Category SPORTS

Drug side effects are common, and often quite troublesome.

Major side effects, such as severe or even life-threatening allergic reactions, require immediate treatment and discontinuation of the drug. More minor symptoms may be tolerable when weighed against drug benefits. And sometimes, these go away on their own as the body gets used to the drug.

But there’s another type of side effect you hear much less about: ones that are beneficial. Though uncommon, they’re worth keeping in mind when you’re starting a new medicine.

Aren’t all side effects bad?

The term side effect is usually assumed to be a bad thing. And that’s typically true. But that leaves out the “good” side effects. Relatively little is published on this, so it’s not clear how common they are. But four notable examples include:

• Minoxidil (Rogaine, Gainextra, other brands). Developed in the 1970s for high blood pressure, this drug also increased hair growth in study subjects. What was initially considered a bothersome side effect eventually became its primary use: topical forms of this drug are commonly used to treat hair loss.
• Diphenhydramine (Benadryl or generic versions). This common treatment for allergic conditions has the side effect of drowsiness. For adults with allergy issues and trouble sleeping, the sedative effect can be helpful. Regular, long-term use of diphenhydramine is not recommended, as it may increase the risk of dementia.
• Sildenafil (Viagra or generic versions). Originally developed as a treatment for high blood pressure and angina, it didn’t take long for male users to realize the drug could trigger erections within 30 to 60 minutes. The makers of sildenafil recognized that under the right circumstances, this could be a highly beneficial side effect. In 1998 it was approved as a treatment for erectile dysfunction.
• Semaglutide (Ozempic, Wegovy, Rybelsus). This drug was developed to treat diabetes, but early users noticed reduced appetite and significant weight loss. Now, several formulations of these related drugs are approved for diabetes and/or weight loss.

In the best study I’ve read on the topic, researchers found more than 450 reports of serendipitous beneficial effects of various drugs since 1991. And that may be an underestimation, since report forms did not specifically ask for or label this type of side effect, according to the study authors.

Silver linings: Repurposing and repackaging drugs

While the discovery of helpful drugs can arise unexpectedly, drug developers are increasingly using a more intentional approach: using side effect profiles to look for new uses.

For example:

• A drug reported to cause reduced sweating as a side effect may be effective for hyperhidrosis, a condition marked by excessive sweating.
• Drugs reported to cause low blood pressure as a side effect might be effective treatments for high blood pressure (hypertension).
• New treatments for breast cancer may include older medicines that have a similar side effect profile as known anti-cancer drugs.

The availability of large side effect registries has made this method of identifying drugs for repurposing a more realistic option. So, even negative side effects can have a silver lining.

Bad side effects and the nocebo effect

While side effects can be positive, most are not. Medication side effects are a common reason people give for not taking prescribed drugs regularly. And adverse reactions to medicines prompt up to 8% of hospital admissions, according to one analysis.

To make matters worse, in some cases the expectation of side effects seems to make them more likely to occur. Called the nocebo effect, it increases the chances of experiencing a negative side effect and seems due, at least in part, to expectations. Contrast this with the placebo effect, where a sugar pill or another inactive treatment can lead to benefit.

The bottom line

Many people avoid taking medications because they fear possible side effects. That’s understandable. But not taking a medication can mean missing out on its benefits. And anticipation or expectation of side effects can increase the chances you’ll have them.

So, while it’s important to be aware of the most common side effects caused by the medicines you take, it’s also important not to overestimate your chances of experiencing them. And remember: there’s always a chance you’ll have a side effect you actually welcome.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Are you finding yourself with itchy, irritated skin that you can’t stop scratching? Or have you wondered why your child’s eczema is suddenly worse and so hard to control? Mounting evidence suggests that wildfires, which are increasing in intensity and frequency, contribute to skin problems, including eczema flares.

What is eczema?

Eczema is a common chronic skin condition that affects about one in 10 people in the US. Its hallmarks are inflamed and dry, itchy patches of skin.

Atopic dermatitis is the most common type of eczema. It can run in families, often beginning in childhood. Typically, in the northern hemisphere, it grows worse during the winter season when the weather is cold and drying. Now some experts are seeing that pattern change. At Massachusetts General Hospital, for example, one dermatologist noted an unusual spike last summer in patients with flare-ups of eczema.

Why is eczema getting worse during summer?

In 2023, Canada experienced more than 6,000 wildfires that burned over 16 million hectares of land — an area larger than the entire state of Georgia. While far away from the devastation, the smoke reached across the US and more than 2,000 miles to Europe. Poor air quality from these distant wildfires caused eye and throat irritation and difficulty breathing.

In Boston, Dr. Arianne Shadi Kourosh, a dermatologist at Massachusetts General Hospital, also began to notice skin symptoms. Normally the dermatology clinics would see fewer than 20 people during a summer month for eczema, including atopic dermatitis. Suddenly that jumped to 160.

Looking back at summer month records from the last four years, her research showed that the number of visits for these skin complaints tracked with the severity of air pollution. These findings are consistent with other research noting an uptick in eczema flares and psoriasis flares associated with wildfire pollution. But why?

Researchers theorize that airborne pollutants might set off a cascade of effects within the body by activating an oxidative stress pathway. This damages the skin barrier and prompts an inflammatory response. This cascade also may play a role in the development of eczema.

What can you do to protect your skin?

Air pollutants in wildfire smoke may harm multiple organs — not just your heart and lungs, but also our skin, it seems. So, when outdoor air quality is bad due to wildfires, limiting your exposure can help reduce health risks. While we can say the same for industrial air pollution, wildfire pollution is likely worse due to its additional toxic particles.

• Seek help if you’re itching. Check with a dermatologist or your health team if you think wildfire smoke or other forms of air pollution might be affecting your skin.
• Check local air quality.AirNow.gov shares local, real-time air quality information and activity guidance. When recommended, stay indoors if possible. Shut doors, windows, and any outdoor air intake vents.
• Protect your skin. When you’re outdoors, wear a mineral-based sunscreen containing zinc or titanium. While most other sunscreens work through a chemical reaction to absorb the ultraviolet (UV) rays that damage skin, zinc and titanium sunscreens help by forming a barrier over skin that reflects off UV rays. The barrier also reduces the amount of pollutant particles getting to the skin to set off the inflammatory cascade. Wearing sunscreen protects against skin cancer, as well.
• Wash up. After coming back inside, cleansing your skin and applying a hypoallergenic moisturizer will help keep it healthy. If you do have eczema, choose cleansers and moisturizing products recommended by your dermatologist or health care provider.

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD

On the Gulf Coast of Florida where I live, the telltale sign of summer is not an influx of beachcombers, afternoon storms that arrive exactly at 2 p.m., or the first hurricane warning, but the appearance of hundreds of paddleboarders dotting the inlet waters.

From afar, paddleboarding looks almost spiritual — people standing on nearly invisible boards and gliding across the surface as if walking on water.

But this popular water sport offers a serious workout, just as kayaking and canoeing do. While floating along and casually dipping a paddle in the water may look effortless, much goes on beneath the surface, so to speak.

As warm weather beckons and paddle season arrives, it pays to get key muscles in shape before heading out on the water.

Tuning up muscles: Focus on core, back, arms, and shoulders

“Paddling a kayak, canoe, or paddleboard relies on muscles that we likely haven’t used much during winter,” says Kathleen Salas, a physical therapist with Spaulding Adaptive Sports Centers at Harvard-affiliated Spaulding Rehabilitation Network. “Even if you regularly weight train, the continuous and repetitive motions involved in paddling require endurance and control of specific muscles that need to be properly stretched and strengthened.”

While paddling can be a whole-body effort (even your legs contribute), three areas do the most work and thus need the most conditioning: the core, back, and arms and shoulders.

• Core. Your core comprises several muscles, but the main ones for paddling include the rectus abdominis (that famed “six-pack”) and the obliques, located on the side and front of your abdomen. The core acts as the epicenter around which every movement revolves — from twisting to bending to stabilizing your trunk to generate power.
• Back: Paddling engages most of the back muscles, but the ones that carry the most load are the latissimus dorsi muscles, also known as the lats, and the erector spinae. The lats are the large V-shaped muscles that connect your arms to your vertebral column. They help protect and stabilize your spine while providing shoulder and back strength. The erector spinae, a group of muscles that runs the length of the spine on the left and right, helps with rotation.
• Arms and shoulders: Every paddle stroke engages the muscles in your arms (biceps) and the top of your shoulder (deltoids).

Many exercises specifically target these muscles, but here are three that can work multiple paddling muscles in one move. Add them to your workouts to help you get ready for paddling season. If you haven’t done these exercises before, try the first two without weights until you can do the movement smoothly and with good form.

Three great exercises to prep for paddling

Wood chop

Muscles worked: Deltoids, obliques, rectus abdominis, erector spinae
Reps: 8–12 on each side
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with your feet about shoulder-width apart and hold a dumbbell with both hands. Hinge forward at your hips and bend your knees to sit back into a slight squat. Rotate your torso to the right and extend your arms to hold the dumbbell on the outside of your right knee.

Movement: Straighten your legs to stand up as you rotate your torso to the left and raise the weight diagonally across your body and up to the left, above your shoulder, while keeping your arms extended. In a chopping motion, slowly bring the dumbbell down and across your body toward the outside of your right knee. This is one rep. Finish all reps, then repeat on the other side. This completes one set.

Tips and techniques:

• Keep your spine neutral and your shoulders down and back
• Reach only as far as is comfortable.
• Keep your knees no farther forward than your toes when you squat.

Make it easier: Do the exercise without a dumbbell.

Make it harder: Use a heavier dumbbell.

Bent-over row

Muscles worked: Latissimus dorsi, deltoids, biceps
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with a weight in your left hand and a bench or sturdy chair on your right side. Place your right hand and knee on the bench or chair seat. Let your left arm hang directly under your left shoulder, fully extended toward the floor. Your spine should be neutral, and your shoulders and hips squared.

Movement: Squeeze your shoulder blades together, then bend your elbow to slowly lift the weight toward your ribs. Return to the starting position. Finish all reps, then repeat with the opposite arm. This completes one set.

Tips and techniques:

• Keep your shoulders squared throughout.
• Keep your elbow close to your side as you lift the weight.
• Keep your head in line with your spine.

Make it easier: Use a lighter weight.

Make it harder: Use a heavier weight.

Superman

Muscles worked: Deltoids, latissimus dorsi, erector spinae
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Lie face down on the floor with your arms extended, palms down, and legs extended.

Movement: Simultaneously lift your arms, head, chest, and legs off the floor as high as is comfortable. Hold. Return to the starting position.

Tips and techniques:

• Tighten your buttocks before lifting.
• Don’t look up.
• Keep your shoulders down, away from your ears.

Make it easier: Lift your right arm and left leg while keeping the opposite arm and leg on the floor. Switch sides with each rep.

Make it harder: Hold in the “up” position for three to five seconds before lowering.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Editor's note: Health inequities have long been an issue for people in the LGBTQ+ community. We're pleased to share a post from our colleagues in Corporate Learning at Harvard Medical School focusing on solutions that health care leaders can champion.

Health care business professionals can improve patient outcomes and reduce health inequities by championing the health care needs of the lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, and two-spirit (LGBTQIA2+) community. These issues are an important priority for health care professionals year-round, not just during Pride Month.

Research shows that the LGBTQIA2+ community faces disproportionate adverse health conditions due to health inequities. It’s important for those working in the health care industry to be aware of the challenges the LGBTQIA2+ community faces to help make systemic changes and improve health outcomes.

The LGBTQIA2+ community — which is less likely to trust the health care system — is a rising part of the population. The 2022 national Gallup survey shows that at least 20% of Gen Z identifies as LGBTQIA2+. This includes our coworkers, customers, and clients, says Dr. Alex Keuroghlian, a psychiatrist at Massachusetts General Hospital and faculty advisor for LGBT and Allies at Harvard Medical School (LAHMS).

“LGBTQIA2+ people experience pervasive stigma and discrimination, as well as numerous adverse social determinants of health, all of which negatively impact health outcomes,” says Dr. Keuroghlian. “Health care professionals, organizations, and governmental agencies need to intentionally provide clinical care and design health systems and policies, in a manner that is culturally responsive and improves health outcomes for LGBTQIA2+ people.”

Due to the politicized nature of these issues, health care providers around the world, including in several U.S. states, face limitations and backlash when providing gender-affirming care. In some places, Dr. Keuroghlian says, “legal restrictions on access to gender-affirming care create challenges for clinicians to deliver this care and for transgender and gender diverse people to safely receive it.”

Everyone in health care — including health care business professionals — can work to improve health outcomes and decrease inequities. “It is critical for all businesses to offer welcoming, inclusive, and affirming work environments and service delivery for LGBTQIA2+ people,” Dr. Keuroghlian says.

Supporting LGBTQIA2+ health begins in the workplace

With thoughtful action, health care business professionals can contribute to greater health equity for these underserved individuals. Some ways to do so include:

1. Take an active interest in better understanding the needs and perspectives of the LGBTQIA2+ community.

Conducting research, including surveys and consumer focus groups, is a good way to help better understand specific health needs and priorities. “This community has historically been excluded from studies and research that would be very helpful in understanding their needs and their challenges,” says Dr. Enrique Caballero, an endocrinologist at Brigham and Women’s Hospital and the faculty director of International Innovation Programs in the HMS Office for External Education. “We need to get to know the population better.”

2. Prioritize inclusive language.

Whether you are involved directly in care delivery or other aspects of health care, pay attention to the words you use — for both customers and employees. Gendered language in job postings, informational or marketing materials, and even casual conversation can be off-putting. That means lost opportunities for organizations and LGBTQIA2+ individuals. Slight shifts in language and conscious efforts like adding pronouns to your email signature speak volumes.

3. Train staff to be community allies.

Gaining awareness of our unconscious biases and making shifts in our everyday language doesn’t happen overnight. Health care industry businesses can help their staff be better allies to the LGBTQIA2+ community by providing access to workshops delivered by community members.

“No one becomes fully competent after one conversation, lecture, or video,” Dr. Caballero says. “It’s a lifelong process in which we all learn how to be more respectful, inclusive, and to embrace diversity.”

4. Support companies and community organizations that focus on LGBTQIA2+ health.

Show, don’t tell. Making financial contributions to organizations already on the ground and working with this population demonstrates that you aren’t just concerned about the bottom line. You are truly dedicated to helping the LGBTQ+ population access good health care.

5. Hire LGBTQIA2+ staff.

The best way to ensure your company is prioritizing health equity is by having a diverse group at the decision-making table. It is crucial to have employees that represent the diversity of your customer base — not only diversity in gender expression and sexuality, but also diversity in race, ethnicity, age, ability, and beyond.

“Part of our obligation is to really open the doors for everybody,” Dr. Caballero says. “Talent is not exclusive to a particular group, and I think that is important to embrace as an organization.”

6. Include LGBTQIA2+ representation in all communications.

Diverse representation is key. Make a pointed effort to include same-sex couples, non-traditional family units, and transgender and non-binary individuals in all kinds of communications, participating in everyday activities.

7. Acknowledge any missteps.

On an institutional level, company acknowledgments can go a long way in rebuilding trust with the LGBTQIA2+ community. Within the organization, it’s valuable to encourage ongoing communication about company culture.

“All organizations should have a system in place for people to provide feedback on how things are going and to report anything that they want to call the leadership team's attention to,” Dr. Caballero says. “Having a system that truly listens to members of the organization — and being sure that follow-up action is taken — is very important.”

8. Make action consistent beyond Pride Month.

Embracing the LGBTQIA2+ community consistently and with commitment all year long “is truly an opportunity for everyone,” Dr. Caballero says. “This is not good just for the members of the community, but for everybody that works in a place that embraces diversity, equity, and inclusion.”

Industry professionals turn to HMS for custom corporate learning programs, including on topics like LGBTQIA2+ health, that leave a lasting impact on participants. To provide these programs, HMS leverages faculty expertise from throughout the School and the entire Harvard University community to share with health care teams. To learn about HMS Corporate Learning custom programs, read about the approach or hear from clients themselves.

About the Author

Corporate Learning Staff

Harvard Medical School’s Corporate Learning solutions provide emerging and established companies with the knowledge they need to address the industry's toughest business challenges. Their extensive portfolio of learning solutions helps teams achieve their potential by advancing … See Full Bio View all posts by Corporate Learning Staff

Before going any further, here’s the main thing parents should know about swimming lessons: all children should have them.

Every year, over 4,500 people die from drowning in the United States — and, in fact, drowning is the leading cause of death for children ages 1 to 4. Swimming lessons can’t prevent all of those deaths, but they can prevent a lot of them. A child doesn’t need to be able to swim butterfly or do flip turns, but the ability to get back to the surface, float, tread water, and swim to where they can stand or grab onto something can save a life.

10 things parents should know about swimming lessons

As you think about swimming lessons, it’s important to know:

1. Children don’t really have the cognitive skills to learn to swim until they are around 4 years old. They need to be able to listen, follow directions, and retain what they’ve learned, and that’s usually around 4 years old, with some kids being ready a little earlier.

2. That said, swim lessons between 1 and 4 years old can be useful. Not only are some kids simply ready earlier, younger children can learn some skills that can be useful if they fall into the water, like getting back to the side of a pool.

3. The pool or beach where children learn must be safe. This sounds obvious, but safety isn’t something you can assume; you need to check it out for yourself. The area should be clean and well maintained. There should be lifeguards that aren’t involved in teaching (since teachers can’t be looking at everyone at all times). There should be something that marks off areas of deeper water, and something to prevent children from getting into those deeper areas. There should be lifesaving and first aid equipment handy, and posted safety rules.

4. The teachers should be trained. Again, this sounds obvious — but it’s not always the case. Parents should ask about how teachers are trained and evaluated, and whether it’s under the guidelines of an agency such as the Red Cross or the YMCA.

5. The ratio of kids to teachers should be appropriate. Preferably, it should be as low as possible, especially for young children and new swimmers. In those cases, the teacher should be able to have all children within arm’s reach and be able to watch the whole group. As children gain skills the group can get a bit bigger, but there should never be more than the teacher can safely supervise.

6. There should be a curriculum and a progression — and children should be placed based on their ability. In general, swim lessons progress from getting used to the water all the way to becoming proficient at different strokes. There should be a clear way that children are assessed, and a clear plan for moving them ahead in their skills.

7. Parents should be able to watch for at least some portion. You should be able to see for yourself what is going on in the class. It’s not always useful or helpful for parents to be right there the whole time, as it can be distracting for children, but you should be able to watch at least the beginning and end of a lesson. Many pools have an observation window or deck.

8. Flotation devices should be used thoughtfully. There is a lot of debate about the use of “bubbles” or other flotation devices to help children learn to swim. They can be very helpful with keeping children safe at the beginning, and helping them learn proper positioning and stroke mechanics instead of swimming frantically to stay afloat, but if they are used, the lessons should be designed to gradually decrease any reliance on them.

9. Being scared of the water isn’t a reason not to take, or to quit, swimming lessons. It’s common and normal to be afraid of the water, and some children are more afraid than others. While you don’t want to force a child to do something they are terrified of doing, giving up isn’t a good idea either. Start more gradually, with lots of positive reinforcement. The swim teacher should be willing to help.

10. Just because a child can swim doesn’t mean he can’t drown. Children can get tired, hurt, trapped, snagged, or disoriented. Even strong swimmers can get into trouble. While swimming lessons help save lives, children should always, always be supervised around water, and should wear life jackets for boating and other water sports.

The Centers for Disease Control and Prevention website has helpful information on preventing drowning. The American Red Cross offers an online water safety course for caregivers and parents and water safety videos for children. Many public pools and organizations like Boys & Girls Clubs and the YMCA offer swimming classes for all ages.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It’s undeniable: modern medicine offers ever-expanding ways to heal and prevent disease. But it’s also true that health care can cause harm. One analysis found that about 6% of health care encounters caused preventable harm, leading to thousands of deaths each year. And it’s not just errors that cause trouble. Highly skilled health care providers can cause harm even when they do everything right.

So, how can you reduce your chances of being harmed? Understanding what you can do to lessen the possibility of harm and what’s beyond your control are good first steps.

Whatever happened to “first do no harm”?

Fortunately, it remains a central tenet of medical care. Yet our health care system is complex and fragmented. Each year new medications are added to an ever-growing list, and people live longer with more chronic medical conditions than happened in the past. So in one sense, the successes of modern medical care may contribute to the high rate of health care–related harm.

These harms are often due to our complicated system of health care rather than one individual’s mistake. Harm due to substandard or negligent care is known as medical malpractice. Both health care providers and health care systems have important roles to play in preventing harm to patients.

Are there harms that cannot be prevented?

An enormous volume of scientific research teaches the best ways to diagnose, treat, and prevent disease. Yet people can react to treatments in completely unpredictable ways.

For example, a common and standard antibiotic treatment (think penicillin) can cause anaphylaxis, a life-threatening allergic reaction. Fortunately this is rare, but unless you or your doctor know to avoid it due to past side effects, there’s always a small chance of a severe reaction.

Often less dramatic — yet also unpreventable — harms are:

• Medication side effects. Every medicine comes with potential side effects, such as nausea, sleepiness, or rash.
• Misdiagnosis. Because no one has perfect diagnostic skills, even the most skillful health care provider can be wrong. This can result in unnecessary or delayed treatment.
• Inaccurate test results. Just as no health care provider is perfect, no test is either. False-positive results (indicating an abnormality when none is present) and false-negative results (normal results when disease is present) are common in medical practice. These results can lead to unnecessary treatment or false reassurance.

Which harms can be prevented?

Preventable harms can be dramatically reduced. They’re often due to mistakes that can be caught and corrected. Frequently, it takes a combination of things to go wrong for harm to occur.

The “Swiss cheese model” is often applied here: imagine you’re a fly trying to travel through several chunks of Swiss cheese. (I know it’s an odd scenario, but stick with me here.) It’s impossible to fly through the cheese unless the holes line up just so.

Frequently in health care, several factors must line up for an error to sneak through — for example, giving a hospitalized patient a medication to which they are allergic. For that to happen, the wrong drug has to get past the prescribing doctor, the computerized ordering system, the hospital pharmacist, the nurse giving the medication, and the patient. That’s a lot of layers, so most often an error like this will be caught.

What can you do to avoid preventable harms?

Where do you fit in? In these three scenarios, here’s what you can do to avoid preventable harms.

The problem: Taking medicines you no longer need or more medicines than necessary.

It might not seem like a big deal to keep taking a medicine if it isn’t causing any problems. But all medicines can cause side effects that you’d do better to avoid if you can safely stop taking it or reduce the dose. Plus, harmful interactions can occur if another medicine is added to your list.

What you can do: Make sure you know why you need to take each of your medicines. Ask the providers who prescribe each medicine if it is still necessary to take it or if the dose can be safely reduced. Reducing a dose may reduce the risk of side effects and the likelihood of a harmful interaction.

The problem: Taking the wrong medicine or the wrong dose.

What you can do: At your doctors’ visits, take notes or bring a friend or family member to help you remember medicine instructions. Ask whether you can record the medication instructions your doctor gives you. Take a photo of the instructions you’re given in case you lose the written version. Double-check details of your medicine list with your pharmacist. And ask questions if you’re unsure about the medicines recommended to you.

The problem: Wrong site surgery.

Despite efforts to make this a “never error,” surgery on the wrong part of the body still happens.

What you can do: Make sure you and your surgeon agree on what part of your body and which side requires surgery. Most surgeons now mark the site with a special pen before surgery and ask you to confirm the site by adding your initials. (The ink doesn’t come off easily with skin cleaners applied prior to surgery).

Some of these tips require time or resources that aren’t available to everyone: you might not be able to bring another person with you to medical visits or have a recording device. But asking questions — and getting answers you understand — should be routine.

Where does malpractice fit in?

When the topic of health care–related harm comes up, malpractice may be the first thing you think about. Yet, the approximately 10,000 malpractice payments made each year in the US likely represent only a small portion of all harm related to health care.

There are several reasons for this, including:

• Even when negligent or substandard care occurs, it doesn’t always cause major or long-lasting harm that leads to a malpractice claim.
• Many people who could file malpractice suits elect not to, or may not even realize that they’ve experienced negligent care. Past studies suggest that less than 5% of people experiencing harm related to medical care file malpractice claims.
• Increasingly, health care providers and health care systems accept responsibility for preventable harm occurring on their watch, and offer compensation rather than waiting for a legal claim to be filed.

The bottom line

It’s an unfortunate reality that some harms due to health care are inevitable. But there are steps you can take to avoid preventable harm and lessen the chances that the person harmed is you.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Cognitive behavioral therapy (CBT) teaches people to challenge negative thought patterns and turn less often to unhelpful behaviors. These strategies can improve your mood and the way you respond to challenging situations: a flat tire, looming deadlines, family life ups and downs.

Yet there’s much more depth and nuance to this well-researched form of psychotherapy. It has proven effective for treating anxiety, depression, and other mental health conditions. Tailored versions of CBT can also help people cope with insomnia, chronic pain, and other nonpsychiatric conditions. And it can help in managing difficult life experiences, such as divorce or relationship problems.

What are the key components of CBT?

One important aspect of CBT relates to perspective, says psychologist Jennifer Burbridge, assistant director of the Cognitive Behavioral Therapy Program at Harvard-affiliated Massachusetts General Hospital.

“Therapists who practice CBT don’t see the problems or symptoms people describe as having one single cause, but rather as a combination of underlying causes,” she says. These include

• biological or genetic factors
• psychological issues (your thoughts, physical sensations, and behaviors)
• social factors (your environment and relationships).

Each of these factors contributes to — and helps maintain — the troublesome issues that might prompt you to seek therapy, she explains.

How does CBT describe our emotions?

Our emotions have three components: thoughts, physical sensations, and behaviors.

“Thoughts are what we say to ourselves, or 'self-talk,'” says Burbridge. Physical sensations are what we observe in our bodies when we experience an emotional situation: for example, when your heart rate rises in stressful circumstances. Behaviors are simply the things you do — or do not do. For instance, anxiety might prevent you from attending a social event.

All three components are interrelated and influence one another. That’s why CBT helps people to develop skills in each of them. “Think of it as a wellness class for your emotional health,” says Burbridge.

How long does CBT last?

CBT is a goal-oriented, short-term therapy. Typically it involves weekly, 50-minute sessions over 12 to 16 weeks. Intensive CBT may condense this schedule into sessions every weekday over one to three weeks.

Is CBT collaborative?

“When I first meet with someone, I’ll listen to what’s going on with them and start thinking about different strategies they might try,” Burbridge says. But CBT is a collaborative process that involves homework on the patient’s part.

What might that mean for you? Often, a first assignment involves self-monitoring, noting whether there are certain things, events, or times of day that trigger your symptoms. Future sessions focus on fine-tuning approaches to elicit helpful, adaptive self-talk, and problem-solving any obstacles that might prevent progress.

Certain thinking patterns are often associated with anxiety or depression, says Burbridge. Therapists help people recognize these patterns and then work with patients to find broader, more flexible ways to cope with difficult situations.

“We’re cognitive creatures with big frontal lobes that help us analyze situations and solve problems. That’s useful in some situations. But at other times, when you’re trying to manage your emotions, it may be better to pause and acknowledge and accept your discomfort,” says Burbridge.

Which CBT tools and strategies can help?

That particular skill — paying attention in the present moment without judgement, or mindfulness — is a common CBT tool. Another strategy that’s helpful for anxiety, known as exposure or desensitization, involves facing your fears directly.

“People avoid things that make them nervous or scared, which reinforces the fear,” says Burbridge. With small steps, you gradually expose yourself to the scary situation. Each step provides learning opportunities — for example, maybe you realize that the situation wasn’t as scary as you though it would be.

By trying new things instead of avoiding them, you begin to change your thought patterns. These more adaptive thinking patterns then make it more likely you will try new or challenging experiences in the future, thereby increasing your self-confidence.

How does CBT work?

Brain imaging research suggests conditions like depression or anxiety change patterns of activity in certain parts of the brain. One way CBT may help address this is by modifying nerve pathways involved in fear responses, or by establishing new connections between key parts of the brain.

A 2022 review focused on 13 brain imaging studies of people treated with CBT. The analysis suggested CBT may alter activity in the prefrontal cortex (often called the “personality center”) and the precuneus (which is involved in memory, integrating perceptions of the environment, mental imagery, and pain response).

Who might benefit from CBT?

CBT is appropriate for people of all different ages. This can range from children as young as 3 years — in tandem with parents or caregivers — to octogenarians. In addition to treating anxiety and depression, CBT is also effective for

• eating disorders
• substance abuse
• personality disorders
• attention deficit hyperactivity disorder (ADHD)
• obsessive compulsive disorder (OCD).

Additional evidence shows CBT may help people with different health issues, including irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, insomnia, migraines, and other chronic pain conditions. The therapy may also benefit people with cancer, epilepsy, HIV, diabetes, and heart disease.

“Many medical conditions can limit your activities. CBT can help you adjust to your diagnosis, cope with the new challenges, and still live a meaningful life, despite the limitations,” says Burbridge.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

You’ve probably heard the news: Cicadas are coming. Or — wait — they’re already here.

And are they ever! Due to an unusual overlap of the lifecycles of two types (or broods) of cicadas, trillions of cicadas are expected to emerge in the US by the end of June, especially in the Midwest.

If you’d like to see where they’ve already arrived, track them here. And if you’re wondering if this cicada-palooza could help with grocery bills, read on to decide for yourself how appealing and how safe snacking on cicadas is for you. The pros and cons could change your outlook on the impending swarm.

What to know about cicadas

Don’t worry, cicadas are largely harmless to humans. In fact, their appearance is welcome in places where people routinely snack on them as a low-cost source of calories and protein.

Estimates suggest up to two billion people regularly eat insects, especially in South and Central America, Asia, Africa, Australia, and New Zealand. Cicadas, when available, are among the most popular. And if you thought no one in the US eats cicadas, check out this video from a May 2024 baseball game.

Are you tempted to eat cicadas?

For plenty of people, cicadas aren’t the food of choice. Some people can’t get past the idea of eating insects as food. That’s understandable: after all, the culture in which we are raised has a powerful influence on what we consider acceptable in our diets. Something some Americans might find off-putting (such as eating snakes) is common in China and Southeast Asia. Meanwhile, people outside the US find aspects of the typical Western diet unappealing (such as root beer, peanut butter and jelly, and processed cheese).

But some people shouldn’t eat cicadas because it could be dangerous for them.

Why you should — or shouldn’t — eat cicadas

Eating cicadas is common in many parts of the world because they are

• nutritious: cicadas are low in fat and high in protein, including multiple essential amino acids
• inexpensive or free
• tasty (or so I’m told): descriptions of their flavor vary from nutty to citrusy to smoky and slightly crunchy.

In years when cicadas emerge, recipes for dishes containing cicadas emerge as well.

Then again, there are several good reasons to avoid making cicadas a part of your diet, including these:

• You just can’t get past the “ick” factor. Adventurous eaters may be willing to try or even embrace consuming cicadas, while others will be unable to view the idea as anything other than horrifying.
• You find the taste or consistency unappealing.
• You’re “cicada intolerant.” Some people get stomach upset, nausea, or diarrhea if they eat too many cicadas.
• You’re pregnant or breastfeeding, or are a young child. Concerns about even low levels of pesticides or other toxins in cicadas have led to recommendations that these groups not eat them. Doesn’t this suggest the rest of us should also steer clear? Well, thus far, at least, there’s no evidence that toxins in cicadas are causing health problems.

But there is one more very important entry on this list: people with a shellfish allergy should not eat cicadas. Odd, right?

The shellfish-cicada connection

Cicadas are biologically related to lobsters, shrimp, crabs, and other shellfish. So if you’re allergic to shellfish, you might also be allergic to cicadas. A particular protein called tropomyosin is responsible for the allergy. It’s found in shellfish as well as in many insects, including cicadas.

The allergic reaction occurs after eating the cicada. Just being around them or handling them won’t trigger a reaction.

Among people with a shellfish allergy, developing a reaction after eating cicadas could be a bigger problem than it seems: up to 10% of people have shellfish allergies and, as noted, insect consumption is common worldwide.

Is it okay for your dog or cat to eat cicadas?

Walking your dog after the emergence of cicadas can be a new and exciting experience for you and your pet! Dogs may chase after cicadas and eat them. Cats might, too, if given the chance. That can be a problem if your pet eats too many, as some will experience stomach upset or other digestive problems.

While the insects are considered harmless to dogs, the American Kennel Club says it’s best to steer them away from cicadas once they’ve eaten a few.

Which other insects trigger allergies?

While insect-related allergic reactions (think bee stings) and infections (like Lyme disease) are well known, the insect-food-allergy connection is a more recent discovery.

One recently recognized condition is the alpha-gal syndrome, in which a person bitten by certain ticks develops an allergy to meat. The name comes from a sugar called galactose-α-1,3-galactose (or alpha-gal) found in many types of meat including beef, lamb, pork, and rabbit. According to the CDC, up to 450,000 people in the US may have developed this condition since 2010.

There aren’t many rigorous studies of the overlap of insects and food allergies, so there are probably others awaiting discovery.

The bottom line

When it comes to eating cicadas, I’ll pass. It’s not because of the risks. I’ve never had a problem with shellfish, and for most people the health risks of eating cicadas seem quite small. It’s just unappealing to me, and I’m not a particularly adventurous eater.

But let’s go easy on those who do enjoy snacking on cicadas. Insects offer a good source of calories and protein. Just because eating them seems unusual in the US doesn’t make it wrong.

So, if you like to eat cicadas and have no shellfish allergy or other reason to avoid them, go for it! This may be a very good summer for you.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD