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

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

10 things parents should know about swimming lessons

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

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

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

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

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

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

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

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

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

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

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

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

About the Author

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

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

About the Reviewer

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

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

If you spend time outdoors — which we all should do, for all sorts of reasons — you are likely to encounter biting bugs. Most of the time the bites are just a nuisance. But besides the fact that sometimes they can be painful or itchy, bug bites can lead to illness — like Lyme disease from ticks, or Zika, malaria, or West Nile disease from mosquitoes. So preventing bites is a good idea for all of us, and certainly for children.

Simple precautions will help

Before talking about insect repellents, it’s important to remember that there are simple and effective precautions, nearly all of which don’t involve any chemicals. For example:

• Empty out any standing water outside your home. That’s where mosquitoes breed.
• Wear long-sleeved shirts and long pants if you are going to be in areas with lots of biting insects. If you treat clothes (and shoes and gear) with 0.5% permethrin, it can be helpful.
• Be aware that mosquitoes are most likely to be out at dusk and dawn, and plan activities accordingly.
• To avoid tick bites, avoid wooded and brushy areas and keep to the center of paths when you hike. Be sure to do a tick check when you come home — not just of all the people in your group, but also any pets or gear that came along. Taking a shower soon after arriving home can help with both tick checks and washing off any unattached ticks.

Make choices about insect repellent

Insect repellents can be very useful. Some are more effective than others, and some can have side effects, so it’s important to do your homework. The Environmental Protection Agency has a great interactive tool that can help you choose the best repellent for your particular situation.

The most effective repellent is DEET (N, N-diethyl-meta-toluamide). It works against both mosquitoes and ticks, and is definitely the go-to repellent if you really want or need to prevent bites. The higher the concentration, the longer it lasts: 10% will give you about two hours of coverage, while 30% can protect you for about five hours. The American Academy of Pediatrics (AAP) recommends not using more than 30% on kids, and not using any repellents on infants less than 2 months old.

The most common side effect is skin irritation, and if you ingest it (you never know with little kids) it can lead to nausea and vomiting. Eye irritation is possible, which is why you should never spray any repellent directly to the face, but rather put it on your hands and then carefully apply to the face. In very rare cases, like one in every 100 million users, DEET can lead to brain problems such as seizures if used in high doses. This is an incredibly rare side effect, and not something that should stop you from using it, especially if you are in an area with a lot of ticks, or an area with lots of disease-carrying mosquitoes.

Here are some alternatives with minimal to no side effects (eye irritation most common; avoid as noted above):

• oil of lemon eucalyptus, or PMD (the manmade alternative). This works nearly as well as DEET.
• picaridin, which works better against mosquitoes than ticks
• 2-undecanone
• IR-3535, the active ingredient in Avon products, although it is not very effective
• citronella, although it is even less effective.

Applying insect repellent — and sunscreen

Whatever you use, follow label directions and be sure that you are careful as you apply it to all exposed skin. It’s best to spray in an open area — and spray clothing too. Pump bottles and wipes with insect repellent may help you apply products carefully. Try to choose the best product for your situation so that you can apply it just once; the EPA tool is great for that. Don’t forget sunscreen; apply that first so your skin can absorb it.

The Centers for Disease Control and Prevention (CDC) has more information about applying insect repellent on children and preventing bites from mosquitoes and ticks.

Also visit the Harvard Health Publishing Lyme Wellness Initiative to learn about preventing –– or living with –– Lyme disease and other tick-borne illnesses.

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

When you live in a coastal area, preparing early for potential hurricanes is a must. Storms can develop quickly, leaving little time to figure out where you’ll be safe or which items to pack if you have to evacuate. And health care necessities, such as medications or medical equipment, are often overlooked in the scramble.

“People might bring their diabetes medication but forget their blood sugar monitor, or bring their hearing aids but forget extra batteries for them,” says Dr. Scott Goldberg, medical director of emergency preparedness at Brigham and Women’s Hospital and a longtime member of a FEMA task force that responds to hurricane-damaged areas.

Here’s some insight on what to expect this hurricane season, and how to prioritize health care in your hurricane kit.

What will the 2024 hurricane season look like?

This year’s hurricane predictions underscore the urgency to start preparations now.

Forecasters with the National Oceanic and Atmospheric Administration’s National Weather Service expect above-normal activity for the 2024 hurricane season (which lasts until November 30).

Meteorologists anticipate 17 to 25 storms with winds of 39 mph or higher, including eight to 13 hurricanes — four to seven of which could be major hurricanes with 111 mph winds or higher.

What kinds of plans should you make?

Preparing for the possibility of big storms is a major undertaking. Long before ferocious winds and torrential rains arrive, you must gather hurricane supplies, figure out how to secure your home, and determine where to go if you need to evacuate (especially if you live in a flood zone). Contact the emergency management department at your city or county for shelter information.

If you’ll need help evacuating due to a medical condition, or if you’ll need medical assistance at a shelter, find out if your county or city has a special needs registry like this one in Florida. Signing up will enable first responders to notify you about storms and transport you to a special shelter that has medical staff, hospital cots, and possibly oxygen tanks.

What should you pack?

While a shelter provides a safe place to ride out a storm, including bathrooms, water, and basic meals, it’s up to you to bring everything else. It’s essential to pack medical equipment and sufficient medications and health supplies.

“It’s natural to just grab the prescription medications in your medicine cabinet, but what if it’s only a two-day supply? It might be a while before you can get a refill. We recommend at least a 14-day or 30-day supply of every prescription,” Dr. Goldberg says. “Talk to your doctor about the possibility of getting an extra refill to keep on standby for your go bag.”

Other health-related items you’ll want to pack include:

• medical supplies you use regularly, such as a blood pressure monitor, heart monitor, CPAP machine, wheelchair, or walker
• over-the-counter medicines you use regularly, such as heartburn medicine or pain relievers
• foods for specific dietary needs, such as gluten-free food if you have celiac disease (if you have infants or children, you’ll need to bring foods they can eat)
• healthy, nonperishable snacks such as nuts, nut butters, trail mix, dried fruit, granola bars, protein bars, and whole-grain bread, crackers, or cereals
• hygiene products such as soap, hand sanitizer, toothbrushes and toothpaste, shampoo, deodorant, infant or adult diapers, lip balm, moist towelettes, and toilet paper — because shelters often run out of it.

Remember the basics

In some ways, you can think of shelter living like camping. You’ll need lots of basic supplies to get through it, including:

• a sleeping bag or blanket and pillow for each person in your family
• clean towels and washcloths
• a few extra changes of clothes per person
• a first-aid kit
• flashlights and extra batteries
• chargers for your electronic gadgets
• rechargeable battery packs.

Bring important paperwork

In addition to supplies, bring important documents such as:

• a list of your medications, vitamins, and supplements (include the name, dose, and frequency of each one)
• a list of the names, addresses, and phone numbers of your primary care provider and any specialists who treat you
• a list of your emergency contacts and their phone numbers
• your pharmacy’s phone number and address
• copies of your birth certificate and driver’s license
• copies of home, car, or life insurance policies
• copies of your health insurance cards
• a copy of your advance directive — which includes your living will and health care proxy form.

“Store these documents on a flash drive. Also make photocopies of them, which are easiest for doctors to consult in an emergency setting. Place them in a plastic zip-top bag to keep them dry,” Dr. Goldberg advises.

Prepare right now

Start today. Gather as many go-bag supplies as you can, including the bags. A small suitcase, backpack, or duffel bag for each person in your family will work well.

And try not to put off these important preparations. “Hurricanes are major stressors. You might be worried, sleep deprived, fatigued, and emotional,” Dr. Goldberg says. “All of that will make it hard to think clearly. You’ll do yourself and your family a favor by having discussions now and getting started on your hurricane plan.”

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

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

What is eczema?

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

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

Why is eczema getting worse during summer?

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

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

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

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

What can you do to protect your skin?

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

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

About the Author

Wynne Armand, MD, Contributor

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

Animals renowned for their outstanding night vision include owls, cats, tarsiers (a tiny primate in Southeast Asia) — and even the dung beetle.

But humans? Not so much.

Over time, many people suffer from night blindness, also known as nyctalopia. This condition makes seeing in dim or dark settings difficult because your eyes cannot adjust to changes in brightness or detect light.

What are the dangers for those experiencing night blindness?

Night blindness is especially problematic and dangerous when driving. Your eyes cannot adjust between darkness and the headlights of oncoming vehicles, other cars may appear out of focus, and your depth perception becomes impaired, which makes it difficult to judge distances.

Night blindness also may affect your sight at home by making it hard for your vision to quickly adjust to a dark room after turning off the lights. “This can cause people to bump into furniture or trip and suffer an injury,” says Dr. Isabel Deakins, an optometrist with Harvard-affiliated Massachusetts Eye and Ear.

What happens in the eye to create night blindness?

The ability to see in low-light conditions involves two structures in the eye: the retina and the iris.

The retina, located in the back of the eye, contains two types of light-detecting cells called cones and rods. The cones handle color vision and fine details while the rods manage vision in dim light.

The iris is the colored part of your eye. It contains muscles that widen or narrow the opening of your pupil to adjust how much light can enter your eyes.

If your irises don’t properly react, the pupils can dilate and let in too much light, which causes light sensitivity and makes it hard to see in bright light. Or your pupils may remain too small and not allow in enough light, making it tough to see in low light.

What causes night blindness?

Night blindness is not a disease but a symptom of other conditions. “It’s like having a bruise on your body. Something else causes it,” says Dr. Deakins.

Several conditions can cause night blindness. For instance, medications, such as antidepressants, antihistamines, and antipsychotics, can affect pupil size and how much light enters the eye.

Eye conditions that can cause night blindness include:

• glaucoma, a disease that damages the eye’s optic nerves and blood vessels
• cataracts, cloudy areas in the lens that distort or block the passage of light through the lens
• dry eye syndrome.

However, one issue that raises the risk of night blindness that you can’t control is age. “Our eyes react more slowly to light changes as we age, and vision naturally declines over time,” says Dr. Deakins.  “The number of rods in our eyes diminish, pupils get smaller, and the muscles of the irises weaken.”

What helps if you have night blindness?

If you notice any signs of night blindness, avoid driving and get checked by an eye care specialist like an optometrist or ophthalmologist. An eye exam can determine if your eyeglass prescription needs to be updated.

“Often, a prescription change is enough to reduce glare when driving at night," says Dr. Deakins. “You may even need separate glasses with a stronger eye prescription that you wear only when driving at night.”

Adding an anti-reflective coating to your lens may help to cut down on the glare of the headlights of an oncoming car. However, skip the over-the-counter polarized driving glasses sold at many drug stores. "These may help cut down on glare, but they don't address the causes of night blindness," says Dr. Deakins.

An eye exam also will identify glaucoma or cataracts, which can be treated. Glaucoma treatments include eyedrops, laser treatment, or surgery. Cataracts are corrected with surgery to replace the clouded lens with an artificial one. Your eye care specialist can also help identify dry eye and recommend treatment.

Ask your primary care clinician or a pharmacist if any medications that you take may cause night blindness. If so, it may be possible to adjust the dose or switch to another drug.

Three more ways to make night driving safer

You also can take steps to make night driving safer. For example:

• Wash the lenses of your glasses regularly. And take them to an optician to buff out minor scratches.
• Keep both sides of your front and rear car windshields clean so that you can see as clearly as possible.
• Dim your dashboard lights, which cause glare, and use the night setting on your rearview mirror.

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

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

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

Whatever happened to “first do no harm”?

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

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

Are there harms that cannot be prevented?

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

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

Often less dramatic — yet also unpreventable — harms are:

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

Which harms can be prevented?

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

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

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

What can you do to avoid preventable harms?

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

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

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

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

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

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

The problem: Wrong site surgery.

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

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

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

Where does malpractice fit in?

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

There are several reasons for this, including:

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

The bottom line

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

About the Author

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

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

Drug side effects are common, and often quite troublesome.

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

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

Aren’t all side effects bad?

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

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

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

Silver linings: Repurposing and repackaging drugs

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

For example:

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

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

Bad side effects and the nocebo effect

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

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

The bottom line

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

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

About the Author

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

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

Nantucket, a beautiful, 14-mile-long island off the coast of Massachusetts, has a 40-point resiliency plan to help withstand the buffeting seas surrounding it as climate change takes a toll. Perhaps we can all benefit from creating individual resilience plans to help handle the big and small issues that erode our sense of well-being. But what is resilience and how do you cultivate it?

What is resilience?

Resilience is a psychological response that helps you adapt to life’s difficulties and seek a path forward through challenges.

“It’s a flexible mindset that helps you adapt, think critically, and stay focused on your values and what matters most,” says Luana Marques, an associate professor of psychiatry at Harvard Medical School.

While everyone has the ability to be resilient, your capacity for resilience can take a beating over time from chronic stress, perhaps from financial instability or staying in a job you dislike. The longer you’re in that situation, the harder it becomes to cope with it.

Fortunately, it’s possible to cultivate resilience. To do so, it helps to exercise resiliency skills as often as possible, even for minor stressors. Marques recommends the following strategies.

Shift your thoughts

In stressful situations, try to balance out your thoughts by adopting a broader perspective. “This will help you stop using the emotional part of your brain and start using the thinking part of your brain. For example, if you’re asking for a raise and your brain says you won’t get it, think about the things you’ve done in your job that are worthy of a raise. You’ll slow down the emotional response and shift your mindset from anxious to action,” Marques says.

Approach what you want

“When you’re anxious, stressed, or burned out, you tend to avoid things that make you uncomfortable. That can make you feel stuck,” Marques says. “What you need to do is get out of your comfort zone and take a step toward the thing you want, in spite of fear.”

For example: If you’re afraid of giving a presentation, create a PowerPoint and practice it with colleagues. If you’re having conflict at home, don’t walk away from your partner — schedule time to talk about what’s making you upset.

Align actions with your values

“Stress happens when your actions are not aligned with your values — the things that matter most to you or bring you joy. For example, you might feel stressed if you care most about your family but can’t be there for dinner, or care most about your health but drink a lot,” Marques says.

She suggests that you identify your top three values and make sure your daily actions align with them. If being with family is one of the three, make your time with them a priority — perhaps find a way to join them for a daily meal. If you get joy from a clean house, make daily tidying a priority.

Tips for success

Practice the shift, approach, and align strategies throughout the week. “One trick I use is looking at my calendar on Sunday and checking if my actions for the week are aligned with my values. If they aren’t, I try to change things around,” Marques says.

It’s also important to live as healthy a lifestyle as possible, which will help keep your brain functioning at its best.

Healthy lifestyle habits include:

• getting seven to nine hours of sleep per night
• following a healthy diet, such as a Mediterranean-style diet
• aiming for at least 150 minutes of moderate-intensity activities (such as brisk walking) each week — and adding on strength training at least twice a week
• if you drink alcohol, limiting yourself to no more than one drink per day for women and two drinks per day for men
• not smoking
• staying socially connected, whether in person, by phone or video calls, social media, or even text messages.

Need resilience training?

Even the best athletes have coaches, and you might benefit from resilience training.

Consider taking an online course, such as this one developed by Luana Marques. Or maybe turn to a therapist online or in person for help. Look for someone who specializes in cognitive behavioral therapy, which guides you to redirect negative thoughts to positive or productive ones.

Just don’t put off building resilience. Practicing as you face day-to-day stresses will help you learn skills to help navigate when dark clouds roll in and seas get rough.

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