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Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give then or throughout the year could be truly life-changing? A gift that could save a life or free someone from dialysis?

You can do this. For people in need of an organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. Fittingly, Valentine’s Day is also known as National Donor Day, a time for blood drives and sign-ups for organ and tissue donation. Have you ever wondered what can be donated? Had reservations about donating after death or concerns about risks for live donors? Read on.

The enormous impact of organ, tissue, or cell donation

Imagine you have kidney failure requiring dialysis 12 or more hours each week just to stay alive. Even with this, you know you’re still likely to die a premature death. Or, if your liver is failing, you may experience severe nausea, itching, and confusion; death may only be a matter of weeks or months away. For those with cancer in need of a bone marrow transplant, or someone who’s lost their vision due to corneal disease, finding a donor may be their only good option.

Organ or tissue donation can turn these problems around, giving recipients a chance at a long life, a better quality of life, or both. And yet, the number of people who need organ donation far exceeds compatible donors. While national surveys have found about 90% of Americans support organ donation, only 40% have signed up. More than 103,000 women, men, and children are awaiting an organ transplant in the US. About 6,200 die each year, still waiting.

What can you donate?

The list of ways to help has grown dramatically. Some organs, tissues, or cells can be donated while you’re alive; other donations are only possible after death. A single donor can help more than 80 people!

After death, people can donate:

• bone, cartilage, and tendons
• corneas
• face and hands (though uncommon, they are among the newest additions to this list)
• kidneys
• liver
• lungs
• heart and heart valves
• stomach and intestine
• nerves
• pancreas
• skin
• arteries and veins.

Live donations may include:

• birth tissue, such as the placenta, umbilical cord, and amniotic fluid, which can be used to help heal skin wounds or ulcers and prevent infection
• blood cells, serum, or bone marrow
• a kidney
• part of a lung
• part of the intestine, liver, or pancreas.

To learn more about different types of organ donations, visit Donate Life America.

Becoming a donor after death: Questions and misconceptions

Common misconceptions about becoming an organ donor limit the number of people who are willing to sign up. For example, many people mistakenly believe that

• doctors won’t work as hard to save your life if you’re known to be an organ donor — or worse, doctors will harvest organs before death
• their religion forbids organ donation
• you cannot have an open-casket funeral if you donate your organs.

None of these is true, and none should discourage you from becoming an organ donor. Legitimate medical professionals always keep the patient’s interests front and center. Care would never be jeopardized due to a person’s choices around organ donation. Most major religions allow and support organ donation. If organ donation occurs after death, the clothed body will show no outward signs of organ donation, so an open-casket funeral is an option for organ donors.

Live donors: Blood, bone marrow, and organs

Have you ever donated blood? Congratulations, you’re a live donor! The risk for live donors varies depending on the intended donation, such as:

• Blood, platelets, or plasma: If you’re donating blood or blood products, there is little or no risk involved.
• Bone marrow: Donating bone marrow requires a minor surgical procedure. If general anesthesia is used, there is a chance of a reaction to the anesthesia. Bone marrow is removed through needles inserted into the back of the pelvis bones on each side. Back or hip pain is common, but can be controlled with pain relievers. The body quickly replaces the bone marrow removed, so no long-term problems are expected.
• Stem cells: Stem cells are found in bone marrow or umbilical cord blood. They also appear in small numbers in our blood and can be donated through a process similar to blood donation. This takes about seven or eight hours. Filgrastim, a medication that increases stem cell production, is given for a number of days beforehand. It can cause side effects such as flulike symptoms, bone pain, and fatigue, but these tend to resolve soon after the procedure.
• Kidney, lung, or liver: Surgery to donate a kidney or a portion of a lung or liver comes with a risk of complications, reactions to anesthesia, and significant recovery time. It’s no small matter to give a kidney, or part of a lung or liver.

The vast number of live organ donations occur without complications, and donors typically feel quite positive about the experience.

Who can donate?

Almost anyone can donate blood cells –– including stem cells –– or be a bone marrow, tissue, or organ donor. Exceptions include anyone with active cancer, widespread infection, or organs that aren’t healthy.

What about age? By itself, your age does not disqualify you from organ donation. In 2023, two out of five people donating organs were over 50. People in their 90s have donated organs upon their deaths and saved the lives of others.

However, bone marrow transplants may fail more often when the donor is older, so bone marrow donations by people over age 55 or 60 are usually avoided.

Finding a good match: Immune compatibility

For many transplants, the best results occur when there is immune compatibility between the donor and recipient. Compatibility is based largely on HLA typing, which analyzes genetically-determined proteins on the surface of most cells. These proteins help the immune system identify which cells qualify as foreign or self. Foreign cells trigger an immune attack; cells identified as self should not.

HLA typing can be done by a blood test or cheek swab. Close relatives tend to have the best HLA matches, but complete strangers may be a good match as well.

Fewer donors among people with certain HLA types make finding a match more challenging. Already existing health disparities, such as higher rates of kidney disease among Black Americans and communities of color, are worsened by lower numbers of donors from these communities, an inequity partly driven by a lack of trust in the medical system.

The bottom line

You can make an enormous impact by becoming a donor during your life or after death. In the US, you must opt in to be a donor after death. (Research suggests the opt-out approach many other countries use could significantly increase rates of organ donation in this country.)

I’m hopeful that organ donation in the US and throughout the world will increase over time. While you can still go with chocolates for Valentine’s Day, maybe this year you can also go bigger and become a donor.

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

Early in the new year, promises to reboot your health typically focus on diet, exercise, and weight loss. And by now you may have begun making changes — or at least plans — to reach those goals. But consider going beyond the big three.

Below are 10 often-overlooked, simple ideas to step up personal health and safety. And most won’t make you break a sweat.

Review your health portals

Your medical information is kept in electronic records. You have access to them through the patient portal associated with your doctor’s office. Set aside time to update portal passwords and peruse recent records of appointments, test results, and notes your doctor took during your visits.

“Many studies have shown that when patients review the notes, they remember far better what went on during interactions with their clinicians, take their medicines more effectively, and pick up on errors — whether it’s an appointment they forgot to make or something their doctor, nurse, or therapist got wrong in documenting an encounter,” says Dr. Tom Delbanco, the John F. Keane & Family Professor of Medicine at Harvard Medical School and cofounder of the OpenNotes initiative, which led shared clinician notes to become the new standard of care.

Doing this can help you become more engaged in your care. “We know from numerous studies that engaged patients who share decisions with those caring for them have better outcomes,” he adds.

Ask about health insurance freebies

Your insurance plan may offer perks that can lead to better health, such as:

• weight loss cessation programs
• quit-smoking programs
• free or reduced gym memberships.

Some insurers even offer breastfeeding counseling and equipment. Call your insurance company or take a close look at their website to find out if there’s anything that would help you.

Get rid of expired medications

Scour your cabinets for expired or unneeded drugs, which pose dangers for you and others. Look for prescription and over-the-counter medications (pills, potions, creams, lotions, droppers, or aerosol cans) as well as supplements (vitamins, minerals, herbs).

Bring your finds to a drug take-back site, such as a drugstore or law enforcement office, or a medical waste collection site such as the local landfill.

As a last resort, toss medications into the trash, but only after mixing them with unappealing substances (such as cat litter or used coffee grounds) and placing the mixture in a sealable plastic bag or container.

Invest in new sneakers

The wrong equipment can sabotage any exercise routine, and for many people the culprit is a worn pair of sneakers. Inspect yours for holes, flattened arch support, and worn treads. New sneakers could motivate you to jazz up your walking or running routine.

For example, if it’s in the budget, buy a new pair of walking shoes with a wide toe box, cushy insoles, good arch support, a sturdy heel counter (the part that goes around your heel), stretchy uppers, and the right length — at least half an inch longer than your longest toe.

Cue up a new health app

There are more than 350,000 health apps geared toward consumer health. They can help you with everything from managing your medications or chronic disease to providing instruction and prompts for improving diet, sleep, or exercise routines, enhancing mental health, easing stress, practicing mindfulness, and more.

Hunt for apps that are free or offer a free trial period for a test drive. Look for good reviews, strong privacy guardrails, apps that don’t collect too much information from you, and those that are popular — with hundreds of thousands or millions of downloads.

Make a schedule for health screenings and visits

Is it time for a colonoscopy, mammogram, hearing test, prostate check, or comprehensive eye exam? Has it been a while since you had a dermatologist examine the skin on your whole body? Should you have a cholesterol test or other blood work — and when is a bone density test helpful?

If you’re not sure, call your primary care provider or any specialists on your health team to get answers.

Four more simple healthy steps

The list of steps you can take this year to benefit your health can be as long as you’d like it to be. Jot down goals any time you think of them.

Here are four solid steps to start you off:

• Take some deep breaths each day. A few minutes of daily slow, deep breathing can help lower your blood pressure and ease stress.
• Get a new pair of sunglasses if your old ones have worn lenses. Make sure the new pair has UV protection (a special coating) to block the sun’s ultraviolet (UV) light, which can cause eye damage and lead to permanent vision loss.
• Make a few lunch dates or phone dates with friends you haven’t seen in a while. Being socially connected wards off loneliness and isolation, which can help lower certain health risks.
• Do a deep cleaning on one room in your home per week. Dust and mold can trigger allergies, asthma, and even illness.

You don’t have to do all of these activities at once. Just put them on your to-do list, along with the larger resolutions you’re working on. Now you’ll have a curated list of goals of varying sizes. The more goals you reach, the better you’ll feel. And that will make for a very healthy year, indeed.

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

If your fingers or toes ever turn pale (or even ghostly white) and go numb when exposed to cold, you might assume you just have poor circulation. That’s what I used to think when I first started noticing this problem with my own hands many years ago.

It usually happened near the end of a long hike on a spring or fall afternoon, when the temperature dropped and I didn’t have any gloves handy. My pinkie, third, and middle fingers would turn white, and the fingernails took on a bluish tinge. As I soon discovered, I have Raynaud’s phenomenon, an exaggeration of normal blood vessel constriction.

Raynaud’s phenomenon: Beyond poor circulation

When you’re exposed to a cold environment, your body reacts by trying to preserve your core temperature. Blood vessels near the surface of your skin constrict, redirecting blood flow deeper into the body. If you have Raynaud’s phenomenon, this process is more extreme.

Is wintry weather the only trigger for Raynaud’s phenomenon?

“Cold weather is the classic trigger for Raynaud’s phenomenon," says rheumatologist Dr. Robert H. Shmerling, senior faculty editor at Harvard Medical School's Harvard Health Publishing.

"But it can occur any time of year — for example, when you come out of a heated pool, walk into an air-conditioned building, or reach into the freezer section at the supermarket. Even slight changes in air temperature can trigger an episode.”

What happens when an episode occurs?

During an episode, the small arteries supplying the fingers and toes contract spasmodically, hampering the flow of oxygen-rich blood to the skin. Some of these vessels even temporarily collapse, and the skin becomes pale and cool, sometimes blanching to a stark white color.

In addition to the hands, Raynaud’s can also affect the feet. Less often, the nose, lips, and ears.

Is Raynaud’s phenomenon a circulation problem?

Technically, Raynaud’s phenomenon is a circulation problem, but it’s very different than what doctors typically mean by poor circulation, says Dr. Shmerling. Limited or poor circulation usually affects older people whose arteries are narrowed with fatty plaque (known as atherosclerosis). This condition is often caused by high cholesterol, high blood pressure, and smoking.

In contrast, Raynaud’s usually affects younger people (mostly women) without those issues. And the circulation glitch is generally temporary and completely reversible, he adds.

How can you prevent episodes?

As I can attest, the best treatment for this condition is to prevent episodes in the first place, mainly by avoiding sudden or unprotected exposure to cold temperatures. I’ve always bundled up in the winter before heading outside, but now I bring extra layers and gloves even when the temperature might dip even slightly, or the weather may turn rainy or windy. Preheating the car in winter before getting in, and wearing gloves in chilly grocery store aisles, can also help.

Generally, it’s best to avoid behavior and medicines that cause blood vessels to constrict. This includes not smoking and not taking certain medications, such as cold and allergy formulas that contain pseudoephedrine and migraine drugs that contain ergotamine. Emotional stress may also provoke an episode of Raynaud’s, so consider tools and techniques that can help you ease stress, such as mindfulness techniques.

If necessary, your doctor may prescribe a medication that relaxes the blood vessels, usually a calcium-channel blocker such as nifedipine (Adalat, Procardia). If that’s not effective, drugs to treat erectile dysfunction such as sildenafil (Viagra) may help somewhat. Other treatment options include losartan (Cozaar), fluoxetine (Prozac), and topical nitroglycerin. You may only need to use these medications during the cold season, when Raynaud’s tends to be worse.

What steps may help during an episode?

Once an episode starts, it’s important to warm up the affected extremities as quickly as possible. For me, placing my hands under warm running water does the trick.

When that’s not possible, you can put them under your armpits or next to another warm part of your body. When the blood vessels finally relax and blood flow resumes, the skin becomes warm and flushed — and very red. The fingers or toes may throb or tingle.

Is Raynaud’s phenomenon linked to other health problems?

Some people with Raynaud’s phenomenon have other health problems, usually connective tissue disorders such as lupus or scleroderma. Your doctor can determine this by reviewing your symptoms, performing a physical exam, and taking a few blood tests. But most of the time, there is no underlying medical problem.

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

The tongue is secured to the front of the mouth partly by a band of tissue called the lingual frenulum. If the frenulum is short, it can restrict the movement of the tongue. This is commonly called a tongue-tie.

Children with a tongue-tie can’t stick their tongue out past their lower lip, or touch their tongue to the top of their upper teeth when their mouth is open. When they stick out their tongue, it looks notched or heart-shaped. Since babies don’t routinely stick out their tongues, a baby’s tongue may be tied if you can’t get a finger underneath the tongue.

How common are tongue-ties?

Tongue-ties are common. It’s hard to say exactly how common, as people define this condition differently. About 8% of babies under age one may have at least a mild tongue-tie.

Is it a problem if the tongue is tied?

This is really important: tongue-ties are not necessarily a problem. Many babies, children, and adults have tongue-ties that cause them no difficulties whatsoever.

There are two main ways that tongue-ties can cause problems:

• They can cause problems with breastfeeding by making it hard for some babies to latch on well to the mother’s nipple. This causes difficulty with feeding for the baby and sore nipples for the mother. It doesn’t happen to all babies with a tongue-tie; many of them can breastfeed successfully. Tongue-ties are not to blame for gassiness or fussiness in a breastfed baby who is gaining weight well. Babies with tongue-ties do not have problems with bottle-feeding.
• They can cause problems with speech. Some children with tongue-ties may have difficulty pronouncing certain sounds, such as t, d, z, s, th, n, and l. Tongue-ties do not cause speech delay.

What should you do if think your baby or child has a tongue-tie?

If you think that your newborn is not latching well because of a tongue-tie, talk to your doctor. There are many, many reasons why a baby might not latch onto the breast well. Your doctor should take a careful history of what has been going on, and do a careful examination of your baby to better understand the situation.

You should also have a visit with a lactation specialist to get help with breastfeeding — both because there are lots of reasons why babies have trouble with latching on, and also because many babies with a tongue-tie can nurse successfully with the right techniques and support.

Talk to your doctor if you think that a tongue-tie could be causing problems with how your child pronounces words. Many children just take some time to learn to pronounce certain sounds. It is also a good idea to have an evaluation by a speech therapist before concluding that a tongue-tie is the problem.

What can be done about a tongue-tie?

When necessary, a doctor can release a tongue-tie using a procedure called a frenotomy. A frenotomy can be done by simply snipping the frenulum, or it can be done with a laser.

However, nothing should be done about a tongue-tie that isn’t causing problems. While a frenotomy is a relatively minor procedure, complications such as bleeding, infection, or feeding difficulty sometimes occur. So it’s never a good idea to do it just to prevent problems in the future. The procedure should only be considered if the tongue-tie is clearly causing trouble.

It’s also important to know that clipping a tongue-tie doesn’t always solve the problem, especially with breastfeeding. Studies do not show a clear benefit for all babies or mothers. That’s why it’s important to work with a lactation expert before even considering a frenotomy.

If a newborn with a tongue-tie isn’t latching well despite strong support from a lactation expert, then a frenotomy should be considered, especially if the baby is not gaining weight. If it is done, it should be done early on and by someone with training and experience in the procedure.

What else should parents know about tongue-tie procedures?

Despite the fact that the evidence for the benefits of frenotomy is murky, many providers are quick to recommend them. If one is being recommended for your child, ask questions:

• Make sure you know exactly why it is being recommended.
• Ask whether there are any other options, including waiting.
• Talk to other health care providers on your child’s care team, or get a second opinion.

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

Feeling sad, anxious, or angry at times is a normal part of the human experience. But do you — or someone you’re close to — seem to experience these and similar emotions more quickly, more frequently, and more intensely than most people?

This problem, known as emotional dysregulation, is a hallmark of many mental health conditions, but especially borderline personality disorder. The most effective treatment for borderline personality disorder is dialectical behavior therapy (DBT), which has also been shown to help people experiencing other issues. What is DBT, who might benefit from this form of therapy, and how is it applied?

What is DBT?

DBT focuses on teaching people skills to manage intense emotions, cope with challenging situations, and improve their relationships. It encourages people to learn and use mindfulness training in practical ways.

During individual and group sessions, therapists encourage a nonjudgmental attitude and emphasize acceptance, compassion, and other aspects of mindfulness.

Who may benefit from DBT?

DBT has a proven track record for addressing the most debilitating symptoms of borderline personality disorder: self-injury and suicide threats or attempts. It is now also used to treat depression, post-traumatic stress disorder, eating disorders, and substance use disorders.

In fact, the cornerstone of DBT — the skills training — can help anyone navigate emotionally charged situations with more ease.

How can mindfulness change how people experience strong emotions?

Many people in therapy have very strong emotions that lead to negative thoughts, says Dr. Blaise Aguirre, a psychiatrist who founded the 3 East Dialectic Behavior Therapy Continuum at Harvard-affiliated McLean Hospital. “They say things like, ‘I’m stupid,’ or ‘I can’t control my anger,’ or ‘No one will ever love me,'” he says.

The mindfulness aspect of DBT teaches people to pay careful attention to the nature, quality, and volume of their thoughts. The idea is to observe these thoughts as separate from yourself without identifying with their meaning. This is the first step to addressing the impact of those thoughts, Dr. Aguirre explains.

How does DBT differ from cognitive behavioral therapy?

DBT is derived from cognitive behavioral therapy (CBT). CBT assumes that certain negative thoughts (cognitions) are distortions, and if you learn how to swap those distorted thoughts with more productive ones, you’ll be less depressed or anxious.

“But for someone with very deep emotions and convictions, telling them that their thoughts and feelings are somehow ‘wrong’ feels very invalidating,” says Dr. Aguirre. A DBT-trained therapist would instead acknowledge that the person’s thoughts make sense, given who they are and their experiences. This practice, known as validation, is a central tenet of DBT. It’s key to know that you can validate a person’s thoughts even if you don’t agree with them.

That concept touches on the core of DBT — the dialectical part. It refers to the idea that two opposite things can be true at the same time. Rather than viewing things in extremes of black and white, DBT encourages people to recognize there’s more than one way to view a situation and to try to “walk the middle path.” A classic DBT mantra is “I’m doing the best that I can in this moment, and I want to and can do better.”

What other skills does DBT rely on?

In addition to mindfulness, DBT teaches three other main skills:

• Distress tolerance is the ability to manage emotional distress in the moment, using techniques such as distraction.
• Emotion regulation involves recognizing, accepting, and managing intense emotions.
• Interpersonal effectiveness focuses on improving communication with other people to strengthen relationships and improve your self-esteem.

What does DBT entail?

Ideally, DBT includes one-on-one sessions with a therapist (who is also available between sessions for phone or text coaching). The one-on-one sessions are combined with weekly group sessions led by a therapist who teaches the specific, interconnected skills and gives homework that helps to reinforce the skills. Participants are encouraged to keep a daily diary to track their emotions, behaviors, reactions, and examples of how they’re practicing their skills.

DBT has been shown to be effective for people ranging from adolescents to older adults with a range of mental health conditions. It appears to be especially useful for adolescents, perhaps for the same reason that it’s easier to learn a language or how to play an instrument when you’re younger rather than older, says Dr. Aguirre.

Are there different options for gaining access to DBT?

Accessing the full DBT experience can be challenging for many people. The skills groups meet for one to two hours weekly for six to 12 months, which is in addition to weekly, hour-long sessions with an individual therapist. Individual therapy may cost as much as $250 to $300 per hour, and the groups are often around $100 per hour. Not all DBT providers accept insurance.

“We’re starting to recognize that the majority of people can improve just doing the skills groups and don’t need the full DBT,” says Dr. Aguirre.

But for teens who are suicidal or harming themselves, intensive DBT can help keep them out of the hospital and potentially save their lives. “If your child had cancer, you wouldn’t think twice about taking them in for chemotherapy infusions twice a week,” says Dr. Aguirre.

Another problem is that there aren’t many DBT-trained providers in less populated parts of the country. Online DBT therapy may be an option, although its effectiveness hasn’t been studied.

Is there one simple DBT tool I can try?

If a family member struggles with very strong emotions, Dr. Aguirre offers this mini-DBT lesson about validation. Situations that trigger intense emotions are often rooted in a perception of abandonment, neglect, or rejection, he says. For example, if a person believes that someone at work is avoiding them, or a romantic partner doesn’t show up on time, it can trigger a rapid rise in emotional distress.

Here’s what to avoid saying:

“You have to calm down.”

“You are making a big deal over nothing.”

“When I am upset, I make myself a nice cup of tea and that should help you, too.”

Here’s what you can say instead:

“You seem really upset. Do you want to talk about it, or do you want some time by yourself?’

“You seem very sad. I am around if you want to talk.”

“Is there anything that I can do to help?”

“These types of statements validate the person’s feelings and convey that you’re listening and open to helping, if that’s what they want,” says Dr. Aguirre.

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

Lung cancer kills more Americans than any other malignancy. The latest American Cancer Society (ACS) updated guidelines aim to reduce deaths by considerably expanding the pool of people who seek annual, low-dose CT lung screening scans.

Advocates hope the new advice will prompt more people at risk for lung cancer to schedule yearly screening, says Dr. Carey Thomson, director of the Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program at Harvard-affiliated Mount Auburn Hospital, and chair of the Early Detection Task Group for the ACS/National Lung Cancer Roundtable. Currently, fewer than one in 10 eligible people in the US follow through on recommended lung screenings.

What are the major changes in the new ACS lung cancer guidelines?

The updated ACS guidelines are aimed at high-risk individuals, all of whom have a smoking history. And unlike previous ACS recommendations, it doesn’t matter how long ago a person quit smoking. The updated guidelines also lower the bar on amount of smoking and widen the age window to seek screening, which aligns with 2021 recommendations issued by the US Preventive Services Task Force.

These changes combined may mean another six to eight million people will be eligible to have screening.

How many people get lung cancer?

Although lung cancer is the third most common malignancy in the United States, it’s the deadliest, killing more people than colorectal, breast, prostate, and cervical cancers combined. In 2023, about 238,000 Americans will be diagnosed with lung cancer and 127,000 will die of it, according to ACS estimates.

What is the major risk factor for lung cancer?

While people who have never smoked can get lung cancer, smoking and exposure to secondhand smoke is a major risk factor for this illness. Smoking is linked to as many as 80% to 90% of lung cancer deaths, according to the CDC.

Indeed, people who smoke are 15 to 30 times more likely to develop or die from lung cancer than those who don’t. The longer someone smokes and the more cigarettes they smoke each day, the higher their risks.

Is lung cancer easier to treat if found in early stages?

Yes. As with many cancers, detecting lung malignancies in their earliest stages is pivotal to improving survival.

Depending on the type of lung cancer diagnosed, up to 80% to 90% of people with a single, early-stage tumor that can be removed surgically can survive five years or longer, says the American Society of Clinical Oncology. The number of people who survive long-term becomes smaller as tumors grow larger, and if they spread to lymph nodes or other areas of the body.

Should you consider lung CT screening?

The updated ACS guidelines recommend screening if you:

• Are 50 to 80 years old. This age range is expanded from the prior ACS recommended cutoff of 55 to 74.
• Are a current or previous smoker. This includes anyone who smoked, not just smokers who quit within the past 15 years.
• Smoked 20 or more pack-years. This means smoking an average of 20 cigarettes per day for 20 years or 40 cigarettes per day for 10 years. Previously, the eligibility cutoff was 30 or more pack-years.

“While an expansion in the number of people screened for lung cancer will find additional early tumors, it also means more false positives will be detected,” says Howard LeWine, MD, Chief Medical Editor at Harvard Health Publishing. False positives are worrisome spots on a CT scan that are not cancer. But they usually require additional testing, perhaps a biopsy and even surgery for something that was harmless.

Before scheduling a low-dose CT lung screening, you’ll need to talk to a health professional about the screening process, your risks, whether it will be covered by your health insurance. Previously, an in-person medical appointment was required.

Why did the ACS change the years-since-quitting screening requirement?

Much international research suggests that the number of years since someone stopped smoking has little or no bearing on their risk of developing lung cancer, says Dr. Thomson.

“You have an equal likelihood of developing lung cancer whether you quit more than 15 years ago or more recently,” she says. “The recommendations on the national scene say that we need to be screening more people and make it easier to be screened. One of the ways to do that is to drop the quit history requirement.”

If you’re eligible for screening, how often should you have it?

Every year, says the ACS.

But why not screen for lung cancer for several years and then take a break, as is done with a malignancy such as cervical cancer? Research hasn’t been done to demonstrate that this type of approach is safe, Dr. Thomson says.

“We know that a large percentage of lung cancers identified in people through low-dose CT scans are identified after their first year of screening,” she says. “And some forms of lung cancer can move quickly, which is part of the reason it’s as deadly as it is.”

Did all guidelines organizations drop the years-since-quitting requirement?

No. The Centers for Medicare & Medicaid Services (CMS) and the U.S. Preventive Services Task Force — which, along with the ACS and other groups, recommend national standards for screenings — haven’t yet signed on to the ACS approach. These two groups maintain that only smokers who quit 15 or fewer years ago should remain eligible for screening.

However, guidelines issued by the National Comprehensive Cancer Network mesh with the new ACS recommendations by not having a years-since-quitting threshold.

Because Medicare and other health insurers may have slightly different rules to determine payment for lung cancer CT screening, it’s best to confirm this with your health care provider or insurer before getting tested.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

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

Dementia usually develops in people ages 65 years and older. So-called young-onset dementia, occurring in those younger than age 65, is uncommon. Now, a new study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia.

Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

A previous study of men in Sweden identified some risk factors for young-onset dementia, including high blood pressure, stroke, depression, alcohol use disorder, vitamin D deficiency, drug use disorder, and overall cognitive function.

What to know about the new study

In the new study, a research team in the Netherlands and the United Kingdom looked at data from the UK Biobank. The biobank follows about half a million individuals in the United Kingdom who were 37 to 73 years old when they first joined the project between 2006 and 2010. Most participants identified as white (89%), and the remaining 11% were described only as “other.” Slightly more than half of the participants (54%) were women.

The researchers excluded anyone age 65 or older and people who already had dementia at the start of the study, leaving 356,052 participants for the analyses. Over roughly a decade, 485 participants developed young-onset dementia. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors.

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

• Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.
• Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.
• Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.
• Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
• Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.
• Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.
• Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.
• Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. These two risk factors make it more likely that dementia symptoms will show up at a younger age.

• Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
• Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

No, and here’s why not: Sometimes research turns up apparent risk factors that might be due to reverse causation. It’s possible, for example, that symptoms of impending dementia appear to be risk factors because they become noticeable before obvious dementia is diagnosed.

• Lower handgrip strength is a sign of frailty, which is often associated with dementia.
• No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
• Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

• High C-reactive protein is a sign of inflammation.
• Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

• Don’t drink alcohol in excess.
• Seek opportunities to socialize with others regularly.
• Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.
• Make sure you are hearing well and use hearing aids if you are not.
• Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, MD

I was in line at a pharmacy recently as the customer ahead of me was picking up her prescription. The pharmacist matter-of-factly said: “that’ll be $850.” All she could say was “really?” She left without her prescription, telling the pharmacist she’d have to call her doctor about a less costly alternative.

Many of us routinely experience sticker shock over drug costs. And ever more dramatic examples suggest there’s no limit. So, let’s talk about ways to minimize what we spend on prescription drugs; how we got to this juncture where some medicines cost more than a million dollars per dose; and what changes are needed in our pricey medication-industrial-complex.

7 ways to minimize your spending on prescription drugs

Consider these seven strategies to pare drug costs. Savings will vary depending on insurance, donut holes, deductibles, and cost-sharing.

• Ask your healthcare provider three questions: Is every medicine you take truly necessary? Is it safe to reduce the dose of any medicines you take? Could a lower-cost or generic drug be substituted?
• If you have health insurance, check the list of preferred medications (the formulary), which tend to cost less than other similar medicines.
• Split pills: In some cases, a prescription will cost less if each pill contains more than your needed dose and can be divided. For example, if you usually take a 25-mg pill, taking half of a 50-mg pill may help you save on drug costs and copays. Ask your pharmacist if the math works for you.
• Ask if a 90-day supply rather than a 30-day supply would reduce copays.
• Look for prescription drug discount programs that offer savings. Restrictions apply and availability varies by location. Also, paying through a discount program might not count toward your insurance deductible or maximum out-of-pocket costs, so it isn’t always less expensive to use these programs.
• Compare prices at different pharmacies and review your options with a pharmacist. Sometimes the price is lower if you don’t use your insurance.
• Consider using an online mail-order service (such as Blink Health or Cost Plus Drug Company). However, spending through these sites may not count toward your insurance deductible. And the prices are not always lower online.

These measures will help some people more than others and can take up a lot of time. The sad truth is that even if you did everything you could, the impact on your wallet might be small.

Why are medicine costs so high in the US?

My top five contenders are:

Drug makers’ profit motive. Pharmaceutical companies routinely reject this idea. They say it’s expensive to develop new drugs and run the required clinical trials to prove safety and effectiveness. Many promising drugs fail, and the FDA drug approval process is difficult and costly.

Yet one recent study published in JAMA Network Open found no connection between how much a drug company spends on research and development (R&D) for a drug and the drug’s price. Even after accounting for R&D spending, most of the top 30 pharmaceutical companies make billions of dollars in profit. And in Europe, where drug prices are negotiated, the very same drugs made by the same companies for the same health problems typically cost far less than in the US.

Pharmacy benefit managers (PBMs) handle drug benefits for large employers, Medicare, and health insurance companies. PBMs negotiate prices with health insurers and pharmacies. They help decide which drugs to cover and how much patients pay. Their fees and incentives — often a share of total spending on medicines, which might encourage approval of higher-priced drugs — contribute to the costs health consumers wind up paying. A flurry of state and federal legislation is intended to limit what PBMs can do and the transparency of their operations.

Cost-sharing. In recent years, insurers have increasingly shifted costs to patients through higher copays, deductibles, and premiums. Sometimes this is justified by the notion that this incentivizes patients to seek care only when truly necessary; of course, it could also discourage people from seeking care even when warranted.

Legal maneuvers. Many drug makers file numerous patents and sue potential competitors to extend their time holding a monopoly on a particular drug (see example). Or they create “me too” drugs by slightly tweaking an existing drug so they can patent it as a brand-new drug. Some pharmaceutical companies acquire patents for older drugs and then jack up the price. Others have bought or merged with another drugmaker to avoid price competition.

Direct-to-consumer advertising. Drug companies spend billions on ads (nearly $8.1 billion in 2022). Marketing costs raise the price of drugs while boosting demand for newer, heavily promoted drugs. Advertised drugs tend to be far more expensive (and not always better) than older drugs. Perhaps this is why such advertising is banned in most other countries.

What might slow rising drug costs?

Although prescription drug prices are likely to remain high for the foreseeable future, three developments could help slow rising drug prices in the coming years:

• The Inflation Reduction Act of 2022 allows the US government to negotiate drug prices for Medicare, which is expected to lower drug costs. The first 10 price-protected drugs — including the blood thinner apixaban (Eliquis) and the diabetes medicine sitagliptin (Januvia) — take effect in 2026. More drugs will be added to this list each year. If you’re on one of these drugs, the impact could be large. But with more than 20,000 approved drugs on the market, it’s not a solution that will help everyone.
• Recent FDA action allowing Florida to import drugs from Canada, and other proposed federal and state legislation aiming to protect people from high prescription drug prices.
• Organizations advocating for lower prescription drug prices, including AARP, Consumers Union, and Patients for Affordable Drugs, appear to have the attention of lawmakers as never before.

The bottom line

Let’s face it: our complex, broken healthcare system incentivizes those who develop and distribute drugs to set the prices well above what many can afford. And the amount you can chip away on your own is limited. What we really need is an overhaul to remove middlemen who contribute to added cost without always adding value.

Until we get there, do what you can, even if the impact is small. Trying your best to stay healthy could be the most important step you take. After all, the best way to limit how much you spend on prescription drugs is to have no reason to take them.

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

As the new year rolls on, sports fans rejoice! You’ve had the excitement of the college football bowl games and the national championship game, the NFL playoff games are winnowing teams down to the Super Bowl contestants, and basketball and hockey seasons are in full swing. Spring training for the upcoming Major League Baseball season is around the corner.

But hold these thoughts a moment. Watching sports — not just playing them — can be hazardous to your health. I’ve seen it firsthand while working in a walk-in clinic near Fenway Park, where people would show up bleeding from cuts that needed stitches (from trips and falls at the stadium), broken bones (from trying to catch a foul ball or an altercation with another fan), and dehydration.

Most of these injuries weren’t life-threatening. But there’s evidence that the health impact of sports spectatorship can be far more serious for some of us — and, perhaps, underappreciated.

What are the health risks of watching live sports?

When you’re watching games in person, some risks are related to the weather and other fans. For example:

• Watching a baseball game in the summer for hours may lead to heat stroke or dehydration.
• Live winter football games may raise the risk of hypothermia, frostbite, or other cold-related problems.
• Stampedes, riots, and brawls between rival fans watching soccer matches are not rare and may actually be on the rise.
• And, as mentioned, spectators of live sports can be injured by balls hit into the stands or other flying objects such as bats, pucks, or golf balls.

How could watching sports on TV boost health risks?

Doctors and nurses often describe how quiet things get in the emergency room during a World Series game or the Super Bowl. But once the game ends, it tends to get much busier. One theory is that people with chest pain, trouble breathing, or other symptoms of a potentially serious problem who ordinarily would have reported to the emergency room right away may delay seeking care until after the game.

Of course, there’s another possibility: the game itself — especially if a game is close and particularly exciting — might cause enough stress on the body that heart attacks, strokes, or other dangerous conditions develop.

Research supporting the idea that watching sports can negatively affect your health includes:

• Older studies have linked hospital admissions for heart failure and cardiac arrest with watching sporting events.
• A 2017 study found that spectators of Montreal Canadiens hockey games experienced a doubling of their heart rate during games. The effect was more pronounced for live games than televised games, but even the latter experience led to faster heart rates similar to the effect of moderate exercise.
• A 2022 study found that hospital admissions for cardiovascular problems jumped 15% during and just after World Cup soccer games.

Together, these studies suggest that watching sports can be stressful enough to trigger dangerous cardiovascular events.

It’s worth emphasizing that most people watching sports enjoy it and do not experience any health problems related to the game. But these studies suggest that spectating may carry some small risk, similar to what might accompany moderate or vigorous exercise. This may be most relevant for people who are older or who already have cardiovascular disease.

What’s a sports fan to do?

One common recommendation is to remember that it’s only a game. Of course, if you care a lot about sports or a particular team, that advice is unlikely to help. A second is to get regular exercise. Staying physically active strengthens the heart and lowers blood pressure, which could help ward off some of the health risks described above.

Five additional game-day precautions are:

• Avoid overeating, especially salty junk food. For some, overindulging in food, drink, and salt can stress the heart or trigger heart failure.
• Be prepared for the weather. Check the forecast. If you’re planning to watch a game in the cold, dress in layers, use hand warmers, and drink warm fluids. If you’re going to be out in the sun, use sunscreen liberally, wear a hat, and hydrate well.
• If you have cardiovascular disease, don’t forget to take your medications, especially if there’s a big game coming up. And if you develop worrisome symptoms, such as chest pain or trouble breathing, seek medical attention right away. Don’t wait till the game ends!
• Stay hydrated and moderate your alcohol intake. Stay well-hydrated by drinking water, especially if you’re out in the heat for hours. Although beer is a liquid, it’s also a diuretic, meaning it can make you urinate more and lose more fluids than other beverages.
• Stay alert at live events. Give yourself a fighting chance of getting out of the way of a line-drive foul ball or an errant bat that’s slipped out of the batter’s hands during a swing.

The bottom line

I can attest to many upsides of watching sports: the excitement of competition and the bonding and camaraderie with likeminded friends, family, and other fans. And perhaps watching sports might improve your health if sports spectatorship sparks sports participation.

While watching sports has been linked to certain health risks, the overall risk is likely low for most people. And you can take steps to reduce this. The health risks of spectatorship only rarely require giving up watching a favorite team. So, put on your team jersey, cheer your team on to victory, and stay healthy while you’re at it. Oh, and watch out for outraged fans or flying bats.

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

Experiencing discrimination in the workplace — where many adults spend one-third of their time, on average — may be harmful to your heart health.

A 2023 study in the Journal of the American Heart Association found that people who reported high levels of discrimination on the job were more likely to develop high blood pressure than those who reported low levels of workplace discrimination.

Workplace discrimination refers to unfair conditions or unpleasant treatment because of personal characteristics — particularly race, sex, or age.

How can discrimination affect our health?

“The daily hassles and indignities people experience from discrimination are a specific type of stress that is not always included in traditional measures of stress and adversity,” says sociologist David R. Williams, professor of public health at the Harvard T.H. Chan School of Public Health.

Yet multiple studies have documented that experiencing discrimination increases risk for developing a broad range of factors linked to heart disease. Along with high blood pressure, this can also include chronic low-grade inflammation, obesity, and type 2 diabetes.

More than 25 years ago, Williams created the Everyday Discrimination Scale. This is the most widely used measure of discrimination’s effects on health.

Who participated in the study of workplace discrimination?

The study followed a nationwide sample of 1,246 adults across a broad range of occupations and education levels, with roughly equal numbers of men and women.

Most were middle-aged, white, and married. They were mostly nonsmokers, drank low to moderate amounts of alcohol, and did moderate to high levels of exercise. None had high blood pressure at the baseline measurements.

How was discrimination measured and what did the study find?

The study is the first to show that discrimination in the workplace can raise blood pressure.

To measure discrimination levels, researchers used a test that included these six questions:

• How often do you think you are unfairly given tasks that no one else wanted to do?
• How often are you watched more closely than other workers?
• How often does your supervisor or boss use ethnic, racial, or sexual slurs or jokes?
• How often do your coworkers use ethnic, racial, or sexual slurs or jokes?
• How often do you feel that you are ignored or not taken seriously by your boss?
• How often has a coworker with less experience and qualifications gotten promoted before you?

Based on the responses, researchers calculated discrimination scores and divided participants into groups with low, intermediate, and high scores.

• After a follow-up of roughly eight years, about 26% of all participants reported developing high blood pressure.
• Compared to people who scored low on workplace discrimination at the start of the study, those with intermediate or high scores were 22% and 54% more likely, respectively, to report high blood pressure during the follow-up.

How could discrimination affect blood pressure?

Discrimination can cause emotional stress, which activates the body’s fight-or-flight response. The resulting surge of hormones makes the heart beat faster and blood vessels narrow, which causes blood pressure to rise temporarily. But if the stress response is triggered repeatedly, blood pressure may remain consistently high.

Discrimination may arise from unfair treatment based on a range of factors, including race, gender, religious affiliation, or sexual orientation. The specific attribution doesn’t seem to matter, says Williams. “Broadly speaking, the effects of discrimination on health are similar, regardless of the attribution,” he says, noting that the Everyday Discrimination Scale was specifically designed to capture a range of different forms of discrimination.

What are the limitations of this study?

One limitation of this recent study is that only 6% of the participants were nonwhite, and these individuals were less likely to take part in the follow-up session of the study. As a result, the study may not have fully or accurately captured workplace discrimination among people from different racial groups. In addition, blood pressure was self-reported, which may be less reliable than measurements directly documented by medical professionals.

What may limit the health impact of workplace discrimination?

At the organizational level, no studies have directly addressed this issue. Preliminary evidence suggests that improving working conditions, such as decreasing job demands and increasing job control, may help lower blood pressure, according to the study authors. In addition, the American Heart Association recently released a report, Driving Health Equity in the Workplace, that aims to address drivers of health inequities in the workplace.

Encouraging greater awareness of implicit bias may be one way to help reduce discrimination in the workplace. Implicit bias refers to the unconscious assumptions and prejudgments people have about groups of people that may underlie some discriminatory behaviors. You can explore implicit biases with these tests, which were developed at Harvard and other universities.

On an individual level, stress management training can reduce blood pressure. A range of stress-relieving strategies may offer similar benefits. Regularly practicing relaxation techniques or brief mindfulness reflections, learning ways to cope with negative thoughts, and getting sufficient exercise can help.

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