After rapidly becoming a household name in the world of e-cigarettes, vape company Juul’s infamous flame-out is now seen as a cautionary tale for public health and industry interests alike.

Founders of the Silicon Valley startup said they developed the product as a safer alternative to cigarettes. The idea echoed arguments that promote vaping to help smokers quit, though research on e-cigarettes’ harms and efficacy as a cessation tool is far from settled. But as Juul went on to become a multi-billion dollar corporation partly owned by tobacco giant Altria, it was widely blamed for getting large numbers of teenagers hooked on nicotine.

Juul is now fighting for its future as it faces a host of legal, regulatory and business challenges. The boom and decline of the e-cigarette company is the subject of a new four-part Netflix docuseries based on the book “Big Vape: The Incendiary Rise of Juul” by journalist Jamie Ducharme. 

The Examination spoke to Ducharme about public health lessons learned from Juul, its impact on the tobacco industry, and what’s next for the controversial company. 

When did you first start reporting on Juul and why? What stood out to you about the company?

I started reporting on Juul for Time Magazine, where I'm a health reporter, in about 2018. This was the time when Juul was really beginning to take off among teenagers. We were getting a lot of interest and concern from parents who were trying to figure out: What is this thing? What effect is it gonna have on my kids? Why are they doing this all of a sudden when they never smoked? At the beginning, my coverage was pretty squarely focused on just what is this thing, what's going on and what's the science behind it? And then I became more interested in the business story and the story of the company's evolution over time. That's what I explored in the book and now will be explored in the series as well.

Your book offers a deeply reported portrait of the company since its beginning. Of everything that you found, what do you consider the most revealing about the company’s inner workings? What surprised you the most?

I found it quite revealing to watch the thesis presentation that [Juul founders] James Monsees and Adam Bowen made when they were design students at Stanford, which is where they got the idea for the product that eventually became Juul. When you watch that presentation – which you can find on Youtube – they're very direct about what they're trying to do, which was in part to design a replacement for cigarettes that was not going to kill you and was safer. But it was also an effort to recreate the cigarette because they were both smokers who wanted to quit because they didn't want to die, but they enjoyed smoking. So, at the very beginning, part of their goal was public health, but it was also a business opportunity and just an interesting design challenge for them. Knowing that shaped how I viewed the company's evolution.

Could you elaborate on how the founders’ pitch shaped your view?

When a lot of teenagers started using Juul and there was all this scrutiny on the company, they would come back with this party line that all they had ever wanted to do was create an alternative for adult smokers and that health was their top concern. And definitely those were values from the very beginning. But in listening to them talk about the size of the business opportunity and the things that they loved about cigarettes that they wanted to recreate in an e-cigarette made me see that the origin story was actually more complicated than this neat sound bite that the company would promote.

As you said, Juul’s founders said that the goal was to help smokers quit by using their product. So how did they explain launching a marketing campaign that appealed to teenagers? And why didn't they apply to get the product authorized by the U.S. Food and Drug Administration?

Well, when they first launched Juul, there was no way to apply for that kind of authorization from the FDA, which is, you know, a huge problem and a huge element of the story, which is that the market really got out ahead of the regulation. The FDA was caught flat-footed because these new products were rapidly coming to market, getting very popular, and yet regulators didn't have any procedure in place for evaluating their health effects. Juul actually couldn't have applied for that authorization right away. But at the same time, I think it's very fair to say that their marketing approach was deeply flawed. If you've seen their early campaigns, they were selling it as a cool lifestyle accessory. They were not selling it as you would expect the company to sell what's supposed to be a tobacco product. So I think that is one of the company's biggest mistakes: that they did not approach marketing and sales with the gravity and responsibility that they should have.

And the justification Juul gave was mainly that they didn't know the marketing campaign would appeal to teenagers, right?

Yeah, largely. They've denied very passionately for years that they meant to hook teenagers. They've just basically said that that was never the intention and that the intention was always to have that campaign appeal to adult millennial smokers, people in their 20s and 30s. But clearly history shows that that was not the effect.

The FDA has a process to authorize drugs that help people quit smoking, like nicotine patches and nicotine gum. Could they have chosen to go through that process? Did they ever say why they didn’t go that route?

I guess you're right. They could have if they wanted to. The FDA created a new regulatory pathway for e-cigarettes that did not exist then, but I guess if they had really wanted to, they could have gone through the process of applying for approval as a smoking cessation device.

I don't know for sure, but my perception is that that's just a more complicated and rigorous regulatory step and because they didn't need to do that, because the e-cigarette process hadn't been finalized, it was probably easier to just not. But that's my own perception. I can't say that with absolute certainty.

Do you know how strong Juul’s research was into whether e-cigarettes could be effective as a way to help smokers quit and about its risks when they started to launch the product?

When they started they had very, very little research. The founders were product design students. They were not med students or public health students. So they were not really equipped to be doing the kind of longitudinal long-term research that you need to assess the health effects of a product. Now that the company has been around for a while and they have more employees, more of that work has been done. But at the beginning, it was an educated guess. They had consulted with people in public health, but they really did not have as much research as you would think and probably would hope they would have to be selling something that you inhale into your lungs.

What do you feel was Juul’s most significant impact on the vaping industry?

I think that Juul, in a lot of ways, created the vaping industry as we know it. Because prior to Juul taking off, there were many e-cigarettes on the market, but none had gotten super popular. Many of them were not that easy to use, or they looked dorky and they weren't cool. People didn't like them that much. Juul was the first e-cigarette that really had mass appeal. What I find so interesting about this story is that if they had handled that better, if they had understood how to responsibly sell and market and research this product, that could have been a good thing for public health. Instead they didn't, they sold it and marketed it in the way that we saw, and it spiraled out of control and became popular with teenagers. 

What do you think was Juul’s most significant impact on the tobacco industry?

As e-cigarettes started to become popular, I think that traditional tobacco companies realized that if they didn't have a piece of that market, they were going to get left behind. So I think that Juul becoming as big and as popular as it did lured tobacco companies into this space. I think most people in public health do not think this conflict of interest between old cigarettes and e-cigarettes is a great thing for the industry. Some of that would have happened regardless of Juul. But I think Juul’s massive popularity made it very hard for traditional tobacco companies to not want to get a piece of that market.

Fast-forward a few years now, Juul Labs nearly had to file for bankruptcy in 2022 and it's unclear whether it will be able to legally sell its products in the U.S. Tobacco giant Altria disinvested from the company this year and rechargeable e-cigarettes face competition from disposable devices. 

What do you think are the main factors that will determine Juul’s future?

I think it all rests with the FDA. As you know, the FDA originally said that Juul had not provided enough data to make the FDA comfortable leaving it on the market. They said there were too many questions about its toxicology and health effects. Juul appealed that decision and, for the last year or so, has just been on the market in this limbo state where the FDA is redoing its review but hasn't made a decision yet. 

At this point, Juul has tried to expand into other countries, and largely those efforts were not very successful. So if the FDA decides that Juul cannot be sold in the U.S., I think it's unlikely or at least very difficult to imagine Juul continuing to exist the way it does now.

What do you think are the lessons learned from the rise and fall of Juul? 

I think the biggest lesson is that the way you sell your product and the way that you describe your product to the public matters immensely. To some degree, the way people perceive the product and the people that it attracts are almost more important than the product itself. 

I think Juul is a perfect cautionary tale of when the desire to make money, to grow as a company and to become popular outweighs the responsibility that any company has, but especially a company selling something that can have such a profound impact on your health.

Juul has reached legal settlements with different states’ attorney generals that require them to make internal documents available to the public.

What unresolved questions might these files be able to answer? What are you most interested in learning from them?

I'm interested in all of it, but something that is still hard to wrap my head around is the idea that the company truly couldn't have guessed the way that its marketing and sales campaign was going to appeal to teenagers. It's possible that they truly didn't know or that they underestimated that possibility, but it's hard for me to accept that. So I would be very interested to see more documents from that time to further elucidate their thinking. I'm also interested in any early studies or science that they did because much of that has not been published, but I'm sure it exists.

Is the new Netflix docuseries going to bring any new reporting compared to what’s in your book?

They bring in a lot of new reporting because many of the people who I interviewed for my book were not comfortable going on camera. So the documentary team had to do a lot of their own reporting and they interviewed people who said no to me or who I couldn't get to, which is a great thing because it brings in an even wider variety of perspectives. And they had more time to work on it. I finished writing in, I think, the beginning of 2021, and they picked up on the story from there. So they were able to take us a little closer to the present day than I was able to in my book.

This interview has been edited for length and clarity.