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 recent Delhi High Court ruling has highlighted reproductive autonomy of women with disabilities. The court dismissed a plea seeking to let a woman with cerebral palsy undergo hysterectomy (uterus removal) solely because she was unable to manage her menstrual cycles independently.

The court stated that “disability can never be the only ground to deny reproductive autonomy”. At the same time, it also said that such surgeries can only be considered if medical experts determine that it is in the person's best interests and would protect their welfare and dignity.

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Delhi HC On Disability And Reproductive Autonomy

The Delhi High Court was hearing a plea from the parents of a differently-abled woman suffering from cerebral palsy with spastic moderate hemiparesis with moderate mental retardation. They had approached the court seeking to let the woman undergo a surgery for removal of the uterus.

According to the petition, the woman was born in March 2005 and had cerebral palsy with spastic moderate hemiparesis and moderate mental retardation.

Her parents argued that her disability was permanent and that she was unable to give consent for the procedure. They also cited difficulties in managing her during menstruation. The court, however, dismissed the plea for the surgery.

Justice Amit Mahajan, instead, directed authorities to constitute an independent multidisciplinary medical board to evaluate whether hysterectomy was medically appropriate. The board was asked to make a decision within four weeks.

The court's stance was that disability by itself cannot justify removing a person's reproductive organs.

The judge said, “It is apposite to mention that disability in itself can never be the only ground to deny reproductive autonomy or approve removal of reproductive organ and thus, such a route of surgical intervention can be adopted if medical evaluations suggest that the same would be in the best interest of the petitioner for protection of her welfare and dignity.”

The court also clarified that allowing the medical board to examine the situation was not the same as approving the hysterectomy.

“The same may not be construed as carte blanche or approval of the surgery, since the opinion on the surgery has to be formed by domain experts, that is, medical experts,” the judge said.

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What Is A Hysterectomy?

Hysterectomy is a surgical procedure to remove the uterus. Depending on medical reasons, other reproductive organs like the cervix, fallopian tubes or ovaries may also be removed.

After the uterus removal, a woman can no longer become pregnant and will no longer have menstrual periods. It is therefore a major, irreversible procedure that warrants careful consideration.

When Is Hysterectomy Medically Necessary?

Difficulty in managing menstruation due to a disability is not automatically the same thing as a medical indication for hysterectomy. Hysterectomy may be recommended for certain serious medical conditions when other treatments are ineffective or inappropriate.

Dr. Renu Raina Sehgal, Chairperson - Department of Obstetrics & Gynaecology, Artemis Hospital, Gurugram, told HealthandMe, “Hysterectomy is not indicated for disability alone. It may be considered if a woman has heavy bleeding, pain, fibroids, cancer and another problem with her uterus.”

Doctors also believe that women with disabilities may have difficilty in managing heavy periods and other symptoms difficult.

Dr. Anagha Chhatrapati, Senior Consultant Gynaecologist, Gleneagles Hospital, told HealthandMe, “For a woman with severe physical or cognitive disability, managing recurrent heavy periods may be particularly difficult, but less invasive options should generally be considered first. The decision should be individualised, medically justified, and made with the woman’s informed consent, wherever she has decision-making capacity.”

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Experts On The Court's Ruling

Delhi High Court’s ruling focuses on medical necessity and reproductive autonomy for disabled women. People with disabilities may require additional support to manage menstruation and reproductive needs. But the need for assistance does not, by itself, mean that an irreversible reproductive surgery is appropriate.

Dr. Raina Sehgal said, “Removal of the uterus cannot be done solely on the wishes of the patient or caregivers. There must be a valid medical indication and in cases involving mental illness and severe debilitating conditions, approval of an appropriate medical board may also be required. Disability may affect care needs but should never automatically determine hysterectomy.”

Alternatives For Disabled Women Besides Hysterectomy

The doctors also explain that women with disability have several alternatives to an irreversible surgery.

Dr. Raina Sehgal said, “Alternatives may include menstrual management with hormonal medications, a hormonal intrauterine device, pain management, management of underlying conditions and endometrial ablation in selected women. Practical support, accessible menstrual products as well as caregiver support could help.”

Dr. Chhatrapati said that the choice should be individualised based on the woman’s medical needs, preferences, and overall wellbeing.

Risks Of Hysterectomy

It is important to consider alternatives to hysterectomy as it is not only irreversible but also has some risks.

Dr. Chhatrapati said, “Hysterectomy can lead to bleeding, infection, blood clots and injury to nearby organs such as the bladder or bowel. Recovery can take several weeks, depending on the type of surgery and the woman’s overall health. It also permanently ends the ability to carry a pregnancy and, if the ovaries are removed, can cause surgical menopause.”

Cholera deaths increased by 30% in 2025, reaching their highest level since 1999, according to a new report by the World Health Organization (WHO).

In 2025, 47 countries reported 451,499 cholera cases and 7,870 deaths to WHO. The actual global burden is likely substantially higher, as many cases go unreported.

“The rise in cholera deaths is a reminder of the challenge ahead,” said Dr Chikwe Ihekweazu, Executive Director of WHO's Health Emergencies Program.

“No one should be dying from cholera today when we have the tools to prevent and treat this disease,” he added.

7 Countries Account For 90% Of Global Cholera Toll

Seven countries accounted for around 90% of reported cholera cases and deaths globally in 2025:

• Angola
• Bangladesh
• The Democratic Republic of the Congo
• Nigeria
• South Sudan
• Sudan
• Yemen

The WHO African Region recorded the largest burden, with cases rising 34% and deaths 58% from 2024.

Further, the WHO stated that more than one in five reported cholera deaths occurred outside health facilities, showing that many patients are still not reaching care in time.

Among patients treated in health facilities, the global fatality rate remained below 1%, the threshold for adequate care. However, it exceeded 1% in 12 countries.

The WHO called for targeted investments in safe water, sanitation and hygiene, along with stronger surveillance, vaccination and access to quality care, to reverse the trend.

The WHO report also covered bacterial meningitis and plague.

Vaccination Behind Declining Bacterial Meningitis Cases

The African meningitis belt, stretching from Senegal to Ethiopia, continues to face a substantial burden. In 2025, 24 of 26 countries reported 21,526 suspected cases and 971 deaths, a fatality rate of 4.5%.

However, among countries reporting data for both years, cases declined 5.9% from the previous year.

Since the meningococcal A conjugate vaccine was introduced in 2010, serogroup A cases have fallen by more than 99% among vaccinated populations.

In 2025, Niger became the first country to conduct a nationwide campaign with the broader Men5CV/MMCV vaccine.

Plague Cases Reported In 10 Countries

Between 2019 and 2025, 10 countries reported suspected human plague cases to WHO, with six reporting confirmed cases.

A total of 3,847 suspected cases and 423 deaths were reported, giving a case fatality rate of 11%.

Most cases came from the Democratic Republic of the Congo and Madagascar, where plague remains endemic in some areas.

What Is Cholera?

Cholera is an acute diarrheal disease caused by Vibrio cholerae bacteria and spreads through food or water contaminated with feces.

It is preventable and treatable but can be fatal when severe dehydration is not treated quickly. Global production of oral cholera vaccines more than doubled from around 30 million doses in 2022 to approximately 80 million in 2025.

What Is Meningitis?

Meningitis is inflammation of the tissues surrounding the brain and spinal cord. Bacterial meningitis is the most serious type and can be life-threatening.

What Is Plague?

Plague is a bacterial disease that usually spreads among animals through fleas but can also infect humans. Surveillance of rodents and other animal populations and rapid outbreak response remain important for preventing transmission.

A powerful synthetic opioid that is described to be up to 10 times stronger than fentanyl is spreading through the US illicit drug supply, raising concerns about a new and deadly driver of overdoses.

According to a drug threat notice from the White House Office of National Drug Control Policy (ONDCP), the drug, cychlorphine, has now been detected in every region of the United States, . It was particularly prevalent in Ohio, Texas and Tennessee.

At least 55 deaths were linked to cychlorphine in 2025 and 2026, according to the federal warning. Tennessee has recorded the largest number of confirmed deaths so far. The number of drug samples containing the opioid also increased sharply, from just one in 2024 to 106 samples from 10 states in 2025.

All About Cychlorphine

Cychlorphine is a synthetic opioid, meaning it is manufactured chemically rather than derived directly from the opium poppy.

Belonging to a growing group of highly potent synthetic opioids, cychlorphine has crept up in the illicit drug supply in the US in the last few years. ONDCP says that cychlorphine could be “up to ten times more potent than fentanyl”.

Fentanyl is already notorious for being an extremely powerful opioid. Cychlorphine adds another layer of risk to an illicit drug supply that is already difficult to predict.

Fentanyl is an incredibly powerful opioid. The CDC says illegally manufactured fentanyl is about 50 times stronger than heroin and 100 times stronger than morphine. Cychlorphine may be up to 10 times more potent than fentanyl, according to the ONDCP.

That level of potency means the difference between an amount that produces an opioid effect and an amount that causes a fatal overdose can be extremely small.

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Cychlorphine Is Hard To Detect

Cychlorphine can be mixed into other drugs or pressed into counterfeit prescription pills, meaning someone may believe they are taking a familiar medication when the tablet actually contains a much more powerful opioid.

Powerful synthetic opioids can be mixed into other drugs or pressed into counterfeit pills. The DEA has similarly warned that nitazenes, another class of potent synthetic opioids, are being mixed with fentanyl, heroin and counterfeit prescription pills.

Fentanyl test strips do not detect cychlorphine, so a negative fentanyl test does not mean a drug is free from cychlorphine. "Cychlorphine is not detected by drug test strips or in routine hospital opioid urine screens," ONDCP warned.

This also means that deaths from the drug are likely being underestimated, according to the Journal of Pain Research. The author, Robert Raffa, professor emeritus at Temple University's School of Pharmacy in Philadelphia, confirmed the drug is detected in a specialized lab.

ONDCP Warns

The New York Times reported that multiple doses of Narcan may be needed to reverse cychlorphine's effects, while people responding to an overdose may have only one or two doses available.

ONDCP has warned that anyone who might respond to an overdose should be ready with extra doses of naloxone (Narcan), a drug that helps reverse opioid overdoses. But response to these extremely potent synthetic opioids can be complicated.