Smoke and Mirrors -- and a Black Medical School

Many advocates for African Americans as well as public health experts are questioning the decision of a historically black medical college to accept a $7 million donation from e-cigarette giant Juul. However, the college’s president has said the college knew exactly what it was getting into.

Meharry Medical College in Nashville, Tenn., recently announced the donation from Juul. Meharry president James Hildreth, in an essay in The Tennessean, said that the college accepted the grant with “eyes wide open.”

“We know exactly who we are,” Hildreth said. “We know exactly who we are dealing with. We know exactly what we are getting into. And we know exactly who we aim to serve: the six million African Americans who are smokers, even as we expect to impact a much larger swath of the population.”

With this grant, which will allow the college to open the Center for the Study of Social Determinants of Health, Hildreth said Meharry will be at the “forefront” of e-cigarette research.

Juul has surged in recent years to lead the e-cigarette market, accounting for 68 percent of the market share in July 2018 according to CNBC, and Reuters found one in 20 American adults were using e-cigarettes as of August 2018. The company has butted heads with the U.S. Food and Drug Administration on a number of occasions amid suspicions Juul is encouraging youth e-cigarette use.

Backlash toward Meharry’s acceptance of the grant is based on evidence that black people are more likely than others to smoke and to experience negative health effects as a result. According to the Centers for Disease Control and Prevention, black Americans have a higher risk than the general population of dying as a result of tobacco-related diseases, such as heart disease, cancer or strokes.

The CDC also warns that the tobacco industry has historically targeted black Americans in advertising campaigns, directing larger amounts of advertising toward black Americans than other groups. The CDC specifically said the tobacco industry has attempted to maintain a positive image among black Americans by “making contributions to minority higher education institutions, elected officials, civic and community organizations, and scholarship programs.”

According to The New York Times, Juul has recently hired a number of black leaders to serve as lobbyists within the organization, including Benjamin Jealous, the former head of the NAACP; Heather Foster, a former adviser to President Obama; and Chaka Burgess, who serves on the board of the NAACP. Sharon Eubanks, an advisory board member of the Center for Tobacco Control Research and Education at the University of California, San Francisco, told the Times the idea that Meharry would be able to a maintain independence from Juul was a “fantasy.”

“Juul is cozying up to the black community, and that makes it harder for some parts of the black community to call them out on their targeting of African Americans,” Eubanks told the Times.

The National African American Tobacco Prevention Network has warned against the use of Juul, particularly because Juul offers menthol flavors, which the NAATPN says is more harmful than regular tobacco and disproportionately affects black Americans. The NAATPN fact sheet on Juul use calls on lawmakers to better regulate Juul.

"JUUL e-cigarette has a potent amount of nicotine with 5 percent of nicotine weight which equals the amount of nicotine in a pack of cigarettes or 200 puffs," the NAATPN fact sheet for Juul reads. "A combination of federal, state and local policy options can be pursued to strengthen regulation of Juul and other e-cigarettes."

Hildreth, in his editorial, said he was aware of the public health questions raised by the tobacco industry's philanthropy.

“This scourge on black America is not of black America’s making. Consider: the tobacco industry has intentionally and maliciously marketed cigarettes to minority communities over the past century. It has sponsored our cultural events and our elected officials,” Hildreth said in the editorial. “It has offered attractive price cuts and promotions. It has lured people in -- especially our young people -- with menthol cigarettes, which are considered even more addictive and damaging to health. It has taken our money and delivered sickness and death in return.”

Hilary Shelton, director of the NAACP, told the Times he was glad Meharry accepted the donation and he has faith they will use it well. Shelton also said he spoke with representatives of Juul and believed the donation was sincere.

Hildreth said the college will continue to pursue science and research vital to the health of the black community and protect the college’s autonomy from Juul.

“We at Meharry intend to advance the fight for better health and longer life by turning that insidious relationship on its head,” Hildreth said. “We are taking matters into our own hands with eyes wide-open. We welcome the opportunity to use significant grant monies from Juul to go where the science takes us and to publish those results no matter what we find.”