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.

Duloxetine, a widely prescribed antidepressant, has been recalled in the United States after the US Food and Drug Administration (FDA) found potentially cancer-causing impurities above federal safety limits.

According to the Cleveland Clinic, duloxetine is commonly used to treat depression, anxiety, fibromyalgia, and certain chronic pain conditions.

The FDA issued a notice stating the presence of N-nitroso-duloxetine, a nitrosamine impurity detected at levels exceeding the agency's recommended safety threshold. The recall affects nearly 370,000 bottles of prescription-only duloxetine delayed-release capsules USP, 30mg, 1000 Capsule bottles, distributed across the US.

The agency warned that exposure to nitrosamine impurities "may increase the risk of cancer if people are exposed to them above acceptable levels and over long periods of time."

The agency classified the action as a Class II recall, indicating that use of or exposure to the product may cause temporary or medically reversible adverse health consequences, while the likelihood of serious health effects remains low.

How Is Duloxetine Linked to Cancer?

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Notably, this is the second duloxetine recall linked to the same impurity. In October 2024, more than 7,000 bottles were recalled because of potential nitrosamine contamination.

According to the FDA, people who take medications containing nitrosamines—even daily for up to 70 years—are not expected to face an increased cancer risk if nitrosamine levels remain at or below the recommended limits.

There is currently no direct evidence linking N-nitroso-duloxetine itself to cancer. However, it belongs to a class of compounds known as nitrosamines, some of which are considered probable human carcinogens.

Moreover, health risks associated with nitrosamines generally depend on both the amount and duration of exposure. Higher levels over extended periods are considered more concerning.

The US National Library of Medicine describes N-nitroso-duloxetine as a compound that is "suspected of causing cancer" and notes that it is toxic if swallowed.

At the same time, the California State Board of Pharmacy emphasizes that exposure does not automatically result in cancer. The agency notes that nitrosamines are commonly found in water and foods, including cured and grilled meats, dairy products, and vegetables.

"Everyone is exposed to some level of nitrosamines," the board states. "These impurities may increase the risk of cancer if people are exposed to them above acceptable levels over long periods of time."

What Are Antidepressants?

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Antidepressants are prescription medications used to treat depression, anxiety disorders, chronic pain, and other conditions by increasing levels of certain brain chemicals involved in mood regulation.

Common classes of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Norepinephrine-dopamine reuptake inhibitors (NDRIs)

These medications often take several weeks to achieve their full therapeutic effect. Common side effects may include dry mouth, dizziness, nausea, and weight changes. Emerging research also suggests that side effects can vary significantly depending on the specific medication.

What Is Duloxetine?

Duloxetine belongs to a class of antidepressants known as SNRIs.

Cleveland Clinic explained that duloxetine is used to treat depression, generalized anxiety disorder, fibromyalgia, and certain types of chronic pain, including nerve, bone, and joint pain.

The medication works by increasing levels of serotonin and norepinephrine in the brain—neurotransmitters that help regulate mood and pain perception.

The ongoing Ebola epidemic in the Democratic Republic of the Congo (DRC) could continue for more than a year, as the outbreak has yet to reach its peak, according to the International Federation of Red Cross and Red Crescent Societies (IFRC).

In a statement, the global aid organization also expressed concern that the Ebola crisis could divert attention and resources from ongoing humanitarian emergencies and conflicts across the region.

"We are afraid that this could last one year to end this disease," said Bruno Michon, Operations Manager for the IFRC.

The warning echoes concerns raised by the NGO Doctors Without Borders (MSF), which has said that the outbreak is currently spreading faster than response efforts can contain it.

The concerns come as both infections and deaths continue to rise. According to the DRC Ministry of Health, 29 new confirmed cases were recently reported, bringing the total number of infections to 837. Four additional deaths have pushed the death toll to 196, while the case fatality rate has increased to 23.4 per cent.

Meanwhile, 49 people have recovered from the disease, and approximately 376 patients remain in isolation.

The outbreak, caused by the Bundibugyo strain of the Ebola virus, is spreading rapidly in remote areas of the DRC and neighboring Uganda.

Uganda has not reported any new cases. So far, the country has recorded 19 confirmed infections and two deaths.

Could It Become the Deadliest Ebola Outbreak?

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The Ebola outbreak in the DRC could surpass the deadliest Ebola epidemic on record—which claimed more than 11,000 lives in West Africa between 2014 and 2016—if it is not brought under control soon, according to Africa's Centers for Disease Control and Prevention (Africa CDC).

"If we don't stop the outbreak very soon, it will be worse than what we had in West Africa and eastern DRC," Africa CDC Director-General Jean Kaseya said during a virtual meeting of African leaders and international donors in Burundi.

Speaking to Al Jazeera, Kaseya said that tens of thousands of people who may have been exposed to the virus have not yet been traced.

"Contact tracing is a major indicator and a major issue. We are missing more than 26,000 people, and we don't know where they are, and we don't know if they are contaminating other people," he said.

Testing and Contact Tracing Challenges

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There is currently no approved vaccine or treatment specifically for the Bundibugyo strain of Ebola. The World Health Organization (WHO) estimates that it could take up to nine months before a vaccine candidate is ready.

Testing remains one of the biggest weaknesses in the outbreak response. WHO Director-General Tedros Adhanom Ghebreyesus also voiced concern after visiting the DRC.

"I'm really worried," Tedros said, according to Stat News.

He explained that in North Kivu, South Kivu, and Ituri provinces—where the outbreak is concentrated—many residents view Ebola as a lesser threat compared with armed conflict, hunger, and other common deadly diseases.

"When the community is not taking it as its priority, it's very hard," Tedros said.

Many communities, particularly those affected by ongoing violence, still lack access to testing facilities and diagnostic kits. Treatment centers are also experiencing significant delays in receiving laboratory results, slowing efforts to identify and isolate infections quickly.

What Is Ebola?

Ebola is a severe and often fatal viral hemorrhagic fever first identified in 1976. Since then, more than 30 outbreaks have been recorded, primarily in Central and West Africa.

Common symptoms include:

• Fever
• Headache
• Weakness and fatigue
• Vomiting
• Diarrhea
• Muscle pain
• Sore throat
• Unexplained bleeding or bruising

In severe cases, the disease can lead to organ failure, internal bleeding, shock, and death. Aid organizations warn that without stronger surveillance, expanded testing, faster laboratory turnaround times, and more effective contact tracing, the outbreak could continue to grow in the coming weeks and months.

Kerala has reported 70 cases and four deaths due to shigellosis (bacillary dysentery), a highly contagious bacterial disease caused by Shigella bacteria, during June alone.

The southern state has recorded a total of 146 cases and five deaths from the intestinal infection since the beginning of the year, according to state Health Minister K. Muraleedharan. While one death was reported in March, the remaining four occurred in June.

Out of the 146 cases, 74 were reported in Kozhikode district, followed by 25 cases in Malappuram, including two deaths. Thiruvananthapuram also reported 25 cases, according to figures released by the minister.

No Shigella cases have been reported this year from Pathanamthitta, Palakkad, or Kasaragod districts.

A one-year-old child undergoing treatment for Shigella infection in the intensive care unit of Kozhikode Medical College Hospital remains in critical condition.

Why Children Are Most Vulnerable

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Young children are particularly vulnerable to the disease, which is primarily spread through contaminated food, contaminated water, and poor hygiene practices.

Of the five deaths reported in Kerala this year, four occurred in children under the age of 10. Shigella infections tend to be most severe in children below five years because their immune systems are less efficient at clearing the infection.

Dr. Rajeev Jayadevan, former President of the Indian Medical Association (IMA) Cochin and Convener of the Research Cell, Kerala, explained that the bacteria's resilience contributes to its spread.

“Shigella is able to withstand the hostile acidic environment of the human stomach. Outside the human body, it can stay alive in water for weeks together,” he told HealthandMe.

He added that even a very small number of bacteria—as few as 10 organisms—can cause infection.

Drug-Resistant Shigella Rising In The US

In April, the US Centers for Disease Control and Prevention (CDC) highlighted growing concerns about drug-resistant Shigella strains in its Morbidity and Mortality Weekly Report.

The report noted that changes in epidemiology and antibiotic resistance are transforming Shigella from a largely self-limiting infection into an emerging public health threat with limited treatment options.

According to the CDC, oral carbapenems, pivmecillinam, and fosfomycin may be effective against some resistant strains. However, none have been approved by the US Food and Drug Administration for treating shigellosis.

“Treatment of XDR shigellosis remains challenging because no optimal therapy has been established,” the report stated.

While Kerala's cases have largely been reported among young children, outbreaks in the United States have been more commonly reported among adult men, highlighting sexual activity as a potential route of transmission.

The CDC estimates that approximately 450,000 Americans develop shigellosis each year. Although most patients recover with rest and hydration, severe cases may require hospitalization.

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Shigella: Symptoms And Mode Of Transmission?

Shigella can spread through:

• Touching contaminated surfaces or objects
• Physical contact with an infected person
• Drinking contaminated water
• Consuming ice made from contaminated water

Symptoms usually develop within one to three days after exposure and may initially include:

• Fever
• Diarrhea
• Body aches
• Headache
• Bloody diarrhea
• Severe abdominal cramps

How to Prevent Shigella Infection

Oral Rehydration Solution (ORS) can help prevent dehydration, while zinc supplementation may aid recovery.

Other preventive measures include:

• Washing hands thoroughly with soap and water, especially before handling food and after using the toilet
• Maintaining strict hygiene among food handlers
• Controlling flies and preventing food contamination.