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If the first goal of a drug advertisement is to grab your attention, this ad for Entyvio (vedolizumab) works.

You see a young woman getting into her car, sitting in her work cubicle, sitting in a restaurant, and finally in the waiting room of her doctor’s office. But she’s not sitting on the seat of the car or on a chair; in every scene, she’s sitting on the lid of a toilet.

Strange, right?

Why all the toilets?

The voiceover provides a clue: “When you live with moderate or severe Crohn’s disease or ulcerative colitis, your day can be full of reminders of your condition. Never knowing, always wondering.” And there’s another hint: the woman keeps grimacing and clutching her belly.

But these clues may not be enough. What’s never explained in this ad is that abdominal pain and sudden diarrhea are among the most common symptoms of Crohn’s disease and ulcerative colitis, conditions known collectively as inflammatory bowel disease (IBD). The “never knowing, always wondering” refers to the way people with these conditions often have unpredictable bouts of diarrhea and an urgent need to get to a restroom. And that’s why there are toilets everywhere.

What does this ad get right?

The ad provides useful information about:

• How this treatment works. Crohn’s disease and ulcerative colitis are two forms of IBD that cause inflammation of the intestinal tract. Given as an infusion every two months, vedolizumab works by blocking cells involved in that inflammation. The ad uses visually appealing animations and graphics to get these points across.
• Side effects. The FDA requires every drug ad to describe common and potentially serious side effects. For vedolizumab, possible side effects include infusion reactions, allergic reactions, liver problems, and an increased susceptibility to infection. The ad highlights an infection called PML, noting that it’s “a rare, serious, potentially fatal brain infection.”
• Benefits. The voiceover states that “in clinical trials, Entyvio helped many people achieve long-term relief and remission.”

What else do you need to know?

As with most drug ads, this ad doesn’t provide all the information that’s important to know about this medication, especially if you’re a person with IBD for whom this drug might be helpful.

For starters, the ad never explains that diarrhea and abdominal pain are among the most common symptoms of Crohn’s disease and ulcerative colitis. And while the ad focuses on frequent diarrhea, it never mentions more serious complications, such as

• bleeding, fistulas (abnormal connections between the intestines and other parts of the body), perforation of the bowel, and bowel blockage 
• an increased risk of colorectal cancer
• inflammation in other parts of the body, including joints and eyes.

The ad also omits:

• Explaining how moderate to severe Crohn’s and ulcerative colitis is defined. Generally, it would include people with either condition who have large areas of intestinal inflammation, deep ulcers in the walls of the intestines, or who have had surgery; and those who haven’t responded to other standard treatments.
• Other ways to treat Crohn’s disease or ulcerative colitis. Steroids, azathioprine, infliximab, ustekinumab, risankizumab, and other drugs are also options to treat these disorders. 
• The high cost of this drug (up to $52,000/year). For some, health insurance may cover much of this cost, and a discount program is mentioned at the end of the ad (though eligibility details are not provided). Still, for many people with IBD, the cost of expensive drugs like Entyvio is a major barrier to receiving optimal care.

Also troubling is the way the ad skims over two important points:

• Little information is provided about PML. The ad doesn’t even say what the letters stand for: progressive multifocal leukoencephalopathy. PML is a virus that can infect the brain, often causing death or severe neurologic disease.
• What benefits does the drug deliver? Only one sentence speaks confidently about benefits, and no details are provided. How often people do taking this drug have at least some relief from their symptoms? How often do they experience remission of symptoms? And how long do these improvements last?

The bottom line

The ad ends with the young woman driving home after her doctor’s visit. She’s sitting on a regular seat for the first time. She glances at the rearview mirror and smiles at the toilet that’s been relegated to the back of the car. The message is clear: she’s better now and doesn’t have to worry about having to rush to the toilet since her doctor prescribed vedolizumab.

Of course, it doesn’t always work out this way in real life. Then again, drug ads aren’t intended to show real life. They’re intended to promote a product. That’s a good reason to maintain a healthy dose of skepticism about drug ads, and to rely instead on your doctor and other unbiased sources for your health information, such as the National Institutes of Health websites.

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

Wriggling toes in the sand and wearing sandals are warm weather treats, unless you’d rather keep your toes under wraps due to thickened, yellowish nails. Nail fungal infections (known as onychomycosis) are common, affecting up to 14% of the general population. In advanced cases, nails can become brittle, crumbly, or ragged, or even separate from the nail bed.

While completely curing these fungal infections is difficult, the right treatments can discourage the problem from spreading and make your nails look better.

Do nail fungal infections only affect toenails?

No, fingernails can become infected, too. However, toenails are a more common target because of certain habits, including wearing shoes, so we’ll concentrate on them in this post.

How do people get toenail fungus?

“Feet are more likely to be sweaty and damp, which provides a better environment for the fungi, yeasts, and molds that are naturally present on your skin to flourish,” says Dr. Abigail Waldman, a dermatologist at Harvard-affiliated Brigham and Women’s Hospital.

People also can be exposed to various fungi, known as dermatophytes, by walking barefoot in locker rooms, spas, or near swimming pools, or getting a pedicure at a nail salon, she says. A fungal overgrowth can infect the area between your toes and the skin or your feet, causing athlete’s foot. The fungus can then spread to the toenails.

What makes toenail fungus hard to treat?

While antifungal creams can easily treat skin infections, toenails are another story.

“Nail tissue is harder and thicker, so these medications don’t penetrate very well,” Dr. Waldman explains. That’s also true for antifungal drugs taken as pills. Toenails grow slowly and the tissue isn’t very metabolically active. So although the medication gets into your bloodstream, only small amounts end up in your toenails. That’s why it’s hard to get rid of toenail fungus once it takes hold.

What counts as a cure?

Research reports so-called clinical cure rates between 60% to 80%, but this means only the absence of symptoms — that is, your toenails return to their normal appearance. The fungal infection may still be lurking under your nails, says Dr. Waldman.

In fact, in clinical trials when investigators recheck toenail clippings for any residual fungus after treatments applied to nails, only around 10% to 15% show no detectable fungal spores. As a result, recurrences of toenail fungal infections are fairly common.

Despite this, there’s a reasonable chance that different treatment approaches can improve your symptoms and the appearance of your toenails.

What works for treating toenail fungus?

Here is a rundown of the different treatment options, starting with Dr. Waldman’s go-to first-line suggestion, which uses inexpensive products you may already have in your home.

Home remedies

Soaking your toes to soften your nails before applying a fungus-fighting agent will help the remedy penetrate the nail. For the soak, Dr. Waldman recommends mixing one part white or apple cider vinegar to three parts warm water. Soak your toes for at least 10 minutes (but up to 40 minutes is better). Instead of vinegar, you can use Listerine, which contains thymol, the main compound in the herb thyme. Like vinegar, thymol has antifungal properties.

Then dry your feet well and apply an antifungal substance to all the affected nails. One option is a paste of crushed garlic, but most people will probably find the over-the-counter drugstore products listed below more convenient to use.

Over-the-counter products

The best evidence is for 100% tea tree oil, but another popular option is Vicks VapoRub (which also contains thymol and other essential oils that may fight fungus), Dr. Waldman says. Or you can use one of the various creams sold to treat athlete’s foot on your toenails.

Be sure to apply the product right after soaking. The clinical cure rates for each of these approaches vary between products, and depend on the severity and duration of the infection. But about 60% of people notice improvements after a few months of treatment, Dr. Waldman says.

Drugstores also carry several other toenail treatments, including a treated patch you put on your nails overnight. It contains urea, an acidic substance that improves the look of your nails by making them less brittle and discolored. Another product that promises similar results uses a tiny LED light that you clip onto your toenail after applying a liquid containing polyethylene glycol, which softens nails.

Prescription treatments to put on toenails

These topical products, which are best for milder infections, include amorolfine (Loceryl, others), efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox (Penlac). They are clear lacquers that you brush on your toenails once daily, usually for months. It may take as long as a year to see results. Clinical cure rates range from 35% to 60%.

Prescription pills

More severe infections may respond better to oral drugs, which include fluconazole (Diflucan), griseofulvin (Grifulvin), itraconazole (Sporanox), and terbinafine (Lamisil). These are taken daily in pill form for three months. While the clinical cure rates are higher (around 80%), these drugs have more side effects, including stomach upset, diarrhea, and (in rare cases) liver damage.

Laser therapy

Lasers penetrate and break down nail tissue, helping to destroy the fungus. There are many different types of lasers and protocols. Clinical cure rates are hard to pin down, but some have been reported as ranging between 60% and 75%.

Advice on toenail clippers, nail polish, new shoes, and more

During and after treatment, Dr. Waldman advises people to use two sets of toenail clippers — one for infected nails and one for noninfected nails — to prevent fungal spread. If you’re embarrassed by the appearance of your toenails, it’s okay to use nail polish for short periods of time, she says.

Once you finish treatment, buying new shoes will help avoid reinfection. “I also always recommend people do a diluted vinegar soak once or twice a week after finishing treatment, which helps prevent any lingering fungus from reinfecting the nail,” says Dr. Waldman.

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 first two weeks of July were the Earth’s hottest on human record, and people across the country continue to suffer from lingering, suffocating heat waves. The US Centers for Disease Control and Prevention has issued repeated warnings and tips about recognizing and preventing heat-related illnesses, like heat stroke, heat exhaustion, and heat cramps.

But one heat-related illness that people do not always recognize is heat rash.

“Heat rash can indicate that your exposure to excessive heat could lead to other serious heat-related issues, if not addressed,” says Dr. Abigail Waldman, a dermatologist with Harvard-affiliated Brigham and Women’s Hospital. "While heat rash is not dangerous in itself, sustained exposure to high heat can lead to heat exhaustion and heat stroke, so it's important to note any early signs that your body is struggling with the heat.”

What are the signs of heat rash?

Heat rash is also known as miliaria or prickly heat. It is caused when ducts from eccrine sweat glands that lead to the skin's surface are blocked or inflamed.

Eccrine sweat glands help your body maintain a steady temperature. When your internal temperature rises, these glands release water that rises to the surface of your skin through tiny ducts. There, it quickly evaporates, cooling your skin and the blood beneath.

However, sweat ducts may get blocked when you sweat excessively in hot temperatures, particularly if skin folds or tight-fitting clothes hinder their function.

Sweat is then trapped beneath the skin. This triggers inflammation, which leads to the appearance of small, itchy red bumps, similar to tiny pimples or blisters. In people with darker skin tones, these small, itchy bumps may not appear red, but will look slightly darker than surrounding skin.

Where and when is heat rash likely to occur?

Heat rash can appear on the neck, scalp, chest, groin, or elbow creases.

“Heat rash can occur any time the body sweats, so it is common in hot, humid climates, during hospitalizations, from fever, and during exercise,” says Dr. Waldman.

Heat rash also can occur in newborns, as their eccrine sweat glands are not fully developed. In newborns, heat rash looks like very thin blisters or water drops widely distributed on the face, trunk, arms, and legs. Call your pediatrician for advice if you notice a rash like this.

How can you treat heat rash?

Heat rash in adults is easy to treat with home remedies. “The techniques to relieve symptoms also can help prevent heat rash for adults and babies,” says Dr. Waldman.

• Cool down. The first step is to get out of the heat and cool and dry your skin. Use a fan or air conditioner, take a cool shower, or apply cool compresses to the affected areas. It's important to know that some people are more vulnerable to heat, and to make plans to help stay safe when temperatures are dangerously high.
• Prevent irritation. To prevent skin irritation, avoid wearing clothes made from synthetic materials, which can trap heat. (While dry-fit clothing helps to wicks away moisture from the skin, it often can be too tight fitting.) Instead, wear light, loose-fitting cotton clothing that allows airflow over your skin. If a heat rash occurs around your groin area, avoid wearing undergarments until it clears up.
• Try anti-itch products. Use an over-the-counter topical corticosteroid cream or calamine lotion for itching. However, avoid baby powder, oily or greasy moisturizers, and sunscreen, as they can further block sweat ducts.

Heat rash typically goes away within one to two days once you cool down your body. More severe heat rashes can last a week or longer. See your doctor (or follow up with your pediatrician) if a heat rash has not cleared up after a week. Also seek immediate care if you experience pain, intense itching, or the rash appears infected.

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

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

“Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field,” says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

• Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.
• Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.
• Bend your legs when you land. Don’t lock your knees.
• Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

• You can hold your arms in front of you or let them swing naturally.
• Try not to hunch or round your shoulders forward as you jump.
• To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

• Begin with two minutes of jumping rope, then increase the time or add extra sets.
• Break it up into 10- to 30-second segments if two minutes is too difficult.
• If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

• Let your arms swing naturally during the hop.
• To make this exercise easier, hop a shorter distance and stay closer to the floor.
• If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

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

Ever see ads for products that promise to supercharge immunity? Activate your body’s natural defenses? Support a healthy immune system while delivering a potent boost derived from nature’s hottest immune-enhancing ingredients?

While the words may change to reflect the latest trends, the claims certainly sound amazing. But do the multitude of products promoted as immune boosters actually work? What steps can we take to support the immune system? Both are important questions, especially in the wake of a deadly pandemic and as flu and cold season arrives.

IV drips, supplements, cleanses, and superfoods

The lineup of immune-boosting products and advice includes:

• Home intravenous (IV) drips. Want a health professional to come to your home with IV fluids containing various vitamins and supplements? That’s available in many US cities, and some companies claim their formula is designed to supercharge immunity. These on-demand IV treatments aren’t risk-free and can be quite expensive.
• Vitamins and supplements. Popular options include turmeric, milk thistle, and echinacea, often in combination with various vitamins. Hundreds of formulations are available.
• Superfoods and foods to avoid. If you search online for “foods to boost the immune system” you’ll see thousands of articles touting blueberries, broccoli, spinach, dark chocolate, and other foods to keep infections away. There’s also a list of foods to avoid, such as sugary drinks or highly processed meats, because they’re supposed to be bad for your immune system.
• Cleanses and detox treatments. No doubt you’ve seen pitches for cleanses and detox products intended to remove toxins from the body. Their marketing warns that the environment is full of harmful substances that get into the body through the air, water, and food, which we need to remove. Advocates suggest that, among other harmful effects, these often unnamed toxins make your immune system sluggish.

Are the heavily marketed IV drips, supplements, or detox products endorsed by the FDA?

No. In fact, the standard disclaimer on supplements’ claims of immune-boosting properties says: “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Yet sellers are allowed to use phrases like “boosts immune function” and “supports immune health.” These terms have always seemed vague to me. More importantly, they’re confusing:

• Boosting immunity is what vaccinations do. They prime your immune system to help fight off a specific infectious organism (like the flu shot before each flu season).

• Immune support typically describes vitamins such as vitamin C, or other nutrients necessary for a healthy immune system. It’s true that a deficiency of vital nutrients can cause poor immune function. But that doesn’t mean a person with normal levels of nutrients can expect supplements to improve their immune system.

Can products marketed as immune boosters actually boost immunity?

Unless you have a deficiency in a key nutrient, such as vitamin C or zinc, the short answer is no.

That is, there’s no convincing evidence that any particular product meaningfully improves immune function in healthy people. For example, results of studies looking at various supplements for colds and other similar infections have been mixed at best. Even when taking a particular supplement was linked to reduced severity or duration of an infection like a cold, there’s no proof that the supplement boosted overall immune function.

This goes for individual foods as well. None has ever been shown to improve immune function on its own. It’s the overall quality of your diet, not individual foods, that matters most. A similar approach applies to advice on foods you should avoid, such as sugary drinks or highly processed meats: the best foods to avoid in support of your immune system are the same ones you should be limiting anyway.

How to get the most out of your immune system

It’s not a secret and it’s not a product. What’s good for your overall health is good for immune function. The best ways to keep your immune system at peak performance are:

• Eat well and follow a heart-healthy diet, such as the Mediterranean diet.
• Exercise regularly and maintain a healthy weight.
• Don’t smoke or vape.
• If you drink alcoholic beverages, drink only in moderation.
• Get plenty of sleep.
• Minimize stress.
• Get regular medical care, including routine vaccinations.
• Take measures to prevent infection such as frequent hand washing, avoiding people who might have a contagious illness, and wearing a mask when it’s recommended.

This list probably looks familiar. These measures have long been recommended for overall health, and can do a lot to help many of us.

Certain illnesses — HIV, some cancers, and autoimmune disorders — or their treatments can affect how well the immune system works. So some people may need additional help from medications and therapies, which could truly count as immune boosting.

The bottom line

Perhaps there will come a time when we’ll know how to boost immune function beyond following routine health measures. That’s simply not the case now. Until we know more, I wouldn’t rely on individual foods, detox programs, oral supplements, or on-demand IV drips to keep your immune system healthy, especially when there are far more reliable options.

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 the eyes are the windows to the soul, then consider the tongue a sort of check-engine light for the body. The tongue’s appearance gives doctors an idea about certain aspects of your health, and its color is an important clue.

What should your tongue look like?

The tongue should have a rounded, symmetrical shape. It’s generally light pink, though it may have a little purple or brown pigmentation in African, Asian, and Mediterranean populations. It can also have a hint of white coating.

“The coating comes from a tough protein called keratin, which helps keep your tongue from being scratched when you eat,” says Dr. Tien Jiang, a prosthodontist in the Department of Oral Health Policy and Epidemiology at the Harvard School of Dental Medicine.

Up close, you might be able to see that your tongue is covered in tiny bumps (papillae) that serve several purposes:

• They sense temperature and touch.
• They contain taste buds that enable you to detect if food is sweet, salty, sour, bitter, or savory.
• They create friction to help you form a little ball of food (bolus) that you can swallow.

Can diet affect tongue color?

Yes. Sometimes diet may be partly to blame for a shift away from your usual tongue tone. That’s because the papillae can absorb the colors and residues of foods and drinks you consume. For example, that blue popsicle or candy you ate as a kid probably turned your tongue an exciting shade of azure. Coffee, tea, and many types of foods, such as curried dishes with lots of yellow turmeric, can also leave their marks.

Discoloration is usually just temporary, however. Drinking plenty of water and maintaining good oral hygiene will wash away food and dyes that cling to the tongue.

A dark or bright tongue, white patches, and other causes for concern

Some tongue colors and appearances are signs of health issues. Check with your doctor if you notice any of the following:

• A brown or black tongue signals a condition called “black hairy tongue.” This occurs when papillae get too long. These tiny bumps don’t usually get much chance to grow because they are shed regularly with all the activity in your mouth. If they do grow, they can trap bacteria and a mix of food colors, leading to the brown or black tinge. Risk factors include taking antibiotics or antihistamines, smoking, dry mouth, drinking excessive amounts of coffee or black tea, or poor oral hygiene.
• Thick white patches or white sores on the tongue probably mean you have an overgrowth of yeast in the mouth (thrush). Thrush can be triggered by conditions such as diabetes or HIV, side effects of antibiotics or cancer treatment, wearing dentures, smoking, dry mouth, or using steroid inhalers. In rare cases, white patches or sores are symptoms of oral cancer.
• If your tongue has painful red or yellow sores, you might be dealing with canker sores (irritated tissues), thrush (which can sometimes appear as red patches), or (in rare cases) oral cancer.
• A bright red tongue can indicate that you have a vitamin B12 deficiency or an infection called scarlet fever — a Streptococcus bacteria infection in the throat (strep throat) accompanied by a red body rash. If you have bright red patches that don’t hurt and seem to migrate from one place on the tongue to another, you might have a harmless, incurable condition called “geographic tongue.”

Should you brush your tongue or use a tongue scraper?

Good oral hygiene requires that you floss your teeth at least once a day and brush them at least twice a day. Take a few seconds to use the brush on your tongue.

“Stick out your tongue and swipe your toothbrush from the back of your tongue to the front: one swipe down the middle, one swipe down the left side, and one swipe down the right side. That helps remove bacteria and debris that collect in papillae,” Dr. Jiang says.

Some people swear by using a tongue scraper to clean the tongue. Dr. Jiang isn’t a fan, but doesn’t have a problem with someone using the tool, which is pulled forward on the tongue in a similar fashion to brushing the tongue. “The data about tongue scraper effectiveness are mixed,” she says. “It just comes down to what you’re willing to do daily to keep your tongue, teeth, mouth, and gums as healthy as possible.”

Worried about your tongue? What to do

If you’re worried about anything wrong with your tongue — especially if you also have a fever, a very sore throat, sores that won’t go away, or other new symptoms — call your primary care doctor or dentist.

Your doctor or dentist can

• assess your condition
• prescribe or suggest treatments to relieve discomfort, such as medicated mouthwashes or warm-water rinses
• urge you to stay hydrated and step up your oral hygiene.

If necessary, your doctor can refer you to a specialist for further evaluation.

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

Brittany Jordan-Arthur was at loggerheads with her 7-year-old daughter one recent morning. The little girl simply did not want to head out the door to summer camp, finding any and all excuses to hang back.

But instead of expressing exasperation or annoyance — knowing that would make her daughter dig in her heels even more — Jordan-Arthur, a psychologist at Harvard-affiliated McLean Hospital, decided to use a valuable communication technique: validation. Like many skills, the more you practice validation, the easier it becomes to apply when it’s most needed. Here’s what to know and do.

What is validation?

An approach that can help people feel heard and understood, validation is especially useful when navigating emotionally charged situations. Validating someone shows you understand their feelings and point of view, even when you disagree. It establishes trust, helping the other person feel supported and open to discussing solutions.

And that’s precisely what happened in Jordan-Arthur’s stalemate with her daughter.

“I just sat with her and said, ‘You really don’t want to go.’ It was a great example of saying, ‘I hear you,’ and ultimately I didn’t tell her she had to go or why — she came to that conclusion herself,” Jordan-Arthur says. “We walked out the door without all the need for explanations.”

Many try validation but don’t succeed

Validation is fundamental to a type of talk therapy called dialectical behavior therapy (DBT), which is geared toward people who experience emotions very intensely. Many people use some aspects of validation in everyday communications with family members, friends, and colleagues, but usually fall short, Jordan-Arthur says. How?

“They jump into problem-solving, saying something validating, but then immediately tell the person what they should have done or what they should do next,” she says. “They don’t let that validation sink in. It’s like putting on anti-itch cream and then immediately washing it off.”

How can you offer validation?

Jordan-Arthur shares these pointers for validating another person:

• Give them your full attention.
• Make eye contact and nod appropriately, saying “uh huh” while showing your interest.
• Reflect what you’ve heard by restating their message, such as, “It sounds like you feel worse about this situation today than yesterday.”
• Verbalize the unspoken, such as, “I hear that you feel you can’t get anything done because of this obstacle,” or “It sounds like you’re frustrated.”
• Give it time to work! Be sure to let the validation sink in before attempting to problem- solve.

Does validation condone troubling behavior?

Validation isn’t the same as condoning someone’s bad or frustrating behavior, Jordan-Arthur notes. It’s not akin to reassuring them when reassurance isn’t appropriate.

“You may be afraid you’re going to communicate that you approve of their behavior or agree with their actions or choices,” she says. “But if you slow down and validate how someone feels in the moment, before a poor decision is made, validating accomplishes exactly the opposite.”

Try this phrasing instead:

• “I hear that this is important to you.”
• “I can see how this has been so upsetting/difficult/scary for you.”

How can you validate teens?

Validating teenagers isn’t dissimilar from the tactics Jordan-Arthur used with her 7-year-old — the problems just tend to be bigger. For example, teens often feel stuck with teachers they don’t like or complain that teachers seem overly harsh.

“Parents have lots of urges to say, ‘Oh, the teacher isn’t that bad’ or ‘I’m sure they mean well,’ defending the teacher and his or her perspective,” Jordan-Arthur says. “The odds are, by the time a kid is a teen, they also have that skill, but it’s going to take them a moment to get there.”

Here’s what to say instead:

• “I hear that you don’t feel respected.”
• “It’s so hard to feel helpless.”
• “It’s difficult to feel your teacher has control over how well you do in class.”

“You can validate their feelings even if you feel the teacher is being respectful,” Jordan-Arthur adds.

How can you validate adults?

Validating other adults in your professional or personal life involves much the same approach. With a colleague who’s feeling undervalued at the office, for instance, try saying, “It makes total sense that you’re feeling really frustrated. I know how important your work is to you.”

If you’re arguing with a spouse or partner, you can believe them as being genuine, Jordan-Arthur says, despite a difference of opinion. Try saying, “I can tell that this issue feels really important to you and you want me to pay attention to what you’re saying.”

It’s also wise to pay attention to the other person’s body language during heated moments. After validating them — but before offering a potential solution to a problem — look for clues that they’re calming down, such as breathing and gesturing more slowly.

“I encourage people to count to 10 in their heads, because we still tend to jump the gun and not wait for the other person to feel that validation,” she says. “If we do that, they’ll often move past the idea that ‘this person wronged me’ and start solving the problem on their own.”

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

While the FDA rules for blood donation were revised twice in the last decade, one group — men who have sex with men (MSM) — continued to be turned away from donating. Now new, evidence-based FDA rules embraced by the American Red Cross will focus on individual risk rather than groupwide restrictions.

Medical experts consider the new rules safe based on extensive evidence. Let’s review the changes here.

The new blood donation rules: One set of questions

The May 2023 FDA guidelines recommend asking every potential blood donor the same screening questions. These questions ask about behavior that raises risk for HIV, which can be spread through a transfusion.

Blood donation is then allowed, or not, based on personal risk factors for HIV and other blood-borne diseases.

Questions for potential blood donors

Screening questions focus on the risk of recent HIV infection, which is more likely to be missed by routine testing than a longstanding infection.

The screening questions ask everyone — regardless of gender, sex, or sexual orientation — whether in the past three months they have

• had a new sexual partner and engaged in anal sex
• had more than one sexual partner and engaged in anal sex
• taken medicines to prevent HIV infection (such as pre-exposure prophylaxis, or PrEP)
• exchanged sex for pay or drugs, or used nonprescription injection drugs
• had sex with someone who has previously tested positive for HIV infection
• had sex with someone who exchanged sex for pay or drugs
• had sex with someone who used nonprescription injection drugs.

When is a waiting period recommended before giving blood?

• Answering no to all of these screening questions suggests a person has a low risk of having a recently acquired HIV infection. No waiting period is necessary.
• Answering yes to any of these screening questions raises concern that a potential donor might have an HIV infection. A three-month delay before giving blood is advised.

Does a waiting period before giving blood apply in other situations?

Yes:

• A three-month delay before giving blood is recommended after a blood transfusion; treatment for gonorrhea or syphilis; or after most body piercings or tattoos not done with single-use equipment. These are not new rules.
• A waiting period before giving blood is recommended for people who take medicines to prevent HIV infection, called PrEP (pre-exposure prophylaxis). PrEP might cause a test for HIV to be negative even if infection is present. The new guidelines recommend delaying blood donation until three months after the last use of PrEP pills, or a two-year delay after a person receives long-acting, injected PrEP.

Who cannot donate blood?

Anyone who has had a confirmed positive test for HIV infection or has taken medicines to treat HIV infection is permanently banned from donating blood. This rule is not new.

Why were previous rules more restrictive?

In 1983, soon after the HIV epidemic began in the US, researchers recognized that blood transfusions could spread the infection from blood donor to recipient. US guidelines banned men who had sex with men from giving blood. A lifetime prohibition was intended to limit the spread of HIV.

At that time, HIV and AIDS were more common in certain groups, not only among MSM, but also among people from Haiti and sub-Saharan Africa, and people with hemophilia. This led to blood donation bans for some of these people, as well.

A lot has changed in the world of HIV in the last several decades, especially the development of highly accurate testing and highly effective prevention and treatment. Still, the rules regarding blood donation were slow to change.

The ban from the 1980s for MSM remained in place until 2015. At that time, rules were changed to allow MSM to donate only if they attested to having had no sex with a man for 12 months. In 2020, the period of sexual abstinence was reduced, this time to three months.

Why are the blood donation guideline changes important?

• Removing unnecessary restrictions that apply only to certain groups is a step forward in reducing discrimination and stigma for people who wish to donate blood but were turned away in the past.
• The critical shortage in our blood supply has worsened since the start of the COVID-19 pandemic. These revised rules are expected to significantly boost the number of blood donors.

The bottom line

Science and hard evidence should drive policy regarding blood donation as much as possible. Guidelines should not unnecessarily burden any particular group. These new guidelines represent progress in that regard.

Of course, these changes will be closely monitored to make sure the blood supply remains safe. My guess is that they’ll endure. And it wouldn’t surprise me if there is additional lifting of restrictions in the future.

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