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.

India’s Union Ministry of Health and Family Welfare has introduced "healthy lifestyle and mental wellness" as two key priority areas at the First Health Working Group (HWG) Meeting under the BRICS framework for the year 2026 in New Delhi.

HWG is a key platform for advancing cooperation in public health, said Punya Salila Srivastava, the Union Health Secretary while chairing the meeting.

She noted that as the BRICS Chair for 2026, India is guided by the overarching theme “Building for Resilience, Innovation, Cooperation and Sustainability”, reflecting a people-centric and humanity-first approach.

The theme underscores India’s commitment to strengthening collaborative frameworks that are responsive, inclusive, and future-ready.

India’s 2026 Chairship

While reaffirming commitment to existing priorities, the Union Health Secretary also proposed two new priority areas under India’s Chairship:

• BRICS Mission for Healthy Lifestyles: Aimed at promoting healthy behaviors and addressing key risk factors such as unhealthy diets, physical inactivity, tobacco use, and harmful use of alcohol
• Promotion of Mental Health and Wellness: Focusing on strengthening mental health services, addressing stigma, and integrating mental health into broader public health frameworks.

In addition, under the country’s Chairship, Srivastava said that the HWG aims to:

• Foster inclusive, sustainable, and evidence-driven health cooperation,
• Recognize the diverse health systems and socio-economic contexts of BRICS nations.
• Integrating traditional, complementary, and integrative medicine into health systems.

The BRICS Health Working Group

Srivastava hailed the BRICS Health Working Group meetings for having paved the way for collaboration on pressing health challenges in the recent year. She said that the HWG made efforts towards tackle communicable and non-communicable diseases, enhancing health systems, as improving access to affordable medicines.

“These efforts have further strengthened cooperation in pandemic preparedness, health technology innovation, and the promotion of Universal Health Coverage,” Srivastava said.

The meeting also deliberated on the nine priority areas, which include:

1. BRICS TB Research Network;
2. collaboration among BRICS Medical Products Regulatory Authorities;
3. BRICS Integrated Early Warning System for prevention and response to mass infectious diseases;
4. Digital Health Architecture for continuum of care, including specialised healthcare in remote areas;
5. BRICS Mission for Healthy Lifestyles;
6. promotion of mental health and wellness;
7. Traditional, Complementary and Integrative Medicine (TCIM);
8. fight against diseases driven by social determinants of health (DDSDH);
9. BRICS Network of National Public Health Institutes.

The meeting brought together senior health officials, technical experts, and delegates from BRICS member countries—Brazil, Russia, India, China, South Africa, Egypt, Ethiopia, the United Arab Emirates, and Indonesia to deliberate on priority areas of cooperation in public health.

The global experts welcomed India’s leadership and the shared theme of building resilience through innovation, cooperation, and sustainability.

They also emphasized

• deepening collaboration on tuberculosis through the BRICS TB Research Network,
• strengthening the BRICS integrated early warning system for infectious diseases,
• enhancing digital health architectures to improve access (especially in remote and vulnerable communities),
• advancing regulatory cooperation
• local production of medicines and vaccines.

Weeks after the US Food and Drug Administration (FDA) approved Eli Lilly's Orforglipron, marketed as Foundayo, the regulator is asking Eli Lilly to share more safety data on its first oral pill for weight loss.

The FDA has also sought more information on whether Foundayo could be linked to liver and heart problems, according to the FDA's new drug application approval letter.

Foundayo won FDA approval this month under the Commissioner’s National Priority Voucher, a pilot program intended to fast-track drug reviews.

Foundayo: What More Does The FDA Want From Lilly

In the approval letter, the FDA noted that the currently available data do not fully clarify several potential risks, including

• heart problems such as heart attack and stroke,
• drug-induced liver injuries,
• delayed stomach emptying, which is when food remains in the stomach for too long.

However, the FDA asking for more data “doesn’t mean a safety problem has been found. It means they want more definitive long-term data,” Dr. Christopher McGowan, a North Carolina-based gastroenterologist, told NBC News.

“With orforglipron, it’s a newer, non-peptide version of a GLP-1, so we don’t yet have the same depth of safety data as the injectables,” he added.

Also read: Eye Drops: US FDA Recalls Over 3 Million Products Over Safety Concerns

Further, the agency also requires Lilly to run a series of new studies, including a registry tracking children with obesity who use weight loss drugs and a pregnancy registry to monitor outcomes.

Foundayo: How Did The FDA Approve?

In a statement, the US FDA said that "Foundayo has been approved for use in combination with a reduced-calorie diet and increased physical activity. The pill is targeted to reduce excess body weight and maintain weight reduction for the long term in adults with obesity or overweight".

The US FDA approved Foundayo after two randomized, double-blind, placebo-controlled trials in adults with obesity or overweight showed benefit.

In these trials, 72 weeks of treatment with Foundayo, in combination with a reduced-calorie diet and increased physical activity, resulted in a statistically significant and clinically meaningful reduction in body weight.

Foundayo’s approval comes after the US FDA in December last year approved Novo Nordisk’s Wegovy pill — the first-ever GLP-1 pill for weight loss. The Danish drugmaker rolled out the pill in January this year.

Novo Nordisk was also the first to launch oral GLP 1 Rybelsus to treat type 2 diabetes. It was approved by the US FDA in September 2019.

Also read: US FDA Recalls China-made Cough Drops And Throat Lozenges

How Did Lilly React To The FDA's Query?

The FDA’s post-approval requirements are routine and consistent with the agency’s approach to ongoing safety reviews of newly approved drugs, according to a Lilly spokesperson, NBC News reported.

“Patient safety is Lilly’s top priority, and we actively monitor, evaluate, and report safety information for all our medicines,” the spokesperson said.

Meanwhile, Lilly has started selling the drug from April 6 through its direct-to-consumer platform LillyDirect at $149 per month for the lowest dose for self-pay customers, on par with Novo's pill. "Shortly after,” it will be available through retail pharmacies and telehealth providers in the US, as per Lilly.

Indian pediatrician Dr Sivaranjani Santosh has resigned from the Indian Academy of Paediatrics (IAP) over lack of support, alleged threats, and false allegations, amid an ongoing controversy over the marketing of oral rehydration solution (ORS)-like products.

The Hyderabad-based pediatrician has been a key public health figure who fought for eight long years to stop FSSAI—the country’s apex food regulator—from using the term ORS by brands of fruit-based, non-carbonated beverages, in October last year.

She again voiced her concerns with the IAP when the manufacturer in January 2026 launched a rebranded version, ERZL for everyday hydration.

Dr Santosh opposed the move and called out on IAP to prevent the launch, saying it closely resembled ORS and could mislead people, especially those in rural areas.

However, she did not receive any support from the IAP, and no action was taken. Rather, she received a legal notice from Kenvue over her comments. Kenvue Inc. is an American consumer health company and was formerly the Consumer Healthcare division of Johnson & Johnson.

The notice from Kenvue claimed that Dr Santosh has been maligning the names of ORSL and ERZL for her "own commercial benefits" and for "increasing the number of followers" on her page.

Deeply saddened by the leadership at the IAP, which she alleged is supporting Kenvue, Dr Santosh resigned. She now vouches to fight alone.

“I thought enough of this toxicity. I'll fight it alone. All this while, if I could fight it alone, why can't I do it?” she told HealthandMe.

What Is The Controversy About Dr Sivaranjani Santosh?

Speaking to HealthandMe, the pediatrician narrated the ordeal – legal notices from pharmaceutical companies, false accusations of her integrity and character in the last few years.

Dr Santosh has been campaigning that commercial beverages labeled as ORS were often high in sugar and nutritionally different from the World Health Organization (WHO)-recommended Oral Rehydration Solution, a life-saving treatment for dehydration.

Her fight began in 2022, when she filed a Public Interest Litigation (PIL) in the Telangana High Court seeking directions for manufacturers to remove the letters “ORS” from the product name ORSL.

Eight years after the PIL, the Food Safety and Standards Authority of India (FSSAI), in October 2025, banned the use of the ‘ORS' label on beverages — including ORS that did not meet the WHO standards. The regulator deemed such branding to be misleading and a potential health risk, as many products contained excessive amounts of sugar compared to genuine medical ORS.

However, Kenvue launched a rebranded version, ERZL, in January this year. She again opposed and stated: “ERZL is not ORS. And it should not be given to children below two years of age".

Noting that her messages "upset these people”, she faced a backlash, including a legal notice from the company.

According to Dr Santosh, attempts were also made to gather endorsements from pediatricians claiming that sucralose is safe and to submit these to the FSSAI. She publicly criticized the move, calling it “shameful.”

Further, Dr Santosh also voiced out her concerns against IAP for allowing the company to set up a stall with the controversial product at the Pedicon, a major pediatric conference.

When she raised the matters on social media, the company made the statement: “Our products are very scientific. Some people are spreading misinformation and scientific information”.

The pediatrician also claimed to have alerted IAP leadership weeks earlier, warning that the ERZL’s branding could mislead people—especially in rural areas—into confusing it with ORS.

“We are not talking about the educated people who have been following this. We are talking about the ignorant poor people in the villages,” the doctor said.

She further alleged that instead of backing her concerns, sections of the leadership attempted to discredit her.

Following a series of exchanges and growing tensions, she announced her resignation, citing a “toxic environment.”

Dr Santosh said that "parallelly, the leadership was spreading messages to all the people that I am abusive and I'm arrogant." In response, she stated: "If I have to choose between children and IAP, I will choose children".

Amid the controversy, the IAP released a position statement on ORS and electrolyte drinks. The doctor criticised the statement as “ambiguous” and questioned its focus solely on sucralose, alleging a potential conflict of interest.

She added that Kenvue also marketed for "ERZL as the new form of ORSL", which also bypassed the FSSAI and Delhi High Court orders.

What Is The Way Forward?

Noting that her battle will continue against ERZL, Dr Santosh said she will continue advocating for child health issues in India

"I'm trying to raise awareness about first aid and CPR. I've trained so many people. Now I'm motivated."

The pediatrician also wants to advocate for safer drug formulations, restrictions on over-the-counter medicines, and wider awareness of first aid and CPR.

The list includes paracetamol, which is being sold under various names and doses in the country.

"We want one paracetamol in India".

HealthandMe is trying to reach out to the Indian Academy of Paediatrics (IAP). The copy will be updated once a response is received.