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Also called as vaping, the use of e-cigarettes is on a sharp rise. A lot of people consider e-cigarettes as a safer alternative to smoking the conventional cigarettes. Here we discuss the differences between e-cigarettes and conventional cigarettes to understand what they are and how they can impact human health. How do conventional cigarettes and e-cigarettes compare with each other? As far as we talk of their commonness, cigarettes and e-cigarettes hardly have anything in common between them excepting their names carrying the word ‘cigarette’. Both cigarettes and e-cigarettes are habit forming and addictive in the first place. Both of them carry the risk of making people dependent on them. In a study undertaken by the Northwestern University, the head of the study Matthew Olonoff remarked, "Before we start making policy changes, such as controlling nicotine or flavor options in e-cigarettes, we need to better understand what role these unique characteristics have." The studies that compare conventional cigarettes and e-cigarettes view e-cigarettes as a unique kind of sophisticated nicotine delivery system. However, looking deeply, there are a number of key differences we can note between cigarettes and e-cigarettes. How do Cigarettes and e-cigarettes differ from each other? Nicotine intake The amount of nicotine contained in e-cigarettes vary significantly from product to product. We cannot expect any consistency in the devices used for vaping (e-cigarette). The amount of nicotine intake during vaping depends on the device used and the vaper’s behavior. Whereas, the nicotine contained in a conventional cigarette is already known and well-defined. How nicotine is taken in? While smoking, the smoker consumes the smoke containing nicotine. The user of an e-cigarette inhales (vapes) nicotine by taking in the e-liquid through the device used for vaping. Control over the usage E-Cigarettes allow more control over how they are used. It is possible to stop them and restart with them. This gives room for more variability in terms of the intermittent use and consequently how much nicotine is consumed by the vaper. The nicotine intake is completely predictable in case of conventional cigarettes. Legalities of using them Cigarettes are widely banned in a number of regions across the world. In some places where the conventional cigarettes are banned, e-cigarettes are permitted. Risk factor Teens are at a greater risk for becoming addicts to e-cigarettes more than the conventional cigarettes as e-cigarettes travel forward on the most alluring technological innovations to be able to attract the youth in a better way. Policy matters e-cigarettes found their debut in mid-2000s. Since those times, they are commercially available to the people. Since their advent, the vaping technology is continuously advancing in a rapid phase. Hence it becomes very difficult to set any up-to-date policy initiatives. They have very less things in common as per studies Commenting on the differences between the conventional cigarettes and e-cigarettes, Olonoff said, "From a research perspective, when we call it a 'cigarette,' we know how many puffs are typically in a cigarette, how people use it, the amount of nicotine in it. Even though it has the word 'cigarette' in it, e-cigarettes are not the same thing."

Difference between E-Cigarettes and Conventional Cigarettes

During recent years, the use of e-cigarettes has swelled exponentially. Today e-cigarettes have become the most sought after tobacco products by the youth. In terms of their volume sales, e-cigarettes have surpassed the cigars and conventional cigarettes. Given this background, now it is more appropriate and necessary than ever to understand how harmful e-cigarettes are. The government reports Recently, two government reports have cast more light on the effects of e-cigarettes on human health. Especially a lung specialist at Hendry Ford Hospital Geneva Tatem, M.D., has given more information on e-cigarettes and how they impact human health in order to help the patients make a better choice with regard to their smoking habits and health. Dr Tatem remarked, “We need to balance the current science and evidence we have with the advocacy, to figure out the right way we should proceed in counselling our patients.” E-cigarettes could be lesser harmful In 2018, the National Academies of Sciences, Engineering and Medicine (NASEM) published the findings of what was called a highly comprehensive analysis of the present studies in the field of e-cigarettes. The report said, “E-cigarettes are not without health risks, they are likely to be far less harmful than conventional cigarettes.” The study also observed that the use of e-cigarettes could eventually move users to smoke conventional cigarettes. The available knowledge on e-cigarettes is inadequate In the year 2016, the U.S. Surgeon General observed, “The use of e-cigarette is a “public health concern that warrants immediate and coordinated action. Many questions remain about e-cigarettes and their long-term impact, even as evidence on patterns of use and risks to health continue to emerge.” Overview of e-cigarettes and how they harm human health An e-cigarette can be understood as an electronic apparatus that works by heating a liquid. The heated liquid becomes vapour and is then inhaled by the person using it. The e-liquid used for vaping burns at a lower temperature than the conventional cigarette. Unlike the traditional cigarette, an e-cigarette does not contain tar. However, it does produce a list of other chemicals. Commenting on the harmful releases they make, Dr Tatem says, “What we do know is that e-cigarettes contain some products that are harmful, particularly hard or heavy metals. Things like cadmium and other metals.” Doctors advise not to get fooled The most common name of e-cigarettes is vape pens. E-cigarettes make use of vaping liquids or e-liquids that come in different flavors. There are a large number of flavors we come across in the world of e-liquids. This fact must not fool the user encouraging the notion that their health is not at risk. Dr Tatem says, “The products that are produced by an e-cigarette are much different than the products produced by a traditional tobacco cigarette. So, using it may still be harmful to the lungs. We don’t have enough research yet that tells us how much less harmful it is using an e-cigarette versus a traditional tobacco cigarette.” Concluding remarks Though e-cigarettes are in no way safe for human use, they only mark a technological shift in the way people consume tobacco and other drugs. In the NASEM report published sometime back, three potential effects of e-cigarettes have been highlighted. <ul><li>e-cigarettes are lesser harmful than the conventional cigarettes.</li><li>e-cigarettes contain lesser amounts of harmful substances than the conventional cigarettes.</li><li>e-cigarettes might help people aspiring to quit smoking to gradually escape their addiction. </li></ul>Commenting that e-cigarettes are not tob e resorted without any discretion, Dr Tatem says, “As a pulmonologist, I see lots of patients who have developed the disease as a result of tobacco and smoking products. Anything you can use to reduce the amount of tobacco you smoke is potentially a good thing. More research is needed to help us clarify the difference between e-cigarettes and vape pens, and how much less harmful they can be relative to tobacco cigarettes.”

How harmful are E-Cigarettes - Risks, Legalities, ingredients and case studies

<div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div>Hello,It was another busy week on the healthcare desk here at Business Insider, with news that <a href="https://www.businessinsider.com/national-cancer-institute-director-dr-norman-sharpless-on-cancer-trials-2018-3">National Cancer Institute director Dr. Ned Sharpless</a> will be acting FDA commissioner when Dr. Scott Gottlieb steps down. We were also following developments from Silicon Valley startups, both new ones, and one whose founders have since faced criminal charges (ahem, Theranos). But first, I wanted to bring to your attention a report I put out over the weekend about <a href="https://www.businessinsider.com/unitedhealth-on-the-cost-of-free-standing-emergency-rooms-2019-3">free-standing emergency rooms.</a> Curious to hear what you all have experienced with these new, not-hospital-connected set-ups.I've been mulling over what the future of the hospital might look like, and it's seeming like these centers - as well as versions that are affiliated with a larger hospital - might be a part of it. But an expensive. Are you new to our weekly newsletter? You <a href="http://newsletter.businessinsider.com/join/4np/health-insider&amp;hash=f4e91136c13f3c40c496d77bc7347502">can sign up here</a>.To start the week, <a href="https://www.businessinsider.com/author/erin-brodwin">Erin Brodwin</a> had the scoop about a <a href="https://www.businessinsider.com/virta-digital-health-diabetes-startup-keto-diet-hiring-derek-newell-castlight-2019-3">new hire</a> over at Virta. The startup, which uses the keto diet to reverse diabetes, <a href="https://www.businessinsider.com/virta-digital-health-diabetes-startup-keto-diet-hiring-derek-newell-castlight-2019-3">hired healthcare veteran Derek Newell</a>.It was a big day for West-Coast-based startup news, as I finally wrote about the pharmacy that's powering so many of the direct-to-consumer startups that seemingly pop up overnight.Meet Truepill. It's been the pharmacy behind companies like Nurx and Hims, shipping out birth control and erectile dysfunction medications around the country. <h3><a href="https://www.businessinsider.com/truepill-online-pharmacy-api-direct-to-consumer-healthcare-hims-nurx-2019-3">Meet the pharmacy quietly powering hot startups like Hims and Nurx that ship Viagra and birth-control pills straight to your door</a></h3><ul><li>Meet Truepill, the pharmacy startup that has been quietly powering companies that prescribe and ship Viagra and birth control to customers' doors.</li><li>The startup, which describes itself as a "pharmacy API and fulfillment service," works with companies like Hims, Nurx, and Lemonaid by filling prescriptions and sending them out around the US.</li><li>With $14 million in funding from investors led by Alexis Ohanian's Initialized Capital, Truepill is plotting its international expansion.</li></ul>Interestingly, Truepill's working with <a href="https://www.businessinsider.com/goodrx-displays-mail-order-options-for-direct-to-consumer-health-startups-2019-3">drug-pricing website GoodRx,</a> which these days has a whole marketplace of online options for consumers to get mailed their prescriptions instead of going in-person. Rounding out a busy Tuesday, Emma Court had the scoop on e-cig restrictions, just ahead of the <a href="https://www.businessinsider.com/us-proposing-limits-flavored-e-cigs-juul-vaping-scott-gottlieb-fda-2019-3">official decision Wednesday.</a><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div><h3><a href="https://www.businessinsider.com/fda-to-finish-rules-on-e-cigarettes-juul-before-gottlieb-resigns-2019-3">The US plans to restrict sales of candy-flavored e-cigs at convenience stores before the top FDA leader leaves office</a></h3><ul><li>The US Food and Drug Administration will soon announce broad restrictions on where flavored e-cigarettes are sold.</li><li>FDA Commissioner Scott Gottlieb told Business Insider he is "100% certain" that it will be settled before he leaves the job in a few weeks. Gottlieb gave notice this month that he's resigning to spend more time with his family.</li><li>The change "will effectively mean that they're not going to be sold in convenience stores in the way they're being sold right now," Gottlieb said.</li></ul>Spoiler alert: The restrictions came the following morning. Erin, following the crack-down, had a good piece analyzing how the move might impact e-cigarette makers like Juul. <h3><a href="https://www.businessinsider.com/wall-street-says-fda-crackdown-e-cigs-good-juul-altria-2019-3">Regulators are cracking down on vaping, but that might actually be good news for the standout e-cig maker Juul</a></h3><ul><li>On Wednesday, the Food and Drug Administration's outgoing chief announced moves that would crack down further on flavored versions of e-cigarettes, such as Juul products.</li><li>Juul products represent 80% of the e-cigarette market. In advance of the FDA's announcement, the company chose to pull its fruit-flavored varieties from retail stores last fall.</li><li>Wall Street analysts think the FDA's moves could positively influence Juul by "leveling the playing field" with other e-cigarette makers, who may now need to follow Juul's lead.</li></ul><div class="KonaFilter image-container display-table"><div><div class="image"></div></div></div>And who's getting excited about the HBO Theranos documentary?? I've already watched it twice. "<a href="https://www.hbo.com/documentaries/the-inventor-out-for-blood-in-silicon-valley">The Inventor: Out for Blood in Silicon Valley</a>" from award-winning director Alex Gibney debuts Monday on HBO at 9 p.m. ET. ABC's "20/20" documentary "The Dropout" debuts Friday at 9 p.m. ET for those who can't wait until then or who want all the Theranos content they can get. In the meantime, I chatted with Gibney earlier this week to get a sense of how the movie came together, thanks in large part to some incredible leaked footage (definitely keep an eye out for the gift card commercial - it is WILD). <h3><a href="https://www.businessinsider.com/leaked-footage-of-elizabeth-holmes-in-the-theranos-documentary-2019-3">100 hours of leaked footage, a bouncy house, and MC Hammer: How HBO's documentary on disgraced blood-testing company Theranos came together</a></h3><ul><li>In "The Inventor: Out for Blood in Silicon Valley," director Alex Gibney explores how the blood-testing startup Theranos and its CEO, Elizabeth Holmes, went from tech darlings to the company shutting down and Holmes facing criminal charges.</li><li>Along the way, Gibney got his hands on 100 hours of leaked footage from within the company, and HBO went to court to unseal deposition footage from Theranos' court case with investors.</li><li>The documentary, available on Monday at 9 p.m. ET on HBO, includes footage from all-hands meetings and company parties, as well as video of Holmes dancing to "U Can't Touch This" by MC Hammer.</li></ul>In the meantime, thoughts, tips, reactions to the influx of new Theranos content? Find me at lramsey@businessinsider.com or the whole healthcare team here at healthcare@businessinsider.com. - Lydia

Dispensed: New Theranos footage, an e-cig crackdown, and the pharmacy powering DTC companies like Hims

<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Phillip MorrisInternational tobacco firm Phillip Morris is phasing out cigarettes with its new non-burning alternative.</div></div></div>Marlboro-producer and tobacco giant <a href="http://www.pmi.com/eng/pages/homepage.aspx" target="_blank">Philip Morris International</a> on Wednesday launched a non-burning cigarette alternative in the UK in a bid to phase out traditional cigarettes.The Iqos device looks similar to an e-cigarette. But unlike most modern e-cigs, it uses real tobacco. The difference between traditional cigarettes and the Iqos? The tobacco is heated, rather than burned, Philip Morris said at an event on Tuesday.But is the Iqos the silver bullet for smoking without the deadly side effects? And will it help Philip Morris with its goal to replace cigarettes with non-combustible alternatives? Business Insider investigates.<h2>First up, cigarettes kill</h2>Philip Morris, the world's largest international tobacco company, came under fire in 1999, when the US government brought a lawsuit claiming that leading cigarette makers were <a href="http://articles.latimes.com/2005/apr/08/business/fi-smoke8" target="_blank">conspiring to lie about the dangers of cigarettes for decades</a>.The company, which owns cigarette makers like Marlboro and Benson &amp; Hedges, has since recovered, and reported <a href="http://investors.philipmorrisinternational.com/phoenix.zhtml?c=146476&amp;p=irol-earnings" target="_blank">net earnings of more than £16 billion ($19.9 billion)</a> in the third quarter of 2016.About <a href="http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html">15% of American adults</a> smoke, compared with about <a href="http://www.ash.org.uk/files/documents/ASH_93.pdf">19% of adults</a> in the UK. In the US, where it is the leading cause of preventable death, smoking <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/">kills 480,000 people each year and shortens the life of an average user by 10 years</a>. In Great Britain, smoking causes <a href="https://www.nhs.uk/smokefree/why-quit/smoking-health-problems" target="_blank">86% of lung cancer deaths</a>. The burden is sharply felt by low-income communities in both countries; in the US, <a href="http://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html">more than a quarter of people who currently live below the poverty level smoke</a>. In the UK, that figure is <a href="http://www.ash.org.uk/files/documents/ASH_93.pdf">closer to 30%</a>.<h2>Burning tobacco is terrible for you</h2><div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Getty Images</div></div></div>According to the <a href="https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes">National Institute on Drug Abuse,</a> "the worst health consequences associated with smoking (e.g., cancer and heart disease) are linked to inhalation of tar and other chemicals produced by tobacco combustion; the pleasurable, reinforcing, and addictive properties of smoking are produced mostly by the nicotine contained in tobacco."Since the tobacco in the Iqos is not burned but heated to 350 degrees Celsius, Philip Morris claims it is healthier than traditional cigarettes. (The temperature of a burning cigarette, for contrast, typically ranges from about 800 to 900 degrees Celsius, <a href="http://www.nature.com/nature/journal/v247/n5440/abs/247405a0.html">according to a study published in the journal Nature</a>.)Importantly, these health claims have yet to be verified by an outside agency.<h2>Not a traditional cigarette, not an e-cig</h2>Instead of generating smoke, the Iqos device produces a vapour that delivers the nicotine from specially-designed "tobacco sticks." This is similar to the way many e-cigarettes currently on the market work, aside from one huge thing: Unlike most e-cigs, the Iqos still contains tobacco.Most e-cigs are battery-powered devices that convert liquid nicotine from a cartridge into a vapour that the user inhales. While e-cigs don't contain all of the harmful chemicals that traditional cigarettes do - including carbon monoxide and tar - they're not completely harmless, either.<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Kevin Smith/Business Insider</div></div></div>E-cig cartridges are typically filled with propylene glycol, the same stuff that's used by fog machines. The US Food and Drug Administration approved propylene glycol for use in food. When you buy an e-cig cartridge, you can get differing amounts of nicotine (or none at all). You can also purchase flavoured liquids such as chocolate, strawberry, and mint.The Iqos would ostensibly contain both propylene glycol and tobacco.Martin Inkster, Philip Morris' UK and Ireland Managing Director, told Business Insider that the UK launch was part of the company's <a href="https://www.google.com/url?hl=en&amp;q=https://www.pmiscience.com/platform-development/platform-portfolio/heat-not-burn&amp;source=gmail&amp;ust=1480594653064000&amp;usg=AFQjCNGILMSGbssm0qjbDD4Tr_JQ64WVRQ" target="_blank">overall aim</a> to "replace cigarettes with non-combustible alternatives."The company claims that its new product - the Iqos - produces 90-95% less harmful chemicals than traditional cigarettes, but these claims have not been verified externally.<h2>This is not the first time a cigarette company has experimented with heating, rather than burning, tobacco</h2>In the 1980s, <a href="http://www.nytimes.com/1988/11/19/business/smokeless-cigarette-s-hapless-start.html">US tobacco giant Reynolds debuted a device called the Premier</a>, which drew hot air from a burning piece of carbon placed over rolled tobacco and an aluminum ''flavour capsule'' which contained nicotine and artificial flavouring. That product proved "highly unpopular," <a href="http://www.nytimes.com/1988/11/19/business/smokeless-cigarette-s-hapless-start.html">the New York Times reported</a> in 1988.After Reynolds spent $300 million on research, development and marketing for the Premier, the product lasted just a year.<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Scott Barbour/Getty Images</div></div></div>In addition to being wildly unpopular, the Premier faced opposition from health officials in states where it came out. An Arizona pharmacy organisation, for example, voted in 1988 to ask Reynolds to voluntarily pull the cigarette, after the American Medical Association and several state-level medical groups said the device should be considered a <a href="http://www.nytimes.com/1988/11/19/business/smokeless-cigarette-s-hapless-start.html">''new and hazardous system intended to deliver the drug nicotine,"</a> according to the New York Times.Philip Morris International has spent £2.4 billion ($3 billion) developing the Iqos, which launched in the UK on Wednesday.The device costs £45 for the battery pack, which charges a slim cigarette holder. You can also buy the tobacco sticks (called "heets") separately - which cost £8 for a pack of 20. In the US, e-cigarette prices range from $20 to $60 for a basic "starter kit," which includes the e-cigarette, along with several cartridges and a charger for the device. In the UK, similar kits typically sell for around £20 to £40.In 2015, Philip Morris <a href="http://uk.businessinsider.com/r-in-twist-scientists-join-tobacco-companies-to-fight-cancer-2015-6" target="_blank">hired more than 400 scientists and toxologists</a> in a bid to enter the e-cigarette market. <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/what-your-lungs-look-like-after-just-20-cigarettes-medspiration-experiment-on-healthy-lungs-trachea-2016-7">This is what your lungs look like after just 20 cigarettes</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="FzMHR2NDE6kCm7nPjYdcM6abqQHGrMsQ" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

Tobacco behemoth Philip Morris just launched a cigarette 'alternative' - but it is far from problem-free

<div class="KonaFilter image-container display-table"><div><div class="image on-image">Hollis Johnson/Business Insider</div></div></div>We surveyed 1,800 teens and 20-somethings about how they view the world and analyzed data from the Pew Research Center, industry experts, and more. Here are 28 of the biggest things you need to know about Gen Z.<ol><li>Gen Z ranges from 7 to 21 years old.</li><li>This is the first generation to really grow up online. </li><li>Today's 17 year old was just two when Facebook launched, three when YouTube was founded, and in kindergarten when Apple unveiled the iPhone. </li><li>Gen Z is the most racially diverse generation in US history, with minorities about to outnumber the white population.</li><li>Most of the generation sees diversity as good for society.</li><li>One in three Gen Zers knows someone who prefers to use gender-neutral pronouns. </li><li>Gen Z is the first generation in which the majority believes that forms should include gender options other than "man" or "woman." </li><li>Most of Gen Z doesn't work, but it's not because they don't want to. They cite not having time or not being able to get a job as the main reason they're unemployed.</li><li>Gen Z believes things in America are going poorly.</li><li>When it comes to political beliefs, Gen Z skews more conservative than many realize. The generation is split between the right and the left. </li><li>Still, the overwhelming majority say the biggest issue America is facing today is President Donald Trump.</li><li>Gen Z pretty firmly believes humans are causing climate change, even young Republicans.</li><li>Younger voters are pushing hard for legalized weed. Americans under 35 are twice as likely to support legalization as baby boomers.</li><li>More than one in four Gen Zers say they use cannabis or marijuana, more than twice the national average, according to a survey by Bloomberg.</li><li>Gen Z seems to be resisting ecigs. While they're more likely to vape than smoke a cigarette, most say they won't do either. Most also aren't interested in drinking alcohol. </li><li>Gen Z's shopping habits could destroy a lot of traditional <keyword id="6354851" type="UNKNOWN" weightage="100" keywordseo="retail">retail</keyword> brands. That's because they don't shop by label. In fact, they actively avoid labels - seeking out little known thrift stores and boutiques to find unique styles - and shop by price instead.</li><li>McDonald's reigns supreme.</li><li>They're all about Amazon: 90% of Gen Zers say they've shopped there.</li><li>As Gen Z constantly multitasks, adding up all the hours they spend on various screens and social media networks makes it appear as if they have more than 24 hours in a day.</li><li>Netflix is easily winning the streaming wars</li><li>Most of Gen Z gets its news from social media, and Instagram has become the new front page.</li><li>In general, Instagram and YouTube dominate Gen Z's social-media usage, with more than 60% percent saying they use them every day.</li><li>But Facebook's teen problem is real. Gen Z says it's fleeing Facebook and Kik quickly.</li><li>Snap is still the communication toolof choice. They talk to friends primarily by text or snaps.</li><li>If you don't own an iPhone, you're more or less "a loser," and Gen Z will make you feel like one. Some 83% of teens own an iPhone, according to a recent Piper Jaffray survey.</li></ol><div id="5cf01be07de1e" data-container-id="5cf03eeebea53"></div><a href="https://www.businessinsider.com/intelligence/generation-z?IR=T&amp;itm_source=businessinsider&amp;itm_medium=ctgr_bii&amp;itm_term=ctgr_hub&amp;itm_content=gen_z&amp;itm_campaign=generation-z"></a> <div class="margin-top"> <h3>NOW WATCH: <a href="https://www.businessinsider.com/pink-himalayan-salt-expensive-health-benefits-minerals-2019-6">Why pink Himalayan salt is so expensive</a></h3> <div> </div> </div>

1,800 teens and 20-somethings reveal what's cool and what's not in 2019

<div class="KonaFilter image-container display-table"><div><div class="image on-image">ReutersFDA Commissioner Scott Gottlieb said one way to make a big improvement to the US health system would be to make sure everyone is getting their vaccinations.</div></div></div><ul class="summary-list"><li>We asked FDA Commissioner <a href="https://www.fda.gov/aboutfda/commissionerspage/default.htm">Scott Gottlieb</a> if there was one thing someone could do right now to fix healthcare.</li><li>Gottlieb quickly indicated <a href="https://www.businessinsider.com/why-vaccines-are-so-important-2015-2">vaccines</a>, a crucial scientific advance that protect us from dangerous diseases. They have also come under attack from an anti-vaccine movement spreading<a href="https://www.businessinsider.com/lies-anti-vaxxers-spread-about-measles-vaccine-debunked-2019-1"> false claims.</a></li><li>Current trends suggest that the US is approaching a tipping point on vaccines, Gottlieb told Business Insider. If attitudes toward vaccines change completely, "the implications could be quite profound," he said. </li></ul>The US health system has all kinds of problems.But when we asked <a href="https://www.fda.gov/AboutFDA/CentersOffices/ucm557569.htm">FDA Commissioner Scott Gottlieb</a> if there was one fix that could significantly improve the system, he quickly pointed to vaccines. He told Business Insider that it's important that everyone get their shots.Today, "you see complacency around some of the achievements that we've made, and declining willingness, or even confidence in, some of the products that have vanquished a lot of human illness," he said. <a href="https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Pages/Immunization-Schedule.aspx">Vaccines</a> are a powerful <a href="https://www.businessinsider.com/why-vaccines-are-so-important-2015-2">scientific advance</a> that bolster the body's natural defense systems. That, in turn, can protect an individual from dangerous diseases like smallpox, polio, cholera and measles, and also prevent those from spreading in the community. But vaccines have come under attack from a movement of "<a href="https://www.businessinsider.com/doctors-warn-google-twitter-facebook-anti-vaxxers-2019-3">anti-vaxxers</a>," who use <a href="https://www.businessinsider.com/lies-anti-vaxxers-spread-about-measles-vaccine-debunked-2019-1">incorrect ideas</a> about vaccines to <a href="https://www.businessinsider.com/why-vaccines-continue-to-frighten-people-2016-4">argue</a> against them. There have been worrisome outbreaks of preventable diseases like <a href="https://www.businessinsider.com/r-explainer-low-vaccination-rates-global-outbreaks-fuel-us-measles-spread-2019-2">measles</a> in the US, including nearly 300 cases across 15 states in <a href="https://www.cdc.gov/measles/cases-outbreaks.html">2019 thus far.</a>Gottlieb told Business Insider that the US is approaching a tipping point on vaccines. Once people are no longer accepting of vaccines and willing to be vaccinated, "the implications could be quite profound," Gottlieb said.If current trends continue, "it's not going to be a gradual evolution towards the resurgence of certain diseases that were once vanquished," he said. "It's going to be all of a sudden, we're going to see epidemics and maybe worse than that."Read more: <a href="https://www.businessinsider.com/fda-to-finish-rules-on-e-cigarettes-juul-before-gottlieb-resigns-2019-3">The US plans to restrict sales of candy-flavored e-cigs at convenience stores before the top FDA leader leaves office</a><h2>What we could do</h2>Experts have become increasingly <a href="https://www.businessinsider.com/bill-gates-warning-to-anti-vaccine-parents-2019-2">concerned</a> about anti-vaccine sentiment.The World Health Organization even added peoples' reluctance or refusal to vaccinate to its list of <a href="https://www.thisisinsider.com/anti-vaxxing-global-health-threat-2019-who-2019-1">global public health threats</a> this year, alongside climate change and cancer. The US doesn't compel everyone to get vaccinated. Instead, vaccines requirements are enforced at a state level, where they are often needed for kids to go to school. But states do allow <a href="https://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html">exemptions</a>, including for medical, religious and philosophical reasons. One approach might be to look at those state-level exemptions, Gottlieb said. Gottlieb gave notice <a href="https://www.businessinsider.com/fda-commissioner-scott-gottlieb-to-resign-2019-3">earlier this month</a> that he would resign, and has just weeks left in the job. He is leaving the post to spend more time with his family, including his three young children, he told Business Insider last week.<ul class="read-more-links"><li>Read more:</li><li><a href="https://www.businessinsider.com/fda-commissioner-scott-gottlieb-to-resign-2019-3">FDA Commissioner Scott Gottlieb just resigned as head of the US's top food and drug regulator in a surprise announcement</a></li><li><a href="https://www.businessinsider.com/gene-therapy-treats-disease-but-prices-could-strain-us-health-system-2019-2">Drugs that cost as much as a house are on the way to treat rare and devastating diseases. The US is scrambling to figure out how to pay for them.</a></li><li><a href="https://www.businessinsider.com/pharma-ceos-on-trumps-rebate-plan-effect-on-drug-prices-2019-2">7 pharma execs just told Congress: Don't expect the Trump administration's newest drug pricing plan to lower all US drug prices yet</a></li><li><a href="https://www.businessinsider.com/hims-and-roman-target-erectile-dysfunction-which-can-signal-health-issues-2019-2">Hot startups like Hims and Roman are marketing Viagra to young men online, but their approach raises 2 big questions</a></li></ul> <a href="http://www.businessinsider.com/intelligence/ai-in-us-healthcare?IR=T&amp;utm_source=businessinsider&amp;utm_medium=ctgr&amp;utm_term=ctgr_leadgen&amp;utm_content=dhealth_ctgr_leadgen&amp;utm_campaign=dhealth_ctgr_leadgen_ai_in_us_healthcare"></a></hr> <div class="margin-top"> <h3>NOW WATCH: <a href="https://www.businessinsider.com/most-extreme-sex-animal-kingdom-2019-2">5 animals that have the most extreme sex in the animal kingdom</a></h3> <div> </div> </div>

The FDA's top leader says the US is approaching a tipping point on vaccines that could lead to 'epidemics and maybe worse'

<div class="KonaFilter image-container float_right"><div class="image"><a href="http://www.businessinsider.com/e-cigarettes-will-be-3-billion-market-2013-5">BluCigs</a>blu eCig spokesman Stephen Dorff.</div></div>Remember e-cigarettes?
They were among <a href="http://www.businessinsider.com/citi-disruptive-innovation-2013-5">Citi's Disruptive Innovations of 2013</a>, a list which came out a year ago. 
Since then, we've seen <a href="http://www.no-smoke.org/pdf/ecigslaws.pdf">a flood of state and local regulations</a> restricting their use by minors and banning them from certain venues. And the restrictions have likely only just begun.
Last week, Citi updated its view of the e-cig market to reflect this and other changes. Their conclusion: E-cigarettes have now reached, at best, a temporary plateau in expanding. The most immediate issue is that they've worked their way through all possible early adopters.
Over the last six months, we have seen both dollar and volume sales growth decelerate in the e-cigarette category (Nielsen-tracked, brick and mortar). Indeed, the deceleration is coming from both negative mix shifts [e.g. margins - ed.] as well as softening volumes. The negative mix-shift seen for the category is inevitable as technology improves, formats change, competition intensifies, and prices come down.
Here's the chart showing the deceleration in growth:
<div class="KonaFilter image-container display-table"><div><div class="image">Citi</div></div></div> 
They continue - emphasis ours:
...We believe the decelerating volume growth that we are seeing reflects: 1) changing retailer brand preferences (e.g., brand destocking / replacements); as well as 2) consumer dissatisfaction with the product. Indeed, we suspect that the ~26% adoption rate for e-cigarettes, relative to a trial rate of 40%-50% (including non-purchase), probably falls well below that seen for many consumer electronics. 
They are not wholly bearish, maintaining that consumers are still interested in e-cigs, but that producers will have to pull forward spending to boost numbers. But they warn that all new possible state and federal regulations and taxes must be turfed out first.

The E-Cigarette Boom Is Over

<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image">Photo credit should read GLYN KIRK/AFP/Getty Images</div></div></div>Fidelity's <a href="http://www.businessinsider.com/fidelity-wrote-down-the-value-of-its-snapchat-stake-by-25-2015-11">recent 25% writedown</a> of its stake in disappearing photo-app Snapchat sent shockwaves through the tech industry.But Snapchat is not the only highly-valued company to get cut down to size and have its value slashed by the mutual fund. Zenefits, Dataminr, and Blue Bottle Coffee Co were all marked down by Fidelity in the third quarter, <a href="http://fortune.com/2015/11/11/snapchat-isnt-the-only-startup-in-fidelitys-crosshairs/">according to Fortune's Dan Primack</a>. Perhaps the most brutal Fidelity write down: electronic cigarette maker NJoy, which saw a $9.52 million investment by Fidelity written down to just $12 - essentially the price to buy two of NJoy's own "e-cigs." Fidelity cut the value of its shares in Zenefits, which is officially called YourPeople, by 48%. And the value of its stake in Dataminr was slashed by 35%As for Blue Bottle, the hipster coffee chain that counts Google Ventures as a backer, Fidelity wrote down its investment by 43%.It's important to note, as Fortune points out, that these write-downs are more art than science. And we still don't know why Fidelity decided to write down the investments. Not every Fidelity private company investment was marked down in the third quarter however. Uber, the ride-hailing service currently valued at more than $50 billion, saw its valuation hold steady in Fidelity's eyes. And actress Jessica Alba's Honest Company also retained its value. Fidelity also increased the estimated value of its SpaceX investment during the third quarter. <div class="margin-top"> <h3>NOW WATCH: <a href="http://www.businessinsider.com/engineering-behind-void-first-vr-park-2015-11"> A nuclear engineer is solving virtual reality's biggest problem</a></h3> <div> <div> <div class="ooyala-video-player" data-video-autoplay="false" data-video-id="l4cXQweDr-vj2WOz8XvIk7VMvS5Xcnqm" data-player-variable="ooyalapopvideo" id="ooyalaplayer_popvideo" style="width:1280px;height:720px"></div> </div> </div> </div>

Fidelity wrote down a $9.5 million investment in one startup to just $12 and it slashed a lot of other valuations

<div class="image-container float_right" style="width:400px"><div class="image"></div>Robert Johnson</div>Sorry, big <keyword id="6361871" type="ORGANIZATION" weightage="60" keywordseo="tobacco">tobacco</keyword>. 
"Smoking" <a href="http://www.businessinsider.com/e-cigarette-health-effects-2013-5">e-cigarettes</a> is infinitely better than smoking the real thing.
I used to be a cigarette smoker.
Now I'm what you might call an early adopter of e-cigarettes. I've been "<keyword id="1744074" type="UNKNOWN" weightage="60" keywordseo="Vaping">vaping</keyword>" ("vaping" is short for vaporizing, and is what the kids are calling smoking e-cigarettes these days) for about one year and four months. 
This is what I've learned. 
Feeding the addiction
Make no bones about it, e-cigarettes provide users with a means of feeding an addiction. The delivery method is different from smoking or chewing, but the end result is essentially the same. You're still after a nicotine fix and puffing away on an e-cig provides it.
Though with an <keyword id="491563" type="UNKNOWN" weightage="60" keywordseo="E-cigarette">e-cigarette</keyword>, that fix is provided via inhaled, atomized, nicotine-infused water vapor instead of smoke. If you're addicted to nicotine and an e-cigarette smoker, not using an e-cig for a period of time results in the same withdrawal symptoms as not smoking a cigarette. 
Cost, where to buy, and brands
Some of the most commonly purchased and visible brands of e-cigarettes found in New York City convenience shops and online are <a href="http://www.eonsmoke.com/" target="_blank">Eonsmoke</a>, <a href="http://www.logicecig.com" target="_blank">Logic</a>, <a href="http://www.blucigs.com/" target="_blank">Blu</a> (<a href="http://www.businessinsider.com/are-e-cigarettes-cool-2013-3">Stephen Dorff endorses</a>, so e-cigs still have a way to go in the coolness factor), and <a href="http://www.pufcigs.com" target="_blank">Puf Cigs</a>. They offer a variety of nicotine levels in a variety of flavors like mint, tobacco, and watermelon that are meant to cater to light or heavy smokers. 
E-cigarettes can be purchased as one-time use, typically for $10 a pop, which is supposed to be good for around 400 to 900 "puffs" and provide the nicotine equivalent of a pack and a half to three packs of cigarettes. 
Rechargeable e-cigarettes can also be bought along with refill packs that contain the "juice." The Logic's rechargeable e-cigarettes cost $20 and a pack of five refills costs the same.
<div class="image-container" style="width:590px"><div class="image"></div>Robert JohnsonAtomizer and refill cartridge.</div>
<div class="image-container" style="width:590px"><div class="image"></div>Robert JohnsonTwist them together and you're ready to vape.</div>
Compare this to the high price of cigarettes in New York City — around $12 a pack — and this seems like a complete bargain. In other cities where the cost of a pack of cigarettes is much lower, it might not seem like such a great deal. 
E-Cigarettes are easy enough to find in New York City and just about any corner shop carries them. They can also be found at some RITE AIDS and CVS stores. Specialized <a href="http://www.vapeny.com/" target="_blank">Vape shops</a> have started popping up, and there is a <a href="http://www.c9v-forum.com/" target="_blank">growing community of hardcore vapers</a> out there who are into creating their own "juice" (nicotine liquid) and vape delivery systems. 
But on a last-minute-trip to California last year, out of four gas stations and convenience stores that I visited, none had any e-cigarettes. Zero. I ended up buying a pack of Camels. So finding them can be hit or miss, and if you're trying not to smoke, being put in a situation where you can't find an e-cigarette is an easy way to relapse back to smoking. That's what happened to me. 
The availability can be an issue depending on where you live. 
Fuzzy nicotine math
Inhaling on an e-cigarette and the resulting buzzy satisfaction can vary greatly depending on the brand used, the nicotine content of the liquid, and the user's tolerance. My brand of choice as of late has been the Logic rechargeable with refills. On a typical week I'll go through about five refill cartridges of "extra high" nicotine volume, which I suppose would put me at about just over two packs a day if worked out to regular cigarettes.
When I was smoking cigarettes, I would smoke maybe a half pack a day. But I'm not convinced I'm getting more nicotine per day puffing on e-cigarettes than I would if I were smoking cigarettes. 
This is because my e-cigarette inhaling habits vary wildly and I suspect the nicotine levels also vary from e-cig to e-cig and refill to refill. It is easy to suck on one of these things all day, like an adult pacifier. It's also easy to take inconsistent drags, and each brand has a different draw. Also, the lower the battery the harder you have to draw on the e-cig to get a proper hit.
Where you can (and can't) smoke
You can legally vape just about anywhere, but if you're planning on vaping in places where regular smoking isn't allowed, be prepared to feel awkward. It would feel similar to wearing Google Glasses with a little red RECORD light on. People know you're doing something annoying and possibly invasive, they just don't know what it is. 
Puffing away in a packed movie theater is awkward. You become the center of attention for the wrong reasons. Same thing in a restaurant. If you want uncomfortable attention, pull out an e-cigarette and start puffing during dinner. After the confused stares, you'll have to explain to somebody what you're doing.
At a former employer, one of my colleagues in the newsroom (not me, I swear) had quit smoking and taken up e-cigarettes. He tried to discreetly puff them in the newsroom. Didn't last long. Somebody submitted an anonymous complaint saying that it made them feel uncomfortable, so he was forced to go hide somewhere and be banished like a regular smoker. 
He later went back to cigarettes. 
But walking down the street and knowing that the smoke you're blowing isn't actually smoke, but vapor, isn't going to cause any passersby any risks, or anger them or make you feel like a schmuck, is liberating. There's no smell, you don't get nasty looks on the street for vaping an e-cigarette. 
<div class="image-container" style="width:590px"><div class="image"></div>Rob JohnsonDon't want nasty looks for smoking? Here are your alternatives. </div>
The biggest benefit is using an e-cigarette in your own home and not stinking up the house or yourself with real cigarettes. You don't have to go outside. Your clothes don't smell. You can sit there and do whatever it is you're doing while puffing away, no harm no foul. No house fires for smoking in bed. No giving your loved ones cancer from second-hand smoke. Quite a good deal. 
Teething problems
Prepare to gnaw. There is a tendency to want to just leave an e-cigarette in your mouth instead of using the smoking motion of a regular cigarette. Smelly smoke doesn't blow in your eyes and face and you can just go to town and suck vapor as much as you want. By the time you're done with a refill, it can look like it was attacked by small rodents. 
After over a year of consistent use I haven't had any teeth problems even with the gnawing. My teeth are actually whiter and my gums in better shape than when I was smoking. 
Speaking of benefits
I can breathe again. My lung capacity has seemed to increase back to a reasonable level for a human. I don't get out of breath. I don't smell like grandma's stale curtains. My contact lenses tend to last longer because smoke isn't blowing into my eyes. My wife kisses me more because my breath doesn't smell like smoke. In many ways, e-cigarettes are a revelation. 
What isn't a revelation is the battery life or reliability of the brands commonly found. USB battery chargers bust. The one-time-use e-cigarettes seem to vary as to how many puffs you actually get per use, and there is a very good chance that you can fall off the wagon and begin smoking again. 
Official FDA research as to the long-term health effects of using e-cigarettes is lacking, but that's likely to change as more people take up vaping. 
What there is plenty of, though, is research into the effects of smoking regular cigarettes. As the lesser of two evils, e-cigarettes are the way to go, and that is a belief that will be hard for me to shake unless somebody other than big tobacco is able to come up with a study proving e-cigarettes are as bad for people as cigarettes.
As an alternative to smoking or chewing tobacco, it would be hard for me to not recommend e-cigarettes. As something you should just start doing for the heck of it? Not so much. The best bet is to just not get started with nicotine in the first place, but for those smokers out there looking for an alternative besides the patch, gum, or drugs like <a href="http://www.chantix.com/" target="_blank">Chantix</a>, e-cigarettes are an easy sell.

I'm A Smoker And I Love E-Cigarettes

<div class="KonaFilter image-container display-table float_right"><div><div class="image on-image"></div></div></div>
Get your week off to a flying start by reading up on the 10 things in <keyword id="35666" type="COMPANY" weightage="100" keywordseo="advertising">advertising</keyword> you need to know this morning.
1. <a href="http://www.businessinsider.com/vip-e-cigarette-first-vaping-ad-2014-11">Here's the first UK TV ad showing someone using an e-cigarette.</a> The ad, for e-cig brand VIP, follows a rule change last month allowing the depiction of "vaping" on TV.
2. <a href="http://www.businessinsider.com/john-lewis-christmas-ad-facebook-vs-youtube-2014-11">Facebook is stealing a huge chunk of YouTube's video audience.</a> Early stats for the John Lewis 2014 Christmas ad - the most anticipated UK annual advertising event - show Facebook stole 40% of the online audience for the video, which would have previously belonged entirely to YouTube. 
3. <a href="http://www.businessinsider.com/33-british-brands-that-are-not-british-2014-10#boots-uk-is-the-latest-british-brand-to-defect-walgreens-the-biggest-pharmacy-company-in-the-world-bought-it-this-august-for-565-billion-9-billion-it-was-previously-owned-by-stefano-pessina-an-italian-entrepreneur-33">Check out the 33 quintessentially "British" brands that are not actually British.</a> There are quite a few surprises in there, like Jaguar and Branston Pickle. 
4. <a href="http://www.businessinsider.com/the-economist-eric-schmidt-ad-2014-11">Google's Eric Schmidt is the star of the latest ad for The Economist.</a> The ad shows a businessman trying - and failing - to come up with a conversation starter when Schmidt enters the elevator he is standing in. 
5. <a href="http://www.businessinsider.com/epl-vs-nfl-commercial-revenue-2014-11">The NFL is getting trounced by the English Premier League in terms of global sponsorship deals.</a> The Premier League may lag behind the top North American sports leagues in terms of total revenue, but it is outpacing its American counterpart on commercial revenue, according to data from Deloitte and IEG. 
6. <a href="http://variety.com/2014/tv/news/cable-network-ratings-1201346782/">Variety has published a detailed feature on the decline of the cable TV market.</a> The perilous situation cable networks are in was summed up by NBCUniversal CEO Steve Burke last month who admitted: "The fact of the matter is, the next five or 10 years in basic-entertainment cable, as it relates to ratings, are going to be much more difficult than the last five to 10 years."
7. <a href="http://www.marketingweek.com/2014/11/07/unilever-to-advertise-corporate-brand-on-uk-tv-for-first-time/">Unilever is to advertise its corporate brand on TV for the first time, Marketing Week reports.</a> The CPG company is looking to raise awareness of the sustainability work it is doing as part of its Project Sunlight initiative. 
8. <a href="http://blogs.wsj.com/cmo/2014/11/10/machinima-unveils-rebranding-effort-and-expanded-partner-program/">Machinima, the popular gaming-centric web video company, is rebranding, The Wall Street Journal's CMO Today reports.</a> The company is set to unveil a new logo and the tagline "Heroes Rise." 
9. <a href="http://www.adweek.com/news/advertising-branding/sapients-net-income-falls-amid-publicis-groupes-bid-buy-company-161287">Sapient, the digital marketing company being bought by Publicis Groupe for $3.7 billion reported a 15% drop in third-quarter net income on Friday, Adweek reported.</a> One analyst said the financials were "potentially alarming," having come so soon after the acquisition announcement. 
10. <a href="http://www.bloomberg.com/news/2014-11-07/high-speed-ad-traders-profit-by-arbitraging-your-eyeballs.html">Bloomberg has explored the murky world of arbitrage in ad exchanges.</a> The report details how anonymous traders are exploiting price discrepancies and reselling them on for profit, generating margins of as much of 60%.

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