud of mystery surrounding vapes right now due to how little time they've been on the market. It feels like vaping has been around a while, but it's still relatively new and studies are still emerging on the health effects. Questions like, are they safe at all? What are the long-term consequences of regular usage? What exactly are we ingesting here? All swirl around without solid answers.

Nevertheless, the stat that I've seen is that 1 in 20 people vape in this country, despite lacking information about how this habit might affect their health in the future. For some, this statistic is a beacon of hope though. Cigarette smoking is down in the United States, and if vaping is helping adults quit that and younger people not to start, it's likely that millions will avoid premature death by making that particular switch. For others, the rise of vapes represents a new crisis, like for teenagers who can't resist blowing fruity flavored o's, if you know what I mean.

According to the FDA, about 2.8 million youths are using tobacco products, and no surprise here, e-cigarettes are now by far the most favored. Today, Audible and Prologue Projects are releasing a new podcast called Backfired: The Vaping Wars, taking listeners right into the storm of the debate and through the rise and fall of the company that started it all, Juul. J-U-U-L. Juul. Here's a one-minute sample from this series.

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Leon Neyfakh: You know the Cambrian explosion that's responsible for all the world's biodiversity, that's where we're at with nicotine vapes right now.

Speaker: Juul is not cool anymore. It's the Puff Bar.

Arielle Pardes: Elf Bar and Escobar.

Speaker: It's almost like we just can't stop this.

Arielle Pardes: This is not just a story about an industry gone wild. It's also a story about what we've come to think of as the vaping wars.

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Leon Neyfakh: On one side, there are those who think vaping is a scourge on our society and a mortal threat to young people.

Speaker: We didn't predict an epidemic of e-cigarette use among teenagers.

Speaker: They're coming home and they're saying, mom, I want to vape.

Arielle Pardes: On the other, are those who believe it's the best hope we have to help millions of adult smokers quit cigarettes?

Speaker: First puff, I knew that I was going to quit smoking.

Speaker: This is it. This is the dream.

Brian Lehrer: So joining me now are the hosts of Backfired: The Vaping Wars. Journalist, Leon Neyfakh and Arielle Pardes. Welcome to WNYC, Leon and Arielle.

Leon Neyfakh: Thanks for having us.

Arielle Pardes: It's good to be here.

Brian Lehrer: Leon, I'm going to start here because I know you have a personal stake in this investigation. Here for our listeners, is another clip from the show that starts with your voice.

Leon Neyfakh: I've tried the air bar. I've tried elf bars. I've tried Esco bars. I've tried Miley's, and I like them. I hate how much I like them, and I hate how hard it is for me to stop using them. I bought one this morning.

Arielle Pardes: Why did you buy an air bar this morning?

Leon Neyfakh: Because my air bar died last night.

Arielle Pardes: You know that's not what I meant.

Leon Neyfakh: [laughs]

Brian Lehrer: That's the two of you. You want to just continue that conversation, Leon?

Leon Neyfakh: Yes. I was a smoker starting in college. Both my parents smoked. My father died very young of lung cancer, and yet I just kept smoking all through my 20s and even a little bit into my 30s. One day I discovered the Juul. I think it was around 2016 or 2017. They came in a couple of different flavors like mango. I just started vaping my head off as did all my friends who were smokers, and suddenly we weren't smoking anymore. I was very happy Juuling. Pretty quickly, I realized that I was juuling so much and doing it all the time, everywhere.

At work, on the train, in bars, that I realized I was way more addicted to nicotine than I'd been as a smoker. That felt confusing to me. That made me wonder whether I had solved a problem or created a new one.

Brian Lehrer: Have you come to answer that question for yourself?

Leon Neyfakh: Somewhat. Yes. I don't want to spoil anything, but I also can say that I am still addicted to nicotine. The truth of the matter is when I am vaping, when I have a vape in my pocket, I don't smoke. Then I get into the cycle of quitting the vape because I think, I can't keep doing this. I can't be this person who's walking around with a watermelon ice plastic toy and sucking on it like a fiend. I just can't keep doing this. I quit and I don't do anything for a while or maybe I have the patch. Then eventually I bum a cigarette from someone or even in some cases I buy a pack of cigarettes and then suddenly the cycle starts again.

I just didn't know if I was torturing myself for no reason. I just wanted to know what I was supposed to be doing and also where this thing had come from that had taken over my life.

Brian Lehrer: Right. Arielle, one of the questions for Leon and a gazillion other people is, does it matter from a health perspective? If he's not smoking cigarettes, which we know is a good thing, if he's addicted to nicotine and has his vaping device with him a lot and is hitting on it a lot, from a health perspective, does that really matter?

Arielle Pardes: I think that is the $1 million question. I will say that when I started this project, I had much less conflicted views about vaping. I was convinced that it was bad, full stop. I was really surprised through our reporting process to find that there's a very convincing public health argument around harm reduction, which is to say that if you are a cigarette smoker and you switch to vaping that is a net positive. It just is. There's amazing research published in places like the Cochrane Review that has looked at meta-analyses of over 80 studies that shows very convincingly that the harm reduction argument is true.

For someone like Leon, you could say that if you're vaping, and that means you're not smoking, that's good. We know that smoking is deadly. It kills something like 400,000 Americans every year, and so if--

Leon Neyfakh: It's the worst, there's nothing worse.

Arielle Pardes: There's nothing worse than it. On the other hand, we don't really know what the long-term effects of vaping are. We had one physician in our series describe the tension here as the devil you know versus the devil you don't. We know that cigarettes are deadly. We don't really know what the long-term health effects of vaping are, but we do know that, at least compared to cigarettes, it is the preferred option.

Leon Neyfakh: I think it's important to note one thing we don't know is, what does it do to one's body to be ingesting so much nicotine for so long? Because I think it's not maybe universally true, but for most people who switch to vaping from smoking, they just end up taking in so much more nicotine, especially with these new disposables that are way stronger and have way more nicotine per hit. We don't know what happens to a person who ingests that much nicotine for 40 years or something. Those studies just haven't been done.

Brian Lehrer: Listeners, vapers out there, former smokers, Juul users, although I don't think there's Juul anymore.

Leon Neyfakh: No, there is.

Brian Lehrer: There is?

Leon Neyfakh: Yes.

Brian Lehrer: Oh, okay, but we're going to talk about the rise and fall of that company. 212 43--

Leon Neyfakh: They fell, but not all the way.

Brian Lehrer: 212-433-WNYC. Tell us a story or ask our guests a question now that they've got this new podcast series called Backfired: The Vaping Wars. Journalists Leon Neyfakh and Arielle Pardes. 212-433-WNYC. 212-433-9692. Call or text. Arielle, originally, I gather you both thought this would be a podcast solely about Juul, right?

Arielle Pardes: That's exactly right. I've spent most of my career working as a tech journalist covering the biggest companies in technology. For me, Juul was this very interesting story of like an Icarus that flew too close to the sun. This company was at one point worth $38 billion. That's about as much as Ford Motors. Within just a few years, that valuation dried up and it became public enemy number one in the United States. That story was very interesting to me on its own, but actually even more interesting is what happened after, which is to say that in the years that the FDA and states and cities and parent groups and teacher groups were waging their war against Juul, the market was basically wide open for new companies to come in and create products that are completely unregulated and in some ways much scarier than Juul.

The second half of our podcast is all about the rise of these disposable companies that do not have anyone following what's in their products, how they're marketed, what flavors they use or where they show up. I think there's an interesting lesson there in focusing too much on Juul. In some ways, regulators left the door wide open for the industry that we have now today, where the vast majority of vapes you see on shelves are completely illegal and completely unregulated.

Brian Lehrer: As a non-vaper, I'm going to admit my ignorance in not knowing the difference quantitatively, qualitatively, between Juul and some of these other products that you just mentioned.

Arielle Pardes: I'm not a vaper either. We'll let Leon describe from his personal reporting experience.

Leon Neyfakh: I think one important difference is that the Juul is a cartridge-based device, and that means the actual liquid containing the nicotine is in a disposable pod. You buy the device and then you buy pods, and then they run out and then you buy more. The reason I mentioned that, is that when the government made a move against flavored vapes under President Trump, they left a loophole in their law. They said that cartridge-based flavored vapes were no longer allowed and could not be sold, but they left it open. A company that doesn't use a pod that just puts their liquid in the device itself and that you can just throw away when it runs out, their road was free and clearance.

Brian Lehrer: Was that an oversight because they didn't think about that alternative delivery system? Was it something more calculated to protect a certain end of the industry?

Leon Neyfakh: I think different people would say different things, but it does seem to me, and I think to us both, that loophole was left there as part of a compromise that Donald Trump made. He initially was very excited to ban flavored vapes because he thought it was like a total winner of an issue. Like suburban mothers, whom they were trying to woo, would love this strong position against--

Brian Lehrer: Right. Because all these flavors that you've referred to so far in this conversation, they really sound like candy flavors being targeted at kids.

Leon Neyfakh: Yes. He thought it was a winning issue. He was very excited about it, and then he quickly realized that there was actually a pretty real constituency of adult former smokers who were going to treat this as a single issue when they went to the polls. His advisor got spooked about alienating these adult smokers. I don't know exactly how it happened, but I suspect that loophole was related to a desire to soften the initial flavor ban.

Brian Lehrer: Arielle, here's a science question that I don't know if you can answer from a listener who writes, "Does vaping create more intense, heat in the lungs than cigarettes? If so, isn't that really dangerous?"

Leon Neyfakh: I don't know.

Arielle Pardes: What a great question. The harm from smoking is indeed caused by burning the tobacco leaves, which creates tar that builds up in the lungs. Vaping doesn't work exactly the same way. I'm not 100% sure that I can answer this without full medical authority. My understanding of the scientific literature is that you're not getting the same buildup of tar in your lungs or the same burning of carcinogens as you are when you're smoking a cigarette. That said, vaping does have some chemical byproducts that are produced by heating them up.

Leon and I had this question when we started the show, which was, "What exactly is in these vapes?" Particularly, the disposable ones that are completely unregulated. The FDA hasn't looked at any of their scientific literature. We did a little experiment, which you can hear about on the show, which is that we took five disposable vapes that we bought at a vape shop in Los Angeles, and we took them to a lab to get tested. The lab not only tested the vape liquid itself, but actually what happens when you inhale it. There's this amazing smoking machine that mimics the process of inhaling a vape.

That lab found that there were some chemical byproducts produced by vaping things like Elf bars that included trace amounts of formaldehyde and acetaldehyde, which are both known carcinogens. Now, these were found in very, very small trace amounts. I don't want to alarm anyone, but it is true that by heating up any kind of chemical, you are exposing your lungs to things that wouldn't necessarily be in fresh air that you're breathing.

Leon Neyfakh: Arielle and I had very different reactions to the numbers that the slab shared with us, because you hear formaldehyde, your eyebrows go up. Then he tells you that the amount of formaldehyde is so minuscule and so far below the limits that OSHA says are safe. Do I need to worry about this just because it's called formaldehyde and that sounds scary?

Brian Lehrer: Bob in Hopewell is calling in and saying he's a scientist who follows FDA notices. Bob, you're on WNYC. Hello.

Bob: Hi. Hello. I follow the FDA warning letters for really bad quality of adulterated products. A large number that I see on a weekly basis, off of vaping companies, there's a whole slew of different quality issues. I just wonder how a user could figure out that their vaping company that they're using has good quality. It's really bad.

Arielle Pardes: Absolutely. The warning letters are part of the FDA's enforcement strategy to try to eradicate all of these illegal vapes that are on store shelves really everywhere in America. I think if you are looking to buy a vape and use a vape perhaps for reasons that Leon described, to prevent yourself from smoking a cigarette, the best bet would be to use one of the products that is authorized by the FDA. The FDA has reviewed literally millions of applications for different e-cigarettes, and it's approved just 23 products. They're all tobacco flavor.

You could go to one of those products and at least you have the stamp of approval from the FDA. Again, it's a very, very small fraction of what's actually on the market. There are a small number of e-cigarettes that the FDA has said, "These ones pass muster and the benefits outweigh the risks."

Brian Lehrer: Let's talk more about Juul, because in the podcast you trace the start of Juul skyrocketing popularity at the beginning of the vaping era to a 19-year-old's party in New York City. It reminds me of the beginning of hip hop that we talked about last year for the 50th anniversary. It was one party in the Bronx. Take us to this party. How did Juul tap into the power of early influencer marketing and what happened at this particular event?

Leon Neyfakh: Juul was in the process of introducing the world to their product. They had been working on different iterations of it for years at this point. None of the earlier efforts had really delivered the kick that they needed nicotine wise. None of them were satisfying to the people who were trying to use them to not smoke. Finally, they figured it out. They designed a beautiful sleek product that they were excited to tell people about, and showed it off. They did so through a number of marketing moves, I would say. There was some advertising, there was a billboard in Times Square, there was a print ad advice, I believe.

Also they threw parties. They threw parties all over the country in influencer-heavy markets. In New York, one of the important things was to get the right people there. We interviewed a young-- Actually, you mentioned with the Hip hop, she's a rapper, Tabby Wakes. She was like classic New York cool kid who threw her own parties for her high school friends, and was just an early self-made promoter. Someone she knew, who knew the people who were planning the Juul Launch party got in touch. They paid her $200 to show up and bring all her friends, spread the word.

It was really great for them because these kids made it look really cool. I think for Tabby Wakes, it was the beginning of an addiction. She and her friends came home from that party with pockets full of free pods. Then they went to college in some cases and gave their new friends some. We say this in the show, but it was viral marketing as God intended it.

Brian Lehrer: Now, Juul is on the decline, and you were able to interview James Monsees, the former CEO of Juul on the record for the first time since his departure from the company, I understand. Here's a particularly striking excerpt of that interview with his reflections on the very public downfall of the company. This is 42 seconds.

James Monsees: I see the story of Juul in large part as a microcosm of a lot of America. It is capitalism. It is addiction. It is regulation. It is advocacy. It is shouts and lies and manipulation. It is everything. I view it something of an extreme reflection of just the complexity of making change in a longstanding industry, in particular in the United States today.

Brian Lehrer: That is a really poignant clip. Leon, we could apply it to so many things, right? We could apply it to fossil fuels. We could apply it to defense contractors and foreign policy. We could apply it to education. How did you hear James' analysis of what happened with Juul in the context of what America is about?

Leon Neyfakh: I think for him from, where he's sitting, Juul got a really unfair rap. You can hear it in his voice. He feels, I think, that all these forces lined up against Juul and didn't give them a chance. Were reflexively skeptical about their intentions, saw them as Silicon Valley entrepreneurs who just wanted to make a name for themselves and had chosen this field, the same way their colleagues at Uber and, and wherever else had done. I think James maintains that their mission was to get people to stop smoking. I've wondered to myself, should I be more cynical about him saying this?

My conclusion, in part through sitting with him for four hours was, that sure the guy wanted to make money doing this, but I think he really saw a market for people who wanted something that would help them quit. He saw that there were millions of people who smoked and who weren't able to get off cigarettes using what was already out there, like the patch and lozenges and so on. I do think they wanted to help people quit smoking. I think he feels like all these powers that he ticked off in that clip you just heard, they've all lined up around, encircled him, and encircled Juul and didn't give them a chance to the detriment of the people that are still smoking cigarettes.

Brian Lehrer: Although I'd say probably without having done a scientific study and the ongoing battle between capitalists and regulators, the capitalists more often win. He thought the regulators won in this particular case, and the advocates. Listener writes, "As a physician, I am concerned that a number of young never cigarette smokers have significant lung damage from burning the solvent that the nicotine or flavoring causes when they inhaled so hot that needs much more study." Writes one physician. Rob in Brooklyn, you're on WNYC. Hi, Rob.

Rob: [unintelligible 00:22:53].

Brian Lehrer: Rob, are you there?

Rob: [unintelligible 00:22:58].

Brian Lehrer: That's okay. Rob's having a conversation with somebody off air. He's allowed. Let's try Jacob in East Harlem. You're on WNYC. Hello, Jacob.

Jacob: Hi, Brian. Thanks for having me on. Going off of your last point, I was not a regular smoker neither was my wife. A couple years ago, maybe a decade ago at this point, we were introduced to the Juul via her aunt. It was a thing where it was like, "Vapor is safe. Nicotine is actually okay. It's actually just the smoking that's bad for you." We vaped for a number of years. I don't anymore, and neither does she but all my friends do. None of them were previous smokers. A lot of them use pouches now, or gum, they're full on addicted to nicotine, and they were never smokers.

I'm sure it's great on the public health level to get smokers away from cigarettes, but there's this whole new constituency of nicotine users that were definitely introduced through vaping. The Juul in particular too. That was the first thing that we were introduced to. I don't know if your guests can comment on if there's any studies on long-term nicotine use, what does that say? Also I've heard that what is a secondhand vapor is potentially worse than secondhand smoke. I don't know if that's true, but because of how far the small molecules can travel. I don't know if that was based in any sort of science or if that was just something someone said to me. Just an interesting note there.

Brian Lehrer: Thank you. I think these are the questions that you're raising in the podcast that you say cannot be answered yet, right?

Arielle Pardes: I think this is such an important point. I'll just say in response, if you went back 15 years and you talked to anyone in public health, and you said, "There's a device that's going to get smokers off of cigarettes," many people would've said, and in fact did say, "Amazing. Hallelujah. This is the solution." Of course, that's not how people in public health respond today. It's one of the most polarizing issues in public health because of exactly this tension, which is that for some people it's lifesaving, and for other people it's the start of an addiction.

We actually heard Scott Gottlieb, who was the FDA commissioner from 2017 to 2019, say very explicitly that he wasn't willing to accept this trade off of a new generation of young people getting addicted to nicotine in exchange for saving some smokers' lives. That continues to be how the FDA thinks about this today, which is that it's not a fair trade off. From a regulatory standpoint, it's not worth it. That's where the debate lies though, of course. How can you try to balance the scales between a generation of people who had no addiction before, and now they do, and a generation of people whose lives are in danger by continuing smoking cigarettes?

Brian Lehrer: One more call. Debbie in Sussex County in Jersey, you're on WNYC. Hi, Debbie.

Debbie: Hi. Your guest had said earlier that his own father passed away at an early age indirectly or directly because of smoking. I have a 30-year-old son who went from cigarettes to vaping and now has an addiction to nicotine. The thing about smoking-- I am a non-smoker, but I intellectually can understand that most people who smoke that I know do it as a way to relieve tension, to soothe anxiety. I used to joke that if you just took a pencil, put it in your mouth, breathed in, breathe out several times with a dummy cigarette, you'd almost have that same experience, which I know is simplistic.

I wanted to ask your guest. I would be in fear of my life seriously, if I were to start smoking or vaping today because of the dangers of smoking and of nicotine addiction. I know my son, who does have anxiety, almost can't quit the vaping, but along with it being I think physically harmful and psychologically harmful, where do these young people get the money to buy these things? They're very expensive. I couldn't--

Brian Lehrer: Debbie--

Debbie: I couldn't have an addiction like that if I wanted to.

Brian Lehrer: Thank you very much. All right, Leon, how, how expensive is your habit?

Leon Neyfakh: It fluctuates. I would say with my experience, I do worry that quitting through vaping simply extends the danger zone. It means that I'm continuing to live with this nicotine addiction that's always threatening to get me back on cigarettes. In an alternate universe where perhaps I was stronger or perhaps one of these other cessation devices worked better for me, or if I didn't like smoking as much as I do, I would be able to quit another way. It would be better to quit another way. I think most doctors would tell you vaping is not the first line of defense. Try these other things. If you can kick nicotine, do. To the earlier caller, I would say, if you don't smoke, you don't vape. No one would disagree with that. I think that's just--

Brian Lehrer: If you can avoid it.

Leon Neyfakh: Yes, but then just since your caller mentioned my father, I find it quite likely that if Juul had been invented when he was in his mid-20s, which is how old I was when I was smoking, he might have not died at 47 years old of lung cancer. Maybe he would've turned out to have other issues from a lifetime addiction to nicotine, but they would be different problems, I think.

Brian Lehrer: We're going to leave it there. My guests have been the hosts of the new podcast Backfired: The Vaping Wars. They are journalists, Leon Neyfakh, and Arielle Pardes. You can hear the podcast starting today on Audible. Thank you for sharing your stories with us. In your case, Leon, some of your true confessions. You really struck a nerve out there with a lot of listeners, and I think this conversation was really useful for folks. Thank you very much.

Leon Neyfakh: Thank you so much for having us on.

Arielle Pardes: Thank you so much.

 

 

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