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.

A Chinese-Russian surgical team has reportedly replaced a damaged section of a paralysed patient's spinal cord with tissue from a brain-dead donor, executing the world's first human spinal cord transplant successfully.

However, with no evidence of neurological recovery, scientists have been questioning whether the procedure can restore movement so far. The 12-hour operation was performed at the Sklifosovsky Research Institute for Emergency Medicine in Moscow on October 14–15, according to Chinese surgeon Ren Xiaoping, one of the doctors who participated in the procedure. The patient had sustained a severe spinal cord injury three years ago.

Ren told the South China Morning Post, “It was our Guangxi University of Chinese Medicine Second Affiliated Hospital and the Russian team working together.”

Moscow Mayor Sergei Sobyanin announced the procedure on October 16, describing it as a significant development in spinal surgery. “A patient who was threatened with complete immobility had a chance to recover. Now he feels good,” he wrote.

However, feeling well after surgery does not mean that a patient has regained movement. The surgical team has not publicly released neurological evidence showing whether signals can travel across the transplanted section.

How Was The Spinal Cord Tissue Transplanted?

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According to Ren, surgeons removed the damaged section of the patient's spinal cord and replaced it with tissue obtained from a brain-dead donor. They used microsurgery and polyethylene glycol (PEG), a substance that can fuse cell membranes to join the tissues.

This technique addresses one of the central challenges of treating severe spinal cord injuries. The spinal cord carries signals between the brain and the rest of the body. When it is severely damaged, these signals cannot pass normally through the injury, causing paralysis and loss of sensation below the affected area.

But joining two sections of tissue is not enough. Nerve fibres must establish functional connections across the damaged area and the tissue that is transplanted must receive blood supply. The recipient's immune system may also attack the donor tissue.

These challenges become important when the injury is several years old. Repairing a recently damaged spinal cord is different from replacing tissue in a patient with a longstanding injury.

Scientists Have Raised Questions

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Scientists have raised concerns about the evidence about whether it can restore meaningful neurological function in humans.

Melissa Andrews, a neuroscientist at the University of Southampton, questioned the quality of the animal studies supporting the technique and warned about the risks involved, according to New Atlas.

Experiments involving PEG has shown some promise in animals but they do not prove that the technique can reconnect a human spinal cord successfully enough to restore movement.

The lack of publicly available evidence is another limitation. Details about the patient's injury, the precise location of the transplanted segment, neurological examinations after the procedure and changes in movement or sensation have not been disclosed. No peer-reviewed clinical report documenting the operation and its outcomes has been published.

Ren told New Atlas, “We have informed the patient of every potential risk and surgical outcome, and the patient's current condition is good.”

The operation is an experimental treatment, not proof that transplanting spinal cord tissue can reverse paralysis. Even if the patient survives the operation without major complications, recovery would depend on whether functional nerve connections develop and whether the brain can communicate with the body across the damaged region. Rehabilitation and long-term follow-up would be needed to assess any improvement.

Kerala's decision to switch from an expensive branded medicine for children with spinal muscular atrophy (SMA) with a much cheaper Indian-made alternative has sparked a dispute over the drug’s safety, regulatory procedures and parents' right to know what treatment their children receive.

Health Minister K Muraleedharan has defended the switch to Natco Pharma's generic risdiplam, which is sold as Natsmart. However, some parents and opposition leaders have questioned why bottles supplied to children at the Sree Avittom Thirunal (SAT) Hospital in Thiruvananthapuram were labelled “Physician's Sample” and “For Clinical Trials Only”.

The controversy has since expanded beyond the medicine's price. It now concerns how the drug reached the hospital and what evidence backs its use in children already receiving treatment.

Why Did Kerala Switch To The Generic SMA Medicine?

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SMA is a rare inherited disorder that causes progressive muscle weakness and wasting because of the loss of motor neurons. It can affect movement, swallowing and breathing. Its treatment may need to continue over a long period.

The branded risdiplam, Evrysdi, is manufactured by Swiss pharmaceutical company Roche. Its reported market price is around ₹6.2 lakh per bottle. Natco's generic alternative, Natsmart, is listed at ₹15,900 per bottle. The Kerala government has negotiated even a lower procurement price.

The difference could substantially reduce public expenditure. The state has been providing risdiplam free to eligible children through its KARE programme. Reports indicate that around 109 children are receiving treatment under the scheme.

The generic switch was intended to make treatment more affordable.. Public health expert B Ekbal has backed the decision, arguing that lower-cost medicines can expand access without compromising quality.

The debate is not over whether generic medicines should be used. Opposition leaders, including former chief minister Pinarayi Vijayan, say their objections concern the handling of the medicine that were labelled for clinical trials and the transparency of its distribution.

‘Clinical Trial’ Label Alarmed The Parents

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The controversy surfaced after families received bottles bearing the clinical trial and physician sample labels. Parents questioned whether their children had been given medicine intended for testing and whether they had adequately informed before.

Former Kerala health minister and CPI(M) leader K K Shailaja raised concerns about quality and the need for transparency and evidence before changing treatment.

“Just because a new company offers a price reduction doesn’t mean we can purchase everything. Besides price reduction, quality is what matters most. Some companies might lower prices just to push unsold products or for other interests,” she said, according to The South First.

The government says the labels indicate that they belong to sample stock and do not mean that the children were enrolled in a clinical trial.

Dr R Shankar, who heads the technical committee that evaluated the medicine, said, “If the concern is over the label, there was ‘physician’s sample’ written on it. It means it is a tested molecule. The container contains the same medicine.”

Hospital authorities said the disputed bottles were taken back after parents raised concerns. The minister has maintained that this was done to address their apprehensions, not because the government had concluded that the medicine was unsafe.

Muraleedharan has said the switch was based on an expert committee's recommendations and that the drug had received regulatory approval.

On October 24, he said, “People had concerns, but the doctors have addressed them. The treating doctors themselves have cleared the doubts.” He also said he would provide further clarification in the state Assembly on October 26.

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SMA Patient Says The Generic Medicine Worked For Her

Amid the concerns, SMA patient Seba P A has defended Natsmart, saying she has taken Natco's generic risdiplam since April through a patient assistance programme. “Taking Natsmart produces the same effect as when I was taking Evrysdi,” she said. “I have felt no issues due to the change in brand.”

Seba also said bottles supplied to her free of cost carried the same physician sample and clinical trial labels. She argued that the labels were intended to prevent the free medicine from being resold.

Is the Generic SMA Drug Safe?

Natsmart contains risdiplam, the same active pharmaceutical ingredient as Evrysdi. The Central Drugs Standard Control Organisation (CDSCO) has approved Natco's formulation for marketing in India.

They maintain that the generic medicine is suitable for patients and that the labels do not indicate an ongoing clinical trial involving the children.

However, questions have been raised about bioequivalence evidence, quality checks and the process followed before procurement. Bioequivalence studies are used to establish whether a generic formulation delivers an active ingredient into the bloodstream at a rate and to an extent comparable with the reference medicine.

The dispute therefore cannot be resolved by comparing prices or relying solely on individual patient experiences. Families need clear information about the product's approval, the evidence for its use in children, the significance of the labels and the safeguards in place to monitor adverse effects.

A combination of two cancer drugs cut the risk of death by 58% in people who have advanced small cell lung cancer, an aggressive form of the disease, according to results from a Phase 3 clinical trial.

The combination pairs Imdelltra (tarlatamab), developed by Amgen, with Imfinzi (durvalumab), an immunotherapy made by AstraZeneca.

In the DeLLphi-305 trial, patients who received both drugs lived a median of 21.1 months, compared to 12.7 months among those who received Imfinzi alone.

The findings were presented at the European Society for Medical Oncology (ESMO) Congress in Madrid on October 24, 2026, and published in The New England Journal of Medicine.

More About Imdelltra-Imfinzi Trial

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The results indicated that using tarlatamab earlier in treatment could be beneficial. It is currently approved in the United States for adults with extensive-stage small cell lung cancer that has progressed during or after platinum-based chemotherapy.

The trial examined its application as a maintenance treatment after patients had completed initial chemotherapy and immunotherapy without their cancer progressing.

“For a disease where durable survival has remained extremely difficult to achieve, the magnitude and consistency of benefit in DeLLphi-305 are striking,” said Jacob Sands, an associate chief of the Lowe Center for Thoracic Oncology at Dana-Farber Cancer Institute and an investigator in the trial.

The Phase 3 trial included 563 patients with extensive-stage small cell lung cancer whose disease had not progressed after initial treatment with Imfinzi, platinum-based chemotherapy and etoposide. The main findings were:

- 58% lower risk of death: The combination reduced the risk of death compared to Imfinzi alone.

- 21.1 months median overall survival: This compared to 12.7 months in the Imfinzi-only group.

- Nearly 80% alive at one year: About 79% of patients receiving the combination were alive after 12 months, compared to 53% of those receiving Imfinzi alone.

- 66% lower risk of progression or death: Median progression-free survival was 7.4 months with the combination, versus 1.9 months with Imfinzi alone.

These results indicate that the combination improved both overall survival and the time patients lived without their cancer progressing.

More About The Two Drugs

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Imdelltra, also known as tarlatamab, is a bispecific antibody that brings immune system T cells into contact with cancer cells, helping the immune system recognise and attack them.

Imfinzi, or durvalumab, blocks the PD-L1 protein, which some cancer cells misuse to evade immune attack.

The two drugs therefore target different aspects of the immune response. Researchers hope that combining them will improve the body's ability to control the cancer.

Jay Bradner, Amgen's executive vice-president of research and development, said, “These results represent an unprecedented advance for patients with extensive-stage small cell lung cancer, demonstrating a magnitude of survival benefit rarely seen in this aggressive disease.”

Side effects related to grade 3 or higher treatment occurred in 20.9% of the patients who received the combination, compared to 10.8% of those receiving Imfinzi alone.

Cytokine release syndrome, an inflammatory reaction caused by immune system activation, occurred in 49.6% of patients who received Imdelltra. Most cases were mild or moderate, and one was classified as severe. No deaths were reported.

The findings provide evidence that adding tarlatamab to maintenance immunotherapy can extend survival in extensive-stage small cell lung cancer. The researchers also reported benefits among patients with brain or liver metastases.

Despite promising findings, researchers say that the trial focused on a particular cancer type and treatment. Regulatory authorities will need to examine the evidence adopting this combination for earlier stage of treatment.