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.

As the number of migrants and refugees continue to grow due to wars, famine, disease etc, so does that of people living with dementia. Healthcare experts are warning of an escalating health emergency among aging displaced populations, and stating that dementia among migrants is not only on the increase, but commonly undiagnosed and unsupported. This piece uncovers the complex connection between displacement, stress, and dementia to determine whether it is solely the displacement that results in this increased incidence or if prolonged stress plays a crucial part in the illness.

The recent report by the World Health Organization (WHO) presents a dismal picture of rising numbers of elderly migrants suffering from dementia. The population of individuals aged 60 and older who reside outside their native countries has increased by nearly two-thirds in the past three decades. In 1990, it stood at approximately 25.5 million; by 2020, it had risen to 48.2 million. This demographic trend translates to more and more older persons being at risk of developing dementia, a condition more commonly linked with the elderly, especially those in their sixties and beyond.

This growth has been particularly fast in areas like Western Asia, encompassing the Middle East, a refugee hotspot from conflict, including Syria and Afghanistan. The WHO has pointed out that a third of the world's refugees hail from these two war-stricken nations, and as they get older, the risk of dementia increases.

Does Displacement Influence Dementia Risk?

Although there is no direct connection between migration and the risk of dementia, experts are increasingly analyzing how forced migration may amplify health risks. Upending life instantly, displacement also comes with accompanying trauma, financial uncertainty, lack of food security, and access to healthcare limitations—each having the potential to complicate both mental and physical conditions, such as dementia.

The trauma of displacement, as well as the difficulties of adapting to new settings, may be central to the acceleration of cognitive decline. There is mounting evidence, says Dr. Marco Canevelli of Sapienza University in Rome, that the barriers to healthcare for migrants—language barriers, low health literacy, and absence of access to medical resources—result in an under-diagnosis of dementia. Migrants cannot always obtain the proper care to receive an accurate diagnosis," he explained in a WHO press briefing.

Is Long-Term Stress To Blame For Dementia Among Migrants?

Among the most compelling questions about how dementia has been increasing among displaced populations is how long-term stress affects it. Chronic stress, particularly if incurred in early childhood or over very long periods of time, has disastrous consequences on brain function. For most migrants and refugees, the stress of escaping war zones, adapting to new and sometimes hostile surroundings, and living in economic uncertainty is not only short-term but chronic. This chronic burden of stress may well hasten the development of dementia, especially in those who are prone to cognitive decline.

The brain reacts to stress by releasing cortisol, a hormone that, when present in excess over long durations, can have a detrimental effect on the hippocampus, which is responsible for learning and memory. Chronic stress can therefore impair cognitive function, leading to the development of symptoms of dementia.

In addition, studies indicate that migrants are more likely to suffer from greater psychological distress, especially following traumatic events such as war, persecution, and natural disasters. The cumulative psychological and emotional burden of these experiences may be a factor in increased susceptibility to neurodegenerative illnesses such as dementia.

Why Care is Challenging for Migrants with Dementia?

The challenges for people with dementia among migrants go far beyond diagnosis—as they also struggle to access needed care. It is reported in research by Edith Cowan University (ECU) alongside HammondCare that immigrants with dementia tend to be seen with signs of agitation and aggression, one of the challenging behaviors that cultural and language gaps can make even worse. To compare, other patients with dementia who are non-immigrants present more typical features such as hallucinations and delusions.

These behavioral and psychological symptoms of dementia (BPSD) are a frequent phenomenon, but they can differ widely depending on the cultural background of the individual. The research indicates that cultural variations have a profound impact on how dementia symptoms are expressed and how caregivers should react to them. For caregivers, usually family members with little support, dementia care in a foreign country can be a daunting and lonely experience. Language issues, lack of knowledge regarding dementia, and a lack of access to specialized care only serve to complicate the problem.

The growth of dementia in migrants highlights the imperative for rapid policy intervention to tackle both the prevention and management of migrants with dementia. The WHO report underscored that refugees and migrants with dementia need to have their health needs acknowledged and incorporated into general health systems, particularly during crisis and emergency phases. This encompasses ensuring improved access to diagnosis, care, and treatment for ageing migrants who are vulnerable to dementia.

Besides healthcare access, cultural competence within healthcare systems needs to be enhanced. Healthcare providers need to be trained to identify the specific needs of migrants and refugees with dementia, particularly in the recognition of cultural factors that might impact symptoms and care strategies.

As the number of displaced persons keeps increasing, it is imperative that the international health community recognizes the increasing burden of dementia among migrants and refugees. To address this looming health crisis, policymakers should ensure that migrants and refugees are provided with quality care and dementia services specific to their needs. As the WHO itself reminds us, the health requirements of these at-risk groups cannot be overlooked, and their difficulties in accessing care must be addressed to secure their well-being.

Ultimately, the development of dementia among migrants is not so much about the displacement process but also about the chronic stress and trauma that are a part of it. Uncovering the underlying causes of dementia in these groups will be imperative to establishing effective prevention strategies and care systems that enhance the quality of life for older migrants globally.

The United States Food and Drug Administration has recently approved cabozantinib (Cabometyx) for patients with previously treated advanced neuroendocrine tumors. This is an oral tyrosine kinase inhibitor, which is offering a new standard for care of this patient group. This has been announced by the Dana-Farber Cancer Institute.

How Was The Drug Approved?

The approval came on the bases of the results from the phase 3 CABINET study. The study compared cabozantinib to a placebo in patients with advanced pancreatic neuroendocrine tumors.

As per the National Cancer Institute, neuroendocrine tumor grows from neuroendocrine cells. These cells receive and send messages through hormones to help the body function. These cells are found in organs throughout the body. The neuroendocrine tumor was called carcinoid tumor

These tumors grow very slowly and are mostly found in appendix, also known as appendiceal neuroendocrine tumors. When found in lungs, they are also called bronchial tumors. These areas are more common in children and young adults. Whereas for adults, it is mostly found in the digestive tract, called the GI neuroendocrine tumor. What makes it concerning is that it can also spread to other parts of the body but does so more in adults than in children.

They are rare in children and more common in adults, affecting up to 4 in 100,000 adults.

The drug which FDA has approved based on the phase 3 CABINER study's results have been published last September in the New England Journal of Medicine. Patients who were treated with cabozantinib survived significantly longer with no worsening of their disease compared with patients who received placebo. This also improved the efficacy as was observed in the interim analysis. The trial was in fact terminated early and unblinded in August 2023.

Are There Any Side Effects From The FDA Approved Drugs?

The reported side effects of cabozantinib were similar to those found in other studies of the drug. They include:

• Hypertension
• Fatigue
• Diarrhea

"Patients with neuroendocrine tumors often face a difficult journey," lead author of the CABINET study, Jennifer Chan, M.D., M.P.H., of the Dana-Farber Cancer Institute, said in a statement. "Despite advances in recent years, there has remained a critical need for new and effective therapies for patients whose cancer has grown or spread. Cabozantinib significantly improved outcomes in this patient population and this FDA approval provides new hope."

How Is Neuroendocrine tumor diagnosed?

While some people have symptoms, others may do not have any symptoms. These symptoms depends on where in your body the tumor has grown.

Patients who have appendiceal neuroendocrine tumors may have symptoms of appendicitis, such as pain in abdomen. They could also be later diagnosed with carcinoid tumor in case the doctor removes the appendix and finds a tumor. Patients with carcinoid tumor in other parts of the digestive tract may have symptoms such as:

• Pain in the abdomen
• Nausea or vomiting
• Diarrhea

Other ways to detect is by lab tests, imaging, and biopsy.

For most women, this reality is what menopause feels like, a time when hormonal changes impact everything from sleep routines to mood stability. Oprah Winfrey recently shared her own personal battle with menopause, exposing how it left her unable to read her favorite books or even host her famous book club. In a candid conversation, Winfrey explained how the overwhelming symptoms—especially heart palpitations and an inability to concentrate—left her feeling like she was “literally going to die every single night.”

It’s a topic that’s often kept behind closed doors, but menopause affects millions of women globally. According to the National Institute on Aging, menopause is reached when a woman has had no period for 12 months in a row, normally between the ages of 45-55, and may create a variety of symptoms ranging from hot flashes to emotional upset. Oprah's announcement of her own menopause experience highlights the not-so-well-known symptoms and raises awareness of the need for greater information and support. Let's take Oprah's journey and see how we can learn more about and cope with this natural but too-often-misunderstood phase of life.

But media mogul Oprah Winfrey is breaking that. In a recent interview, Winfrey, 71, spoke candidly about her own menopause experience, describing an ordeal so overwhelming that she thought she was "going to die every single night."

Winfrey's confession is not simply another celebrity revelation—it's a wake-up call for millions of women across the globe who suffer from menopausal symptoms in ignorance, without proper medical attention, or public support.

Menopause, that phase of life when a woman's menstrual cycle permanently ceases because of the decrease in estrogen and progesterone levels, is usually coupled with symptoms of hot flashes and night sweats. But in Winfrey's case, it was different—though no less unsettling.

One of the most surprising and disturbing symptoms that she experienced was one of inattention. An avid reader since childhood and the face of Oprah's Book Club, she discovered that she couldn't read.

The worst for me, this is when I realized I really was in trouble, is when I couldn't focus reading," Winfrey explained to ABC News' Kayna Whitworth. "I adore reading so much, but I abandoned the book club because I could not focus when I was reading. I could no longer complete a book.

It wasn't until she began hormone therapy with estrogen that she regained her concentration. "I brought back [the book club] when I began taking estrogen because I could concentrate again, but I actually never mentioned that before," she confessed. "It makes me want to cry."

Lesser-Known Symptoms of Menopause

Although night sweats and hot flashes are universally acknowledged as symptoms of menopause, other physical and psychological consequences tend to go unmentioned. Winfrey felt palpitations of the heart—a symptom she never correlated with menopause.

"I did not have night sweats, and I did not have hot flashes, but I had never heard that palpitations [were] a symptom of menopause," she explained. "When I was going through it, there was nothing. There was nobody."

This absence of knowledge concerning the entire range of menopausal symptoms is a crucial concern. Menopause influences each woman uniquely, with some suffering from anxiety, depression, insomnia, mental fogginess, or even arthritis, says the National Institute of Health (NIH). And though it touches everyone equally, menopause has been among the least talked about and most under-studied topics in women's health.

Committed to making sure that other women do not have to endure in silence, Winfrey is leveraging her platform to ignite a long-overdue discussion. Her new Hulu special, An Oprah Winfrey Special: The Menopause Revolution, seeks to inform and empower women on menopause, offering expert advice and real-life stories to guide them through this stage of life with confidence.

She also tweeted to highlight how crucial it was to discuss menopause. "When I underwent menopause, I couldn't sleep for two years. I couldn't concentrate. I couldn't read my favorite books. I had heart palpitations. Nobody informed me about this. Now we're discussing it, so no woman suffers," she posted on Facebook.

Winfrey's advocacy is part of a larger effort to make menopause conversations mainstream and better healthcare responses. Women should have access to proper information and healthcare providers who seriously consider their symptoms.

What Women Need to Know About Seeking the Right Medical Support?

Winfrey's experience teaches an important lesson: women need not be afraid to get a medical consult when they are experiencing symptoms of menopause. "Because it hits every cell in your body, the first time you have any of the symptoms, that's when you need to go go find a doctor who will hear you, listen to you, and take action for you," she encouraged.

Far too frequently, women's menopausal symptoms are downplayed, and they must cope with the changes by themselves. Professionals advise going to see a gynecologist or a menopause specialist as early as perimenopause—the pre-menopause phase—so that possibilities such as hormone therapy, lifestyle modifications, and other forms of treatment can be discussed.

Oprah Winfrey's honest narrative about her battle with menopause is a call to change the way society understands and responds to this natural phenomenon. It's about tearing down the taboo and myth surrounding menopause so that future generations of women will be better equipped and empowered.

With powerful voices such as Winfrey at the forefront, menopause is no longer a silent battle—it's a dialogue that must be heard.