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.

In a major milestone in fetal and paediatric neurosurgery in India, doctors at the All India Institute of Medical Sciences (AIIMS), New Delhi, have performed the country's first open fetal surgery to repair myelomeningocele, the most severe form of spina bifida.

The six-hour procedure was carried out at 25 weeks of pregnancy, in which surgeons were able to repair the baby's spinal defect before birth. The surgery, performed on November 12, entailed repairing a cerebrospinal fluid leak in the lower back while the baby was still in the uterus.

According to AIIMS press release, the operation followed more than five weeks of preparation in multiple disciplines, including detailed fetal imaging, counselling, planning anaesthesia and surgical simulations.

The procedure was done by more than 30 clinicians and nurses from neurosurgery, maternal-fetal medicine, obstetrics, anaesthesia, plastic surgery, radiology and neonatology.

Professor PS Chandra, Head of Neurosurgery at AIIMS, who facilitated the entire surgical execution by the neurosurgery team, said that prenatal surgery could help reduce the incidence of hydrocephalus and Chiari malformations linked with spina bifida.

What Is Myelomeningocele?

Myelomeningocele is an open neural tube defect in which the spinal cord and its protective coverings protrude through an opening in the developing spine. It occurs when the neural tube, which eventually develops into the brain and spinal cord, does not close completely during early pregnancy.

The condition can cause permanent nerve damage, muscle weakness or paralysis, loss of bladder and bowel control, and complications involving the brain and spinal cord. Some affected babies also develop hydrocephalus, a condition in which excess cerebrospinal fluid accumulates in the brain.

In many cases, surgery to close the spinal defect is performed after birth. However, exposure of the spinal cord to the surrounding amniotic fluid during pregnancy can contribute to further neurological injury.

India continues to face a burden of neural tube defects. A 2024 review of 27 Indian studies estimated their pooled prevalence at 9.46 per 1,000 births.

Also read: India’s Xenotransplantation Push: Can Pig Organs Help Bridge the Organ Shortage? | Interview

Is Fetal Surgery The Way Forward?

Unlike conventional postnatal surgery, open fetal repair involves operating on the fetus while it is still inside the uterus. The surgeon accesses the uterus, exposes the affected area of the baby's spine and closes the defect, protecting the exposed spinal cord and its coverings. The aim is to limit further damage to the developing nervous system and improve certain neurological outcomes.

Professor Deepak Gupta, who led the neurosurgical part of the procedure, said, “This establishes an important new capability for fetal care and paediatric neurosurgery in India. In rigorously selected cases, prenatal repair seeks to limit ongoing injury to exposed neural tissue, reduce the subsequent need for cerebrospinal-fluid diversion for hydrocephalus, and improve selected neurological outcomes. It is not a cure, and long-term multidisciplinary care remains essential.”

Evidence for prenatal repair comes from the landmark Management of Myelomeningocele Study (MOMS), an international clinical trial. It found that 40% of children who underwent prenatal surgery required a cerebrospinal fluid shunt by 12 months of age, compared to 82% of those who underwent surgery after birth. Prenatal repair also helped with better motor outcomes and a lower incidence of hindbrain herniation linked with Chiari II.

But fetal surgery comes with its risks. It can increase the chances of premature delivery. It also carries risks related to the opening and subsequent healing of the mother's uterus. It is therefore performed only on carefully selected pregnancies at specialised centres equipped with resources.

Milestone In Fetal Surgery

The AIIMS procedure brings a complex fetal intervention, which is already done in other countries, to India's public healthcare system.

Professor Neena Malhotra, who led the maternal-fetal medicine and obstetric part of the surgery alongside Professor K Aparna Sharma, said, “This accomplishment reflects the collective commitment of an exceptional multidisciplinary team.”

Professor Sharma added, “Fetal intervention in this case is a very well-reasoned and planned decision to optimise the outcomes of both the baby and the mother. The safety of both mother and fetus depends on detailed counselling, high-quality anaesthesia, and coordinated surveillance before and after surgery.”

AIIMS said the procedure was performed free of cost under the Government of India's Janani Shishu Suraksha Karyakram (JSSK). The mother and fetus will continue to receive close monitoring throughout the remainder of the pregnancy, delivery and newborn period.

Also read: First Human Spinal Cord Transplant Reported In Russia But Can It Reverse Paralysis?

Can Spina Bifida Be Prevented?

Prevention of spina bifida remains essential even though the option of fetal surgery is available. Neural tube closure takes place within the first 28 days after conception, often before a woman realises she is pregnant.

Adequate folic acid intake before conception and during early pregnancy can significantly reduce the risk of neural tube defects. Preconception counselling, folic acid intake and dietary interventions with folate are therefore important to prevent spina bifida.

The World Health Organization (WHO) has issued its first-ever guidelines for the diagnosis and management of type 1 diabetes in adults. The recommendations aim to improve insulin access and blood glucose monitoring in countries where healthcare resources are limited.

Released on November 14 to mark World Diabetes Day 2026, the guidelines cover insulin treatment, blood glucose monitoring and care in emergency and humanitarian settings. They are meant to help healthcare providers deliver safer treatment, regardless of the resources available.

The guidelines come as the global burden of type 1 diabetes continues to grow. In 2025, 500,000 people were diagnosed with type 1 diabetes, adding to an estimated 9.5 million people living with the condition worldwide in 2025, according to the WHO. Although type 1 diabetes is often diagnosed during childhood, it can develop at any age, including adulthood.

WHO Guidelines On Type 1 Diabetes

Also read: Effect of Diabetes on Different Organs: Why the Damage Is Not the Same Everywhere

A primary recommendation is intensified insulin treatment through multiple daily injections, along with the doses adjusted according to blood glucose levels. People with type 1 diabetes cannot produce enough insulin and therefore need lifelong insulin therapy to survive.

The guidelines recognise insulin as an effective and affordable treatment option. Insulin analogues, which are modified forms of insulin designed to alter how long the medicine works, may also be used when needed. The guidelines also address how treatment and monitoring can be adapted in low-resource settings and during emergencies.

The recommendations also emphasise regular blood glucose monitoring.

• HbA1c testing: A blood test that provides an estimate of average blood glucose levels over the previous two to three months.
• Finger-prick testing: Allows people to check their blood glucose levels at home at different points during the day.
• Continuous glucose monitoring (CGM): Uses a small sensor worn on the skin to track glucose levels throughout the day.
• Urine glucose testing: May be considered when blood glucose testing is not available.

Importance Of WHO Guidelines

Also read: World Diabetes Day 2026: Is India's Toxic Air Adding To Its Diabetes Crisis? What Experts Say

More than a century after insulin was discovered, access to affordable treatment remains a challenge for many people with type 1 diabetes. Interruptions in insulin supply can be life-threatening because the body depends on externally administered insulin to regulate blood glucose.

Without enough insulin, blood glucose can rise dangerously and lead to diabetic ketoacidosis (DKA), a fatal complication.

“Insulin is a lifesaving treatment, discovered more than 100 years ago. Yet many people with type 1 diabetes do not have access to affordable and high-quality insulin,” said Dr Søren Brostrøm, WHO Director of Noncommunicable Diseases and Mental Health.

“The new WHO guidelines provide evidence-based recommendations to help countries deliver the best possible care, including in settings where resources are limited and health services are disrupted.”

The WHO guidelines aim to reduce these gaps by providing recommendations that can be implemented across different healthcare systems, including those with limited resources. They also support the organisation's bigger target of ensuring universal access to affordable insulin treatment and blood glucose self-monitoring by 2030.

The WHO has encouraged countries to involve people living with type 1 diabetes in designing diabetes programmes, so that they reflect practical challenges patients face.

Type 1 diabetes is an autoimmune condition in which the immune system destroys the insulin-producing beta cells in the pancreas. Unlike type 2 diabetes, it is not primarily caused by insulin resistance or lifestyle factors.

People with the condition need lifelong insulin treatment, alongside regular glucose monitoring and medical follow-up. Without appropriate management, diabetes can lead to complications affecting the eyes, kidneys, nerves and cardiovascular system.

Did Robert F Kennedy Jr. lie during his 2025 confirmation hearings to become US health secretary? US senators have opened up an investigation into whether Kennedy misled Congress about his 2019 trip to Samoa, months before a measles outbreak killed 83 people.

Ron Wyden of Oregon, incoming chair of the Senate Finance Committee, has launched an investigation into evidence that Kennedy “unlawfully lied” during his confirmation hearings, The Guardian reported.

Wyden is also expected to seek records from Children's Health Defense (CHD), the anti-vaccine non-profit Kennedy headed at the time, including documents related to his Samoa visit.

“We are beginning an investigation into evidence that Secretary of Health and Human Services Robert F Kennedy, Jr unlawfully lied to Congress on multiple occasions,” Wyden said in a letter to the group sent on Wednesday and obtained by The Guardian. The letter was also signed by Angela Alsobrooks, a Democratic senator from Maryland.

The investigation comes as the US faces its worst measles crisis in decades. More than 5,000 cases and eight deaths have been reported in 2026, the highest annual case count since 1991. The country is also at risk of losing its measles elimination status, achieved through decades of public health and vaccination efforts.

Also read: US Set To Lose Measles-Elimination Status After 26 Years: Prof Devi Sridhar Explains Reasons Behind Resurgence

What Is The Controversy Surrounding RFK Jr's Samoa Trip?

Kennedy allegedly misrepresented the purpose of his 2019 Samoa visit during two congressional hearings last year, telling lawmakers that the trip had “nothing to do with vaccines”.

However, letters obtained by The Guardian and the Associated Press in August reportedly contradicted his testimony.

In a letter to the Samoan prime minister before the visit, Kennedy explicitly said he wanted to study the measles, mumps and rubella (MMR) vaccine. He used the words “vaccine” or “vaccination” eight times.

“I am writing this letter to you in the hope that we might be helpful to the people of your great nation,” he wrote, suggesting that the deaths of two children following MMR vaccination could have resulted from manufacturing issues.

“I would propose my team conduct detailed health informatics assessment in Samoa of what happened with your MMR vaccines,” Kennedy wrote.

How Is Kennedy's Visit Linked To Samoa's Measles Outbreak?

Kennedy visited Samoa just months before a measles outbreak killed 83 people. Critics have argued that his presence emboldened anti-vaccine activists and worsened the country's vaccination crisis.

Children were among those who died in the outbreak, which exposed the consequences of low vaccination coverage.

Kennedy has denied the allegations, saying he never made public statements about vaccines or discouraged Samoans from getting vaccinated.

Read More: EXCLUSIVE: Ex-CDC Vaccine Advisor Says Measles Outbreak Bigger Than Reported, Slams RFK Jr’s ‘No-See Evil’ Approach

Why Is RFK Jr Under Scrutiny?

The letters have raised questions about the purpose of Kennedy's visit and the accuracy of his congressional testimony.

During his confirmation process, Kennedy pledged to maintain existing vaccine policies. However, after taking office, he moved to change several of them.

“We are deeply concerned by the tactics Kennedy has used – both before and during his tenure as secretary – to stand in the way of children receiving life-saving vaccinations,” the two Democratic senators wrote.

“In Samoa and in the United States, unvaccinated children have died tragic and preventable deaths during measles outbreaks. We intend to hold Secretary Kennedy accountable for the grave harm he has caused to vulnerable children. We also intend to hold him accountable for any false statements made to Congress, a crime that undermines the Senate’s ability to fulfill its constitutional duties.”

What Has Kennedy Said About Measles Vaccination?

Long known for his vaccine-skeptic views, Kennedy has spent years amplifying misinformation about vaccines, including the MMR vaccine.

But as measles cases mounted in the US, he urged American parents to vaccinate their children during an August CNN interview, marking a notable shift in his public messaging.

The appeal came as US measles cases surpassed the 2025 annual total.

"I've never questioned the efficacy of the MMR vaccine," the health secretary told CNN. However, the damage had already been done, with cases continuing to rise and eight deaths reported in 2026.