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Back To JUUL
Labor day is over, which means a few things.
- I better not see you wearing white (for some reason)
- Everything you eat will have pumpkin in it
- Kids are going back to school, possibly with JUULs. FDA Commissioner Scott Gottlieb is having none of it.
E-cigarette maker JUUL has been in the spotlight recently as the company has soared to a $15B valuation incredibly quickly. The question is whether this is because it converted tons of cigarette smokers into JUULers, or non-smoking teenagers into JUULers.
This is a very tough question. Part of the trickiness is that people under 18 (21 in some states) aren't allowed to buy JUULs, so there isn't super accurate data around buying/usage in teens and the available data is usually from self-reporting.
Additionally, the company's rise has been so meteoric and the product is so unique (both in form factor and nicotine delivery) that old studies on e-cigarette usage seem outdated. Yet the effects of JUULs on teens won't be understood for many years, so any studies without longitudinal data are not going to be particularly comprehensive either.
Finally, the company highlights a problem with any public health intervention, especially in the addiction space. How do you create products that are low friction to get started so that addicts take the extremely difficult first steps to recovery, but don't make it easy/attractive for non-users to begin in the first place?
JUULs initial ads make the product seem trendy and what the cool kids are doing, of course teenagers are going to be attracted to it! Now the company has a way more somber tone after the scrutiny hit.
(If JUUL needs more input about how to make the product less cool to teens, I think my parents are open to consulting.)
Makin' Paper, Makin' Vapers
So what are the next steps for JUUL? Well the company is clearly aware of its current situation, and is hiring for several roles in the "Scientific Affairs" areas to liaise with researchers and healthcare officials. There's also a role for a Director of Community Engagement and Social Responsibility specifically focused on reducing usage among minors and the company set up a $30M fund to prevent underage use.
But the path forward for the company might actually be more clear from a patent it filed (that's also filled with Teenage Mutant Ninja Turtle references, which is an odd move for a company trying to be less kid-friendly).
For one, JUUL seems to be getting closer to connecting user identity with each unique unit. The patent suggests connecting each unique JUUL to a mobile app with user identity via Bluetooth. Also it suggests it could use the app to make a social network or play games with other users...for some reason...(again, weird choice if it's trying to be less kid-friendly).
The other interesting expansion would be to move to cannabis. The company mentions a White Widow cannabis pod in the patent, suggesting the company could move into other non-nicotine products that are better vaporized.
Regardless of which direction the company goes, it's clear that it's going to be one of the most controversial "healthcare" products of the last 5 years. If you have thoughts about JUUL, I'd love to hear them.
Stay healthy,
Nikhil
@nikillinit
P.S. I'll be speaking next week at Intelligent Health in Basel, Switzerland talking about tech giants, AI, and healthcare. I'm super excited to be speaking alongside such smart people from Novartis, Roche, UNICEF, NHS England, the World Health Organization, and more. Use code CBIN50 to get 50% off the ticket price here: https://intelligenthealth.ai/
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Research Spotlight
A new paper studied where patients are going with low-acuity conditions by looking at claims data from Aetna. The emergency department is slowly being unbundled, particularly by urgent care. Interestingly, while retail clinics and telemedicine have increased, it's been miniscule compared to urgent care.
The data is pretty interesting, and demonstrates that there's still an opportunity to convert lower-income patients into users of urgent care or telemedicine instead of the emergency room.
Either way, this is a good sign. The emergency rooms should be used for actual emergencies and are expensive. Creating more granular spectrums for severity and then providing options for the different layers of severity is good business. There are definitely other areas of healthcare where the options either totally overserve the problem and are incredibly expensive, or aren't adequate solutions without a middle ground. Medical transport is another area that's slowly seeing the creation of a spectrum that falls into this category. I'm sure there are others.
Clients can see other ways the hospital is being unbundled in our Consumerization of Healthcare report.
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CB Insights Hits
A new patent from the tech giant hints at a future of smooth human-robot interactions, where robots continuously learn from human reactions. See the patent.
From exoskeletons to social robots, these companies are bringing robotics to the caregiving industry. See the companies.
Aurora Cannabis has been increasingly active in private markets, making acquisitions, investments, and partnerships across the cannabis supply chain, from seed to sale. See its deals.
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Interesting Reads Of The Week
Alzheimer’s gamble. Jocelyn Kaiser reports on NIH’s recent dramatic increase in research funding for Alzheimer’s disease, which has only ever occurred with cancer and AIDS. While traditional drugs have largely targeted beta-amyloid & tau proteins, new research is targeting other areas as the number of people in the US with Alzheimer’s is estimated to reach 14 million by 2050.
Science Magazine
FDA + medical devices. Meg Bryant explores how medical devices often enter the market without the proper clinical testing and the FDA’s rare use of its authority to recall such devices. Bryant outlines the reasons for how this came to be, starting with the premarket process to how difficult it may to recall once they’re already on the market.
MedTech Dive
Small tweaks to fix healthcare. Margot Sanger-Katz discusses the potential of many small tweaks instead of big solutions to see savings in the country’s $3.3 trillion annual health spending. One way to do this may be to rein in long-term hospitals according to a recent paper, which showed that these institutions generate larger bills with little benefit to the patients.
New York Times
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