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.

‘Scromiting’ is back in the news as emergency department visits in the US involving cannabis hyperemesis syndrome (CHS) were 3.7 times as high, according to a CDC report.

CHS is associated with frequent cannabis use and is characterized by episodes of severe nausea, vomiting and abdominal pain. The term “scromiting” refers to a combination of screaming and vomiting that can occur during severe episodes.

The CDC’s Morbidity and Mortality Weekly Report (MMWR), which analyzed data from January 2023 through May 2026, found that the rate of emergency department visits involving CHS remained largely steady from January 2023 through September 2025.

CHS is likely under-recognized in both adolescents and adults. Clinicians may not routinely assess or document cannabis use, while CHS can also be misdiagnosed as other gastrointestinal conditions, including cyclic vomiting syndrome.

To improve clinical identification, a specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge diagnosis code for CHS was introduced on October 1, 2025. The CDC report examined CHS-related emergency department visits before and after the code was introduced.

The change was immediate. From September 2025 to October 2025, CHS-involved emergency department visits jumped from 3.35 per 10,000 to 11.26 per 10,000. The rate rose further to 13.10 per 10,000 by May 2026.

From October 2025 through May 2026, CHS-involved emergency department visits were 3.7 times as high as the monthly average recorded before the new diagnostic code was introduced.

The CDC noted that the new code made the condition easier to identify and track, meaning the sharp increase may partly reflect greater recognition and documentation of CHS.

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What Is Cannabis Hyperemesis Syndrome?

CHS is a syndrome associated with prolonged, frequent cannabis use. It is characterized by sudden episodes of severe nausea, repeated vomiting and abdominal pain.

Reports of suspected CHS increased sharply between 2016 and 2022, with the largest increase occurring during the COVID-19 pandemic. The CDC noted that the rise also coincided with widespread state-level cannabis legalization in the US, although cannabis remains illegal under federal law.

People with CHS often seek medical care because symptoms can be severe and debilitating. Outcomes can range from resolution of symptoms after stopping cannabis use to, in rare cases, death.

When Was CHS First Identified?

CHS was first identified in Australia in 2004, yet nearly two decades later, the condition remains poorly understood. It typically affects people who use marijuana daily or near daily for more than a year. Symptoms can include severe nausea, repeated vomiting and abdominal pain, along with a compulsive desire to take extremely hot showers or baths.

Many patients report that heat temporarily eases their symptoms, although the relief is often short-lived.

Symptoms Can Last For Days

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CHS episodes can last for days, while recovery may take weeks or even months, depending on overall health, eating habits and whether the person stops using marijuana. Continuing to use cannabis can quickly trigger symptoms again.

A study from George Washington University found that nearly half of surveyed patients had been hospitalized at least once because of CHS. Many reported using marijuana more than five times a day before symptoms began. Starting cannabis at an early age was also linked to a higher likelihood of developing the condition.

Why Is CHS Still Poorly Understood?

Researchers emphasize that CHS is real, although many questions remain unanswered, including why hot showers provide temporary relief and how much cannabis use puts someone at risk.

Health experts say greater clinical awareness is needed. Better screening for cannabis use and recognition of symptom patterns could help reduce misdiagnosis and guide patients towards the only proven treatment: stopping marijuana use.

A recent cluster of shigellosis cases in Kerala has raised concerns over antimicrobial resistance (AMR). This adds another challenge to the treatment and management of an infection that can already cause severe intestinal distress. The concern comes as Kerala reported fresh cases of Shigella infection, including a three-year-old child who was hospitalised after consuming a roadside drink.

Shigellosis is caused by Shigella bacteria and can spread through contaminated food, water, hands and surfaces. Unlike some other foodborne infections, only a very small number of bacteria may be enough to cause illness, making the infection highly transmissible. This has raised fresh concerns about food and water safety in the state.

Drug Resistance Can Make Shigellosis Harder To Treat

Most people with shigellosis recover with fluids and supportive care, but people with severe symptoms may need antibiotics. The problem at hand is that Shigella is becoming increasingly resistant to commonly used antibiotics.

Kerala's KARS-NET (Kerala Antimicrobial Resistance Surveillance Network), one of the strongest AMR surveillance systems in the country, has been tracking the AMR profile of Shigellosis since 2023. Its data says that the resistance profile of primary antibiotics used to treat the infection is growing.

According to KARS-NET, Ciprofloxacin, which is recommended by the national guidelines for Shigella dysentery treatment, has a resistance profile of 96%. Therefore, it can no longer be relied upon for Shigellosis treatment.

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R. Aravind, head of infectious diseases, Government Medical College, Thiruvananthapuram, who is also the convener of KARS-Net said, “Till now, community-acquired AMR had not been a problem in the State. If you, as a citizen, have never been worried about AMR, you should be now, because it is showing up right at your doorstep. Our arsenal of effective and affordable antibiotics for common infections in the community is shrinking."

Ceftriaxone is the next available drug that has developed pathogenic resistance. It is a third-generation Cephalosporin class antibiotic, which has gone up to 36%.

He added, “Clinicians have been using Ceftriaxone for treating Shigellosis in patients who get admitted to hospital. But the clinical implication of growing resistance of Shigella to this drug is immense."

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Complications Due To Shigellosis

Shigellosis could get severe in vulnerable populations like children below five years and the elderly. It can lead to severe dehydration, sepsis and neurological complications.

In some cases, the infection can spread beyond the intestine and enter the bloodstream, causing bacteraemia and sepsis, which can become life-threatening. These complications warrant urgent use of antibiotics.

R. Aravind also said, "For Shigellosis patients with severe dysentery going into septic shock and multiorgan failure, it is absolutely important that the correct antibiotic is administered within an hour and that it is 100% sensitive. This means that for such serious patients, we can no longer depend on Ceftriaxone and have to go for high-end drugs like Meropenem which belongs to the Carbapenem class, widely considered the last-resort antibiotics."

Shigellosis: Prevention Tips

Because Shigella can spread through very small amounts of faecal contamination, basic hygiene remains crucial. Health experts recommend:

• Drinking safe or boiled water
• Washing hands thoroughly with soap
• Avoiding food from unhygienic sources
• Eating freshly prepared food
• Avoiding contaminated or improperly stored drinks
• Preventing infected people from preparing food for others

Australia, which has been battling rising cases of highly pathogenic avian influenza since June, has reported its first H5 bird flu detection in a mammal in South Australia.

A seal found dead at Beachport, about 310 km (190 miles) south of Adelaide, was confirmed as the country’s first mammalian detection of H5 bird flu. The seal had no visible signs of injury. The authorities warned the virus could trigger more deaths among the species as it continues to spread.

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Another suspected H5 detection has been reported in a long-nosed fur seal at Pages Conservation Park, a key breeding ground off Kangaroo Island. The case is yet to be confirmed. The site has also recorded a mass mortality event among birds.

“Once the H5 bird flu is spreading in the natural environment, it is not possible to avoid significant losses,” federal Agriculture Minister Julie Collins said.

H5 In Mammals: Are Humans Staring At A 'Catastrophic Pandemic'?

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H5N1 is a highly pathogenic strain of avian influenza that can spread rapidly among poultry and wild bird populations, causing severe disease and high mortality rates in birds.

While human infections remain rare, they can occur through direct and unprotected contact with infected birds, animals, or contaminated environments.

Bird flu viruses generally do not spread easily among humans. Even when a rare bird-to-human jump occurs, the virus has so far not been able to spread efficiently from human to human because it is not well adapted to human cells.

Speaking to HealthandMe, Dr. Rajeev Jayadevan, former President of IMA Cochin and Convener of the Research Cell, Kerala, shared that since H5 virus is primarily adapted to birds, the obvious concern is whether it can adapt to mammals.

While similar incidents globally in recent years are adding to the concern, he noted that infections in mammals show that the virus is taking steps towards infecting a wider range of living beings.

Although risks to humans continue to be low, Dr Rajeev said that it is vital to “keep a close watch on this evolution".

"If this virus hypothetically gains the ability to spread efficiently among human beings, we are looking at a catastrophic pandemic. What makes a human pandemic so devastating is that our immune systems have no prior exposure to this virus.”

He noted that among the isolated human cases reported worldwide, the death rate is typically 50% or higher.

"A typical scenario for a bird-to-man jump of the virus would be a child who comes into contact with a sick hen in the backyard, or a farmer who handles dead birds without precautions,” Dr Rajeev warned.

How Can H5 Bird Flu Be Prevented?

To prevent a future pandemic from this virus, the key thing will be to reduce opportunities for the virus to jump from birds to mammals—which is why mass culling of infected poultry remains a standard practice.

Health authorities recommend the following precautions:

• Avoid direct contact with sick or dead wild birds and other animals whenever possible.
• Wear appropriate personal protective equipment (PPE) if handling sick or dead birds or animals is unavoidable.
• Avoid touching surfaces contaminated with bird droppings, saliva, mucus, litter, or bedding from infected or suspected animals.
• Do not consume raw milk or raw milk products, particularly from animals suspected or confirmed to be infected with avian influenza.
• Report sick or dead birds to local authorities if encountered.

Australia’s Response To H5 Bird Flu

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About 45% of Australia’s roughly 850 bird species are endemic, meaning they are found nowhere else on Earth, according to government data.

To protect these, Australia has announced vaccination for its vulnerable native birds.

“The priority species will be identified based on vulnerability to the H5 bird flu and the potential conservation impact,” Agriculture Minister Julie Collins said.