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Many health-conscious consumers have already cut back on hamburgers, steaks, and deli meats, often by swapping in poultry or seafood. Those protein sources are better than beef, and not just because they’re linked to a lower risk of heart disease, diabetes, and cancer. Chicken and fish are also better for the environment, as their production uses less land and other resources and generates fewer greenhouse gas emissions.

And choosing seafood that’s lower on the food chain — namely, small fish such as herring and sardines and bivalves such as clams and oysters — can amp up those benefits. “It’s much better for your health and the environment when you replace terrestrial food sources — especially red meat — with aquatic food sources,” says Christopher Golden, assistant professor of nutrition and planetary health at the Harvard T.H. Chan School of Public Health. But instead of popular seafood choices such as farmed salmon or canned tuna, consider mackerel or sardines, he suggests.

Why eat small fish?

Anchovies, herring, mackerel, and sardines are all excellent sources of protein, micronutrients like iron, zinc, and vitamin B12, and heart-healthy omega-3 fatty acids, which may help ease inflammation within the body and promote a better balance of blood lipids. And because you often eat the entire fish (including the tiny bones), small fish are also rich in calcium and vitamin D, says Golden. (Mackerel is an exception: cooked mackerel bones are too sharp or tough to eat, although canned mackerel bones are fine to eat).

Small fish are also less likely to contain contaminants such as mercury and polychlorinated biphenyls (PCBs) compared with large species like tuna and swordfish. Those and other large fish feed on smaller fish, which concentrates the toxins.

It's also more environmentally friendly to eat small fish directly instead of using them to make fish meal, which is often fed to farmed salmon, pork, and poultry. Feed for those animals also includes grains that require land, water, pesticides, and energy to produce, just as grain fed to cattle does, Golden points out. The good news is that increasingly, salmon farming has begun using less fish meal, and some companies have created highly nutritious feeds that don’t require fish meal at all.

Small fish in the Mediterranean diet

The traditional Mediterranean diet, widely considered the best diet for heart health, highlights small fish such as fresh sardines and anchovies, says Golden. Canned versions of these species, which are widely available and less expensive than fresh, are a good option. However, most canned anchovies are salt-cured and therefore high in sodium, which can raise blood pressure.

Sardines packed in water or olive oil can be

• served on crackers or crusty, toasted bread with a squeeze of lemon
• prepared like tuna salad for a sandwich filling
• added to a Greek salad
• tossed with pasta, either added to tomato sauce or with lemon, capers, and red pepper flakes.

Golden is particularly fond of pickled herring, which you can often find in jars in supermarkets, or even make yourself; here’s his favorite recipe.

Bivalve benefits

Bivalves are two-shelled aquatic creatures that include clams, oysters, mussels, and scallops. Also known as mollusks, they’re good sources of protein but are quite low in fat, so they aren’t as rich in omega-3’s as small, fatty fish. However, bivalves contain several micronutrients, especially zinc and vitamin B12. Zinc contributes to a healthy immune system, and vitamin B12 helps form red blood cells that carry oxygen and keep nerves throughout the body healthy. While most Americans get enough B12, some may not.

And from a planetary health perspective, bivalves are among the best sources of animal-based protein. “Bivalves can be ‘nature positive’ because they don’t require feed and they filter and clean up water,” says Golden.

Be aware, however, that bivalves can become contaminated from runoff, bacteria, viruses, or chemicals in the water. So be sure to follow FDA advice about buying and preparing seafood safely.

Although we tend to think of coastal cities as the best places to find seafood, it’s available throughout the United States. For less-common varieties, try larger Asian markets, which often carry a wide variety of fish and bivalves, Golden suggests.

Aquatic plant foods

You can even go one step further down the aquatic food chain by eating aquatic plant foods such as seaweed and kelp. If you like sushi, you’ve probably had nori, the flat sheets of seaweed used to make sushi rolls. You can also find seaweed snacks in Asian and many mainstream grocery stores. The truly adventurous may want to try kelp jerky or a kelp burger, both sold online.

Nutrients in seaweed vary quite a bit, depending on species (kelp is one type of brown seaweed; there are also numerous green and red species). But seaweed is low in calories, is a good source of fiber, and also contains iodine, a mineral required to make thyroid hormones. Similar to terrestrial vegetables, seaweeds contain a range of other minerals and vitamins. For now, aquatic plant foods remain fringe products here in the United States, but they may become more mainstream in the future, according to Golden.

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

Social media and stores are full of products that promise perfect skin. Increasingly, these products are being marketed not just to adults but to teens and tweens. Many are benign, but some can cause skin irritation — and can be costly. And even if these products are benign, does buying them support unhealthy notions about appearance and beauty?

It’s worth looking at this from a medical perspective. Spoiler alert: for the most part teens and tweens do not need specialized skin products, especially expensive ones. But let’s talk about when they may make sense.

When can a specialized skin product help tweens and teens?

So, when should your child buy specialized skin products?

• When their doctor recommends it. If your child has a skin condition that is being treated by a doctor, such as eczema or psoriasis, over-the-counter skin products may help. For example, with eczema we generally recommend fragrance-free cleansers and moisturizers. Always ask your doctor which brands to choose, and get their advice on how best to use them.
• If they have dry and/or sensitive skin. Again, fragrance-free cleansers are a good idea (look for ones recommended for people with eczema). So are fragrance-free, non-irritating moisturizers (look for creams and ointments rather than lotions, as they will be more effective for dry skin). If you have questions, or if the products you are buying aren’t helping, check in with your doctor.

What about skin products for acne?

It’s pretty rare to go through adolescence without a pimple. Many teens aren’t bothered by them, but if your child is bothered by their pimples or has a lot of them, it may be helpful to buy some acne products at your local pharmacy.

• Mild cleansers tend to be better than cleansers containing alcohol. You may want to check out cleansers intended for dry skin or eczema.
• Over-the-counter acne treatments usually contain benzoyl peroxide, salicylic acid, azelaic acid, or alpha-hydroxy acids. Adapalene can be helpful for more stubborn pimples.
• Steer away from astringents or exfoliants, which tend to irritate the skin.
• Talk to your doctor about what makes the most sense for your child — and definitely talk to them if over-the-counter products aren’t helpful. There are many acne treatments available by prescription.

Ask questions and help dispel myths

If your teen or tween doesn’t fall into one of these groups, chances are they don’t need anything but plain old soap and water and the occasional moisturizer if their skin gets dry.

If your child has normal, healthy skin yet is asking for or buying specialized skin products, ask them why. Do your best to dispel the inevitable marketing myths — like that the products will prevent problems they do not have. Let them know that should a problem arise, you will work with them — with the advice of their doctor — to find and buy the best products.

Use it as an opportunity, too, to talk about self-image and how it can be influenced by outside factors. This is an important conversation to have whether or not your child is pining for the latest cleanser they see on Instagram. Helping your child see their own beauty and strengths is a key part of parenting, especially for a generation raised on social media.

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

Earlier this year, US defense secretary Lloyd Austin was hospitalized for complications resulting from prostate cancer surgery. Details of his procedure, which was performed on December 22, were not fully disclosed. Press statements from the Pentagon indicated that Austin had undergone a minimally invasive prostatectomy, which is an operation to remove the prostate gland. Minimally invasive procedures are performed using robotic instruments passed through small “keyhole” incisions in the patient’s abdomen.

Just over a week later, Austin developed severe abdominal, hip, and leg pain. He was admitted to the intensive care unit at Walter Reed Hospital on January 2 for monitoring and further treatment. Doctors discovered that Austin had a urinary tract infection and fluid pooling in his abdomen that were impairing bowel functioning. The defense secretary was successfully treated, but then readmitted to the ICU on February 11 for what the Pentagon described as “an emergent bladder issue.” Two days after undergoing what was only described as a “non-surgical procedure performed under general anesthesia,” Austin was back at work. His cancer prognosis is said to be excellent.

Austin’s ordeal was covered extensively in the media. Although we cannot speculate about his specific case, to help our readers better understand the complications that might occur after a prostatectomy, I spoke with Dr. Boris Gershman, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston. Dr. Gershman is also a member of the advisory and editorial board for the Harvard Medical School Guide to Prostate Diseases.

How common are urinary tract infections after a prostatectomy?

Minimally invasive prostatectomy is generally well tolerated. In one study that examined complications among over 29,000 men who had the operation, the rate of urinary tract infections was only 2.1%. The risk of sepsis — a more serious condition that occurs if the body’s response to an infection damages other organs — is much lower than that.

How would a urinary tract infection occur?

Although urinary tract infections are rare after prostatectomy, bacteria can travel into the urinary system through a catheter. An important part of a prostatectomy involves connecting the urethra — which is a tube that carries urine out of the body — directly to the bladder after the prostate has been taken out. As a last step in that process, we pass a catheter [a soft silicone tube] through the urethra and into the bladder to promote healing. Infection risks are minimized by giving antibiotics both during surgery and then again just prior to removing the catheter one to two weeks after the operation.

How do you treat urinary infectious complications when they do happen?

It’s not unusual to find small amounts of bacteria in the urine whenever you use a catheter. Normally they don’t cause any symptoms, but if infectious complications do occur, then we’ll admit the patient to the hospital and treat with broad-spectrum antibiotics that treat many different kinds of bacteria at once. We’ll also obtain a urine culture to identify the bacterial species causing the infection. Based on culture results, we can switch to different antibiotics that attack those microbes specifically. The course of treatment generally lasts 10 to 14 days.

Lloyd Austin also had gastrointestinal complications. Why might that have occurred?

Although I cannot speculate about Austin’s specific case, in general gastrointestinal complications are very rare — affecting fewer than 2% of patients treated using robotic methods. However, a few different things can happen. For instance, the small intestine can “fall asleep” after surgery, meaning it temporarily stops moving food and wastes through the bowel.

This is called an ileus. It can be due to multiple reasons, including as a result of anesthetics or pain medications. An ileus generally resolves on its own if patients avoid food or water by mouth for several days. If it causes too much pressure in the bowel, then we “decompress” the stomach by removing accumulated fluids through a nasogastric tube, which is threaded into the stomach through the nose and throat.

Some patients develop a different sort of surgical complication called a small bowel obstruction. We treat these the same way: by withholding food and water by mouth and removing fluids with a nasogastric tube if necessary. If the blockages are caused by scar tissues, in rare cases this may require a second surgery to fix the obstructing scar tissue.

Fluids might also collect in the pelvis after lymph nodes are removed during surgery. What’s happening in these cases?

Pelvic lymph nodes that drain the prostate are commonly removed during prostatectomy to determine if there is any cancer spread to the lymph nodes. A possible risk from lymph node removal is that lymph fluid might leak out after the procedure and pool up in the pelvis. This is called a lymphocele. Most lymphoceles are asymptomatic, but infrequently they may become infected. When that happens, we treat with antibiotics, and we might drain the lymphocele using a percutaneous catheter [which is placed through the skin]. Fortunately, newer surgical techniques are helping to ensure that lymphoceles occur very rarely.

Are there individual factors that increase the risk of prostatectomy complications?

Certainly, patients can have risk factors for infection. Diabetes, for instance, can inhibit the immune system, especially when patients have poor glycemic or glucose control [a limited ability to maintain normal blood sugar levels]. If patients have autoimmune diseases, or if they’re taking immunosuppressive medications, they may also be at increased risk of infectious or wound healing complications with surgery, and in some cases, may instead be treated with radiation to avoid these risks.

Thanks for walking me through this complex topic! Any parting thoughts for our readers?

It’s important to discuss the potential risks of surgery with your doctor so you can be fully informed. That said, prostatectomy these days using the minimally invasive approach has a very favorable risk profile. The majority of patients do really well, and fortunately severe complications requiring hospital readmission are very rare.

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as one in 10 children and teens overall.  

What should you know — and do — if you think your child or teen may be having migraines?

How early do migraines start to occur?

We don’t tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.

Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.

Which migraine symptoms are most common in children?

Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.

While it’s not always easy to tell a migraine from another kind of headache, children

• often report throbbing pain
• may experience nausea and sensitivity to light and noise.

The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.

What causes migraines in children?

We don’t know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.

Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.

Can migraines be prevented?

The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it’s a good idea to keep a headache diary.

When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child’s particular triggers.

It’s a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!

How can you help your child ease a migraine?

When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it’s not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.

It’s important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!

Are there prescription medicines that can help children with migraines?

If those approaches aren’t enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.

If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.

Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.

When to contact your doctor

If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.

You should always call your doctor, or go to an emergency room, if your child has a severe headache, a stiff neck, trouble with coordination or movement, is abnormally sleepy, or isn’t talking or behaving normally.

The American Academy of Pediatrics has additional useful information about migraines, and how to treat and prevent them, on their website.

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

Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. In 2023 the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter with no prescription needed. This offers many more people access to a new nonprescription option for preventing pregnancy.

Opill is available online and soon to be stocked on drugstore shelves. Here’s what anyone interested — adults, parents, and teens — should know.

What is in Opill and how does it work?

Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by

• affecting ovulation so that the ovaries do not release an egg every month
• thickening cervical mucus, which blocks sperm from reaching an egg
• changing the uterine lining in ways that keep a fertilized egg from implanting.

How effective is Opill at preventing pregnancy?

It depends on how consistent you are about taking Opill:

• Perfect use means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.
• Typical use averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don’t take it perfectly, at least nine could become pregnant in a year.

It’s also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.

How do you take Opill?

• Take it once a day at the same time each day until you finish the entire pack.
• Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.
• After you complete a 28-day pack, you should immediately start a new pack of pills the next day.

What happens if you forget to take a dose at the specific time or miss a dose?

• If you take the pill more than three hours late it will not be as effective at preventing pregnancy.
• Take the missed pill as soon you remember.
• You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.

Is Opill safe for teenagers?

Opill is generally safe for most people who could get pregnant, including teenagers. There’s no evidence to suggest that safety or side effects are different in teenagers compared with adults.

Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.

When teens use birth control, what is the best choice for them?

There isn’t a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.

For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.

Learn more about different contraception methods at the Center for Young Women’s Health website.

What side effects are common with Opill?

Progestin-only pills are usually associated with mild side effects. The most common side effects are:

• unexpected vaginal bleeding or spotting
• acne
• headache
• gastrointestinal symptoms such as nausea, abdominal pain, and bloating
• change in appetite.

Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.

Will Opill cause any mood changes?

Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.

Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.

Can it be used as emergency birth control?

No, it should not be used as emergency birth control.

What should you know about STIs?

This type of birth control does not protect you from sexually transmitted infections (STIs) such as syphilis, gonorrhea, or chlamydia.

You can reduce the chance of getting STIs by correctly using condoms each time you have sex. There are different types of condoms: one made for penises and one made for vaginas.

Vaccines help protect against some STIs such as hepatitis B and human papillomavirus (HPV). A medicine called PrEP can help prevent HIV. Ask your medical team for more information about the right choices for you.

About the Authors

Candice Mazon, MD, Contributor

Dr. Candice Mazon is a second year adolescent medicine fellow at Boston Children's Hospital. She's a board certified pediatrician and received her training at MedStar Georgetown University Hospital. She earned her MD degree from Drexel University … See Full Bio View all posts by Candice Mazon, MD

Amy Desrochers DiVasta, MD, MMSc, Contributor

Amy Desrochers DiVasta MD, MMSc, is chief of the division of adolescent medicine at Boston Children’s Hospital. She is the co-director of the adolescent long-acting reversible contraception program, and co-director of the reproductive endocrinology and PCOS … See Full Bio View all posts by Amy Desrochers DiVasta, MD, MMSc

Are online gambling and sports betting new to your area? Are gambling advertisements catching your eye? Have you noticed sports and news shows covering the spread? Recent changes in laws have made gambling widely accessible, and its popularity has soared.

Occasional bets are rarely an issue. But uncontrolled gambling can lead to financial, psychological, physical, and social consequences, some of which are extreme. Understanding whether gambling is becoming a problem in your life can help you head off the worst of these issues and refocus on having more meaning, happiness, and psychological richness in your life. Gambling screening is a good first step.

Can you screen yourself for problem gambling?

Yes. Screening yourself is easy. The Brief Biosocial Gambling Screen (note: automatic download) is a validated way to screen for gambling disorder. It has three yes-or-no questions. Ask yourself:

• During the past 12 months, have you become restless, irritable, or anxious when trying to stop/cut down on gambling?
• During the past 12 months, have you tried to keep your family or friends from knowing how much you gambled?
• During the past 12 months, did you have such financial trouble as a result of your gambling that you had to get help with living expenses from family, friends, or welfare?

What do your answers mean?

Answering yes to any one of these questions suggests that you are at higher risk for experiencing gambling disorder. Put simply, this is an addiction to gambling. Like other expressions of addiction, for gambling this includes loss of control, craving, and continuing despite bad consequences. Unique to gambling, it also often means chasing your losses.

A yes doesn’t mean that you are definitely experiencing a problem with gambling. But it might be valuable for you to seek a more in-depth assessment of your gambling behavior. To find an organization or person qualified to help, ask a health care provider, your local department of public health, or an advocacy group like the National Council on Problem Gambling.

Are you ready for change?

Your readiness to change a behavior matters when deciding the best first steps for making a change. If someone asks you whether you want to change your gambling, what would you say?

Depending on your answer, you might seek out different solutions. What’s most important initially is choosing a solution that feels like the right fit for you.

What if you don’t feel ready to change? If you haven’t thought about your gambling or only occasionally think about changing your gambling, you might explore lower intensity actions. For example, you could

• read more about how gambling could create a problem for you
• listen to stories of those who have lived experience with gambling disorder.

If you are committed to making a change or are already trying to change, you might seek out more engaging resources and strategies to support those decisions, like attending self-help groups or participating in treatment.

Read on for more details on choices you might make.

What options for change are available if you want to continue gambling?

If you want to keep gambling in some way, you might want to stick to lower-risk gambling guidelines:

• gamble no more than 1% of household income
• gamble no more than four days per month
• avoid regularly gambling at more than two types of games, such as playing the lottery and betting on sports.

Other ways to reduce your risk of gambling harm include:

• Plan ahead and set your own personal limits.
• Keep your entertainment budget in mind if you decide to gamble.
• Consider leaving credit cards and debit cards at home and use cash instead.
• Schedule other activities directly after your gambling to create a time limit.
• Limit your use of alcohol and other drugs if you decide to gamble.

What are easy first steps toward reducing or stopping gambling?

If you’re just starting to think about change, consider learning more about gambling, problem gambling, and ways to change from

• blogs, like The BASIS
• books like Change Your Gambling, Change Your Life
• podcasts like After Gambling, All-In, and Fall In, which offer expert interviews, personal recovery stories, and more.

Some YouTube clips demystify gambling, such as how slot machines work, the limits of skill and knowledge in gambling, and how gambling can become an addiction. These sources might help you think about your own gambling in new ways, potentially identifying behaviors that you need to change.

What are some slightly more active steps toward change?

If you’re looking for a slightly more active approach, you can consider engaging in traditional self-help experiences such as helplines and chatlines or Gamblers Anonymous.

Another option is self-help workbooks. Your First Step to Change is a popular workbook that provides information about problem gambling, self-screening exercises for gambling and related conditions like anxiety and depression, and change exercises to get started. A clinical trial of this resource suggested that users were more likely than others to report having recently abstained from gambling.

Watch out for gambling misinformation

As you investigate options, keep in mind that the quality of information available can vary and may even include misinformation. Misinformation is incorrect or misleading information. Research suggests that some common types of gambling misinformation might reinforce harmful beliefs or risky behaviors.

For example, some gambling books, websites, and other resources exaggerate your likelihood of winning, highlight win and loss streaks as important (especially for chance-based games like slots), and suggest ways to change your luck to gain an edge. These misleading ideas can help you to believe you’re more likely to win than you actually are, and set you up for failure.

The bottom line

Taking a simple self-screening test can start you on a journey toward better gambling-related health. Keep in mind that change can take time and won’t necessarily be a straight path.

If you take a step toward change and then a step back, nothing is stopping you from taking a step forward again. Talking with a care provider and getting a comprehensive assessment can help you understand whether formal treatment for gambling is a promising option for you.

About the Author

Debi LaPlante, PhD, Contributor

Dr. Debi LaPlante is director of the division on addiction at the Cambridge Health Alliance, and an associate professor of psychiatry at Harvard Medical School. She joined the division in 2001 and is involved with its … See Full Bio View all posts by Debi LaPlante, PhD

Last year, headlines describing a study about artificial intelligence (AI) were eye-catching, to say the least:

• ChatGPT Rated as Better Than Real Doctors for Empathy, Advice
• The AI will see you now: ChatGPT provides higher quality answers and is more empathetic than a real doctor, study finds
• Is AI Better Than A Doctor? ChatGPT Outperforms Physicians In Compassion And Quality Of Advice

At first glance, the idea that a chatbot using AI might be able to generate good answers to patient questions isn’t surprising. After all, ChatGPT boasts that it passed a final exam for a Wharton MBA, wrote a book in a few hours, and composed original music.

But showing more empathy than your doctor? Ouch. Before assigning final honors on quality and empathy to either side, let’s take a second look.

What tasks is AI taking on in health care?

Already, a rapidly growing list of medical applications of AI includes drafting doctor’s notes, suggesting diagnoses, helping to read x-rays and MRI scans, and monitoring real-time health data such as heart rate or oxygen level.

But the idea that AI-generated answers might be more empathetic than actual physicians struck me as amazing — and sad. How could even the most advanced machine outperform a physician in demonstrating this important and particularly human virtue?

Can AI deliver good answers to patient questions?

It’s an intriguing question.

Imagine you’ve called your doctor’s office with a question about one of your medications. Later in the day, a clinician on your health team calls you back to discuss it.

Now, imagine a different scenario: you ask your question by email or text, and within minutes receive an answer generated by a computer using AI. How would the medical answers in these two situations compare in terms of quality? And how might they compare in terms of empathy?

To answer these questions, researchers collected 195 questions and answers from anonymous users of an online social media site that were posed to doctors who volunteer to answer. The questions were later submitted to ChatGPT and the chatbot’s answers were collected.

A panel of three physicians or nurses then rated both sets of answers for quality and empathy. Panelists were asked “which answer was better?” on a five-point scale. The rating options for quality were: very poor, poor, acceptable, good, or very good. The rating options for empathy were: not empathetic, slightly empathetic, moderately empathetic, empathetic, and very empathetic.

What did the study find?

The results weren’t even close. For nearly 80% of answers, ChatGPT was considered better than the physicians.

• Good or very good quality answers: ChatGPT received these ratings for 78% of responses, while physicians only did so on 22% of responses.
• Empathetic or very empathetic answers: ChatGPT scored 45% and physicians 4.6%.

Notably, the length of the answers was much shorter for physicians (average of 52 words) than for ChatGPT (average of 211 words).

Like I said, not even close. So, were all those breathless headlines appropriate after all?

Not so fast: Important limitations of this AI research

The study wasn’t designed to answer two key questions:

• Do AI responses offer accurate medical information and improve patient health while avoiding confusion or harm?
• Will patients accept the idea that questions they pose to their doctor might be answered by a bot?

And it had some serious limitations:

• Evaluating and comparing answers: The evaluators applied untested, subjective criteria for quality and empathy. Importantly, they did not assess actual accuracy of the answers. Nor were answers assessed for fabrication, a problem that has been noted with ChatGPT.
• The difference in length of answers: More detailed answers might seem to reflect patience or concern. So, higher ratings for empathy might be related more to the number of words than true empathy.
• Incomplete blinding: To minimize bias, the evaluators weren’t supposed to know whether an answer came from a physician or ChatGPT. This is a common research technique called “blinding.” But AI-generated communication does not always sound exactly like a human, and the AI answers were significantly longer. So, it’s likely that for at least some answers, the evaluators were not blinded.

The bottom line

Could physicians learn something about expressions of empathy from AI-generated answers? Possibly. Might AI work well as a collaborative tool, generating responses that a physician reviews and revises? Actually, some medical systems already use AI in this way.

But it seems premature to rely on AI answers to patient questions without solid proof of their accuracy and actual supervision by healthcare professionals. This study wasn’t designed to provide either.

And by the way, ChatGPT agrees: I asked it if it could answer medical questions better than a doctor. Its answer was no.

We’ll need more research to know when it’s time to set the AI genie free to answer patients’ questions. We may not be there yet — but we’re getting closer.

Want more information about the research? Read responses composed by doctors and a chatbot, such as answers to a concern about consequences after swallowing a toothpick.

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

If you’ve ever tried to lose excess weight, you’ve probably gotten this advice: drink more water. Or perhaps it was more specific: drink a full glass of water before each meal.

The second suggestion seems like a reasonable idea, right? If you fill your stomach with water before eating, you’ll feel fuller and stop eating sooner. But did that work for you? Would drinking more water throughout the day work? Why do people say drinking water can help with weight loss — and what does the evidence show?

Stretching nerves, burning calories, and thirst versus hunger

Three top theories are:

Feel full, eat less. As noted, filling up on water before meals has intuitive appeal. Your stomach has nerves that sense stretch and send signals to the brain that it’s time to stop eating. Presumably, drinking before a meal could send similar signals.

• The evidence: Some small, short-term studies support this idea. For example, older study subjects who drank a full glass of water before meals tended to eat less than those who didn’t. Another study found that people following a low-calorie diet who drank extra water before meals had less appetite and more weight loss over 12 weeks than those on a similar diet without the extra water. But neither study assessed the impact of drinking extra water on long-term weight loss.

Burning off calories. The water we drink must be heated up to body temperature, a process requiring the body to expend energy. The energy spent on this — called thermogenesis — could offset calories from meals.

• The evidence: Though older studies provided some support for this explanation, more recent studies found no evidence that drinking water burned off many calories. That calls the thermogenesis explanation for water-induced weight loss into question.

You’re not hungry, you’re thirsty. This explanation suggests that sometimes we head to the kitchen for something to eat when we’re actually thirsty rather than hungry. If that’s the case, drinking calorie-free water can save us from consuming unnecessary calories — and that could promote weight loss.

• The evidence: The regulation of thirst and hunger is complex and varies over a person’s lifespan. For example, thirst may be dulled in older adults. But I could find no convincing studies in humans supporting the notion that people who are thirsty misinterpret the sensation for hunger, or that this is why drinking water might help with weight loss.

Exercise booster, no-cal substitution, and burning fat demands water

Being well-hydrated improves exercise capacity and thus weight loss. Muscle fatigue, cramping, and heat exhaustion can all be brought on by dehydration. That’s why extra hydration before exercise may be recommended, especially for elite athletes exercising in warm environments.

• The evidence: For most people, hydrating before exercises seems unnecessary, and I could find no studies specifically examining the role of hydration to exercise-related weight loss.

Swapping out high calorie drinks with water. Yes, if you usually drink high-calorie beverages (such as sweetened sodas, fruit juice, or alcohol), consistently replacing them with water can aid weight loss over time.

• The evidence: A dramatic reduction in calorie intake by substituting water for higher-calorie beverages could certainly lead to long-term weight loss. While it’s hard to design a study to prove this, indirect evidence suggests a link between substituting water for high-cal beverages and weight loss. Even so, just as calorie-restricting diets are hard to stick with over the long term, following a water-only plan may be easier said than done.

Burning fat requires water. Dehydration impairs the body’s ability to break down fat for fuel. So, perhaps drinking more water will encourage fat breakdown and, eventually, weight loss.

• The evidence: Though some animal studies support the idea, I could find no compelling evidence from human studies that drinking extra water helps burn fat as a means to lose excess weight.

The bottom line

So, should you bump up hydration by drinking water before or during meals, or even at other times during the day?

Some evidence does suggest this might aid weight loss, at least for some people. But those studies are mostly small or short-term, or based on animal data. Even positive studies only found modest benefits.

That said, if you think it’s working for you, there’s little downside to drinking a bit more water, other than the challenge of trying to drink if you aren’t particularly thirsty. My take? Though plenty of people recommend this approach, it seems based on a theory that doesn’t hold water.

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