Why Did the FDA Approve Flavored Vapes? with Dr. Jamie Rutland

Summary

Podcast Summary

That Can't Be True with Chelsea Clinton

Episode: Why Did the FDA Approve Flavored Vapes?
Guest: Dr. Jamie Rutland, Pulmonologist and American Lung Association Spokesperson
Date: May 21, 2026

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Overview

This episode of "That Can't Be True with Chelsea Clinton" explores the controversy around the FDA’s recent approval of new flavored e-cigarettes. Chelsea Clinton and Dr. Jamie Rutland, a pulmonary and critical care physician with deep expertise in vaping-related lung injury, break down what’s fact and fiction about vaping, the resurgence of smoking as 'cool,' and what the public—especially parents—needs to know to protect children and teens from the risks of nicotine products.

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Key Discussion Points & Insights

1. The Changing Narrative Around Smoking and Vaping

• Decline and Resurgence: Clinton notes that, after significant public health campaigns in the late 20th century, smoking became widely recognized as harmful. However, there's now a resurgence of 'coolness' around smoking and confusion around vaping safety (02:44–03:54).
• Cultural Influence: Both Clinton and Rutland observe how pop culture and celebrities normalize or glamorize cigarette smoking and vaping, impacting youth perceptions and behavior (07:23–08:48).

“It becomes a reinforcement of ‘cool,’ which is not cool for me ... but when you're 10 or 11 or 12 ... you're not quite there yet. And so that's what I worry about the most.”
— Dr. Jamie Rutland (07:23)

2. Comparing Smoking and Vaping – What We Know

• Similar Harms, Less Time Studied: Cigarette dangers are extremely well-documented; vaping is newer, but evidence is mounting that it causes inflammation, DNA damage, and lung injury (09:49–12:58).
• Heavy Metals and Chemicals: Vaping involves inhaling metals and multiple carcinogenic compounds, especially as temperature and usage increase (05:15–06:37).
• Addiction Risk: Vapes can contain significant nicotine. Flavors increase the appeal and addiction risk for youth (13:06–14:35).
• Vaping Not a Harmless Alternative: Vaping was originally developed as a cessation tool for adult smokers, but “that doesn’t mean vaping doesn’t harm you as well.”

“Vaping can lead to DNA damage ... Vaping stimulates an inflammatory response.”
— Dr. Jamie Rutland (09:49)

3. FDA’s Role & Flavored E-cigarettes Decision

• Why Approve Flavors? Dr. Rutland explains the FDA's rationale—studies suggesting more flavors may boost adult quit rates for cigarettes—but criticizes the policy for overlooking increased youth usage (18:41–19:53).
• Regulatory Paradox: Clinton asks if approving certain products allows for better regulation and curbing of illicit products—Rutland finds the argument logical, but insufficient to justify youth exposure (20:15–21:24).

4. What the Science Says—With Caveats

• Injury Trends: Vaping-related lung injuries, including from unregulated marijuana vapes, peaked around 2018–19, but still occur, mostly where devices are less regulated (23:27–26:27).
• Secondhand Effects: Indoor vaping exposes others to metals and chemicals; potential risks are real, though less documented than secondhand smoke from cigarettes (26:52–27:28).
• Other Nicotine Products: Patches and gum are safer alternatives for cessation, but “don’t put any pouches in your mouth ... patches and gum, cool. Use it all you want.”

— Dr. Jamie Rutland (27:56)

5. Guidance For Parents

• Be the Parent, Not the Friend: Rutland stresses the importance of clear expectations and education at home (31:58–34:13).
• Modeling Behavior: Children mimic their parents. If parents vape, children are more likely to follow (34:13–34:55).
• Tailored Conversations: Rutland uses bedtime chats to subtly discuss health, including lungs and vaping, making teaching a regular, approachable part of parenting (32:09–34:12).

6. Debunking Vaping Myths

• Legal ≠ Safe: Legally sold vapes aren’t proven to be safe (38:09).
• Secondhand Vape Smoke: It can be harmful (38:39–38:49).
• Flavored vs. Unflavored, E-juice vs. Salts: “When things are harmful, they're harmful. I don't like to say something's better.” (39:03)
• Nicotine Content: Vape cartridges generally contain less nicotine per unit than a full pack of cigarettes, but high-frequency use can quickly exceed cigarette equivalence (39:37–40:13).
• Intermittent Use: Even infrequent vaping carries risk of severe health events (41:05–41:35).
• Long-term Risks: Many are still unknown due to vaping's relative novelty, but “we know a fair amount of health consequences ... you can extrapolate what we’re going to find out in 10, 20, 30 years.” (40:27–40:47)

“I don't know why anybody would pick up the habit of smoking. It just doesn't make sense to me other than when you advertise it on these shows and people are cool that are doing it ... It's no different than people wearing Nike sneakers.”
— Dr. Jamie Rutland (29:18)

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Notable Quotes & Memorable Moments

• On youth perception:
  “You’re not their friend. I’m their father.”
  — Dr. Jamie Rutland (32:09)

• On regulation and flavors:
  “They weren’t thinking about the consequence of having more flavors available to kids when the decision was made.”
  — Dr. Jamie Rutland (18:58)

• On the limits of knowledge:
  “I think the three most powerful words in the English language are ‘I don’t know.’”
  — Dr. Jamie Rutland (37:08)

• On environmental exposure and immune response:
  “Disease is essentially your immune system’s response to the environment ... if you’re smoking or you’re vaping, your immune system responding to those molecules, that is what disease is.”
  — Dr. Jamie Rutland (35:23)

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Timestamps for Key Segments

• [02:44] — Smoking’s image: Then and now
• [05:15] — The science of inhaled metals & vape heat risks
• [09:49] — Comparing risks: Cigarettes vs. vapes
• [13:06] — Youth vaping, flavors, and brain development
• [18:41] — FDA’s flavored e-cigarette decision
• [23:27] — Vaping-induced lung injury: Trends and stories
• [26:52] — Secondhand consequences of vaping
• [27:56] — Nicotine gum, pouches, and what’s known
• [31:58] — Parental advice: Conversations and boundaries
• [34:13] — The importance of parental modeling
• [35:23] — How immune response mediates disease
• [38:09] — Fact or fiction rapid-fire segment
• [41:05] — Risk from occasional vaping

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Summary of Key Takeaways

• Both smoking and vaping are dangerous, with unique and overlapping risks. Vaping is not a harmless or safe alternative.
• Flavors drive youth initiation and addiction. FDA’s approval seems to prioritize adult cessation over youth protection.
• Legal approval does NOT mean a product is safe. Regulation is imperfect, and research lags behind product proliferation.
• Parental example and frank conversations are crucial. Parents should both talk with and model healthy behavior for their children.
• Long-term effects of vaping remain unknown, but current evidence already links vaping to inflammation, DNA changes, and lung injury.
• Secondhand vape 'smoke' is not safe. There are real risks, especially in enclosed spaces.
• If you need nicotine for cessation, gum or patches are preferable over any smoked or chewed tobacco product.

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This episode empowers listeners, especially parents, with science-based information to help navigate the confusion fostered by vaping’s evolving public perception and regulatory hurdles. It’s a powerful invitation to stay skeptical of marketing and to prioritize real conversations—both at home and in policy.

Transcript

[Dr. Jamie Rutland]

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[Chelsea Clinton]

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[Dr. Jamie Rutland]

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[Chelsea Clinton]

Welcome to that Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton. There are a lot of questions right now about e cigarettes and smokeless nicotine products. And the new FDA decision to authorize some flavored E cigarettes is only adding momentum and also some confusion to this conversation. People are asking, is there ever a safe alternative to smoking that still includes nicotine? And what really are the differences between vaping and smoking? I cannot think of a better person to help us navigate this broader dynamic and these really specific critical questions than Dr. J. Rutland. He's a triple board certified pulmonologist, critical care doctor, and internal medicine doctor. He's also a spokesperson for the American Lung association and an expert in vaping related lung injury. I'm really thrilled and honored to have him join us today. Hi.

[Dr. Jamie Rutland]

Hey. How are you?

[Chelsea Clinton]

I'm. I'm many things. That's my answer these days.

[Dr. Jamie Rutland]

I know. I just got off a plane myself, just rolled into the studio.

[Chelsea Clinton]

Thank you so much for talking to us, especially this week.

[Dr. Jamie Rutland]

No problem, anytime.

[Chelsea Clinton]

You know, if you had told me when I had just turned 8 and when my Grandma Ginger asked me what I wanted for my birthday and I told her I wanted her to quit smoking, I was inspired by Ramona Quinby asking her dad to do the same. And she did it. She quit smoking. And I feel like in the late 80s, 90s, 2000s, we largely came to understand that smoking's just bad for you. And there were a lot of people who quit and never started because of that broad based public awareness. And now it seems like we're maybe in a different moment.

[Dr. Jamie Rutland]

You know, one of the things I find very interesting is when you look at individuals who smoke who vape, I think that there is a lack of education as we're growing up on what the lung's responsibility is, what it's made out of, what it's supposed to do. Because if you look at data across the world, in areas of the world where air pollution is the highest, you also have the highest rates of respiratory disease, of systemic disease, heart attacks, stroke, and that's secondary to air pollution. And when you take something as small as a cigarette or something as wide or something that could fit in your pocket like a vape, you're just inhaling concentrated air pollution. And I think once people understand that, I mean, it's the reason why I started this is once people understand that, they seem to be a little bit more compliant. And my grandfather died from a smoking illness. Right. I was like my dad when I was growing up, and he died at 85, but it was emphysema that ultimately took his life. And so it's something I care about a lot.

[Chelsea Clinton]

I have so many questions that I want to ask you. I thought, though, that we could start with what we call that Can't Be True, where we'll play some tape that's recently been online and get your reaction. So here's a recent clip from social media asking, is vaping worse than cigarettes?

[Dr. Jamie Rutland]

Is it vaping like you're actually breathing in metals? Vaping is way worse for me. For you? Yeah, because you're doing it way longer and more too, than hitting it, like, non stop. Interesting. I think they're both bad, but I

[Chelsea Clinton]

mean, they're bad, but one's just inherently cool.

[Dr. Jamie Rutland]

Yeah, but no, it's not. No, no, no, it's not. I'm just gonna. No, it's not good.

[Chelsea Clinton]

For generations.

[Dr. Jamie Rutland]

I don't care what they say. Let me have that stupid stand on this.

[Chelsea Clinton]

I want the TV commercials again where the doctors are like, I'm Dr.

[Dr. Jamie Rutland]

So.

[Chelsea Clinton]

So. And I smoke, you know, red. Yeah, Like.

[Dr. Jamie Rutland]

Like breathing a breath of fresh air.

[Chelsea Clinton]

A cigarette after a good meal.

[Dr. Jamie Rutland]

My God, throw away.

[Chelsea Clinton]

I mean, Jamie, like, what are your reactions when you hear things like that and you know that they're circulating? And even if it's under the guise of joking, what do you think the real harm is for people who might be listening to that and think, oh, okay, sure, I won't. I won't vape. But maybe cigarettes. Smoking is fine.

[Dr. Jamie Rutland]

You know, there are two parts to that clip. The first part I liked because they were actually correct when they said, you're inhaling metal. You are inhaling metal when you inhale for a longer period of time. Critical. Because the longer that you inhale a vape, for example, the higher the temperature, the more sort of carcinogenic molecules that you create. And so they were right about that. Like, they were right and they were getting to the bottom line of, hey, listen, this is disgusting. You shouldn't be doing this. And then they transition to this. Oh, it's but smoking is cool, right? It's cool again, like, I wish. And they start joking and laughing about cigarette smoking. I didn't appreciate that because it started off by giving great information in a very entertaining way. I love the guy's facial expressions. It was spot on. But then it ended with a joke about how smoking is cool, and that's the wrong message to leave the public with, because kids are watching these things, adults are watching these things, too. And when you associate laughter with something like that, then it becomes a little bit more feel good, right? That might even create some dopamine in your brain. So I thought they did a great job in the beginning, and then towards the end, it just lost my interest. I wasn't happy about it.

[Chelsea Clinton]

Oh, gosh. I have so many questions. I want to start, though, kind of at the end, because right before I joined our conversation today, I was watching one of your Instagram videos where you point out how somehow cigarette smoking hasn't only become arguably more acceptable, but once again, has this sheen of being cool. And you talk about different celebrities who are smoking in movies or in the middle of concerts, which seems wild to me. And you talked about it, really. Also from the posture of a parent, how worried are you about, once again, the resuscitation, if you will, of somehow cigarettes being cool? And are you seeing that in your medical practice, too?

[Dr. Jamie Rutland]

Such a heavy question. So I am a father. I've got two little girls, right? 13 and 11. So when they're watching YouTube and they're going through YouTube and they're seeing these clips of movies or clips of songs or clips of their idols and they're taking a drag of a cigarette, they know their dad's a lung doctor, and they know that smoking is bad for you, but they're just getting hammered down with seeing it, and it becoming so common that when they have the opportunity, they're more likely to try it. My favorite show that I'm streaming is Landman and Billy Bob smokes throughout, right? And it's kind of a cool thing to do, right? He's. When he's stressed out, he's smoking. When he's yelling at somebody, he's smoking. And so for me, it becomes a reinforcement of cool, which is not cool for me. But I also. I'm more mature. I'm 44 years old. And so when I'm looking at this, like, I can separate it, especially as a clinician, but when you're 10 or 11 or 12, like, you can't. You're not. You're not quite there yet. And so that's what I worry about the most is, is that. And then with all the things that are going on from a vaping perspective and flavors and making it more, making it taste good and not even knowing that you're inhaling nicotine, that's going to make you addicted to this product. It's just a problem for me.

[Chelsea Clinton]

I certainly agree. As someone who cares a lot about public health and also am a parent to kids around your daughter's age and a little younger, I do feel like, and Jamie, you'll correct me, that six, eight, ten years ago there was this narrative that vaping was safer than cigarette smoking, that somehow it was better for you, that you were making a healthier choice, that, oh goodness, like, look what we have now to help protect our children from the danger of cigarettes. And yet you were saying in your reaction to our can't be true clip that they get a lot right about actually how dangerous vaping is because of the more extended use because you're breathing in metals. I mean, you're also like effectively chewing on plastic, for crying out loud. Like, there's so many know things how. What do you want people to know about the different risks, dangers, harms of. Of cigarettes versus vaping?

[Dr. Jamie Rutland]

You know, I think the way to look at that, and I'm going to get a little bit in teacher mode here. I'm a teacher.

[Chelsea Clinton]

Be a, be a teacher. Be a teacher, please.

[Dr. Jamie Rutland]

The way your lungs are designed, they're a bunch of pipes that lead to a bunch of balloons stacked on top of one another. You have cells that we call airway epithelial cells that are lining your lungs. Every single breath you take. Your cells are bombarded with the environment that surrounds you. Because you're snatching your environment and you're introducing it to the inside of your body. When you vape and when you smoke, all of the different molecules that you're inhaling that are concentrated, activate those airway cells with both. Leads to more inflammation, leads to more mucus production. The difference is that we've been studying the consequences of cigarette smoke for over a hundred years. Like, we, we know, we know what's going to happen. We know how it affects certain cells. Vaping, which came out around 2,000 or so. We've been studying that for maybe 10, 15 years or so. And we're starting to discover that it does similar things. Right. Vaping can lead to DNA damage. What's cancer? DNA damage? Right. Vaping leads to inflammation and causes asthma exacerbations. We know this. You can inhale heavy metals with vaping, lead, tin, all kinds of heavy metals, because you need that metal to heat up that liquid to make it an aerosol. As you inhale, you are increasing the temperature of that liquid, and you're creating many different types of molecules, volatile organic compounds. You can create aromatic hydrocarbons. You can create these different aldehydes. Because of the flavors, those things can stimulate your cells to change. We call that metaplasia. And. And when your cells start changing, that's also a sign of. Towards. Not of. Towards malignancy. We've seen malignancies in animal studies secondary to vaping and vaping exposure. I'm not gonna say that vaping causes cancer in humans. I can't say that yet. But what I can say is vaping stimulates an inflammatory response that can lead to certain pathophysiologies that can get you in the hospital and can worsen your health over the course of time. Cigarette smoking does the same thing. Cigarette smoking can kill your lung. Right? We call that emphysema or dead lung. Cigarette smoking can cause lung cancer. We all know what lung cancer is, so they're both bad. When people ask the question of, or say or make a statement of, vaping is better for you, really, what that goes back to is vaping was created as a cessation product. So that way we could get people away from cigarette smoking, which we know is really bad and really horrible, and pushes them towards vaping. And there's. I call it slick literature. There's slick literature that's published that shows that adults who vape are more likely to quit cigarette smoking. And so everybody looks at that as a win. And I'm not gonna sit here and say that's not a win. If you've done that, I'm proud of you for quitting cigarettes. I'm happy for you. But it doesn't mean that vaping doesn't harm you as well.

[Chelsea Clinton]

You talked about what the slick literature is for adults, but what about for kids?

[Dr. Jamie Rutland]

There's no slick literature, right. For kids. We know that kids who vape are more likely to smoke cigarettes. Right? We know that. That's a fact. It's been studied. There is no literature that supports vaping in children. There isn't. We know that flavors, an increase in the amount of flavors, also leads to more kids vaping. And so that's an issue as well. So vaping is bad, especially for developing brains. Nicotine is bad for developing brains. And I can't stress that enough. But these kids are carrying around in their pockets and inhaling these vapes all the time. I was just speaking at Coachella on air pollution. I'm on the Air Quality Management District Board in the state of California. Gavin put me on that in November. But I had to go speak at Coachella on air pollution. Right? And you go to Coachella, everybody's wearing a bandana. Everybody's wearing a bandana because they think it's cool. And I just told the audience at Coachella, I said, listen, you're wearing the bandana because of all of the air pollution, the PM 2.5 and the dust particles that you're protecting yourself from. You're trying to calm down the load that you're inhaling, that they all had vapes in their pockets. And so I went through that, I know I went through that immunology. And I'm going to tell you something, Chelsea. This was something that, that meant a lot to me. When we, when I started talking, there's probably about 70 people. When I finished talking, there was like 300 and some odd. Right. People kept coming in.

[Chelsea Clinton]

That's great.

[Dr. Jamie Rutland]

I, I, I liked, the thing that I liked the most is after the talk was over and they came up to ask me questions, everybody who came up to me to ask me a question that had a vape in their pocket, tossed it in the trash can on their way out. So it just tells me that education in regards to how this is affecting the cellular nature of the inside of your body is missing. And if we can provide that and if we do it well with people who can communicate that message, then perhaps we can create a dentist and get that reduction in vaping rates across at least the United States and hopefully across the world.

[Chelsea Clinton]

You mentioned a couple of times now the flavoring that is increasingly pervasive in vaping and that recently, you know, the FDA authorized a new set of fruit flavored E cigarettes despite having resisted previous pressure to do so. And so wonder if you can explain to us what difference, if any, there are between E cigarettes and vaping and why, since you've mentioned the flavors a couple of times, that's particularly concerning for you.

[Dr. Jamie Rutland]

Yeah. So different flavors create different aldehydes, and some aldehydes can be carcinogenic.

[Chelsea Clinton]

Jamie, explain what aldehydes are, please.

[Dr. Jamie Rutland]

So aldehydes are just molecules that are in that liquid. So you know, you guys have all taken chemistry in high school and so you just have a name for certain molecules and aldehyde is a C double bond. O H, that's what an Aldehyde is doesn't matter. It's just the name of a molecule. But aldehydes are what give you the flavor. So we change sort of the branching structures on the aldehyde which give you a different type of flavor. And so as you're doing that and you're changing the flavors, you're creating different molecules that can be sort of manufactured as a result of how long you're inhaling and what the power of your vape is. It's just the different flavors cause different problems because you can't possibly study all of the flavors and figure out exactly what molecules and what the ratio of the molecules that are being created. We just know that these are the molecules that we're finding that are created when people vape a certain type of E cigarette. Now, you asked another question. You said the difference between vaping and an E cig. So an E cig is just a tobacco product that's in a pod and you've got a metal in there to heat up this liquid that becomes an aerosol. Right? That's a. And it has a battery. That's an E cig. But you also have other types of vaping products like marijuana. Right. And whatever else people are smoking these days. And within those pods are going to be different things. And some of these things are regulated and some of these things are not. So you don't really know if you're not getting a specific E cigarette device that's been heavily regulated into how it's constructed, like where you kind of have an idea of what's there. When you get a different kind of device in which you're inhaling marijuana, you have no idea what's in there. And so what we noticed before the SARS CoV2 pandemic, there was a vaping induced lung injury epidemic. And that was because of what was in the components of specifically really marijuana vapes and the vitamin E acetate that was in there that was causing a significant amount of lung injury. We saw a crap ton of inflammation, sometimes scarring in some of these kids. Sometimes some of these kids couldn't come off the ventilator. And it was really scary and we didn't really quite know what it was. We accelerated our studies and figured out what it was. But again, you just, you don't quite know what's in all of these products and you don't quite know all the molecules that are going to be created. And that can create a big problem for your lung and for your body.

[Chelsea Clinton]

And Dr. Rutland, Jamie, presumably that's why the flavored E cigarettes were more heavily regulated and why there were restrictions, because we don't know. And it's not like we've learned enough up until last month when the FDA made a different decision.

[Dr. Jamie Rutland]

Yeah. And it seems to me that they made that decision based on adult quit rates. Right. And so if you have more flavors available, and again, this is a published study too, in jama. Thanks, jama. If you have more flavors available, then more adults quit cigarette smoking. Again, like slick literature. Right. So they weren't thinking about the consequence of having more flavors available to kids when the decision was made. And maybe they're putting it on us. Right. We as parents have to make certain that our kids understand that vaping is bad for you and they understand the consequences and they shouldn't be doing it. And we should monitor our kids. I don't disagree with people saying that. I don't, I don't disagree with that. But we also have to stress the point of the more flavors you have, the more likely a child is going to want to continue to do it when they try it.

[Chelsea Clinton]

You know, one of the arguments for many decisions that the FDA makes is that granting formal approval gives the FDA a greater ability to regulate, to monitor, and to crack down on illicit products that haven't received their imprimatur. Do you think that's a fair argument to make here?

[Dr. Jamie Rutland]

That's a good point. You know, I guess if you're, if you're approving flavors, then that means that you've studied that flavor and you understand the molecules that have been created and you may understand the consequences. I hear that argument, but do I think that it is enough, persuasive enough, yeah. To approve new flavors like they did? No. I mean, I think if you're going to say that, then we should be allowed to say, yeah, but what about the kids? Because it doesn't seem like you made this decision based on the children. And so that's where I have, I take issue. But I understand the argument. I'm not a guy that's going to scream and yell and go back and forth. I'm just going to say, hey, listen, these are the consequences. And I'm going to make sure that my kids and their friends and whoever else is a teenager that's around me, they understand the consequences. Even though policies are created that may seem like they're promoting their use. Amazon Health AI presents painful thoughts.

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[Chelsea Clinton]

You know, I. I really do want to talk about kind of the parent perspective here and what advice you have to those of us who are our parents before though we do that just kind of with your clinician hat on, your scientist hat on. You talked about some of the terrible lung injuries that you saw that were induced by vaping with a synthetic form of vitamin E. Is that still an issue that you're concerned about? Is that something you still see? And are you seeing other vaping related either lung injuries or health consequences that you can tie clearly to someone's either duration or intensity of vaping use?

[Dr. Jamie Rutland]

I still see vaping induced lung injury. Do I see it as severe as I saw it during that epidemic around 20, 19 or 18, whenever it was? I don't see it to that level. And the vaping Rates overall in kids had come down a little bit. The peak was those years, right. It was up to like 7.7% of teenagers or something like that was really high. So I still see vaping induced lung injury. It's a little bit more mild. So the asthma exacerbators that are vaping people who asthma is allergic inflammation of those pipes carrying air to the lungs. So your pipes get really narrow and they make a lot of mucus. And so when you vape, you stimulate more airway narrowing and more mucus, and so you develop shortness of breath. Cough individuals can develop sort of these. We call it interstitial lung disease. So this autoimmune reaction, again, remember, your lung is constantly exposed to the environment. So you have these white blood cells that are monitoring the situation. And when these white blood cells see something that they don't like, they rush to the area. And you have symptoms because they're trying to protect you. Exactly. And you have symptoms because they're rushing to the area, congesting the lungs. They infiltrate the muscle and the muscle contracts. So you're wheezing and you're coughing, you get mucus. And then they could infiltrate the actual spaces where gas exchange is supposed to take place. And you get short of breath because you're not gas exchanging because all your white blood cells are there. So, yes, I see some degree of that. Have I intubated anybody in the ICU secondary to vaping in the last month or two? No, I haven't. Have my partners? No, they haven't. Because I would hear about the case. It would say something, especially if it was a young kid, but. But it does happen. And I'll read case reports again. I was at American Thoracic Society this week and there are case reports of vaping induced lung injury that we still see. And most of the time, I will say this. Most of the time, it is a pod that's not heavily regulated. Right. It is a marijuana vape pen or something of that sort. The E cigarette devices can do it too, but they are a little bit more regulated, a little bit more controlled. But again, you still see injury. You just may not see it to the level of the intensive care unit.

[Chelsea Clinton]

I feel like I have to confess that I'm trying to take very deep, intentional breaths while I'm talking to you, because you keep talking about the structure of our lungs. And I'm like, oh, my gosh, am I. Am I breathing enough? I am curious about indoor vaping. Is there a difference of, like, indoor vaping versus outdoor Vaping. Is secondhand smoke a concern kind of with vaping in the same way it is with cigarettes? What do we need to know about. Yeah, just all of that.

[Dr. Jamie Rutland]

Great question. We're learning more and more about secondhand smoke from vaping. But I think the number one point is this. If you're indoors and your doors closed and there's no windows open and somebody is vaping a product and they blow it out, there's products within that smoke. So you may be inhaling some of these products.

[Chelsea Clinton]

Including the metals.

[Dr. Jamie Rutland]

Including the metals. So can you inhale those products and can that affect you? Of course there's a scenario where it can affect you. Of course there's a scenario like that. Do I hear about that frequently? Not necessarily, but.

[Chelsea Clinton]

But it's a real scenario.

[Dr. Jamie Rutland]

It's a real scenario. There's also evidence that indoor air pollution can be worse than outdoor air pollution, especially in individuals who have a gas stove. Right. So there's that too.

[Chelsea Clinton]

And what about other nicotine containing products that we haven't talked about? I mean, I've heard, you know, that there's been a rise in like Nicorette gum usage recently. You know, that there's a rise in good old fashioned chewing tobacco, a rise in tobacco pouches, all sorts of things.

[Dr. Jamie Rutland]

I give people nicotine patches and nicotine gum and I'm like, do that. I'd rather have you do that. Go on and do that. If you're not gonna smoke or vape or chew tobacco or use a Zyn pouch, which I think is what you were getting at there, fine, chew gum, use the patch. I'm cool with it. The thing about chewing tobacco is we know chewing tobacco can cause mouth cancer. It's done. Like, we know that the Zyn pouches we thought were safer. I think there was a study out of Germany that actually showed that the Zyn pouches can cause metaplasia, which means the cells can change the way that they look. And so then you have to start thinking about, ooh, is there DNA damage? And is this, in 50 years, are we going to understand that, oh, gosh, Zyn pouches can cause cancer too? So I don't think that chewing tobacco, Zyn pouches, e cigs, cigarettes, I don't think that any of that should be a part of anybody's life. I'm a product of. My mom smoked like every day. She was pregnant with me. And I joke with, and I joke with my mom. I'm like, mom, do you realize that if you didn't smoke, I'd be in the NBA, or I'd be like, sitting on an NBA bench, like, coaching. I might be like 6, 5, as opposed to like 6ft tall. You know, she's just like, I quit. And she did. So I'm proud of her. Right? But I think there's no excuse now. Back then, we didn't. We didn't know the consequences as much.

[Chelsea Clinton]

We didn't know.

[Dr. Jamie Rutland]

But now that we do, I. I don't know why anybody would. Would pick up the habit of smoking. It just doesn't. It doesn't make sense to me other than when you advertise it on these shows and people are cool that are doing it, then of course they're going to do it. Right. It's no different than people wearing Nike sneakers.

[Chelsea Clinton]

When we had Dr. Tom Frieden on recently, he said that Americans are smoking less today than they are, or they were, excuse me, in the 1950s, or I think even when I was a kid. But to your point, there's still lots of Americans smoking and vaping.

[Dr. Jamie Rutland]

There are a lot of people smoking and vaping. It. It's scary to me, and I'm sure it is to you as someone who has a daughter that's about to enter high school, because I'm not around her all the time, and I know that vaping is going to be there. And so that's an issue that I have. It hasn't gone away. The United Kingdom, they passed a recent law that won't allow a certain age of person to ever be able to buy a cigarette, which I'm watching that to see how that goes over time. It's really interesting. So other than educating on how the lung works and understanding the consequences of what you're doing to your body, I don't know what else I can. I can say. I don't like to. To lecture people, so to speak. I like to teach people and let them make their own decision based on what they learned. And so that's, you know, again, I don't scream and yell at people. I just kind of make sure they understand how their body works.

[Chelsea Clinton]

You know, I certainly agree that adults should be able to make, you know, whatever choices we all think are right and best for ourselves, provided it's within the realm of what has been legally approved. I do, though, come down pretty hard on the side of protecting kids and wish that we had kind of legal and regulatory infrastructure that was more biased that way. And so I kind of bifurcated admission, admittedly right. For adults. I'm like you as the kids Say you do you. But I think that we should be doing a better job of protecting kids in a myriad of ways. But part of that is what you've referenced earlier of how you talk to your daughters or how you talk to young people. And so I wonder, what advice do you have for me as a parent? But for any parents listening about how to have these conversations with our kids so that hopefully when presented with unhealthy choices they make, they make healthy ones.

[Dr. Jamie Rutland]

I think parents have to be comfortable not being their kid's friend.

[Chelsea Clinton]

Oh, I totally agree with that.

[Dr. Jamie Rutland]

Yeah. You know, you.

[Chelsea Clinton]

I am not my kid's friend. I'm their mother.

[Dr. Jamie Rutland]

Exactly right. And we are what they will grow beyond. I mean, that's true, but I am not their friend. I'm their father. And so the second thing I do is I do take the time to be their father. And I think for my little girls, and I got two girls, the time for my 13 year old is right before she goes to bed, I sit, we talk, we'll talk about soccer, we'll talk about her friends at school, talk about what she wants to do with her life. That's when I have those conversations. And when I'm having that conversation, I sort of put in a little bit of education there. Like, I think every parent should teach their child about the lung. I'm biased, yes. I'm a pulmonologist and a critical care and an internal medicine doctor. Yes, I'm all the above. But I do teach them about the lung because the lung has a tremendous responsibility and it's constantly exposed to the environment. So I put a little teaching into there. Right. And then the other thing I say honestly is I look them in the face and I'm like, if you ever come home with a vape or a cigarette, I swear you will be in so much trouble. That is not something that we're going to be experimenting with. Right. And I'm just very deliberate and I just, you know, I'm not afraid to touch that, you know, and my wife and I will talk about things and it's okay, you're going to take this one, I'll take this one. I can, I'll take that subject and whatever and we'll discuss it. But you know what's really interesting about kids? During the pandemic, I taught a lot about SARS COV2. I taught a lot about antigen presentation and I taught a lot about immunology. And as I was teaching and talking about respiratory viruses and how they worked and those things, you Know, my daughter was probably six at the time, and I didn't think anything of it. She was just watching. And then one day, we're at a friend's house, and she starts reciting the same thing, talking about SARS, COV2. We've got four common coronaviruses. Right, Whatever. And she just spouts it out, like, verbatim. And I just kind of looked at her, and I was like, they're watching.

[Chelsea Clinton]

Yes.

[Dr. Jamie Rutland]

So if you're vaping and your kids see you vape, they're gonna vape. Honestly, like, they're gonna try to emulate you. And I talked about this on a show I was on, and the mom was vaping, and she's really mad at the son who was vaping. And I just looked at the mom, and I was like, you have to quit. Your son's watching you. We have to set the example for our kids. And I know it's hard. Being a grownup is very hard. It's very difficult. It's challenging.

[Chelsea Clinton]

Before we move into our last section, which is called fact or fiction, where I'll throw things out and you'll say, fact or fiction or nuance? Are there any. Well, one, I guess. Is there anything we didn't talk about that we should have as it relates to this broader conversation? And two, are there any kind of myths or persistent misinformation, bits around vaping or smoking that you want to make sure that you debunk that? We also just didn't come up in

[Dr. Jamie Rutland]

conversation if we weren't clear. I think vaping is not good for you. Right? That. That. That's obvious. The other thing I want people to know is, is this. I think this is an important concept within your body. You have an immune system. The immune system is full of white blood cells. All these white blood cells have different jobs to do. Okay, but they're protecting you. But I want you guys to understand this disease is essentially your immune system's response to the environment. So whatever your environment is the food you're eating, the air you're breathing, all of those things, whatever your environment is, your disease is your immune system's response to that environment. So if you're smoking or you're vaping, your immune system responding to those molecules, that is what disease is. That's why you're coughing. That's why you have mucus, that's why you're wheezing, right? And I just want people to understand that aspect of disease is that it's the immune system that's causing a lot of the issues as a result of the environment. So we have to control the environment, but we also have to treat the disease, because sometimes you can't. Right. I'm in Long Beach. A lot of pollution here. I gotta make sure that people have their appropriate asthma therapies and things of that sort. But I do think that that concept is important.

[Chelsea Clinton]

And also something I really appreciated, Dr. Rutland, Jamie, that you did earlier was to be very clear around kind of what we know with, like, you know, mounds or mountains of evidence what we think is true, but we don't yet know with real certainty and where we still don't know.

[Dr. Jamie Rutland]

I think the three most powerful words in the English language are I don't know. And I think it's okay to say I don't know if you don't know, because it's going to stimulate you to want to learn about it, and that's great for society. So it's okay to say I don't know. I tell my kids all the time, just say I don't know. It's okay. And then we learn. So you're right. You're spot on. Right. We don't have all the answers in regards to the consequences of vaping yet. I've told you the things that we know, and all of these things are being studied.

[Chelsea Clinton]

Thank you. And I think that's a perfect segue into our Fact or fiction segment where I'll throw some things out that we've heard online and sometimes actually in the real world, as we say. And you're gonna tell us whether it's fact or fiction, whether there's nuance or whether we don't know. All right, here we go. If a vape is sold legally, it's been proven safe. Fact or fiction?

[Dr. Jamie Rutland]

Fiction.

[Chelsea Clinton]

Alternative nicotine products, including gum, mints, patches, are safer alternatives to smoking or vaping. Fact or fiction?

[Dr. Jamie Rutland]

A fact. Chew gum. Use the patches.

[Chelsea Clinton]

Not the same, though, as the pouches or the chewing tobacco.

[Dr. Jamie Rutland]

Don't put any pouches in your mouth. In your gum. No, no, no. Patches and gum. Cool. Use it all you want.

[Chelsea Clinton]

Even though we talked about this earlier, I really just want to put a finer point on it. Breathing in secondhand vape smoke can be harmful. Fact or fiction?

[Dr. Jamie Rutland]

I'd say fact.

[Chelsea Clinton]

Certain vaping products are better for you than others because they consist of tobacco salts rather than quote E. Juice or vape juice. Fact or fiction? I made you laugh.

[Dr. Jamie Rutland]

Oh, my. I mean, that is like fiction. I don't know. Probably more I don't know than fiction, but I I would say fiction. When things are harmful. I. I don't care about the degree. Right. If you want to talk about risk, fine. But when things are harmful, they're harmful. So I don't like to say something's better.

[Chelsea Clinton]

One vape cartridge is the equivalent to a full pack of cigarettes. Fact or fiction?

[Dr. Jamie Rutland]

One vape cartridge is about 50 milligrams of nicotine. I just have to see how many milligrams are in one cigarette. I can look it up real quick. Let's see how many milligrams of nicotine per cigarette. So it's about 10. So 10 times 20 is 200. So there's less nicotine in a vape cartridge.

[Chelsea Clinton]

But still a lot.

[Dr. Jamie Rutland]

A lot.

[Chelsea Clinton]

Still a lot.

[Dr. Jamie Rutland]

Well, some people go through vape cartridge in an hour and they'll use like 10, 12 in a day. It's crazy.

[Chelsea Clinton]

Wow.

[Dr. Jamie Rutland]

It's nuts. Yeah.

[Chelsea Clinton]

Vaping is a safe way to consume thc. Fact or fiction?

[Dr. Jamie Rutland]

I would say. I would say fiction.

[Chelsea Clinton]

We don't yet know the long term health risks of vaping.

[Dr. Jamie Rutland]

We know some. Let's do nuance there.

[Chelsea Clinton]

We nuance.

[Dr. Jamie Rutland]

We. We know a fair amount of health consequences secondary to vaping. And a lot of the things that we know are happening. You can extrapolate and you can understand how it's what we're going to find out maybe in 10, 20, 30 years down the line.

[Chelsea Clinton]

Vaping is harmless if you only do it a few times a week. Because I'm asking This partly because, Dr. Rutland, one thing I hear a lot now is the kind of weaponization of the dose response of like, well, if you only do it once in a while, it's fine.

[Dr. Jamie Rutland]

Right. I liked your inflection there. It's fine. It's fine. I'm gonna say fiction because you can have a single event from a vape that can be catastrophic to your health, something that you inhale. And again, it was a case I saw this weekend at the conference. Something that you inhale can significantly activate that inflammatory response and you can be presented to the hospital.

[Chelsea Clinton]

It's really scary. Well, Dr. Rutland, Jamie, thank you so much for your time and for all you're doing to help educate all of us, whether at Coachella or here in this conversation and no doubt in many other venues. I think people need more of this information to make at least better informed choices for themselves and for their kids. So really just thank you so much.

[Dr. Jamie Rutland]

Thank you so much for having me. Much appreciated.

[Chelsea Clinton]

You can follow Dr. Rutland rjrutland on Instagram and I hope you'll check out his podcast, the Health Exchange Podcast. Thanks for listening. Talk to you next week. That Can't Be True is a production of Limonada Media and the Clinton Foundation. The show is produced by Katherine Barnes, Mix and sound design by Johnny Vince Evans. Kristin Lepore is Senior Director of New Content and Jackie Danziger is VP of Narrative and Production. Maggie Kral Shore is our Managing Director of Partnerships. Executive producers are Jessica Cordova Kramer, Stephanie Whittles, Wax and me, Chelsea Clinton. Special thanks to Erika Goodmanson, Sarah Horowitz, Francesca Ernst Kahn, Caroline Lewis, Sage Falter, Barry Lurie Westerberg, Emily Young and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. And if you can think of someone who might benefit from today's episode, please go ahead and share it with them. There's more of that Can't Be True with Lemonada Premium subscribers Get excited. Exclusive access to bonus content when you subscribe on Apple Podcasts. You can also listen ad free on Amazon Music with your prime membership.