Cigarettes with ultralow nicotine levels are now being called the game-changer in the fight against smoking. If you are having trouble in quitting smoking, then, it is for you, that soon the Biden White House is expected to formally propose a plan that will order cigarette nicotine levels to be reduced, reports The Washington Post. For now though, it has been a failure, as these cigarettes, also known as VLN cigarettes that stands for very low nicotine are only available in 5,100 stores in 26 states. This is a very small fraction of the overall market for cigarettes. The company that makes it, 22nd Century, is struggling not because of the low supply, but also from the advocates who have long believed slashing nicotine levels altogether.

The Advent and ideation

Nicotine is a chemical that is produced naturally from tobacco that makes the cigarette and also keeps people hooked. While it is believed that it makes people alert, and get the "hit" to keep them going, it exposes the users to harmful substances, carcinogens, and increases the risk of heart disease, lung cancer, and other illness.

Ultralow-nicotine cigarettes, like the VLN brand, contain about 95% less nicotine than the regular cigarettes. The idea is quite simple: without the addictive grip of nicotine, smokers will find it easier to quit. Research too has shown some promise. For instance, the studies funded by the National Institute on Drug Abuse revealed that very low nicotine cigarettes reduced addiction potential significantly without having users to increase their smoking frequency. However, the problem is, why would anyone choose for a low-nicotine that does not make them feel the same way, when the high-nicotine cigarette is right next to it, making them feel the same way, with the same alertness, sold at the same price.

“It’s very hard to imagine someone actively choosing to continue to use a low-nicotine product for the same price when a high-nicotine product is right next to it,” said Eric Donny, a Wake Forest University School of Medicine nicotine researcher.

No wonder, the experiment with low nicotine product by Philip Morris' Next cigarettes in the 1980s and Vector Tobacco's Quest brand in the early 2000s, flopped.

FDA's Role in the Push

The Food and Drug Administration (FDA) has supported the development of such products, even allowing VLN cigarettes to be marketed as lower-risk options. However, these products remain a niche market, available in only a fraction of U.S. stores.

Recently, the Biden administration has considered a bold step—mandating a dramatic reduction in nicotine levels for all cigarettes sold in the United States. Supporters believe this move could save millions of lives, while critics, including tobacco companies, warn of potential unintended consequences.

What Could Be The Challenges?

Resistance from Big Tobacco Companies: They could argue that slashing nicotine levels could backfire. Their claim is, smokers will turn to black markets or smoke more to satisfy their cravings, which may lead to greater exposure to harmful substances.

Consumer Reluctance: History is proof to the instances of smokers being hesitant to embrace the low-nicotine products.

Political Hurdle: It may face political roadblocks, as under the Trump administration, plans to cut nicotine were shelved.

Could Low-Nicotine Cigarettes Be The Solution?

Advocates believe that ultralow-nicotine cigarettes could be a game-changer, comparing them to decaf coffee or non-alcoholic beer—products that reduce harm while offering a similar experience.

Some experts warn that a black market for traditional cigarettes could undermine these efforts. They also stress the need for safer alternatives, such as vaping products, to support smokers transitioning away from traditional cigarettes.

The XFG COVID-19 variant is driving a rise in cases and hospitalizations in the UK and France, while some US regions are also reporting increases.

XFG, nicknamed ‘American COVID’ or Stratus, is a recombinant SARS-CoV-2 variant from the Omicron lineage, formed from LF.7 and LP.8.1.2. The WHO recorded the earliest documented XFG sample on January 27, 2025, and designated it a variant under monitoring in June 2025.

The NHS has advised infected people to stay home to limit spread. The UK is rolling out COVID vaccination, while France is expected to begin its campaign next week.

COVID and flu symptoms can overlap, including cough, fever, sore throat, headache, runny nose and fatigue.

COVID Activity Rises in UK, France

In France, the estimated number of people with COVID consulting GPs for acute respiratory infections rose to 13 per 100,000, from nine the previous week, according to The Connexion. This translates to around 8,806 new cases, up from about 6,000.

In England, hospital PCR positivity rose from 5.9% to 7.0% in the week to September 20, while hospital admissions increased from 0.81 to 1.20 per 100,000. Overall activity remained low.

US CDC data from September 29 showed cases rising in some states while falling or remaining stable in others.

Also read: ‘American Covid’ Strain Drives 50% Surge in UK Hospital Admissions: XFG Symptoms to Know

Is India At Risk?

HealthandMe spoke to experts who said the UK-France rise does not necessarily mean India will see a similar increase.

“The rise in COVID-19 cases in the UK and France does not necessarily mean that India is headed towards a similar increase,” said Dr Suranjit Chatterjee, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospitals, Delhi.

XFG is being monitored because it has become more common in some countries, but available evidence does not indicate that it causes more severe illness than other circulating variants.

“For India, the more relevant question is whether XFG is increasing locally and whether this is translating into a rise in symptoms or hospitalizations,” Dr Suranjit told HealthandMe .

Does XFG Cause More Severe Disease?

Dr Amit Prakash Singh, Consultant - Internal Medicine, CK Birla Hospital, Delhi, said the spread of XFG highlights the need for continued surveillance as SARS-CoV-2 evolves.

“Yet at present there is no evidence to indicate that the XFG variant causes more severe disease than the other Omicron-lineage variants,” he said.

However, the “main concern for India would be a greater rate of transmission, especially among older people, those with comorbidities and the immunocompromised, should the variant become more common in the country”.

What Should India Watch?

Read More: COVID-19 Cases Rise In France, Vaccination Campaign Set To Start Next Week

Dr Amit told HealthandMe India should continue genomic surveillance and monitor hospitalizations and severe disease rather than focusing only on case numbers.

Dr Suranjit said international travel can introduce new variants, but their impact depends on community spread and existing immunity.

“At this stage, there is no reason for people (in India) to be unduly concerned or change their daily routine.”

He added that continued surveillance, timely testing when symptoms occur and sensible precautions during respiratory infections remain appropriate.

Are XFG Vaccines Available?

XFG-specific vaccines have been developed and are either in use or authorized in several countries. The US and UK have opted for XFG-targeted formulations for the 2026–27 season.

In India, an XFG-specific vaccine should be considered available only after regulatory approval and commercial supply.

The WHO continues to stress that vaccination should not be postponed while waiting for an updated formulation.

Canada has determined to restrict medical assistance in dying (MAID) for patients whose sole underlying condition is a mental illness, shelving plans to expand the eligibility in 2027.

Justice Minister Sean Fraser said the government will introduce legislation to maintain the exclusion beyond the current deadline of March 17, 2027.

The decision comes weeks after an Ontario court rejected a woman's request for an exemption that could have allowed her to seek MAID because of severe, longstanding mental illness.

Canada Extends Ban On Medical Assistance In Dying

The government says there is still no sufficient medical consensus on when a mental illness can be considered irremediable, a key requirement under Canada's MAID policy.

Fraser said, “When I hear that there is a lack of consensus within the medical community about the irremediable nature of certain mental illnesses, that gives me real cause for concern.” He also pointed out that access to mental health care in the country is uneven.

He acknowledged that the issue does not have unanimous agreement but defended the government's decision. “While there is not a perfect consensus on this issue, we believe this is the correct approach at this particular time,” Fraser said.

Canada had originally kept the exception as temporary. When MAID eligibility was expanded in 2021 to people whose natural death was not reasonably foreseeable, mental illness as the sole underlying condition that was deemed ineligible.

The exclusion was subsequently delayed several times, with March 2027 becoming the latest planned date for possible expansion.

Also read: Canadian Parliamentary Panel Urges Indefinite Ban on Assisted Dying for Mental Illness Alone

Ontario Court Rejected A Woman’s MAID Request

The announcement comes just after a controversial case involving Claire Elyse Brosseau, a 49-year-old Toronto woman who sought a constitutional exemption from the existing MAID exclusion.

Brosseau said she has lived with severe mental-health problems for decades and had undergone multiple forms of treatment. In May, she asked the Ontario Superior Court for emergency relief that would allow her to apply for MAID.

On September 3, Justice Carissima Mathen rejected that request. She also ordered the federal government to respond to Brosseau's constitutional challenge to the exclusion.

Mathen described Brosseau's evidence of suffering as credible and compelling, but said the case also involved Parliament's role in making decisions on “sensitive social issues” and interpreting the Charter rights involved.

Brosseau, meanwhile, said the decision was nothing but another barrier for people with mental illness. “It is yet another example of governmental systems telling people with mental illnesses that we do not have the same rights nor the same autonomy as others,” she said.

Also read: Impact Of Canada’s Delay In Approving MAID For Mental Illness: Patients Say They Feel Abandoned & Hopeless

Parliament Had Already Recommended An Indefinite Exclusion

The government's decision also follows a recommendation that was passed in June from a joint parliamentary committee, which called to exclude people from MAID eligibility whose only underlying condition is mental illness.

The committee's review highlighted disagreements among experts over whether clinicians can reliably determine that certain mental illnesses are permanently irremediable.

It was based on a report that noted a "divergence of perspectives" on the issue and highlighted concerns raised during testimony about the "pressing need for increased and more equitable access to adequate mental health services".

However, the recommendation was not unanimous. Four senators issued a dismissed the report, questioning the committee's process, arguing that the government should consider seeking guidance from the Supreme Court of Canada.

Also read: New York Assisted Suicide Law: Nearly 20 People Reportedly Died Since August

The government's proposed legislation is expected to circle back to advance requests, which is another another debatable aspect of MAID.

Under the proposed changes, people diagnosed with serious illnesses who may eventually lose the ability to consent could be able to make an advance request for MAID.

According to the latest available figures from 2024, MAID accounts for around 5 per cent of all deaths in Canada. About 96 per cent of MAID cases involved people whose deaths were reasonably foreseeable, most of them terminal cancer patients.

The remaining 4 per cent involved patients whose deaths were not imminent but who had a "grievous and irremediable medical condition".

The Supreme Court, on Thursday, asked the Centre to form a panel to form statutory regulations against unethical practices by pharmaceutical companies. This includes gift giving, hospitality, and other incentives offered to doctors.

A bench of Justices Vikram Nath and Sandeep Mehta issued the direction while hearing a petition seeking stronger regulation of pharmaceutical marketing practices.

The court wants the committee to recommend whether, and how, the unethical interactions between pharmaceutical companies and doctors should be brought under a legally enforceable framework.

The matter will resume in court on January 29, 2027, when the Centre is expected to show compliance with the directions.

What Did The Supreme Court Say?

Also read: Could This Popular Joint Supplement Turn Mild Cognitive Impairment Into Dementia? New Study Finds Link

The court's order follows earlier concerns about whether the existing system is equipped to prevent unethical pharmaceutical marketing.

Justice Sandeep Mehta, reading out the order, said, “We have directed the Union of India to constitute the committee and give its recommendations in terms of our previous directives and observations.”

The committee will examine the representations received and make recommendations to the Union government on the need for statutory regulation.

The Court had reserved order after Solicitor General Tushar Mehta informed the Court that the Union government is to form a three-member committee to assess whether a statutory framework is needed to regulate unethical practices by pharmaceutical companies.

The case was filed by the Federation of Medical and Sales Representatives' Associations of India (FMRAI), which has sought accountability for alleged practices such as expensive gifts, foreign trips, hospitality and other benefits used to promote medicines to doctors.

It said, “This has led to over-prescription of drugs resulting in a serious infringement of the right to life and the right to health of the citizens.”

What Are Pharma Freebies To Doctors?

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Pharmaceutical companies use various marketing strategies to promote their products to healthcare professionals. These can include gifts, hospitality, sponsored travel, benefits related to conference and other promotional incentives.

The concern before the Supreme Court is not just an ordinary interaction between drug companies and doctors, but whether financial or material incentives can unethically influence drug-prescribing decisions.

India already has the Uniform Code for Pharmaceutical Marketing Practices (UCPMP), 2024, which lays down rules concerning gifts, physician samples, brand reminders, continuing medical education and other promotional activities. However, questions remain over whether the framework has adequate statutory regulation.

The Centre has previously said the UCPMP is functioning, but agreed that the question of giving pharmaceutical marketing regulation statutory backing should be examined separately.

The Centre, in its response, said, “The Department of Pharmaceuticals has issued the Uniform Code for Pharmaceutical Marketing Practices (UCPMP), which is applicable to Pharmaceutical Companies, medical representatives and agents.” The code clearly prohibits pharmaceutical companies from offering gifts, travel facilities, hospitality, cash or monetary grants to physicians or their family members, it added.

Unethical Pharma Marketing Could Affect Patients

The biggest concern is that a prescribing decision could become influenced by factors other than clinical need, evidence, safety, and cost. If incentives influence prescribing, patients could potentially face:

• Unnecessary medicines when they are not clinically needed
• More expensive branded drugs when alternatives exist
• Higher doses or longer treatment than necessary
• Polypharmacy, or the use of multiple medicines when fewer may be appropriate
• Higher out-of-pocket healthcare expenses

These concerns have previously been raised before the Supreme Court in relation to alleged pharmaceutical marketing practices. The issue, therefore, goes beyond ethics for patients. The doctor-pharma relationship can directly affect what medicine a patient receives, how long they take it, and how much they pay.