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Erika Sward of American Lung Association Reveals the Dangers of Vaping and IQOS


This Episode's Guest
Erika Sward head shot

Erika Sward

American Lung Association’s Assistant Vice President of National Advocacy

On this episode of the Drugwatch Podcast, our guest is American Lung Association’s Assistant Vice President of National Advocacy, Erika Sward. Sward previously contributed to Drugwatch’s feature on How Juul Created a Teen Vaping Epidemic

Sward joins me to talk about the dangers of e-cigarettes and vaping, and we discuss the risks of a newer heated tobacco product, Philip Morris’ IQOS.   

E-cigarettes work by using an electric heat source to create an inhalable aerosol from liquid containing nicotine, glycerin and a number of other chemicals. IQOS works by heating tobacco at a lower temperature instead of burning it in the way traditional cigarettes do. 

In July 2020, the U.S. Food and Drug Administration allowed Philip Morris to market IQOS as a modified risk tobacco product. This “permits the marketing of a product as containing a reduced level of or presenting a reduced exposure to a substance or as being free of a substance when the issuance of the order is expected to benefit the health of the population,” according to the FDA’s news release. 

Sward says this is a dangerous step toward keeping people addicted to tobacco products and falsely leaves consumers with the idea that these are safer products. Hundreds of people who say they were injured by Juul e-cigarettes and that the company used deceptive advertising filed lawsuits against the company. 

“The Lung Association for more than a decade has been sounding the alarm about e-cigarettes and really recognizing that the false claims the companies made from the get-go … that the products are less harmful, that they can help people quit smoking — none of those have been proven,” Sward said.  

On the podcast, Sward breaks down the risks of vaping and IQOS and offers hope to people who are trying to quit vaping and smoking. 

“What we recognize is that every person can quit tobacco. All tobacco products,” Sward said. 

She points current smokers and parents of teens addicted to e-cigarettes to American Lung Association or 1-800-Quit-Now for help quitting.

Lawsuit Information

Breathing issues, lung problems, stroke and seizures are among the injuries named in e-cigarette and Juul lawsuits. Learn more.

View Lawsuits
Transcript -
Michelle Llamas

Hi there, and welcome to another episode of the Drugwatch Podcast. I'm your host, Michelle Llamas. On this episode, we're going to be talking about e-cigarettes and a newer heated tobacco product marketed by Philip Morris, the IQOS. In July 2020, the FDA allowed Philip Morris to market the IQOS as a modified-risk product. This makes it sound like it's safer than cigarettes, but how safe is it really? My guest on this episode is Erika Sward, the assistant vice president of national advocacy for the American Lung Association. Welcome to the show, Erika.

Erika Sward

Thank you, good to be with you today.

Michelle Llamas

I think there's a lot of things being tossed around, there's cigarettes, there's e-cigarettes, and now the IQOS, which is a tobacco heating system. Can you briefly explain the difference between those three things?

Erika Sward

I will do my best. A lot of people are obviously familiar with traditional cigarettes — they've been around for decades — but I think one thing people may not realize is how sophisticated and how engineered each cigarette is and how the tobacco companies have spent really decades and a tremendous amount of money designing a highly-engineered delivery device for nicotine and other chemicals to make sure that when people are smoking them, it is an immediate hit of nicotine and that it becomes very powerful. It goes right into their lungs and is absorbed into their bloodstream.

Erika Sward

Traditional cigarettes are that piece of paper often with, again, a very highly-engineered filter with tobacco leaf and a whole host of chemicals that are added to them, and they do have thousands of chemicals that have been added to each one. Then e-cigarettes we started to see come onto the market just over about 11 or 12 years ago, in 2008, 2009. These are products that, using vegetable glycerin and other chemicals, essentially aerosolize nicotine and those chemicals so that they can be inhaled into the lungs. Whereas traditional cigarettes are burned, e-cigarettes are aerosolized — all of those chemicals, and there are quite a few, are aerosolized and inhaled into the lung.

Erika Sward

Then finally, now we have the IQOS system, which we're still learning a whole lot about. Most of the studies that have been done on IQOS have been done by the company, and those are of course suspect and should be questioned highly. But they are creating a tobacco product that is heated and then one inhales it into the lungs from there. The company claims that the tobacco is not combusted. I think there is some question about that, if it is ultimately burned at some level. But those are the three different categories that I think people are most familiar with.

Michelle Llamas

Now that's really important that you mentioned, you talk about cigarettes being designed and engineered to deliver this hit, right? I don't think anybody really thinks about the fact that they're designed in a special way, because you think, oh, it's just rolled up tobacco, it's got a filter in it, people know that, but the design of all these things is very specific and interesting.

Michelle Llamas

So the difference is between the IQOS and e-cigarettes then, because you shouldn't put them in the same category.

Erika Sward

Yes, and indeed the Food and Drug Administration considers IQOS to be in its cigarette category, but the tobacco itself is heated, but not aerosolized like you see with an e-cigarette.

Michelle Llamas

Now obviously, you talked a little bit about your concern with all these chemicals and things in these products, and that leads me into my next topic. What is the American Lung Association's position on e-cigarettes and the new IQOS system?

Erika Sward

Well, the one association for really more than a decade has been sounding the alarm about e-cigarettes and really recognizing that the false claims that the manufacturers made from the very get go all the way through now, that the products are less harmful, that they can help people quit smoking, none of those have been proven. Sadly, the public narrative on many of them has been to take the tobacco company's word for it, which is a huge mistake to make on any day.

Erika Sward

But again, what the Lung Association has been very concerned about from the beginning is that, number one, they would be discouraging people from quitting and ending their addiction to tobacco products altogether. What we recognize is, is that every person can quit tobacco, all tobacco products. What we want to make sure is that they are not being bombarded by the tobacco companies, including these cigarette companies, to say, "Hey, look. There's a shiny new object over here. Quitting is hard, if you just switched to this or use both," then that's an easier message for a consumer and we certainly understand that.

Michelle Llamas

The fact that they're marketing it as a stepping stone to quit is what you're talking about, is the dangerous narrative that's being put out there.

Erika Sward

Very dangerous, and the idea, I mean, kids have certainly heard that narrative, as the e-cigarette companies have designed to be, that these products ... Everybody's been warned about cigarettes, all the kids have been warned about bad cigarettes, but e-cigarettes must not be as bad if this is what I'm hearing and so it's okay to pick these up. That's very problematic, and so the Lung Association has been very concerned from the get go, as I said, about people picking them up instead of quitting and seeking help to quit, like from the Lung Association or from 1-800-QUIT-NOW, but also the impact on bringing a whole other generation of kids into big tobacco's lair, and that's exactly what has happened.

Erika Sward

First, we saw it with different flavored products, and of course Juul was the company that really has resulted in millions of kids being addicted to e-cigarettes. We're going to suffer with those ramifications and those consequences for years. Here we have an opportunity for the Food and Drug Administration to do better and to do right when it came to IQOS, and unfortunately, the concerns that the Lung Association and the public health community had with this product following that same path are coming true, that not only did the FDA allow it onto the market in 2019, but of course in July of 2020 allowed it to make this reduced exposure claim. That is already being exploited, as we can see.

Michelle Llamas

Yeah, because that actually has the signal of saying, "Hey, it's safer than even e-cigarettes," is what some people are starting to say, it's the safer e-cigarette, it's the safer cigarette. But of course, as you mentioned, there are no actual studies that prove those things without a doubt. I think even the FDA has said that they have concerns with the data, but they've let it out anyway. I think that that's fascinating.

Michelle Llamas

But so now we talk about the dangers and the safety issues. What are some of the potential health problems that you've seen with the IQOS system? I know that we talked about it being new, but if you've seen any of those things coming out, as well as what are the dangers of e-cigarettes again, it's probably worth mentioning that as well.

Erika Sward

Well, right now IQOS is only for sale in limited test markets in the United States. There's more data coming from other countries where the product has been for sale for a longer time period. I think that there are two ways to look at the danger of IQOS. One is on the individual user's health and then the other is on the public health more broadly. If we started with the public health and looking at this, I mean, this is a product that is being sold by the largest tobacco company in the world, that is aimed at sustaining an addiction to tobacco products so that they can reap their profits at the cost of the health of millions of people around the world. This is more likely to lead to the glamorization of products to make it look like they are a high-tech device, that it's consistent with your iPhone, right, that IQOS makes it really a very tech-savvy looking product. Their social media marketing and other similar kinds of direct appeals to the public are setting it up to be that fashionable and quite fashion forward and trendy product.

Erika Sward

They are both to be marketed to current smokers. We know that that goes well beyond with the demographics that they're looking for, younger people, and that's certainly been apparent in their social media marketing in other places.

Michelle Llamas

Oh yes. Real quick, let me just stop you there, because that was the thing with Juul. Juul has always said that they only market to smokers. Of course, when you see what they did, you know that clearly that wasn't the case.

Erika Sward

Exactly. Philip Morris, and Altria specifically, which is selling the product in the United States, the maker of Marlboro, it has been convicted of racketeering charges by a federal court for how it lied to the American public about its health claims from light and low-tar cigarettes for how it marketed to kids and for other deceptive advertising. So what we're seeing here is right in their wheelhouse and the fact that FDA has gone along with it is very troubling. You have this whole idea that it's working to try to drive down the overall number of tobacco product users and trying to have people use it instead of quitting and ending their addiction altogether, so that's kind of the impact on the public health.

Erika Sward

The other impact is, of course, for the individual's health. That's something that we're still trying to understand. I'm sure that FDA was given a number of studies, and we know that some of the chemicals that are emitted by the product include a lot of the aldehydes and acrolein, which is a respiratory irritant and causes problems with the lungs, tobacco-specific nitrosamines, which of course also are carcinogenic. I think we're seeing a whole host of different chemicals that are in these products and that's deeply troubling. The goal with Congress passing the Tobacco Control Act in 2009 was to stop the flow of these kinds of products and these kinds of claims onto the market, not to open the barn door to let all the horses out.

Michelle Llamas

Yeah. We talked about safety there and the number one claim that I've been seeing, of course, we talked about it being a stepping stone to getting off cigarettes. The thing is, is it actually safer than a traditional cigarette? I mean, are you getting some benefits by being addicted to a new system, as opposed to traditional cigarettes?

Erika Sward

Well, cigarettes are the single most deadly consumer product on the market. About half of the people who use them start using them when they're youth and adolescents will ultimately die from a tobacco-caused disease. We also have 16 million Americans living with tobacco-caused diseases in the U.S. right now. It's never fair to compare anything to how deadly and how unsafe a traditional cigarette is. It doesn't get any worse. That said, these products have carcinogens, chemicals in them that pose a risk to the heart and cardiovascular system, as well as to the lungs, of course.

Erika Sward

The single best thing that people can do is to end their addiction to all tobacco products. There are proven ways to do that and the Lung Association believes everyone can successfully end their addiction. They may not have tried the way that it's going to be best for them. We at the Lung Association are certainly committed to helping them figure out what that best approach is. Usually, it's a combination of one or two FDA-approved pharmaco or drug therapies, and then also some kind of counseling, whether it's phone counseling or a group sit down, which of course are harder to come by during this time of COVID, and we're also starting to see some evidence that chat and online counseling sessions are also effective too. There's a lot that can be done to effectively end and help someone end their addiction. We do not want to see them turning to a tobacco product, which inherently poses risks to their health.

Michelle Llamas

Yeah, that's the most important thing I think we can take from what you said, is that there is definitely help out there for anybody that wants to quit smoking traditional cigarettes and that they don't have to go onto an e-cigarette or the IQOS or any of these other systems with the intention that or with the understanding that it's actually safer, when in truth, the best thing to do is really just to get help and completely stop tobacco products.

Erika Sward

Exactly. E-cigarettes and IQOS are designed to addict new people, to addict them to tobacco, and also to keep current users hooked. They are tobacco products and there is no such thing as a safe tobacco product. The single best thing that you can do for your health is to get the help you need, talk to your doctor, call 1-800-QUIT-NOW, which is the nationwide quit line, go to smokefree.gov, and of course the American Lung Association has also been helping smokers quit for decades and we would love to help everyone get the help they need to end their addiction for good, whether it's to cigarettes, to e-cigarettes or any other kind of tobacco product.

Michelle Llamas

Now here at the end, we're wrapping up, we said a lot of really important things in the show today. What's the most important thing that consumers should know about the IQOS system?

Erika Sward

That it is a tobacco product, that no tobacco product is safe, that this tobacco product is being aimed at youth and young people to bring another generation of people onto tobacco products, and they should not be used, they should be treated the same way as every other tobacco product, and that the Food and Drug Administration's recent orders are deeply troubling, that really parents need to be aware that these products are out there, that they do not look like traditional cigarettes and that they should be warning their kids against them.

Michelle Llamas

Okay, so you mentioned a thing for parents. Can you briefly mention a resource for parents that they might be able to go to, to help them recognize these things or talk to their children about it?

Erika Sward

The American Lung Association has a host of different resources available on our website, lung.org. On September 1, we will be launching a new initiative aimed at ending the tobacco, and especially the e-cigarette, epidemic. Starting September 1, there will be a tremendous amount of information about this on our website.

Michelle Llamas

Oh, wow. That's amazing. I mean, I'm sure that's going to be like a one-stop shop for all this information, which is great because there really isn't a single place that people can go, and as we know, the FDA's site is so not very user friendly. If anybody wants to go in there and find anything, it's kind of crazy. But is there anything else that you would like listeners to know about e-cigarettes or the IQOS?

Erika Sward

For current tobacco users, the Lung Association is standing by ready to help you end your addiction for good. Whether that's on our website at lung.org or by calling 1-800-LUNG-USA, we are here. For parents of young people, I would say be on the lookout, talk to your children, recognize that these are not the tobacco products that you're familiar with from yesterday, that these devices look very similar to USB drives and other types of technology equipment. Then finally, for policymakers, I would say it is long past the time for the Food and Drug Administration, for Congress, and for state lawmakers to act to remove all flavor products from the market, and to really end this nation's addiction to tobacco.

Michelle Llamas

Thank you so much for being on the show, Erika. You gave us a lot of really great information and I'm sure our listeners are going to benefit from that. Again, if anybody wants to go to the American Lung Association's website, that is lung.org, and you can find all the awesome resources that Erika mentioned on the show today. Thanks for being here, Erika.

Erika Sward

Thank you.

Disclaimer: Views, thoughts and opinions of the guest do not necessarily reflect those of Drugwatch.

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Michelle Llamas, Senior Content Writer
Written By Michelle Llamas Senior Writer

Michelle Llamas has been writing articles and producing podcasts about drugs, medical devices and the FDA for seven years. She specializes in fluoroquinolone antibiotics and products that affect women’s health such as Essure birth control, transvaginal mesh and talcum powder. Michelle collaborates with experts, including board-certified doctors, patients and advocates, to provide trusted health information to the public. Some of her qualifications include:

  • American Medical Writers Association (AMWA) Engage Committee and Membership Committee member
  • Centers for Disease Control and Prevention (CDC) Health Literacy certificates
  • Original works published or cited in The Lancet, British Journal of Clinical Pharmacology and the Journal for Palliative Medicine
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