Doctor-run IJCP Group is ‘unethically’ partnering with e-cigarette maker Juul: public health experts

The Indian Journal of Clinical Practice (IJCP) Group, a doctor-run publisher of medical journals, has come under flak from public health experts for partnering with American e-cigarette maker Juul Labs Inc. Juul, which is evaluating an entry into India, has retained the Group to “better understand the India market,” a spokesperson from the company told The Hindu.

Public health experts say it is unethical for journal editors to have financial ties with an e-cigarette maker, especially since the U.S.-based tobacco firm Altria Group is an investor in Juul. “An editor can have personal opinion…But a scientific journal cannot. Therefore, it is highly unethical for a scientific journal to align itself to any side of a scientific debate,” Prakash Gupta, managing director of the Mumbai-based Healis Sekhsaria Institute For Public Health said.

E-cigarettes, which dispense nicotine by heating a liquid, are a controversial subject. Even though their aerosols are thought to contain fewer carcinogens than cigarette smoke, experts are divided about their safety. India’s Union Ministry of Health and Family Welfare favours a ban, and has advised all States to clamp down on the sales and manufacture of these products. However, some experts say e-cigarettes can be a part of “harm reduction” policies, because they are a comparatively safe alternative to combustible cigarettes.

In January this year, a randomised trial of 886 subjects, published in the New England Journal of Medicine (NEJM) suggested that e-cigarettes were more effective than nicotine lozenges and patches in weaning people off smoking. Dr. K.K. Agarwal, Editor-in-Chief of the IJCP Group cited this study and said, “We are convinced of the science and efficacy of [Juul’s] product in helping adult smokers.” Dr. Aggarwal was previously a member of the ethics committee of the Medical Council of India and national president of the Indian Medical Association.

Far from clear

Others say that despite studies such as the one by NEJM, the benefits of e-cigarettes are far from clear. Their addictive-potential is not understood, and some studies show that they can act as a gateway drug for adolescents. “Until independent large scale cohort studies among smokers and mixed tobacco users of varying intensity prove harm reduction benefits of ENDS (Electronic Nicotine Delivery Systems), the introduction of any new technology is a big risk to public health,” said Sonu Goel, a tobacco-control expert at the Post Graduate Institute of Medical Education and Research, Chandigarh.

Another factor muddying the evidence around e-cigarettes is that the tobacco industry funds several harm-reduction initiatives, leading to worries that it may be distorting data. For this reason, the World Health Organisation said in a statement in September 2018 that any industry-funded research “cannot be taken at face value.” The organisation also strongly denounced interference in public policy by the New-York based Foundation for a Smoke-Free World, an NGO claiming to work on harm-reduction, but funded by cigarette-maker Phillips Morris International. “[Apart from tobacco], we see such lobbying in industries like nutrition, too. Corporate interests come in and cleverly couch themselves as beneficial to people. It is certainly not something a group of doctors should be supporting,” said Anant Bhan, a Bhopal-based bioethicist.

When contacted by The Hindu, three of the doctors named as editorial board members on the ICJP Group’s website denied being associated with it. They included Praveen Chandra, a cardiologist at Gurugram’s Medanta-The Medicity; Vijay Vishwanathan, a diabetologist at Chennai’s M.V. Hospital for Diabetes; and V. Seshiah, a diabetologist at Chennai’s V. Seshiah & Balaji Research Institute & Diabetes Care Centre. Dr. Vishwanathan said, “I have no control over what is written in the journal. They have just put my name and are doing what they like.”