“I'm not great at the advice. Can I interest you in a sarcastic comment?”

This is what ‘Friends’ actor Matthew Perry’s character Chandler Bing was known for. He was known for being funny. However, he had his own struggles in his personal life and those struggles were acute depression. He was treating it with ketamine infusion therapy which is legal in the US and the UK.

What is Ketamine infusion therapy?

Ketamine is an anaesthetic used to treat depression, anxiety and pain under supervised and controlled medical settings. However, it does have its side effects, which can lead to distortion of sight, sound and time. It can also produce calming and relaxing effects.

Ketamine increases a person’s heart rate and blood pressure. If overdosed, it can leave users confused and agitated and can cause them to hurt themselves without even realising it. It can also lead to liver damage and bladder problems.

However, when used in moderation and under the supervision of medical doctors, it can treat depression where traditional antidepressants have failed.

Prof Rupert McShane, a University of Oxford psychiatrist who runs an NHS ketamine treatment clinic told BBC that ketamine “probably turns off the area of the brain that is involved in disappointment.”

Can Ketamine Infusion Therapy Kill Someone?

In simple terms, it cannot, be if the dosage is given in a controlled setting and as prescribed. Ketamine infusion therapy uses drugs in small doses than those used for anaesthesia. It acts faster than traditional anti-depressants, but the effects also wear off way quickly. Which is why it is important to monitor patients’ mental state for relapsing back into depression and discouraging them from overdosing on it.

There are ways of giving people ketamine. One of the ways is through “infusing”, which means to use an IV drip. However, injections, nasal sprays and capsules are also methods used to give people ketamine.

Since the dosage of ketamine used in the infusion treatment is small, it being the reason of actor Perry’s death was ruled out. The medical examiner also noted that Perry’s last ketamine infusion therapy session happened more than a week before his death, which means by the time he had died, it must have worn off.

So, What Happened To Perry?

Though Perry’s last session was more than a week before, his post-mortem showed that his blood contained a high concentration of ketamine. He had died of the “acute effects” of ketamine.

If it was not his session, then how did he get ketamine?

Prosecutors alleged that his assistant gave him at least 27 shots of ketamine in four days before his death, reported BBC.

Perry has been open about his personal struggles and this is what the doctors and dealers used against him. Martin Estrada, the US attorney for California’s Central District told the BBC that people took advantage of his condition. They charged him 165 times more than what vials of ketamine cost.

Names that have come up include Dr Salvador Plasencia, drug dealers “Ketamine Queen” aka Jasveen Sangha and Eric Fleming, and Perry’s live-in assistant Kenneth Iwamasa.

Who Are These Names And What Did They Do?

Ketamine Queen or Sangha supplied drugs that led to Perry’s death. Her home was a “drug-selling emporium,” said Estrada. More than 80 vials of ketamine, and thousands of pills including methamphetamine, cocaine and Xanax were allegedly found in her house known as the “Sangha Stash House.”

Sangha is known to deal with high-end celebs and was a “major source of supply for ketamine to others as well as Perry,” said Estrada.

Dr Plasencia called Perry a “moron” while charging him $2,000 for vials that cost only $12. He sold Perry 20 vials of ketamine between September and October 2023, costing $55,000.

He was the one who taught Iwamasa, who had no medical knowledge to inject the drug. This is after he knew that “Perry’s ketamine addiction was spiralling out of control,” as per what the investigators told the BBC.

Another dealer Fleming was told by Sangha to “delete all our messages.” While Fleming pleaded guilty to conspiring to distribute drugs unlawfully, he also allegedly messaged Sangha: “Please call...Got more info and want to bounce ideas off you. I’m 90% sure everyone is protected. I never dealt with [Perry] only his assistant. So the assistant was the enabler.”

The court documents also revealed that he asked Sangha on whether the ketamine stays in your system or “is it immediately flushed out.”

Dr Pepper, Bots, Cans

The people who allegedly exploited Perry used coded language for ketamine and called it “Dr Pepper”, “bots”, or “cans.”

Selling overpriced drugs, taking advantage of Perry’s mental condition and falsifying medical records to make the drugs given to him look legitimate by Dr Plasencia is what took Perry’s life.

Iwamasa is said to have administered more than 20 shots of ketamine and three on the day Perry died. Whereas ketamine is only administered by a physician. Authorities also found that weeks before Perry’s death, Dr Plasencia allegedly bought 10 vials of ketamine and intended to sell to Perry.

He also injected Perry with a large dose, two days later. This caused him to “freeze up” and spiked his blood pressure.

When I Die, I Want Helping Others To Be The First Thing That’s Mentioned

Perry had always been open about his drug addictions, struggles with alcohol and his depression. He said that his openness would help others who are also struggling and wanted to be remembered by his quote which also is on the homepage of the Mattew Perry Foundation that helps others struggling with the disease of addiction: “When I die, I want helping others to be the first thing that’s mentioned.”

Five arrests have been made in the case so far.

Days after the death of Darya Shipilova, a 28-year-old laboratory technician in Irkutsk's Anti-Plague Research Institute, sparked global headlines about a possible pneumonic plague outbreak, reports of a suspected second case instilled concern in global health bodies and citizens.

Russia responded to the reports of the second plague case in Siberia, while the World Health Organization (WHO) says it still lacks enough information to determine what caused the death of the laboratory worker.

Initial reports suggested she could have contracted pneumonic plague following a possible laboratory exposure, although Russian authorities have not confirmed that diagnosis.

Russia Denies Second Plague Case

Also read: Second Plague Death Reported As Russia Denies Outbreak

Local media reported the second death after Baikalsk authorities issued a Telegram warning on October 3 about “unofficial information” of a confirmed plague case in Shelekhov, The Daily Mail reported.

“Due to unofficial information about a confirmed case of plague in a person in the city of Shelekhov, we ask you to limit visits to Shelekhov and nearby settlements until the circumstances surrounding this threat are clarified,” the administration said.

The post was deleted about two hours later, according to local media Lyudi Baikala. There is no official confirmation that the person had plague or died from Yersinia pestis.

Russia's public health watchdog, Rospotrebnadzor, however, has maintained that Shipilova died from pneumonia of unknown or undetermined origin, rather than plague.

The agency said nearly 5,000 laboratory tests conducted among people connected to the incident had found no dangerous pathogens. More than 90% of the people who were placed under medical observation had completed monitoring.

Rospotrebnadzor also said Shipilova had been vaccinated and had immunity against the dangerous infections she worked with. It said there was no epidemic risk in the region.

The Kremlin has also rejected reports of a second suspected case. Kremlin spokesman Dmitry Peskov said the majority of media reports surrounding the incident were false and urged people to rely on official statements from Rospotrebnadzor.

According to Reuters, “There is a great deal of media coverage, and the vast majority of what the media are reporting about this situation is false information,” Peskov said.

WHO Investigates Lab Worker's Death

Also read: Russia Tells WHO No Plague Cases In Irkutsk, But Lab Worker's Death Remains Unexplained

Despite Russia's reassurances, the WHO says important questions about the lab worker's death still remain unanswered. WHO Director-General Tedros Adhanom Ghebreyesus said the organisation has requested details of the laboratory testing carried out on Shipilova and her contacts, the reasons behind the public-health measures and the current health status of those monitored.

The WHO has also asked Russia to verify reports that a second employee developed pneumonia of undetermined cause.

“As we don’t yet have the full picture of this event, we are not able to conduct a full risk assessment,” Tedros said. He stressed that timely, complete and transparent information is necessary to establish what happened and assess any potential public-health risk.

Maria Van Kerkhove, WHO director of epidemic and pandemic management, said the agency does not yet know the causative agent behind Shipilova's death.

“Right now, we don't know the causative agent of how this woman died. And that's really what we want to better understand,” she said.

Bioweapon Claims

There's also uncertainty which has prompted questions in the US about whether the incident could involve a biological weapon.

US President Donald Trump was asked on October 7 whether he believed the Russian lab worker's death was linked to a bioweapon, US President Donald Trump said: “We don't think so. We're going to find out soon enough, but we don't think so.”

He also said his administration was in “very deep discussions” about the incident and that he had a call with Russian President Vladimir Putin scheduled.

US officials, meanwhile, have continued monitoring the situation. CDC Director Erica Schwartz said the agency was prepared to monitor and screen travellers.

Secretary of State Marco Rubio said Washington was monitoring reports of possible plague but said they were not a “cause for alarm”. “There’s very limited travel between the US and Russia, obviously, but like anything else, something like that gets out, it could quickly spread,” Rubio said.

“So we're watching and monitoring it closely. I don't think it's cause for alarm – but it is cause for focus and a cause to just keep an eye on it. And we're doing that.”

Meanwhile, neighboring countries including Mongolia, Kyrgyzstan and Uzbekistan have reportedly tightened border health measures.

Novartis’ drug remibrutinib can now also be used for adults with symptomatic dermographism, according to the US Food and Drug Administration (FDA).

Marketed as Rhapsido, it is the first FDA-approved treatment specifically for symptomatic dermographism in adults whose symptoms do not sufficiently respond to H1 antihistamines.

Symptomatic dermographism is a condition is a form of chronic hives in which even minor scratching, rubbing or friction can trigger itchy, raised welts on the skin.

This has led Rhapsido to become the only prescription treatment in the US with approved uses for both symptomatic dermographism and chronic spontaneous urticaria when antihistamines alone are insufficient.

FDA Approves Remibrutinib For Symptomatic ermographism

The move came after symptomatic dermographism cohort of the Phase III RemIND trial, which included adults who remained symptomatic despite treatment with second-generation H1 antihistamines.

After 12 weeks, 29.3% of patients taking remibrutinib treated hives completely, compared to 14% of those receiving placebo. Novartis said improvements were seen as early as two weeks.

“SD is a chronic, debilitating condition with historically limited treatment options,” said Giselle Mosnaim, MD, MS, lead RemIND trial investigator. “Remibrutinib offers, for the first time, an approach to treatment specifically for SD patients who remain inadequately controlled with H1 antihistamines alone, representing a meaningful step forward for this population.”

Also read: HPV Vaccine May Keep Cervical Cancer Risk Lower In Women With HIV For Years: Lancet

What Is Symptomatic Dermographism?

Dermographism, sometimes called 'skin writing', occurs when the skin develops raised marks or welts after being scratched or pressurised.

In symptomatic dermographism, the reaction is accompanied by significant itching and hives. A person may develop welts after scratching an itch, rubbing against clothing, carrying a bag, drying off with a towel after a shower or any other everyday friction.

The welts can appear within minutes of the physical trigger, making ordinary contact with the skin unexpectedly uncomfortable.

Symptomatic dermographism is classified as a form of chronic inducible urticaria, meaning the hives are triggered by a specific physical stimulus rather than appearing spontaneously.

Also read: New Lymphoma Trial: Experimental Drug Combination Cuts Progression Or Death Risk By 51%

Why Scratching Cause Hives In Symptomatic Dermographism?

The reaction of hives forming after scratching involves mast cells, immune cells found in the skin that can release histamine and other inflammatory substances. When the skin is physically stimulated, these cells activate, triggering the characteristic redness, swelling, and itching.

This is also where remibrutinib works differently from conventional antihistamine. Remibrutinib is an oral, highly selective Bruton’s tyrosine kinase (BTK) inhibitor.

By blocking the BTK process that is involved in immune-cell signalling and histamine release, the drug aims to reduce the chain of events that produce hives and itching.

Living With Symptomatic Dermographism

For most people, the condition is primarily a chronic quality-of-life problem rather than a life-threatening disease. However, persistent itching and unpredictable hives can interfere with sleep, clothing choices, work, and everyday activities.

The FDA approval does not mean remibrutinib is intended for everyone with dermographism. It is approved for adults whose symptomatic dermographism cannot be controlled by existing H1 antihistamines.

The most common adverse events reported with remibrutinib in trials included nasopharyngitis, bleeding, headache, nausea and abdominal pain.

Around 4.9 million people aged 18 years and over (9.8%) smoked cigarettes in the UK in 2025, down from 10.6% in 2024, continuing the long-term decline in smoking, according to the latest report from the UK’s Office for National Statistics (ONS).

But as smoking rates fall, vaping has become increasingly common. In Great Britain, around 5.4 million people aged 16 years and over (9.9%) used an e-cigarette daily or occasionally in 2025, according to the ONS Opinions and Lifestyle Survey.

For the second consecutive year, e-cigarette use was higher than cigarette smoking. In 2025, there were around:

• 5.4 million current e-cigarette users
• 4.8 million current smokers

The proportion of adults using e-cigarettes has also increased over the longer term, rising from 6.4% in 2020 to 9.9% in 2025.

Vaping Highest Among 25-34-Year-Olds

Also read: FDA To Speed Up Approval Process For Vapes & Nicotine Pouches: Does It Mean They Are Safer Than Cigarettes?

E-cigarette use was highest among people aged 25 to 34 years, with 16.4% reporting daily or occasional use.Overall, 6.5% of people aged 16 and over reported vaping daily in 2025, slightly down from 6.7% in 2024. Another 3.4% reported occasional use, up from 3.3%.

The ONS data also show that vaping is not limited to current smokers. In 2025, 7.2% of people reported having previously used an e-cigarette, up from 6.6% in 2024, while the proportion who had never used one fell slightly from 83.4% to 83.0%.

What’s In A Vape?

Vaping is often perceived as a cleaner alternative to smoking because e-cigarettes do not burn tobacco. However, the aerosol produced by these devices can contain substances that may affect the lungs and cardiovascular system.

Unlike harmless water vapour, e-cigarette aerosol may contain:

• Nicotine, which is highly addictive
• Heavy metals, including lead, nickel and tin
• Volatile organic compounds, some of which can be harmful
• Flavoring chemicals, which may have different effects when inhaled
• Ultrafine particles that can penetrate deep into the lungs

“Inhaling these substances directly into the lungs introduces not just nicotine, but also numerous potentially carcinogenic and lung-damaging compounds,” said Dr. Arun Chowdary Kotaru, Head and Senior Consultant of Pulmonology & Sleep Medicine.

“This is not harm reduction—it’s harm diversification.”

Why Are Non-Smokers Turning To Nicotine?

Vaping was initially promoted as a smoking-cessation aid and is generally considered less harmful than smoking combustible cigarettes. However, e-cigarettes are not risk-free.

The concern is particularly relevant for people who have never smoked. For them, taking up vaping can introduce a new source of nicotine exposure and dependence rather than replacing an existing smoking habit.

“Vaping is not harmless,” warns Dr. Arun. “Even if it may contain fewer toxic chemicals than traditional cigarettes, it still delivers a cocktail of harmful substances that are anything but safe.”

Nicotine exposure is also a concern for adolescents because the brain continues developing into the mid-20s.

“The teenage brain is still developing until around the age of 25,” explains Dr. Kotaru. “Nicotine interferes with areas responsible for learning, impulse control, and mood regulation. Early exposure can also set the stage for a lifelong struggle with addiction, increasing vulnerability to other substance abuse later in life.” .