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.

Lung cancer in people who have never smoked is an increasingly recognized global health concern. A new study found that a rare inherited EGFR mutation may increase lung cancer risk by over 60 times in never-smokers.

Lung cancer in never-smokers is the seventh leading cause of cancer death worldwide. Approximately 60% to 80% of lung cancer cases in never-smokers globally occur in females.

The study, published in Science, found that a rare inherited EGFR T790M mutation can increase lung cancer risk by over 60 times in never-smokers and 25 times in smokers.

Smoking itself increases the risk of developing lung cancer fourfold in the general population.

What Did The Study Find?

To look for the rare mutation, researchers evaluated genotyping data from 3.37 million people and found that it occurs in about 1 in 15,850 people.

Among the 17 cancers and non-pulmonary conditions screened, the mutation showed a strong association only with lung cancer. Researchers also traced its origin to southern Appalachian populations in the US.

“Recognition of individuals more likely to carry EGFR T790M, including those with family history of lung cancer, multifocal lung cancer, or lung nodules or Southeastern US ancestry, may help to inform future screening and prevention strategies for those at highest risk,” said the researchers.

“Smoking is bad for lung cancer. This mutation is bad for lung cancer. When you do both, your risk is the sum of those two risks,” said Alexander Gusev, a quantitative geneticist at Dana-Farber. “So, you definitely don't want to smoke.”

The mutation was not linked to any of the 17 other common cancers studied, suggesting that its effects may be largely limited to lung cancer.

Could Genetic Testing Change Lung Cancer Screening?

“Today, lung cancer screening is driven almost entirely by smoking history,” said Jaclyn LoPiccolo, attending physician and lung cancer researcher at Dana-Farber Cancer Institute, who co-led the study.

LoPiccolo added that the findings raise the possibility that, in the future, screening could also be dictated by inherited genetic risk.

“If further studies confirm the benefit, people with EGFR T790M could be identified through genetic testing and offered personalized CT screening to identify lung cancers when they are at their most curable stage,” she said.

How Does The Mutation Increase Risk?

Although most lung cancers are associated with tobacco use or exposure, the proportion diagnosed in people who have never smoked has been rising. Yet the genetic factors underlying these cancers, particularly the role of inherited risk, are not well understood.

In 2005, researchers identified the rare inherited EGFR T790M mutation in a European family with multiple cases of lung cancer. Since then, the mutation has been reported in other families with unusually high rates of the disease.

In the study, LoPiccolo noted that the mutation occurs in about 1 in 15,000 people in the US population, but in certain areas of the Southeastern US, it can be as frequent as 1 in 2,000 people.

Other Lung Cancer Risk Factors

Lung cancer occurs when abnormal cells grow uncontrollably in the lungs. It remains the leading cause of cancer deaths worldwide, with an estimated 2.5 million new cases and 1.8 million deaths in 2022.

Beyond inherited genetic risk, lung cancer can also develop following exposure to second-hand smoke, air pollution, and workplace chemicals and carcinogens.

These include asbestos, silica dust, diesel exhaust, arsenic and other industrial chemicals.

Radon gas is another lesser-known risk factor. It is invisible and odorless, and prolonged exposure to high levels of radon can increase the risk of lung cancer.

A team of doctors at Mumbai’s Tata Memorial Hospital has identified a chemotherapy regimen that was better tolerated in people with high-risk penile cancer.

Published in the Journal of the National Cancer Institute, the BACuP trial compared paclitaxel with 5-FU (fluorouracil), with both drugs given alongside a platinum drug.

The study found that patients receiving paclitaxel had fewer serious side effects and treatment-related hospitalizations. They were also more likely to complete all four planned chemotherapy cycles.

However, the trial was too small to determine whether paclitaxel reduced cancer recurrence or improved survival.

What Did The Study Find?

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The trial included 49 men under 70 who had undergone surgery for penile cancer that had spread to the lymph nodes and had at least one feature linked to a high risk of recurrence.

They were randomly assigned to receive either 5-FU plus a platinum drug or paclitaxel plus a platinum drug. Both groups were scheduled to receive four cycles, three weeks apart.

Serious treatment-related side effects occurred in 77.3 per cent of patients receiving 5-FU and platinum, compared with 40.9 per cent of those receiving paclitaxel and platinum.

Paclitaxel was also easier to administer. 5-FU is usually delivered continuously through a vein over several days, sometimes using a pump, while paclitaxel can generally be given as an intravenous infusion in a day-care or outpatient setting.

Why Does The Study Matter?

Dr. Sandeep Nayak, Chairman of Oncology, MACS-Renova Oncology Institute, KIMS Hospital, Bengaluru, said that penile cancer carries a significant disease burden in India, yet for decades our adjuvant treatment decisions for high-risk, node-positive disease relied largely on retrospective observational data.

He noted that the goal after definitive surgical resection and lymphadenectomy is to prevent systemic recurrence. However, traditional 5-FU-based chemotherapy regimens have historically been notoriously difficult for patients to tolerate, leading to severe toxicities, frequent hospital admissions, and premature treatment dropouts.

“This trial provides evidence showing that the Paclitaxel-Platinum combination offers a far safer, outpatient-friendly regimen with drastically lower serious toxicities and an impressive completion rate of 83% (compared to 48% with 5-FU). Better patient compliance directly impacts real-world disease control,” said Dr. Nayak, who was not part of the study.

"Combined with early clinical presentation and timely surgical interventions, safer adjuvant options like this will meaningfully improve patient compliance and quality of life," he added while stressing the need for larger research.

What Is Penile Cancer?

Penile cancer is rare and is most common in men over 50. It is an uncommon malignancy in India, accounting for less than 1% of all male cancers.

Common symptoms include:

• A growth, lump or sore that does not heal within four weeks
• Bleeding from the penis or under the foreskin
• A rash or change in skin color
• A smelly discharge
• Difficulty pulling back the foreskin

The disease may be more treatable when found early. Treatment depends on the size and location of the cancer and whether it has spread, and may include surgery, chemotherapy or radiotherapy.

The Union Ministry of Health and Family Welfare has proposed mandatory CCTV surveillance at medical stores as an additional regulatory safeguard for prescription drugs.

The move, proposed under amendments to the Drugs Rules, 1945, through Draft Gazette Notification G.S.R. 791 (E), aims to strengthen regulatory oversight of Schedule H, H1 and X drugs.

Once implemented, it will help strengthen monitoring of the sale and distribution of these drugs and curb their unauthorized access and sale without valid prescriptions.

The proposed CCTV surveillance mechanism will also enhance transparency and accountability across the pharmaceutical supply chain, strengthening safeguards for public health. The draft proposal is now open to public objections and suggestions before it is finalized.

What Are Schedule H, H1 And X Drugs?

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Schedule H: Prescription-only medicines, including many blood pressure, diabetes and anti-infective drugs. They must carry the Rx symbol and cannot be sold without a prescription.

Schedule H1: A stricter category covering certain antibiotics, anti-tuberculosis drugs and sedatives. These medicines carry a red-boxed Rx warning and require medical advice.

Schedule X: The strictest category, covering certain high-risk narcotic and psychotropic drugs such as morphine, amphetamines and strong barbiturates. Their sale requires a specific government licence in addition to a standard retail drug licence.

Why Is CCTV Surveillance Being Proposed At Pharmacies?

India is seeing concerns over spurious and fake drugs, with chemists being the major point of contact for medicines for a majority of people.

A recent nationwide survey by LocalCircles, a community social media platform, showed that 64% of consumers said chemists never or rarely ask for a doctor's prescription, while only 31% mostly got a qualified pharmacist at their chemist.

Only 15% of those surveyed said the chemist mostly or always refused to sell medicines without a prescription.

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The survey also found:

• 13% said someone at the chemist assisted them who was not a qualified pharmacist.
• 15% said medicines were found to be fake or counterfeit.
• Another 15% said they received completely ineffective medicines.
• 26% said they were not provided a GST bill.

Counterfeit Medicines Seized In Bengaluru

In a recent shocking case, investigators in Bengaluru seized large counterfeit cancer medicines, life-saving drugs and injections used in intensive care units (ICUs) that were being supplied to hospitals, clinics and medical stores.

According to investigators, the medicines may have been supplied to more than 90 hospitals and clinics in Bengaluru.

A public interest litigation (PIL) has also been filed in the Supreme Court seeking a comprehensive national framework to check the manufacture and sale of counterfeit and adulterated medicines, including vaccines and cough syrups.

Drug Testing Data Shows Continued Quality Concerns

Data placed before Parliament shows that 1,41,322 drug samples were tested in 2025-26, the highest in five years. Of these, 3,012 were found to be Not of Standard Quality (NSQ) and 283 were found to be spurious or adulterated. A total of 779 prosecution cases were filed during the year, while 3,599 cases were filed over five years.

The Central Drugs Standard Control Organisation (CDSCO) has also continued issuing monthly drug alerts through 2026, flagging 240 NSQ samples in January, 194 in February along with four spurious drugs, 168 in March, 157 in May and 159 in June.