A prominent nicotine researcher who has maintained he is independent from the industry was paid by vaping giant Juul to lobby Israel’s health ministry over a ban on high-strength e-cigarettes.

Greek cardiologist Konstantinos Farsalinos was paid 7,000 euros (about $8,100) by Juul via a company he co-owns, according to Juul emails reviewed by The Examination, Le Monde and Reporters United.  

In return, Farsalinos attended a July 2018 meeting with the Israeli health ministry to argue against a proposed ban on high-nicotine vapes. Juul had recently launched its high-strength vape cartridges in Israel after their success in the United States, despite criticisms that such products were driving a youth vaping epidemic. 

Farsalinos’ business-class flights and hotel accommodations for the trip to Israel were also funded by Juul. But he represented himself to government officials as an independent researcher.  

Farsalinos did not disclose the payment to scientific journals that later published his research on vaping or nicotine, even though those journals require such disclosures.

After being contacted by The Examination and its partners, one journal and three journal publishing companies launched investigations into his lack of disclosure.

In a written statement to The Examination and its partners, Farsalinos denied acting on behalf of Juul or any company and said he made it clear to both Juul and Israeli officials that he was speaking as an independent expert. He described the meeting as an “honest discussion presenting scientific evidence,” not lobbying. 

Farsalinos said the payment covered his time, which involved “abandoning” his family in the middle of summer. He argued that the payment did not constitute a conflict of interest because he has never conducted research on Juul products, has never represented the company and has no ongoing relationship with it.

But science history and academic research experts told The Examination that such payments should be disclosed. Journals require researchers to fill out conflict-of-interest declarations so readers can assess potential bias. This is particularly important in a field where the health risks of vapes are contested and billions of dollars in profits are at stake.

“There’s no bigger corrupter of academic integrity than big nicotine,” said Robert N. Proctor, a professor of the history of science at Stanford University. It is not possible to maintain independence while taking money from industry, he said, and regulators would be more skeptical of experts' views if they were aware of industry payments.

Industry doesn’t pay just anyone, he said: “They give it to nicotine friendlies.”

A prominent advocate of “tobacco harm reduction,” Farsalinos promotes public health strategies based on switching smokers to other nicotine products such as vapes. 

As the tobacco industry expands beyond cigarettes, companies such as Philip Morris International and British American Tobacco have developed marketing and lobbying strategies that position their products as harm reduction tools. 

The World Health Organization, however, has warned that tobacco companies have co-opted “harm reduction” to hook a new generation on nicotine as cigarette sales decline globally. The latest WHO figures show that more than 15 million children aged 13 to 15 worldwide vape. 

Present in vape liquids, nicotine is highly addictive and has been linked to an increased risk of heart attacks and damage to the developing brains of adolescents. 

Other quit-smoking methods, such as the prescription drugs varenicline and bupropion, are effective and lack some of the health risks associated with nicotine products. 

In recent months, Farsalinos has lobbied against regulation of e-cigarettes in the European Union. In September, he helped organize a letter signed by 83 health experts and harm reduction advocates urging European Commission President Ursula von der Leyen to reconsider a proposal to require all EU countries to tax vape liquids at a minimum rate.

Farsalinos has published more than 100 academic studies, mainly on vaping and nicotine, some of which have been used by the vaping industry to promote its products and fight regulation. 

During the coronavirus pandemic in 2020, he published a study suggesting that nicotine may protect against severe COVID-19. Though the study made headlines worldwide, subsequent research has shown that smoking actually increases the risk of severe illness and death from COVID-19. Judges cited Farsalinos’ study when ruling in favor of British American Tobacco in a legal battle over a pandemic smoking ban in South Africa.

Farsalinos has told media outlets that he has never done advocacy work for the industry and has not received industry money. He previously described a Le Monde investigation into his links to the vaping industry as a “witch hunt.” 

Paid 7,000 euros to appear as an independent expert

The emails describing Farsalinos’ dealings with Juul are buried in a trove of documents released as part of settlement agreements between the company and several U.S. states and the District of Columbia. The documents were posted online at the Industry Documents Library at the University of California, San Francisco.

Juul approached Farsalinos in June 2018, asking him to appear before Israel’s Ministry of Health in Jerusalem, an email shows. In light of the youth vaping epidemic in the U.S., the Israeli government was considering banning vapes that had a nicotine concentration of 59mg/ml. Juul was allowed to sell vapes with that concentration in the U.S., while the EU’s cap was 20mg/ml. 

The EU had used some of Farsalinos’ research to justify its cap. Farsalinos later wrote to the European Commission, arguing his findings had been misrepresented.

Farsalinos responded a day later with a question about the terms of the deal: “Please clarify if you want me to participate to this meeting as a declared Juul representative or as an external independent expert based on my research experience on this matter,” he wrote.

The Juul employee responded and said the company “would appreciate your support” explaining why the EU’s nicotine limit “is wrong.” Farsalinos reiterated his question about the conditions and summarized the argument against nicotine limits: They stop smokers from switching to vapes or force them to consume more vape liquid to get the same nicotine hit.

In a subsequent email, a Juul employee thanked Farsalinos for speaking about the arrangement and asked for a proposal. Farsalinos sent his offer: an “honorarium” of 7,000 euros, business-class flights, hotel accommodation and transportation. Juul agreed to his terms. 

The Greek physician then requested payment through a “Cyprus consulting company” called Merescon Limited and asked Juul to draw up a “short consultancy agreement.” 

Farsalinos appeared at the hearing with Israel’s Ministry of Health on July 5, 2018, along with Juul co-founder and chief technology officer Adam Bowen and staffers in the company’s scientific affairs division and Israeli operation.

Farsalinos presented himself as an independent expert as he argued against the ban on high-nicotine vapes. One of his slides read, “I am not representing Juul or any other company.” His presentation said that the EU limit was “inappropriate” because it reduced e-cigarettes’ potential as a tool to quit smoking.

The meeting would prove to be unsuccessful; the Israeli government introduced its ban on high-strength vapes in August 2018. 

Payment not disclosed to research journals

Juul received an invoice from Merescon Limited three days after Farsalinos' trip. The payment was made soon after, according to a Juul accounting sheet. 

Those kinds of payments must be disclosed to academic journals when researchers submit papers for publication. Journals typically require disclosures of anything that could influence their work, such as research funding or consulting, within the prior three years. 

In the three years after being paid by Juul, Farsalinos published at least 18 papers in journals such as Internal and Emergency Medicine, Toxics, and Nicotine & Tobacco Research.

Told of the payment, those journals or their publishing companies — Elsevier, Springer Nature and MDPI — said they would investigate. “We take all concerns regarding research integrity issues — including potential conflicts of interest — extremely seriously,” a Springer Nature spokesperson wrote in an email.

Farsalinos told The Examination that his research has been independent for several years. He said he received some funding from nonprofit associations in 2013 and 2015 and disclosed them for several years afterward. 

 ‘I think we share a common vision’

Farsalinos and Juul were involved in business negotiations before the trip to Israel, according to Juul documents. In March 2018, Juul approached Farsalinos about a job at the company, emails show. In an email sent around this time, a Juul executive told a colleague that the Greek doctor was being “actively courted by big tobacco.”

Farsalinos was receptive to Juul’s job offer. “I think we share a common vision and common goals, which is an absolute prerequisite for any potential collaboration,” he wrote to the company’s vice president for regulatory and clinical affairs. 

In negotiations with a Juul human resources employee, Farsalinos asked for a full-time salary of 300,000 euros ($350,000) a year. 

He also made an alternative proposal in which he would get 200,000 euros ($230,000) but would continue research that was not “product specific,” as well as advocacy and university public health teaching. That arrangement would have required him to be paid through his consulting company, which Farsalinos said in the email was for “tax reasons.”

Farsalinos reassured Juul that his outside research would not compromise his work for Juul. “Please note that there is a whole team behind these research activities … so I am basically providing guidance and ideas and I don’t spend time doing the studies,” he wrote.

He met with regulators worldwide, he wrote, and some of his research was focused on countries where e-cigarettes face problems. For one study, he wrote, he was surveying vapers in the U.S., which was considering restrictions on flavored vapes. In 2020, the U.S. banned fruit-flavored, pre-filled vape cartridges, such as those sold by Juul. 

“I think all my contacts (National School of Public Health, University of Patras, etc) would be very valuable for Juul, because we can create and coordinate several projects with great potential,” he wrote.

Nothing appears to have come of the negotiations, according to the emails. Informed of Farsalinos’ proposal to work for Juul and continue with his other activities, a company executive wrote, “let’s move on.” 

When asked about Juul’s dealings with Farsalinos, a Juul spokesperson said they took place before 2019, when the company “took a conscious effort to reset its relationship with stakeholders.” It focused on “earning back trust” by “working collaboratively and transparently with regulators, policymakers, and key stakeholders” to advance its mission of moving smokers to vapes.

The company that Juul paid, Merescon, described itself on its website as a “medical research & consulting services” company with “expertise in public health research.” It listed services including analytical testing, population surveys and regulatory assessment. 

After inquiries from The Examination and its partners, those services were removed from the website.

Merescon’s registration documents in Cyprus show the company is co-owned by Farsalinos and Sophia Iliopoulou, a Greek television reporter with her own health show and the mother of his child. Iliopoulou did not respond to requests for comment, but Farsalinos said she is “not involved in smoking or tobacco harm reduction.”

Records show that their company has generated 837,362 euros (nearly $1 million) in revenue since it was founded in early 2017. 

Farsalinos told The Examination and its partners that he established Merescon for “various business activities” that have “no bearing on his scientific, research and harm reduction work.” These include his and his family's business and financial activities as well as those of Iliopoulou and her family, he said. Farsalinos added that the company had “large outbound payments and costs." 

Many businesses incorporate in Cyprus because of its favorable tax rates. But Farsalinos said the company was established there to guard against “Greece’s financial and banking turmoil.” He told The Examination the company “complies with all applicable laws.”