Wildfires: How to cope when smoke affects air quality and health
As wildfires become more frequent due to climate change and drier conditions, more of us and more of our communities are at risk for harm. Here is information to help you prepare and protect yourself and your family.
How does wildfire smoke affect air quality?
Wildfire smoke contributes greatly to poor air quality. Just like fossil fuel pollution from burning coal, oil, and gas, wildfires create hazardous gases and tiny particles of varying sizes (known as particulate matter, or PM10, PM2.5, PM0.1) that are harmful to breathe. Wildfire smoke also contains other toxins that come from burning buildings and chemical storage.
The smoke can travel to distant regions, carried by weather patterns and jet streams.
How does wildfire smoke affect our health?
The small particles in wildfire smoke are the most worrisome to our health. When we breathe them in, these particles can travel deep into the lungs and sometimes into the bloodstream.
The health effects of wildfire smoke include eye irritation, coughing, wheezing, and difficulty breathing. The smoke may also increase risk for respiratory infections like COVID-19. Other possible serious health effects include heart failure, heart attacks, and strokes.
Who needs to be especially careful?
Those most at risk from wildfire smoke include children, older adults, outdoor workers, and anyone who is pregnant or who has heart or lung conditions.
If you have a chronic health condition, talk to your doctor about how the smoke might affect you. Find out what symptoms should prompt medical attention or adjustment of your medications. This is especially important if you have lung problems or heart problems.
What can you do to prepare for wildfire emergencies?
If you live in an area threatened by wildfires, or where heat and dry conditions make them more likely to occur:
- Create an evacuation plan for your family before a wildfire occurs.
- Make sure that you have several days on hand of medications, water, and food that doesn't need to be cooked. This will help if you need to leave suddenly due to a wildfire or another natural disaster.
- Regularly check this fire and smoke map, which shows current wildfire conditions and has links to state advisories.
- Follow alerts from local officials if you are in the region of an active fire.
What steps can you take to lower health risks during poor air quality days?
These six tips can help you stay healthy during wildfire smoke advisories and at other times when air quality is poor:
- Stay aware of air quality. AirNow.gov shares real-time air quality risk category for your area accompanied by activity guidance. When recommended, stay indoors, close doors, windows, and any outdoor air intake vents.
- Consider buying an air purifier. This is also important even when there are no regional wildfires if you live in a building that is in poor condition. See my prior post for tips about pollution and air purifiers. The EPA recommends avoiding air cleaners that generate ozone, which is also a pollutant.
- Understand your HVAC system if you have one. The quality and cleanliness of your filters counts, so choose high-efficiency filters if possible, and replace these as needed. It's also important to know if your system has outdoor air intake vents.
- Avoid creating indoor pollution. That means no smoking, no vacuuming, and no burning of products like candles or incense. Avoid frying foods or using gas stoves, especially if your stove is not well ventilated.
- Make a "clean room." Choose a room with fewer doors and windows. Run an air purifier that is the appropriate size for this room, especially if you are not using central AC to keep cool.
- Minimize outdoor time and wear a mask outside. Again, ensuring that you have several days of medications and food that doesn't need to be cooked will help. If you must go outdoors, minimize time and level of activity. A well-fitted N95 or KN95 mask or P100 respirator can help keep you from breathing in small particles floating in smoky air (note: automatic PDF download).
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
A bird flu primer: What to know and do
A bird flu strain that began circulating in 2020 continues to evolve globally and locally within the United States. If you’re wondering what this means, understanding the basics — what bird flu is, how it spreads, whether foods are safe, and prevention tips — can help. More information will come in as scientists learn more, so stay tuned.
1. What is bird flu and how does it spread?
Bird flu, or avian flu, is a naturally occurring illness. Just as certain flu viruses spread among humans, Type A influenza viruses often spread among wild birds. The strain of virus circulating now is H5N1, named for two proteins on its surface.
Avian flu infections are highly contagious. Infection often spreads first among wild water birds, such as ducks, geese, and gulls, and shore birds, such as plovers and sandpipers. The viruses are carried in their intestines and respiratory tract and shed in saliva, mucus, and feces. Wild birds can easily infect domestic poultry, such as chickens, turkeys, and ducks.
Some bird species, including ducks, may carry and spread infection without appearing sick. Domestic flocks are more likely to sicken and possibly die from bird flus. However, not all avian flu viruses are equally harmful:
- Low pathogenic avian influenza (LPAI) may cause no signs of illness, or signs of mild illness like fewer eggs or ruffled feathers in domestic poultry.
- Highly pathogenic avian influenza (HPAI) causes more severe illness and high rates of death in infected poultry. The current H5N1 virus is considered an HPAI.
2. Can humans get bird flu?
Yes, though this doesn’t usually happen.
When flu viruses mutate, they may be able to move from their original hosts — birds in this case — to humans and other animals. As of early April 2024, only two cases of bird flu in humans had been reported in the US since 2022. In May, an additional case was reported. Newer case numbers of bird flu will continue to be reported by the CDC, which offers weekly snapshots of influenza in the US.
The virus may be introduced into the body through the eyes, nose, or mouth. For example, a person may inhale viral particles in the air (droplets, tiny aerosolized particles, or possibly in dust). Or they might touch a surface contaminated by the virus, then touch their eyes or nose. Bird flu in humans typically causes symptoms similar to seasonal flu, such as fever, runny nose, and body aches.
3. Which animals have been affected by bird flu?
A surprisingly long list of animals affected by the current H5NI bird flu infection includes:
- wild birds, chickens, ducks, geese, and other domestic and commercial poultry in 48 states and more than 500 countries
- livestock, such as dairy cows in nine states at this writing, and other farm animals
- marine animals, such as seals, sea lions, and even dolphins
- wild animals, such as foxes, skunks, and racoons, and some domestic animals, such as farm cats.
4. Why are experts concerned about this bird flu outbreak?
It might seem odd that there’s been so much concern and news coverage about bird flu lately. After all, bird flu has been around for many years. We’ve long known it sometimes infects nonbird animal species, including humans.
But the current outbreak is unique and worrisome for several reasons:
- Fast, far-reaching spread. The virus has been found throughout the US, Europe, the Middle East, Southeast Asia, multiple sub-Saharan African countries, and even Antarctica.
- Many species have been infected. Previously uninfected species have been affected, including animals in our food supply.
- Economic impact. If large numbers of beef and dairy cows and chickens sicken or must be culled (killed) to contain outbreaks, this could have a major economic impact on farmers, agriculture businesses, and affected countries’ economies. This could also mean higher prices at the grocery store.
- Opportunities for exposure. Though only two human infections were reported in the US in recent years — both in people working with animals — the more exposure humans have to bird flu, the more chances the virus has to develop mutations that allow easier spread to humans.
- Potential for fatalities. Severe strains of bird flu have led to H5N1 infections in nearly 900 people in 23 countries since 2003. More than half of these reported cases were fatal. Keep in mind that the math isn’t straightforward. It’s likely that many more cases of bird flu in humans occurred, yet people experiencing few or no symptoms or those not tested weren’t counted, so lethality is likely overestimated.
- New mutations. It’s rare, but possible: If this H5N1 bird flu develops mutations that enable efficient person-to-person spread, bird flu could become the next human pandemic.
5. Are milk, beef, chicken, and the rest of our food supply safe?
Public health officials emphasize that the food supply is safe.
But concern has understandably run high since the discovery that this outbreak has spread from birds to dairy cows for the first time. More alarming? A study found fragments of bird flu DNA — which is not the same as live virus — in 20% of commercially available milk in the US.
So far, there’s been no indication that bird flu found in pasteurized milk, beef, or other common foods can cause human illness. Even if live bird flu virus got into the milk supply, studies show that routine pasteurization would kill it. Initial tests did not find the virus in ground beef.
Of course, if you are particularly concerned, you could avoid foods and beverages that come from animals affected by bird flu. For example, you could switch to oat milk or almond milk, even though there’s no convincing scientific justification to do so now.
6. What if you have pets or work with animals?
Bird flu rarely spreads to pets. While that’s good news, your pets could have exposure to animals infected with bird flu, such as through eating or playing with a dead bird. So, it’s safest to limit your pet’s opportunities to interact with potentially infected animals.
If you work with animals, especially birds or livestock, or hunt, the Centers for Disease Control and Prevention (CDC) recommends precautions to minimize your exposure to bird flu.
7. What else can you do to stay safe?
The CDC recommends everyone take steps to avoid exposure to bird flu, including:
- Avoid contact with sick or dead animals and keep pets away from them.
- Avoid animal feces that may be contaminated by birds or bird droppings, as might be common on a farm.
- Do not prepare or eat raw or undercooked food.
- Do not drink raw (unpasteurized) milk or eat raw milk cheese or raw or undercooked foods from animals suspected of having bird flu infection.
- Wear personal protective equipment (PPE), such as safety goggles, gloves, and an N95 face mask, when working near sick or dead animals or their feces.
Right now, available evidence doesn’t support more dramatic preventive measures, such as switching to an all-plant diet.
8. Is there any good news about bird flu?
Despite all the worrisome news about bird flu, this recent outbreak may wind up posing little threat to human health. Virus strains may mutate to spread less efficiently or to be less deadly. Efforts are underway to contain the spread of bird flu to humans, including removing sick or exposed animals from the food supply and increased testing of dairy cattle before transport across state lines.
And there is other encouraging news:
- Some birds appear to be developing immunity to the virus. This could reduce the chances of continued spread between birds and other animals.
- Developing a vaccine to protect cattle from bird flu may be possible (though it’s unclear if this approach will be successful).
- If spread to humans does occur, genetic tests suggest available antiviral medicines could help treat people.
- So far, human-to-human transmission has not been detected. That makes it less likely that the H5N1 bird flu will become the next pandemic.
- And if human infections with bird flu did become more common, researchers are working on human vaccines against bird flu using virus strains that match well with those causing the current outbreak.
9. How worried should you be about bird flu?
Though there’s much we don’t know, this much seems certain: bird flu will continue to change and pose challenges for farmers and health experts to stay ahead of it. So far, public health experts believe that bird flu poses little health risk to the general public.
So, it’s not time to panic about bird flu. But it is a good idea to take common sense steps to avoid exposure and stay current on related news.
For updated information in the US, check the CDC website .
About the Authors
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 
Francesca Coltrera, Editor, Harvard Health Blog
Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera
About the Reviewer
John Ross, MD, FIDSA, Contributor; Editorial Advisory Board Member, Harvard Health Publishing
Dr. John Ross is an assistant professor of medicine at Harvard Medical School. He is board certified in internal medicine and infectious diseases, and practices hospital medicine at Brigham and Women’s Hospital. He is the author … See Full Bio View all posts by John Ross, MD, FIDSA
Virtual mental health care visits: Making them work for you
Before the pandemic, talking to a therapist or psychiatrist on a video call was novel. Now it’s fairly common. One recent analysis, for example, found that video appointments within the massive Veterans Affairs Health Care System jumped from about 2% of all mental health care encounters in January 2019 to 35% of these encounters in August 2023.
What are some advantages and disadvantages of virtual mental health care visits? Does seeing a therapist or psychiatrist by video instead of in person affect your response to treatment? If you haven’t yet used virtual mental health counseling, what do you need to know? Below, Stephanie Collier, MD, MPH, a psychiatrist at Harvard-affiliated McLean Hospital, shares her expertise and insights.
What are some advantages of virtual mental health visits?
Virtual visits are convenient for many people, including those who might have trouble getting to an office or who live in areas where it’s not easy to find mental health care providers.
“You can chat with your mental health care clinician in the setting of your choice, which might make you feel more comfortable,” says Dr. Collier. “You don’t have to worry about getting to and from an appointment. And you can be confident that your outcome will be similar to receiving in-person treatment. For example, in a 2022 study of about 1,500 people, participants being treated for anxiety or depression reported the same level of symptom improvement on standardized scales, whether they received virtual or in-person treatment.”
How do virtual visits work?
A virtual visit with a mental health care clinician works in much the same way as a virtual visit with your doctor.
You make an appointment to speak with an expert, typically a licensed therapist, psychologist, or psychiatrist. They may be in a private practice or work with your insurance plan or a hospital system. Or they might be affiliated with an online mental health care platform. Often, you can read a bit about their professional background, expertise, and other information to help you decide if they are a good fit for your needs.
Shortly before your appointment, you’ll log on to a specified video platform, and then find yourself in a virtual waiting room. When it’s time for your session, the expert will appear on the screen and conduct a 30- to 50-minute session, depending on what you’ve agreed on, just as they would during an office visit.
Will your insurance pay for virtual visits?
Not necessarily. Make sure your sessions will be covered. Medicare and Medicaid cover virtual mental health care visits, but not all private insurers cover the service. Even if you think you’re covered, double-check in advance.
What should you check on ahead of time?
Getting ready for a virtual visit involves prepping for both a mental health appointment and a video meeting.
- Go over the instructions. The mental health care clinician should give you instructions for accessing the platform where the virtual visit will take place. If you don’t have instructions, contact the clinician’s office or the online service to get them.
- Look for compliance. The platform your clinician specifies for your session should clearly state if it’s HIPAA-compliant, ensuring the privacy and security of your information. If you don’t see any evidence of HIPAA compliance, ask your clinician about it or consider choosing another mental health provider.
- Do an equipment inventory. You’ll need a smartphone, tablet, desktop computer, or laptop to take part in a virtual mental health care visit.The device needs a camera, a microphone, and an internet connection.You’ll also need a quiet space (so you and the expert can hear each other) and decent lighting (so the expert will be able to see you).
- Do a practice run. Well before your appointment, log on to the platform your clinician has specified. Check to see if you need to upgrade your software in order to use the platform. You don’t want any surprises just before appointment time. Try out the volume and your camera angle.
How can you help make video sessions work well for you?
When you have an in-person visit, it may be easier to see body language and express yourself. But many people –– especially younger people –– feel very comfortable online. And others might find the technology and apps easier to navigate with a little guidance.
Here are some tips to ensure that you’re seen and heard.
- Set a reminder to charge your equipment. The device you use should be well charged or plugged in to an electrical outlet for the appointment.
- Gather some supplies. You might want to have a drink of water, a box of tissues, and a pad and pen handy for taking notes.
- Make a list of questions or topics on your mind. “Think of a few topics you want to discuss in advance, so you can get through them during your session,” Dr. Collier says. “If you keep a journal or sleep log, and the information will be important, have it with you at appointment time.”
- Be willing to share your thoughts and emotions. You won’t have to carry the whole conversation. Your therapist will ask you questions and prompts to guide the session and help you open up about your feelings and experiences. For instance, they might ask, “How has your mood been since our last session?” or “What are some challenges you faced this week?”
- If you like, ask a friend to join you. If you’ll feel more comfortable with a friend in the room to support you or help you with the technology, arrange it in advance. During your appointment, tell the expert that someone else is there with you.
- Be patient. Sometimes experts run late. That means you might be stuck in an online waiting room, wondering if the appointment is still on. Dr. Collier advises waiting for about 10 minutes, and then leaving a voice message (if possible) or an email for your expert, explaining the situation.
Should you make another appointment?
If you feel your appointment was productive, consider scheduling another one. Again, make sure your insurance will cover it.
What if you didn’t “click” with the expert? “It’s an important consideration, since your relationship with your therapist is the best predictor of how you’ll do in therapy. So give it a few sessions. If you still don’t think your therapist is a good fit, it’s ok to change clinicians. Many telehealth platforms allow you to do that pretty easily.”
About the Author
Heidi Godman, Executive Editor, Harvard Health Letter
Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman
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
PTSD: How is treatment changing?
Over the course of a lifetime, as many as seven in 10 adults in the United States will directly experience or witness harrowing events. These include gun violence, car accidents, and other personal trauma; natural or human-made disasters, such as Hurricane Katrina and the 9/11 terrorist attacks; and military combat. And some — though not all — will experience post-traumatic stress disorder, or PTSD.
New guidelines released in 2024 can help guide effective treatment.
What is PTSD?
PTSD is a potentially debilitating mental health condition. It’s marked by recurrent, frightening episodes during which a person relives a traumatic event.
After a disturbing event, it’s normal to have upsetting memories, feel on edge, and have trouble sleeping. For most people, these symptoms fade over time. But when certain symptoms persist for more than a month, a person may be experiencing PTSD.
These symptoms include
- recurring nightmares or intrusive thoughts about the event
- feeling emotionally numb and disconnected
- withdrawing from people and certain situations
- being jumpy and on guard.
The National Center for PTSD offers a brief self-screening test online, which can help you decide whether to seek more information and help.
Who is more likely to experience PTSD?
Not everyone who experiences violence, disasters, and other upsetting events goes on to develop PTSD. However, military personnel exposed to combat in a war zone are especially vulnerable. About 11% to 20% of veterans who served in Iraq or Afghanistan have PTSD, according to the National Center for PTSD.
What about people who were not in the military? Within the general population, estimates suggest PTSD occurs in 4% of men and 8% of women — a difference at least partly related to the fact that women are more likely to experience sexual assault.
What are the new guidelines for PTSD treatment?
Experts from the U.S. Department of Veterans Affairs and Department of Defense collaborated on new guidelines for treating PTSD. They detailed the evidence both for and against specific therapies for PTSD.
Their findings apply to civilian and military personnel alike, says Dr. Sofia Matta, a psychiatrist at Harvard-affiliated Massachusetts General Hospital and senior director of medical services at Home Base, a nonprofit organization that provides care for veterans, service members, and their families.
The circle of care is widely drawn for good reason. “It’s important to recognize that PTSD doesn’t just affect the person who is suffering but also their families and sometimes, their entire community,” Dr. Matta says. The rise in mass shootings in public places and the aftermath of these events are a grim reminder of this reality, she adds.
Which treatment approaches are most effective for PTSD?
The new guidelines looked at psychotherapy, medications, nondrug therapies. Psychotherapy, sometimes paired with certain medicines, emerged as the most effective approach.
The experts also recommended not taking certain drugs due to lack of evidence or possible harm.
Which psychotherapies are recommended for PTSD?
The recommended treatment for PTSD, psychotherapy, is more effective than medication. It also has fewer adverse side effects and people prefer it, according to the guidelines.
Which type of psychotherapy can help? Importantly, the most effective therapies for people with PTSD differ from those for people with other mental health issues, says Dr. Matta.
Both cognitive processing therapy and prolonged exposure therapy were effective. These two therapies teach people how to evaluate and reframe the upsetting thoughts stemming from the traumatic experience. The guidelines also recommend mindfulness-based stress reduction, an eight-week program that includes meditation, body scanning, and simple yoga stretches.
Which medications are recommended for PTSD?
Some people with severe symptoms need medication to feel well enough to participate in therapy. “People with PTSD often don’t sleep well due to insomnia and nightmares, and the resulting fatigue makes it hard to pay attention and concentrate,” says Dr. Matta.
Three medicines commonly prescribed for depression and anxiety — paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) — are recommended. Prazosin (Minipress) may help people with nightmares, but the evidence is weak.
Which medications are not recommended for PTSD?
The guidelines strongly recommended not taking benzodiazepines (anti-anxiety drugs often taken for sleep). Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) offer no proven benefits for people with PTSD. They have several potential harms, including negative cognitive changes and decreased effectiveness of PTSD psychotherapies.
What about cannabis, psychedelics, and brain stimulation therapies?
Right now, evidence doesn’t support the idea that cannabis helps ease PTSD symptoms. And there are possible serious side effects from the drug, such as cannabis hyperemesis syndrome (severe vomiting related to long-term cannabis use).
There isn’t enough evidence to recommend for or against psychedelic-assisted therapies such as psilocybin (magic mushrooms) and MDMA (ecstasy). “Because these potential therapies are illegal under federal law, the barriers for conducting research on them are very high,” says Dr. Matta. However, recent legislative reforms may make such studies more feasible.
Likewise, the evidence is mixed for a wide range of other nondrug therapies, such as brain stimulation therapies like repetitive transcranial magnetic stimulation or transcranial direct current stimulation.
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
Harvard Health Ad Watch: New drug, old song, clever tagline
It’s not often that a new drug comes along that could help nearly a quarter of the adult population. But when it does, you can bet you’ll see ads for it on TV and the Internet.
That’s the case with Veozah (fezolinetant), a medicine for hot flashes and night sweats due to menopause that was approved by the FDA in May 2023. One ad has this inventive tagline: “You can have fewer hot flashes and more not flashes.”
So, what is a not flash and what does the ad tell us about this new drug?
The ad: This is a not flash
The ad begins with an upbeat song, “Good Feeling,” a hit by Flo Rida released in 2011. A woman in a crowded elevator is clearly distressed and soaked in sweat as the voiceover declares, “This is a hot flash.” A second woman appears, awakening in her bedroom covered in sweat. Again, the narrator declares “This is a hot flash.” Cut to two smiling women on a dock taking selfies as boats sway behind them: “But this is a not flash.”
The voiceover tells us that Veozah is a prescription treatment for women with moderate to severe hot flashes and night sweats — or vasomotor symptoms, as medical experts say. (Hot flashes may or may not prompt sweating, while night sweats are exactly as billed.)
When the voiceover tells us the drug is “hormone free,” the words “100% hormone-free” appear on the screen. Got it? Apparently, this drug contains no hormones.
Does Veozah work?
But is it effective? The ad voiceover says, “Veozah has been proven to reduce the number and severity of hot flashes day and night. For some women, it can start working in as early as one week.”
The details are easy to miss. They appear in fine print briefly at the bottom of the screen: “At 12 weeks, women taking Veozah experienced 63% fewer hot flashes vs. 42% on placebo.” Sounds good, right? More on what this actually means below.
What does the ad tell us about risks?
The FDA requires drug manufacturers to review the most common or serious risks of taking the drug. So while the catchy song continues, images appear of women peacefully sleeping, teaching a classroom full of students, or working in a hectic office. The voiceover warns that some people shouldn’t take Veozah: anyone with cirrhosis (a form of liver disease) or severe kidney problems, and anyone who takes a medicine known as a CYP1A2 inhibitor.
Next comes the litany of possible side effects, including:
- the need for repeated liver blood tests before and during treatment
- stomach pain
- diarrhea
- difficulty sleeping
- back pain.
What does the ad get right?
This ad highlights significant suffering caused by hot flashes and night sweats, which affect about 80% of women during menopause. Currently, treatment options (and, truth be told, actual research on those dealing with these problems) are quite limited. Hormone replacement with estrogen and related medicines was often prescribed in past years. But concerns about risks associated with estrogen use led many physicians to stop prescribing hormone replacement, and many women decline it when it’s offered.
But Veozah works without hormones: it blocks a protein in the brain that helps regulate body temperature. That’s why the “hormone free” message is emphasized in the ad.
Just how effective is Veozah for hot flashes and night sweats??
Unfortunately, digging more closely into the data shows the difference between Veozah and placebo in reducing hot flashes and night sweats is relatively small. And some important information is missing or incomplete in the ad. I filled in gaps by looking at two pivotal trials of Veozah (called SKYLIGHT 1 and SKYLIGHT 2).
What exactly are “moderate” and “severe” symptoms?
For this study, women had to have at least seven moderate to severe hot flashes per day, although the average was 10 to 12. A moderate hot flash was defined as a sensation of heat with sweating that did not interfere with activities. A severe hot flash was a sensation of heat with sweating that did interfere with activities. So, the number of moderate or severe hot flashes tallied by the researchers in this study included sweats, regardless of what time of day they occurred.
How many hot flashes or night sweats were prevented?
The ad provides data on effectiveness as a percent reduction: 63% fewer hot flashes. Importantly, that doesn’t tell you the actual number of hot flashes prevented. During 12 weeks of treatment, women given the medicine went from experiencing an average of about 11 hot flashes a day at the start to about four a day. By comparison, the group taking a placebo (an inactive pill) dropped from 11 hot flashes a day to 6.5 a day. So, that’s about 2.5 fewer hot flashes a day in total for women taking the drug.
- What about effectiveness after 12 weeks? Based on the published studies (including SKYLIGHT 4), effectiveness persists for at least a year with continued treatment. While that’s good news, it would be helpful to know whether effectiveness wanes or persists beyond one year, because menopausal hot flashes and night sweats can come and go for many years. The average is about seven years, and it’s not rare for them to last a decade or more.
- How diverse were the study participants in the clinical trials that led to FDA approval? More than 80% of study participants identified as Caucasian, 17% as African American, 24% as Hispanic/Latina, and 1% as Asian. Studies of a more diverse population are needed.
What else should you know about possible downsides of Veozah?
The ad covers the most common side effects reported during trials of this drug. Yet advising people to avoid Veozah if they take a CYP1A2 inhibitor is likely to perplex most viewers. This warning relates to an enzyme that helps the body metabolize many medicines, including Veozah.
If you’re already taking a medicine that inhibits the action of this enzyme and you start taking Veozah, the blood levels of Veozah may rise higher than intended and increase the risk of side effects. Many common medicines can cause this interaction (including ciprofloxacin, some oral contraceptives, and cimetidine). Ask your doctor about this before starting Veozah.
Finally, the ad provides no information about cost. According to the drug maker’s website, the list price is $550 a month. That’s the amount you’d be charged if you have no health insurance.
But the average price for people with commercial health insurance is $41 a month. It’s about $77 a month for people covered by Medicare Part D, and $12 a month for people with Medicaid. The drugmaker’s Patient Assistance Program may provide the drug at no cost for some people who are eligible — though eligibility criteria aren’t easy to find and aren’t included in the ad.
The bottom line
A newly approved, nonhormonal drug for hot flashes and night sweats during menopause is big news. But it remains to be seen whether this is a small step forward or a major advance. Either way, the ad mostly does its job: it introduces us to a new medication for a common and burdensome condition that currently has limited treatment options.
Of course, this one-minute ad for Veozah isn’t intended to cover everything a viewer might want to know about it; it’s intended to get people with significant hot flashes and night sweats to ask their doctor about the advertised drug. Keep that in mind when you see ads for this drug — or any drug ad, for that matter.
While I’m not sure whether Veozah will prove to be a wonder drug, one thing’s for sure: that song sure holds up well.
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
Moving from couch to 5K
Need a little motivation and structure to ramp up your walking routine? Want to wake up your workouts but not quite ready for a mud run? Consider trying a couch-to-5K program.
Dr. Adam Tenforde, medical director of the Spaulding National Running Center at Harvard-affiliated Spaulding Rehabilitation Network and a sports medicine physician at Mass General Brigham Sports Medicine, shares tips on what to know and do before lacing up your sneakers.
What is a couch-to-5K program?
These free or low-cost coaching plans are designed to help would-be runners train for a 5-kilometer race, which is about 3.1 miles. The programs are available online, or as apps or podcasts. They typically feature timed walking and running intervals that gradually phase out the walking over a period of about nine weeks.
Why try a couch-to-5K program?
“One purpose of a couch-to-5K program is to give you time to acclimate and start to enjoy the benefits of running and the sense of accomplishment of completing a distance safely,” says Dr. Tenforde. Running provides many cardiovascular benefits, such as lower blood pressure and a reduced cholesterol level, as well as an enhanced sense of well-being, he adds.
What’s more, adding even short bursts of running or other vigorous physical activity to a workout — a practice known as high-intensity interval training or HIIT — appears to help improve mental health, according to a study that pooled findings from 58 randomized trials of HIIT.
Are you ready to tackle a couch-to-5K?
Even though the couch-to-5K programs sound as though they’re geared for completely sedentary couch potatoes, that’s not necessarily true, Dr. Tenforde cautions. These programs often assume you can walk continuously for 30 minutes, which doesn’t apply to everyone.
For some people, an even easier, more gradual training regimen may be more appropriate. Also, keep in mind that you don’t have to run to do a 5K. Many of these races also encourage walkers to participate as well. You’ll still reap the other rewards from committing to a race, such as being more challenged and motivated — and possibly more connected to your community. Many charitable “fun runs” benefit local schools or needy families. Some are in memory of people affected by illness or tragedy. Visit Running in the USA to find 5K races near you.
What to do before you start
If you’re planning to walk or run your first 5K, get your doctor’s approval before you start training. That’s especially important if you have heart disease or are at risk for it.
Comfortable walking or running shoes are a wise investment. Shoes that are too old or too tight in the toe box can cause or aggravate a bunion, a bony bump at the outer base of the big toe. Despite suggestions that people with flat feet or high arches need specific types of shoes, studies have found that neutral shoes (designed for average feet) work well for almost everyone. Walk or jog around the store when you try them on to make sure they feel good and fit properly.
You don’t need to buy special clothes; regular sweat pants or comfortable shorts and a t-shirt will suffice. Women should consider getting a supportive sports bra, however.
Go slow and steady when training
- Always include a warm-up and cool-down — a few minutes of slow walking or jogging — with every exercise session.
- If you haven’t been exercising regularly, start by walking just five or 10 minutes a day, three days a week. Or, if you’re already a regular walker, add some short stints of jogging to each walking session.
- Gradually add minutes and days over the following four to six weeks.
- Once you’re up to 30 minutes a day, check how far you’re traveling. Keep increasing your distance every week until you reach 5 kilometers. Then slowly phase in more jogging and less walking over your route if you like.
Remember that you can always repeat a week. You’re less likely to sustain an injury if you make slow, steady progress. Pay close attention to your body and don’t push yourself too much, Dr. Tenforde advises. Former athletes who haven’t run in years may think they can pick up where they left off, but that’s not a smart move — they should also start low and go slow.
For a good couch-to-5K guide, try this beginner’s program from the United Kingdom’s National Health Service.
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
New urine test may help some men with elevated PSA avoid biopsy
When a prostate-specific antigen (PSA) blood test produces an abnormal result, the next step is usually a prostate biopsy. A biopsy can confirm or rule out a cancer diagnosis, but it also has certain drawbacks. Prostate biopsies are invasive procedures with potential side effects, and they often detect low-grade, slow-growing tumors that may not need immediate treatment — or any treatment at all.
Researchers are exploring various strategies for avoiding unnecessary biopsies. Specialized magnetic resonance imaging (MRI) scans, for instance, can be useful for predicting if a man’s tumor is likely to spread. A blood test called the Prostate Health Index (PHI) measures various forms of PSA, and can help doctors determine if a biopsy is needed.
In April, researchers at the University of Michigan published results with a test that screens for prostate cancer in urine samples. Called the MyProstateScore 2.0 (MPS2) test, it looks for 18 different genes associated with high-grade tumors. “If you’re negative on this test, it’s almost certain that you don’t have aggressive prostate cancer,” said Dr. Arul Chinnaiyan, a professor of pathology and urology at the University, in a press release.
Gathering data and further testing
To create the test, Dr. Chinnaiyan and his colleagues first turned to publicly-available databases containing over 58,000 prostate cancer-associated genes. From that initial pool, they narrowed down to 54 genes that are uniquely overexpressed in cancers classified as Grade Group 2 (GG2) or higher. The Grade Group system ranks prostate cancers from GG1 (the least dangerous) to GG5 (the most dangerous).
The team tested those 54 genes against archived urine samples from 761 men with elevated PSA who were scheduled for biopsy. This effort yielded 18 genes that consistently correlated with high-grade cancer in the biopsy specimens. These genes now make up MPS2.
Then the team validated the test by performing MPS2 testing on over 800 archived urine samples collected by a national prostate cancer research consortium. Other researchers affiliated with that consortium assessed the new urine test’s results against patient records.
Interpreting the results
Study findings showed that MPS2 correctly identified 95% of the GG2 prostate cancers and 99% of cancers that were GG3 or higher. Test accuracy was further improved by incorporating estimates of the prostate’s size (or volume, as it’s also called).
According to the team’s calculations, use of the MPS2 would have reduced unnecessary biopsies by 37%. If volume was included in the measure, then 41% of biopsies would have been avoided. By comparison, just 26% of biopsies would have been avoided with the PHI.
Dr. Chinnaiyan and his co-authors emphasize that ruling out high-grade cancer with a urine test offers some advantages over MRI. The specialized multi-parametric MRI scans needed to assess high-grade cancer in men with elevated PSA aren’t always available in community settings, for instance. Moreover, the interpretation of mpMRI results can vary from one radiologist to another. Importantly, the MPS2 can be updated over time as new prostate-cancer genes are identified.
Commentary
Dr. Boris Gershman, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, and a member of the advisory and editorial board for the Harvard Medical School Guide to Prostate Diseases, described the new study results as promising. “It does appear that the performance of the 18-gene urine test is better than PSA alone,” he says.
But Dr. Gershman adds that it will be important to consider how such a test will fit into the current two-stage approach for PSA screening, which entails prostate MRI when the PSA is abnormal. Where MRI delivers a yes/no result (meaning lesions that look suspicious for cancer are either present or not), the MPS2 provides numerical risk estimates ranging between 0% and 100%. “The challenge with clinical implementation of a continuous risk score is where to draw the line for biopsy,” Dr. Gershman says.
“This research is very encouraging, since many men in rural areas may not have access to prostate MRI machines or the added sophistication that is needed in interpreting these MRI scans,” says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “A widely available urine test may eventually help provide more precision in determining who should undergo a prostate biopsy, and may also help to assess the probability that a cancer is clinically significant and in need of treatment.”
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt
About the Reviewer
Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing
Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD
How do trees and green spaces enhance our health?
Trees enhance life in a multitude of ways. They combat climate change by reducing greenhouse gases in the atmosphere. They muffle sound pollution and reduce air pollution, drawing in carbon dioxide and releasing oxygen. When rain pours from the skies, trees decrease stormwater runoff, preventing flooding and soil erosion. They also provide valuable habitats to support biodiversity in insects, birds, and other animals, and microorganisms. The list goes on.
Equally important is accumulating evidence that simply spending time around trees and green spaces uplifts our health and mood. Below are a few of the biggest benefits we reap.
Keeping it cool: Trees help prevent heat-related illness
Climate change is causing rising temperatures and more heat waves across the US. These effects are worse for those who live in neighborhoods known as urban heat islands, where asphalt and concrete soak up heat during the day and continue to radiate it at night. Temperatures can reach 7° F hotter than suburban, rural, or simply wealthier and leafier neighborhoods.
Trees and their leafy canopy provide shade that helps to prevent urban heat islands. What does that mean for individuals? It translates to fewer heat-related health illnesses, which strike outdoor workers and younger, older, and medically vulnerable people more often. A study published in The Lancet calculated that increasing tree canopy to 30% coverage in 93 European cities could prevent an estimated four in 10 premature heat-related deaths in adults in those cities.
How trees help children: Better mood, behavior, attention, and more
Spending more time in nature has been linked with better health outcomes like lower blood pressure, better sleep, and improvement in many chronic conditions in adults. These findings are prompting a growing interest in forest therapy, a guided outdoor healing practice that leads to overall improved well-being. But what’s also remarkable are the varied benefits of trees and nature for children.
One study of children 4 to 6 years old found that those who lived close to green space demonstrated less hyperactive behavior and scored more highly on attention and visual memory testing measures compared with children who did not.
Just seeing trees can have mental health benefits. In Michigan, a study of children between the ages of 7 and 9 demonstrated that students who could see trees from their school windows had fewer behavioral problems than those with limited views.
In Finland, researchers modified daycare outdoor playscape environments to mimic the forest undergrowth. These daycares were compared to control standard daycares and nature-oriented daycares where children made daily visits to nearby forests. At the end of 28 days, the children in the daycares with modified forest undergrowth playscapes harbored a healthier microbiome and had improved markers of their immune systems as compared to their counterparts.
How green space helps communities
Having green space in neighborhoods also does a lot to enrich the well-being of communities. A randomized trial in a US city planted and maintained grass and trees in previously vacant lots. Researchers then compared these green spaces to lots that were left alone.
In neighborhoods below the poverty line, there was a reduction in crime for areas with greened lots compared to untouched vacant lots. Meanwhile, residents who lived near lots that were greened reported feeling safer and increased their use of the outside space for relaxing and socializing.
How can you help?
Unfortunately, urban tree canopy cover has been declining over the years. To counter this decline, many towns and nonprofit organizations have programs that provide trees for planting.
A few examples in Massachusetts are Canopy Crew in Cambridge and Speak for the Trees in Boston. (Speak for the Trees also offers helpful information on selecting and caring for trees). Neighborhood Forest provides trees for schools and other youth organizations across the US. Look for a program near you!
Planting trees native to your region will better suit the local conditions, wildlife, and ecosystem. Contact your regional Native Plant Society for more information and guidance. If you are worried about seasonal allergies from tree pollen, many tree organizations or certified arborists can give you guidance on the best native tree selections.
If planting trees is not for you but you are interested in contributing to the mission, consider donating to organizations that support reforestation, like The Canopy Project and the Arbor Day Foundation.
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
Concussion in children: What to know and do
Concussion is one of the most common injuries to the brain, affecting about two million children and teens every year. It is a particular kind of injury that happens when a blow to the head or somewhere else on the body makes the brain move back and forth within the skull.
It’s possible to get a concussion after what might seem like a minor injury, like a forceful push from behind, or a collision between two players in a football or soccer game.
What are the signs and symptoms of concussion?
Because the injury may not seem that significant from the outside, it’s important to know the symptoms of a concussion. There are many different possible symptoms, including
- passing out (this could be a sign of a more serious brain injury)
- headache
- dizziness
- changes in vision
- feeling bothered by light or noise
- confusion or feeling disoriented
- memory problems (such as difficulty remembering details of the injury) or difficulty concentrating
- balance or coordination problems
- mood changes.
Some of these are visible to others and some are felt by the person with the concussion. That’s why it’s important to know the signs and to ask all the right questions of a child who has had an injury.
Sometimes the symptoms might not be apparent right away, but show up in the days following the injury. The CDC’s Heads Up website has lots of great information about how to recognize a concussion.
How can further harm to the brain be avoided?
The main reason it’s important to recognize a possible concussion early is that the worst thing you can do after getting a concussion is get another one. The brain is vulnerable after a concussion; if it is injured again, the symptoms can be longer lasting — or even permanent, as in cases of chronic traumatic encephalopathy (CTE), a condition that has been seen in football players and others who have repeated head injuries.
If there is a chance that a child has had a concussion during a sports competition, they must stop playing — and get medical attention. It’s important to get medical attention any time there is concern about a possible concussion, both to be sure there isn’t a more serious brain injury, and to do a good assessment of the symptoms, so that they can be monitored over time. There are some screening questionnaires that are used by doctors that can be used again in the days and weeks after the concussion to see how the child is improving.
What helps children recover after a concussion?
Experts have struggled with figuring out how to protect the brain after a concussion. For a long time, the recommendation was to rest and do very little at all. This meant not doing any exercise, not going to school, not even reading or watching television. As symptoms improved, the restrictions were lifted gradually.
Over time, though, research showed that not only was this much rest not necessary, it was counterproductive. It turns out that getting kids back into their daily lives, and back into being active, is safe and leads to quicker recovery. Experts still recommend rest and then moving gradually back into activities, but the guidelines are no longer as strict as they once were.
One important note: A medical professional should guide decisions to move from rest to light activity, and then gradually from there to moderate and then regular activities based on how the child is doing. This step-by-step process may extend for days, weeks, or longer, depending on what the child needs. Parents, coaches, and schools can help support a child or teen as they return to school and return to activities and sports.
Some children will be able to get back into regular activities quickly. But for others it can take weeks or even months. Schools and sports trainers should work with children to support them in their recovery. Some children develop post-concussive syndromes with headache, fatigue, and other symptoms. This is rare but can be very disabling.
How can parents help prevent concussions?
It's not always possible to prevent concussions, but there are things that parents can do:
- Be sure that children use seat belts and other appropriate restraints in the car.
- Have clear safety rules and supervise children when they are playing, especially if they are riding bikes or climbing in trees or on play structures.
- Since at least half of concussions happen during sports, it’s important that teams and coaches follow safety rules. Coaches should teach techniques and skills to avoid dangerous collisions and other injuries. Talk to your child’s coaches about what they are doing to keep players safe. While helmets can prevent many head injuries, they don’t prevent concussions.
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
How healthy is sugar alcohol?
If you are trying to cut back on added sugar — and you should, because excess sugar increases risks for obesity, diabetes, and heart disease — you might be tempted by products advertised as low sugar, no sugar, or sugar-free.
Many contain familiar low-calorie sugar substitutes like aspartame or sucralose instead of sugar. And as you’re reading labels, you also may run across another ingredient: sugar alcohol, which is used in products like sugar-free cookies, candies, ice cream, beverages, and chewing gums. Are any of these sweeteners a better choice nutritionally? Dr. Frank Hu, professor of nutrition and epidemiology with the Harvard T.H. Chan School of Public Health, weighs in below.
Are low-calorie or no-calorie sweeteners any healthier than natural sugar?
Also known as artificial sweeteners or sugar substitutes, the list of low-calorie and no-calorie sweeteners you may see on product nutrition labels includes acesulfame-K, saccharin, sucralose, neotame, and advantame. These have a higher sweetness intensity per gram than natural sugar.
So far research on them is mixed, although some observational studies have found that beverages containing low-calorie sweeteners are associated with a higher risk for diabetes and weight gain.
What exactly are sugar alcohols and how can you spot them?
Sugar alcohols may have the most misleading name, as they are neither sugar nor alcohol, according to Dr. Hu. “They are a type of carbohydrate derived from fruits and vegetables, although most commercial sugar alcohols are synthetically produced.”
You can usually spot many sugar alcohols on ingredient lists by “-ol” at the ends of their names. Examples include sorbitol, xylitol, lactitol, mannitol, erythritol, and maltitol.
Are sugar alcohols any healthier than other sugar substitutes or natural sugar?
Here is a look at the pros and cons.
The upside of sugar alcohols
Sugar alcohols reside in the sweet spot between natural sugar and low-calorie sweeteners. They are not as overly sweet as sweeteners and don’t add too many extra calories like sugar.
“Sugar alcohols are about 40% to 80% as sweet as natural sugar, whereas artificial sweeteners like aspartame are about 200 times sweeter,” says Dr. Hu. “And they have about 25% to 75% fewer calories per gram than sugar.”
Another upside of sugar alcohols is that they break down slowly in the gut. Hence, your body only absorbs part of their overall carbohydrates. “This keeps your blood sugar and insulin levels from spiking as they do with sugar,” says Dr. Hu. “That makes them a useful sugar substitute for people with diabetes.”
The downside of sugar alcohols
The main downside to sugar alcohols is this: when taken in high amounts they can cause gastrointestinal (GI) problems, such as abdominal pain, diarrhea, or loose stools.
Because sugar alcohols are slowly digested, they have more time to feed bacteria in the gut, which can lead to fermentation and produce excess gas. Their slow digestion also can pull extra water into the colon and cause a laxative effect.
People’s tolerance for sugar alcohols depends on many factors, including body weight, health conditions, and the amount and types of sugar alcohols. “Individual differences in digestion and metabolism, gut microbiome composition, and dietary habits can also make a difference,” says Dr. Hu. “For these reasons, we recommend introducing sugar alcohols into your diet gradually and observing how your body responds.”
For people who experience GI symptoms caused by sugar alcohols, Dr. Hu says cutting back on the amount of foods and drinks made with them often can correct the problem. “Sugar alcohols are commonly found in sugar-free or low-carb products, so pay attention to food labels” he says. “Because different sugar alcohols can have different effects, it might be useful to identify specific types of sugar alcohols that cause GI side effects.”
Do sugar alcohols have health risks?
Possible long-term health risks of sugar alcohol are still being explored. A 2023 observational study found a link between using erythritol as an added sweetener and cardiovascular disease events, such as stroke and heart attack, in people with heart disease or who had risk factors like diabetes and high blood pressure. However, these findings have not been confirmed in subsequent studies.
“Sugar alcohols offer a healthier alternative to sugar because of their lower calorie content and reduced glycemic response, which is the effect food has on blood sugar levels,” says Dr. Hu. “But they also have potential drawbacks, especially for those with sensitive digestive systems, so it’s best to consume them in moderation as part of an overall healthy eating pattern.”
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